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CM(2005)21 14 February 20051
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919 Meeting, 16 March 2005
6 Social Cohesion


6.1 European Health Committee (CDSP) –

Abridged report of the 56th meeting (Strasbourg, 16-17 November 2004)

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1. The European Health Committee (CDSP) held its 56th meeting on 16-17 November 2004 in Strasbourg under the chair of Ms Taru Koivisto (Finland). The agenda is set out in Appendix 1. The list of participants is included in the full report (document CAHP8(2004)1), which can be obtained directly from the Health Division.

2. A summary of the discussions and decisions is given below.

50th anniversary of the European Health Committee (CDSP)

3. The CDSP celebrated its 50th anniversary and appreciated the publication of the book on HEALTH ETHICS AND HUMAN RIGHTS – THE COUNCIL OF EUROPE MEETING THE CHALLENGE.
Mr Cees J.M. Meeuwis, Deputy Permanent Representative of the Netherlands to the Council of Europe, whose Authorities initiated the publication of this book under their Chairmanship of the Committee of Ministers (November 2003 – May 2004), handed over symbolically the first copy of the book to the Deputy Secretary General, Ms Maud de Boer-Buquicchio.

4. The Deputy Secretary General congratulated the CDSP on its 50th anniversary and recognised its achievements. Straight from the start the CDSP had recognised the importance of health as a human right and a key factor for social cohesion and democratic stability.

5. Dr Marc Danzon, the Regional Director for WHO Europe, and Mr Fernand Sauer, Director of Public Health at the European Commission, addressed the CDSP and emphasised the excellent cooperation established between their organisations and the Council of Europe in the health field.

Council of Europe's public health and related activities: towards a strategic approach2

6. In compliance with the request of the Committee of Ministers (880th meeting, CM/Del/Dec(2004)880 – 7 April 2004), the CDSP finalised its discussion on the operationalisation proposals for the implementation of the document called “Council of Europe's public health and related activities: towards a strategic approach”. In doing so, it took account of the opinions received from the Steering Committee on Bioethics (CDBI), the European Committee of Social Cohesion (CDCS) and the Pompidou Group.

7. This discussion was held in the presence of the CDBI Secretariat, the Group Pompidou Secretariat and the CDBI representative to the CDSP. The Regional Director of WHO Europe, who was also present, agreed with the statement that achieving good health for all at pan-European level was to be an objective pursued by all organisations. For the purpose of reaching that objective, each organisation had a specific contribution to make from the perspective of its respective mandate.

8. The CDSP congratulated the Netherlands for their initiative during their Chairmanship of the Committee of Ministers.

Integration of the activities of the Partial Agreement in the Social and Public Health Field into the regular programme of activities3

9. Following a decision of the Committee of Ministers at its 884th meeting (19 May 2004), the CDSP examined at its 55th meeting, in detail, document CM(2004)63, which contained the (previous) Secretary General's proposals as concerns the extension of the activities of the Partial Agreement in the Social and Public Health field to all Council of Europe member states. The CDSP had formulated an interim reply for the Committee of Ministers, which contained a list of questions seeking full transparency and clarification of all the issues and options.

10. The CD-P-SP (Public Health Committee; Partial Agreement) had drafted its opinion at its 73rd session (June 2004) and the CD-P-RR (Committee on the Rehabilitation and Integration of People with disabilities; Partial Agreement) had drafted its opinion at its 27th session (September 2004).

11. In order to address the questions raised in the interim reply (CDSP) and the two opinions (CD-P-SP and CD-P-RR), the Secretariat had prepared a position paper (CDSP(2004)61), which had been approved by all concerned Directorates of the Council of Europe.

12. The CDSP discussed in great detail the position paper of the Secretariat on its draft interim opinion on these (previous) Secretary General's proposals.

13. In conclusion, the CDSP agreed that due to the late arrival of the position paper which made consultation at national level impossible, it was not in a position to formulate a final opinion on the substance of the Secretary General's proposal. In addition, the full picture with all the budgetary, legal, structural and staff implications of the extension was not complete: prior information was to be provided on budgetary figures covering both sectors of the Partial Agreement together with indications of financing and prioritisation of activities bearing in mind that probably also for 2006 the zero growth budget objective will be maintained.

Implementation of the work programme of the European Health Committee (CDSP)

14. The CDSP reviewed the state of implementation of its work programme for 2004.

15. The CDSP adopted:

    · The draft Recommendation on media and health.

This draft Recommendation emphasizes the responsibility of health authorities to provide the general public with health information thus broadening the public's general knowledge about health.

    · The draft Recommendation on the role and training of key organ donation professionals subject to introduction of the amendments proposed by the legal service.

The draft Recommendation recognises the positive impact of key organ donation professionals on the organ donation rate and therefore encourages member states to introduce this profession as part of their transplant system.

Both draft Recommendations will be transmitted to the Committee of Ministers at one of its forthcoming meetings.

    · The report on Cellular Immune Therapies – the provisions of safe products meeting high quality standards.

    · The 11th edition of the technical appendix (The Guide) to Recommendation No R (95) 15 on the preparation, use and quality assurance of blood components with a view to its publication. In this context the CDSP submitted the following two requests to the Committee of Ministers:

        - considering that the Guide is being revised annually, because it has to include most recent, vitally important information concerning safety of blood and blood components, every new edition of the Guide should be put on the Internet concurrently with the publication of the printed edition. The CDSP considers the availability of the Guide on the Internet as a major public health issue;4
        - as the production of the Guide is carried out under the responsibility of the European Health Committee (CDSP), the revenues from the distribution/selling of the Guide should be re-invested into funding the activities of the Health Division.

16. The CDSP agreed on a number of principles on how health issues should be addressed in a possible revision of the relevant articles in the Social Charter and agreed to transmit the conclusions of the Committee of Experts to the Governmental Committee of the Social Charter Committee.

17. The CDSP took note of the progress in the implementation of the work carried out by the Committees of Experts on “Health services in a multicultural society”, “Management of safety and quality in health care – prevention of adverse events in health care, a system approach”, “Hospitals in transition: new balance between institutional and community care” and “Transborder mobility of health professionals and its implications for functioning of health care systems”.

Publications

18. The CDSP welcomed the publication of the following texts:

    · Special edition of the Social Cohesion Newsletter on Health as a social right;
    · Book on Health, Ethics and Human Rights – the Council of Europe meeting the challenge;
    · Second edition of the Guide to safety and quality assurance for organs, tissues and cells;
    · Recommendation Rec(2003)24 on the organisation of palliative care together with its explanatory memorandum.

Work programme of the European Health Committee (CDSP) for 2005 - 2006

19. The CDSP discussed its work programme for 2005–2006 and submitted for approval to the Committee of Ministers the terms of reference of the following bodies:

    · Committee of Experts on the inclusion of gender differences in health policy (Appendix 1);

    · Committee of Experts on the impact of genetics on the organisation of health care services and training of health professionals (Appendix 2);

    · Committee of Experts on the organisational aspects of cooperation in organ transplantation (SP-CTO) (Appendix 3);

    · Committee of Experts on safety and quality assurance for organs, tissues and cells (SP-SQA) (Appendix 4)

20. The CDSP agreed to organise a European Conference on the organisation of palliative care. The CDSP thanked the Authorities of Serbia and Montenegro for their offer to host the Conference in Belgrade, on 20-21 October 2005.

Polish Presidency of the Committee of Ministers: Conference on “Patient safety as a European challenge”

21. The CDSP welcomed the initiative of the Polish Chairmanship of the Committee of Ministers of the Council of Europe to organise a Conference on “Patient safety as a European challenge”. The Conference will be held on 14–15 April 2005 in Cracow.

Cooperation with the European Union and the World Health Organisation (WHO)

22. With reference to the European Union Directive on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells (2004/23/EC), adopted on 31 March 2004, the CDSP noted with satisfaction the cooperation between the Council of Europe and the European Commission in this field; it welcomed in particular that the standards of the technical requirements to be elaborated under Article 28 of the said Directive will be compatible with the Council of Europe's 2nd edition of the Guide to the safety and quality assurance for organs, tissues and cells.

This cooperation will ensure that the same technical requirements for tissues and cells will apply pan-European wide.

23. The CDSP noted with satisfaction the progress made on the health component in the Stability Pact Social Cohesion initiative by the South Eastern Europe Health Network of the region set up by the Council of Europe and the World Health Organisation (WHO), with the participation of the Council of Europe Development Bank. Jointly with WHO, the Second Ministerial Forum of the South Eastern Europe Health Network will be held on 24–25 November 2005 with the participation of the Ministers of Finance on “Health and Economic Development in South-Eastern Europe in the 21st Century”.

Health and the Third Summit of the Council of Europe

24. The CDSP was informed that the Council of Europe will hold its Third Summit of the Heads of State on 16–17 May 2005 in Warsaw, Poland. The Summit will adopt a declaration and an action plan. The CDSP agreed to the following contribution regarding the action plan:

“Health as a social and human right

We agree that health is a main source of human capital and an essential condition for social and economic stability. Therefore, we urge the Council of Europe to continue its globally recognised work in the promotion of ethical principles and the protection of donors and recipients in the field of blood transfusion and organ, tissue and cell transplantation. The introduction of the social, ethical and human rights dimension in its work on equity in access to good quality services and on delivery of health care for all European citizens is to be pursued and intensified.”

Date and venue of the next meetings

25. Following an invitation from the Minister of Health of the Czech Republic, the CDSP Bureau agreed to hold its spring meeting on 15–16 March 2005 in Prague. The CDSP agreed to hold its 57th plenary meeting on 7 and 8 June 2005 in Strasbourg.

Appendix 1

AGENDA

1. OPENING OF THE MEETING

2. ADOPTION OF THE AGENDA

3. REPORT OF THE BUREAU

4. ELECTION OF A NEW CHAIRPERSON AND OF NEW MEMBERS OF THE BUREAU

5. DECISIONS OF THE COMMITTEE OF MINISTERS

5.1 Report of the 56th meeting

6. COOPERATION WITH OTHER INTERNATIONAL ORGANISATIONS

6.1 European Commission, WHO (Europe) and the Federation of Red Cross and Red Crescent Societies

6.2 Meeting of the Chief Medical Officers of the member states of the European Union

6.3 6th Tripartite meeting (European Commission, WHO, Council of Europe)

7. INTEGRATION OF THE ACTIVITIES OF THE PARTIAL AGREEMENT IN THE SOCIAL AND PUBLIC HEALTH FIELD INTO THE REGULAR PROGRAMME OF ACTIVITIES

A. IMPLEMENTATION OF THE CURRENT WORK PROGRAMME

8. EQUITY IN ACCESS TO HEALTH CARE AND HEALTH PROMOTION – PATIENT'S RIGHTS AND CITIZEN PARTICIPATION

8.1 The media and health

8.2 Health services in a multicultural society

8.3 Management of safety and quality in health care – prevention of adverse events in health care, a system approach

8.4 Hospitals in transition: new balance between institutional and community care

8.5 Transborder mobility of health professionals and its implications for functioning of health care systems

8.6 Health Promotion and health education – the ENHPS

8.7 Assistance activities

9. AVAILABILITY OF AND ACCESS TO SAFE AND GOOD QUALITY IN HEALTH CARE SERVICES

9.1 Blood Transfusion and Immunohaematology

9.2 Preparation, use and quality assurance of blood components

9.3 Cellular immune therapies – ways to provide safe products meeting high quality standards

9.4 Organ transplantation

9.5 Safety and quality assurance for organs, tissues and cells

9.6 Assistance activities

B. FUTURE PROGRAMME AND METHODS OF WORK

10. INTERGOVERNMENTAL PROGRAMME OF ACTIVITIES FOR 2005

11. ASSISTANCE PROGRAMME OF ACTIVITIES FOR 2004
COOPERATION WITH THE COUNCIL OF EUROPE DEVELOPMENT BANK

C. INFORMATION

12. EXCHANGE OF INFORMATION

13. THE COUNCIL OF EUROPE'S PUBLIC HEALTH AND RELATED ACTIVITIES – TOWARDS A S TRATEGIC APPROACH – PROPOSALS FOR THE IMPLEMENTATION OF THE STRATEGIC APPROACH

D. MISCELLANEOUS

14. OTHER BUSINESS

14.1 The work of the various bodies of the Council of Europe in the sectors of interest of the European Health Committee

14.2 Agreement No. 80 on the transfer of corpses

15. DATE AND PLACE OF THE NEXT MEETING

Appendix 2

Specific terms of reference

1. Name of Committee:

Expert Committee on the inclusion of gender differences in health policy

2. Type of Committee:

Committee of Experts

3. Source of terms of reference:

European Health Committee (CDSP)

4. Terms of reference:

There are a number of differences between women and men in the area of health, most of which seem to stem from biological differences, although cultural and social differences also play a part. These differences may pose inequalities in health policies and therefore must be taken into account when elaborating these policies. Being a woman or a man is a health determinant that is as significant as social origin, economic situation and ethnic origin.

The committee is charged with the task of:

A. Making an inventory of

- Data;
- The biological and social specificities of both genders in health matters;

B. Performing analysis

- Identifying and delimiting gender-related (technical, political, social and cultural) difficulties;
- Analysing these difficulties in order to overcome them and genuinely incorporate gender differences in health policies;
- Determining the added value of a gender approach in terms of a specific response by institutions, healthcare providers, research and industry and the voluntary sector.

C. Submitting proposals

- Determining good practices and drawing up clear recommendations on how to integrate the biological, cultural and social dimension of gender into Council of Europe member states' public health programmes (prevention, diagnosis, care);
- Integrating the gender dimension in training programmes for health professionals (e.g. adequate communication with the patient, choices of treatment methods and diagnostics).

5. Membership of the Committee:

a. The governments of all member states are entitled to appoint one expert. The Council of Europe's budget will cover travel and subsistence expenses of one expert from each of the following 8 member states: Austria, Belgium, Finland, Georgia, Ireland, Poland, Romania, Switzerland.

b. The European Commission may send representatives to the Committee's meetings, without the right to vote or defrayal of expenses.

c. The following observer states with the Council of Europe may send representatives to the Committee's meetings, without the right to vote or defrayal of expenses:

Canada;
Holy See;
Japan;
Mexico;
United States of America.

d. The following observers with the Committee may send representatives to the committee's meetings without the right to vote or defrayal of expenses:

WHO (Regional Office for Europe);

    European Patient Association.

6. Structures and working methods:

In discharging its terms of reference, the committee should build on the work already done by other Council of Europe steering committees, in particular the Steering Committee for Equality between Women and Men (CDEG).

In view of the technical nature of the subject, it will be necessary to appoint a consultant to assist the committee with its task.

The Committee may organise hearings and written consultation exercises.

7. Duration:

These terms of reference will expire on 31 December 2006.


Appendix 3

Specific terms of reference

1. Name of the Committee:

Committee of Experts on the impact of genetics on the organisation of health care services and training of health professionals

2. Type of Committee:

Committee of Experts

3. Source of terms of reference:

European Health Committee (CDSP)

4. Terms of reference:

The developments in the field of the application of genetics in the health care service will have a major impact on the organisation of health care. They include the shift from curative to preventive services, from in-patient to out-patient treatment, from specialised genetic services to genetics as part of general health services.

When considering the introduction of genetic screening and testing for individual health care purposes in the organisation of their health services, member states have first to examine its implications for the availability, the organisation and the financing of health care.

General ethical and legal principles of genetics will be laid down in a future additional protocol on genetics to the Convention of human rights and Biomedicine. However, in addition to the planned protocol, the implications of genetic testing and follow up treatment for the organisation, financing and functioning of health care services have to be considered, in particular from the perspective of their utility, cost effectiveness and availability.

Therefore, the committee of experts is requested to study the impact of genetics on the availability, the organisation and the financing of genetic services as an integrated part of health care services with particular emphasis on:

- The availability and organisation of genetic testing;
- The integration of genetic services in university hospitals and general health care services;
- The effectiveness and quality of the organisation of genetic services;
- The cost effectiveness of genetic testing and screening, as compared also to traditional methods;
- The consequences of self- referral by patients for the service provisions;
- The consequences for the care providers working practices, including the possibilities for task delegation;
- The consequences for the medical curricula and those of other health care personnel.

On basis of this study, the committee of experts is required to:

1) Develop criteria for the standard availability of forms of genetic diagnosis and treatment, taking into account equitable access, possibilities to provide treatment and care following a genetic diagnosis, including demonstrable effectiveness of diagnosis and treatment.

In doing so, particular attention should be paid to the potential primary care centred systems offer in limiting referrals to and demand for specialised services not essential for improving health, while avoiding at the same time under-detection and under-management of non-minor genetic problems.

2) Propose a model framework for best practices regarding genetic testing in individual medical practice.

5. Composition of the Committee:

a. The governments of all member states are entitled to appoint an expert. The Council of Europe's budget will cover travel and subsistence expenses of one expert from each of the 10 following member states: Armenia, Austria, Belgium, Finland, Germany, Russian Federation, Slovenia, Sweden, Switzerland, United Kingdom.

b. The European Commission may send representatives to meetings of the Committee without the right to vote or defrayal of expenses.

c. The following observer states with the Council of Europe may send representatives to the meetings of the Committee, without the right to vote or defrayal of expenses:

Canada;
Holy See;
Japan;
Mexico;
United States of America.

d. The following observers with the Committee may send representatives to meetings of the Committee without the right to vote or defrayal of expenses:

WHO (Regional Office for Europe).

6. Working structures and methods:

In carrying out its task, the Committee of Experts should follow closely the work carried out by the Steering Committee on Bioethics (CDBI) regarding the elaboration of a future protocol on genetics to the Convention on Human Rights and Biomedicine.

In view of the technical nature of the subject, it will be necessary to appoint a consultant to assist the Committee of experts.

In carrying out its terms of reference, the Committee of Experts may organise hearings and written consultations.

7. Duration:

These terms of reference will expire on 31 December 2006.

Appendix 4

Terms of reference

1. Name of Committee:

Committee of Experts to study organisational aspects of cooperation in organ transplantation (SP-CTO)

2. Type of Committee:

Committee of Experts

3. Source of terms of reference:

European Health Committee

4. Terms of reference:

The Council of Europe first made proposals on organ transplantation in 1978 in Rec R (78) 29 on the Harmonisation of legislation of member states relating to removal, grafting and transplantation of human substances.

This recommendation was followed by a 3rd Conference of European Health Ministers in 1987 on the ethical, organisational and legislative aspects of organ transplantation. The Conference considered that the organisational aspects of organ transplantation were particularly important in meeting the organ shortage and that European cooperation was needed to ensure an efficient organisation.

The Committee of Experts will:

- examine the organisational structures concerning organ transplantation in the member states with a view to detecting the causes of organ shortage;

- study ways of promoting the availability of organs and of improving the organisational infrastructure;

- propose standards for quality assurance of organs and tissues and draw up legal instruments for this purpose;

- develop links between the exchange organisations;

- follow (technological) developments in organ transplantation, particularly with regard to their ethical, social, and organisational implications;

- encourage training in organ transplantation, through the organisation of courses and other measures.

5. Composition of the Committee of Experts:

a. The governments of all member states are entitled to appoint an expert.

The Council of Europe's budget will cover travel and subsistence expenses of one expert from each of the following member states: Armenia, Bulgaria, France, Finland, Germany, Italy, Malta, Moldova, Netherlands, Norway, Russian Federation, Slovak Republic, Spain, United Kingdom. 5

b. The European Commission may send representatives to meetings of the Committee without the right to vote or defrayal of expenses.

c. The following observer states with the Council of Europe may send representatives to meetings of the Committee, without the right to vote or defrayal of expenses:

Canada;
Holy See;
Japan;
Mexico;
United States of America.

d. The following observers with the Committee may send representatives to meetings of the Committee without the right to vote or defrayal of expenses:

Australia;
Israel;
New Zealand;
World Health Organisation (WHO);
Eurotransplant;
Scandiatransplant.

6. Working structures and methods:

In view of the technical nature of the subject, the appointment of a consultant might prove necessary in the study of specific themes.

The Committee of Experts must cooperate by appropriate methods with other relevant Committees of the Council of Europe whenever indicated.

7. Duration:

These terms of reference will expire on 31 December 2006.

Appendix 5

Terms of reference

I. Name of the Committee:

Committee of Experts on safety and quality assurance for organs, tissues, and cells (SP-SQA)

2. Type of Committee:

Committee of Experts

3. Source of terms of reference:

European Health Committee (CDSP)

4. Terms of Reference:

Transplantation of human organs, tissues, and cells is a practice that can enhance the quality and duration of life, restore function and facilitate human reproduction. However, transplantation carries risks that include disease transmission, genetic defects, immunology damage, sepsis and toxic transfer. Transmission of diseases includes potentially infectious pathogens, malignancies, genetic defects and other aspects of quality of organs, tissues, and cells that may have an adverse effect on the future health of the recipient.

Against this background of risks, there is an increasing demand for quality assurance and continuous quality improvement in transplantation. Quality assurance is thus turning into an important factor in medical practices including transplantation practices. Therefore, standards have been set regarding safety and quality assurance in using organs, tissues and cells for transplantation purposes.

The Committee of Experts will regularly up-date according to scientific progress the guidelines on safety and quality assurance standards of procurement, preservation, processing, and distribution of organs, tissues, and cells of human origin used for transplantation purposes.

5. Composition of the Committee of experts:

a. The governments of all member states are entitled to appoint an expert.

The Council of Europe's budget will cover travel and subsistence expenses of one expert from each of the six following member states of the Council of Europe: Germany, Finland, Portugal, Slovak Republic, Switzerland, United Kingdom.

These member states will endeavour to ensure representation of the various disciplines necessary to cover the whole range of aspects of safety and quality assurance for organs, tissues and cells used for transplantation purposes.

b. Other Committees of the Council of Europe active in this field may send a representative to meetings of the Committee of Experts without the right to vote and at the charge of the corresponding budget subhead.

c. The European Commission may send representatives to meetings of the Committee without the right to vote or defrayal of expenses.

d. The following observer states with the Council of Europe may send representatives to meetings of the Committee, without the right to vote or defrayal of expenses:

Canada;
Holy See;
Japan;
Mexico;
United States of America.

e. The following observers with the Committee may send representatives to meetings of the Committee without the right to vote or defrayal of expenses:

Australia;
Israel;
New Zealand;
World Health Organisation (WHO);
European Society for Organ Transplantation (ESOT);
European Association of Tissue Banks (EATB);
European Group for Blood and Marrow Transplantation (EBMT).

6. Working structures and methods:

In carrying out its terms of reference, the Committee of Experts may consult all member states of the Council of Europe and may organise hearings and written consultations. The Committee of Experts may also have recourse to consultants. It will report to the Committee of experts on the organisational aspects of cooperation in organ transplantation (SP-CTO).

The Committee of Experts may cooperate (for example by holding joint meetings) with other relevant Committees of the Council of Europe in matters of common interest.

The Committee of Experts will have one meeting of 4 days each year.

7. Duration:

These terms of reference will expire on 31 December 2006.

Note 1 This document has been classified restricted at the date of issue. Unless the Committee of Ministers decides otherwise, it will be declassified according to the rules set up in Resolution Res(2001)6 on access to Council of Europe documents.
Note 2 The final proposals for the operationalisation of the document “Council of Europe's public health and related activities: towards a strategic approach” will be submitted to the GR-SOC at one of its forthcoming meetings.
Note 3 This item will be discussed by the GR-SOC at one of its forthcoming meetings.
Note 4 Council of Europe current practice requires that publications on sale be made available on Internet six months after the publication of the printed version only.
Note 5 The Committee of Experts is open to all member States but participants will be covered by the Council of Europe budget on a rotating system.
Note For 2005 and 2006 the Council of Europe budget will cover expenses for one expert from each of the listed member States.


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