Opinion by Apostolos Tzitzikostas,
President of the European Committee of the Regions
For more than one year now the COVID-19 pandemic has swept across Europe. It has forced us to restrict the lives of our people and introduce other urgent unprecedented measures. This dreadful virus has tragically taken more than 680.000 lives in the European Union.
Throughout these difficult times, the CoR, and the one million regional and local elected politicians in more than 300 regions and 90 000 municipalities it represents, has never stopped working to serve the people living in regions, cities and villages across Europe.
As the pandemic crisis has clearly shown, our Union’s foundations lie in our local communities. As local leaders, our responsibilities are great – from running health services and schools to providing social services in these troubled times.
Despite the unprecedented difficulties, we have found new ways to encourage research, support businesses, adapt the local economy, and work with civil society. We have been fighting side by side with doctors and nurses.
The months ahead will continue to be difficult for all of us, but there is light at the end of the tunnel if we work in solidarity and continue striving for a smooth and comprehensive vaccination campaign. We must make sure that our key values of cohesion and solidarity remain the principles for the vaccination strategy in the EU and its regions. We must avoid competition for vaccines between Member States and within Member States and avoid a ”vaccine divide’’ that would increase inequalities between our regions, cities and villages.
Europe must emerge from this crisis more resilient and formally recognise the central importance of local and regional administrations. We are a cornerstone for the health, prosperity, resilience and vibrancy of our local communities.
We must ensure that EU funds are used effectively to help the recovery of our local communities. We must be fully involved in designing and implementing EU and national recovery plans. Our contribution is key to forging policies that manage the fundamental societal transformations we are facing. COVID-19 is one of those transforming forces. So too are the climate crisis, the digitalisation of our economies and the demographic evolution.
Trust will pull us through this crisis, and we, locally and regionally elected leaders, are the most trusted level of government. We know best the citizens’ needs and concerns and we know how to address them via concrete actions on the ground.
If we are to boost the European project we must enhance its democratic functioning. We must build together our common House of European Democracy with its roof – the European Union –, its walls – the Member States – and its foundations – the regions, cities and villages.
The Conference on the Future of Europe is a great opportunity to strengthen the democratic functioning of the EU. The Conference is not an objective per se: its goal must be to honestly engage with people, also via the European Committee of the Regions that represents the vote of the citizens living all across Europe.
We can make sure that citizens participate in this process and have their say because local and regional authorities are the closest and most trusted level of government.
By listening to our people, the Conference must allow an honest reflection through a profound democratisation process. We want less institutional complexity and more democratic representation of people’s trust via their vote in the European, national, regional and local elections.
Our recently established High-Level Group on Democracy led by former European Council President Herman van Rompuy will strive to promote our Committee’s contribution to the Conference. We will team up with the business sector and civil society, youth associations and territorial European and national associations and, of course, with the three EU institutions which are steering the Conference – the Parliament, Commission and Council. Our local dialogue on 9 May marks the territorial dimension of the Conference and, in addition to many local dialogues across the UE, we will organise the Summit of Regions and Cities during the French Presidency in early 2022 in Marseille.
As governors, presidents of regions, mayors, regional and local councillors, we have been at the forefront, fighting the pandemic, and now we are ready to start the recovery. Today Europe and its people need trust and leadership. The Conference on the Future of Europe can contribute to this process if it genuinely and concretely involves our local communities and if it gives voice to people in our regions, cities and villages. This is key to avoid a top-down exercise that would only feed the demagogic and anti-European false narrative of populists and Euro-sceptics.
Our purpose, as European Committee of the Regions, is to establish a strong regional and local dimension of the entire Conference in all EU Members States by engaging with citizens at regional and local level. We are fully convinced that by working together, based on mutual respect, we can increase the trust of our citizens in our common European project, strengthen the EU democratic architecture and bring Europe closer to its people.
MEP Vasile Blaga: Firm decisions are needed to boost vaccination in Romania. We cannot afford new pressure on the health system
MEP Vasile Blaga (PNL, EPP) believes that “firm decisions are needed to stimulate vaccination in Romania”, stressing that “we cannot afford a new pressure on the health system like in wave 4”.
“The year 2021 ends primarily under the sign of the pandemic generated by COVID 19. We all know the effects of wave 4 in Romania. Even if at the moment the figures are in reasonable ranges, what is happening in countries with high vaccination rates is a warning signal for the new wave of the pandemic. Authorities in Bucharest need to take firm decisions to increase vaccination rates. There is no time for hesitation. Sceptics should take a closer look at the fact that despite high infection figures, the number of deaths and serious cases is low in countries with high vaccination rates. This is where the effectiveness of vaccines can be seen,” said Blaga.
He said that the Romanian health system can no longer afford an over-supply such as in wave 4, which had a major and totally unfair impact on all sick people in Romania.
“We must activate the community spirit in Romania and realise that the fact that we vaccinate helps our neighbours, including the fact that a potential infection with Covid 19 does not deny access to hospital to a patient with a chronic disease,” the MEP added.
“The decision of each of us on vaccination has knock-on effects”, concluded Vasile Blaga.
MEP Vasile Blaga: Eliminating gender gaps in the European labour market – a priority for the European Parliament
Closing the gender gap in the European labour market was at the top of last week’s plenary agenda, said MEP Vasile Blaga (PNL, EPP) on Monday.
The European Parliament’s last plenary session this year put gender inequality in the European labour market on the agenda. Statistics show that at EU level there is still a pay gap of more than 14 percentage points (14.1%) between men and women and a wider pension gap of almost 30 percentage points, both to the disadvantage of women. Moreover, the report voted on at the last plenary session of the European Parliament also notes that women face a precarious situation in the labour market.
“Together with the EPP Group in the European Parliament, I voted in favour of the report on gender equality to draw attention once again to the fact that Member States must come up with concrete proposals to minimise gender inequalities and to strongly support women’s rights in the European Union”, said the EPP MEP for CaleaEuropeană.ro.
The report adopted in the European Parliament also focuses on eradicating violence against women, a phenomenon which has increased significantly during the pandemic.
“Abuse against women must be vigorously prosecuted and the perpetrators must be investigated and punished without hesitation. Moreover, monitoring and protection programmes for victims of domestic violence need to be improved in order to minimise this phenomenon”, added Vasile Blaga.
In a non-legislative report adopted last Wednesday by 500 votes to 105 with 87 abstentions, MEPs reiterated that equal pay and equal treatment are an essential prerequisite for women to enjoy equal rights, economic independence and professional fulfilment.
They call on Member States to take practical measures to ensure that women have equal access to the labour market and jobs and that they enjoy equal pay and equal rights as workers. For example, to achieve this, sanctions should be imposed on companies that do not comply with labour law. In this respect, MEPs welcome the Commission’s proposal for mandatory pay transparency measures. However, they stress that pay transparency alone will not be enough to address deep-rooted gender inequalities.
A government project to digitise healthcare is needed. More calls from Romanian experts at national and European level
The COVID-19 pandemic has highlighted the need for a health system that can cope with paradigm shifts in remote healthcare, and telemedicine has been a great help to patients as well as doctors over the past two years. Thus, the digitalisation of the health system and health services is a topic of interest at European and national level. However, there is an uneven development of digitisation and e-Health solutions in EU countries in Central and Eastern Europe, according to a report by PricewaterhouseCoopers, for the European Federation of Pharmaceutical Industries and Associations (EFPIA).
National authorities, European decision-makers, representatives of the pharmaceutical industry responded to the initiative launched by www.CaleaEuropeana.ro and the Romanian Association of International Pharmaceutical Manufacturers (ARPIM) and held an open dialogue on the European opportunities for digitisation of the healthcare system in Romania, but also on the steps that our country needs to go through in the digital transition so that Romanian patients can benefit in the coming years from easy access to healthcare and telemedicine.
The main lessons learned by the European Union since the beginning of the pandemic and until now were discussed, as well as the need to accelerate the digital transition in the European Union’s health systems, but especially the importance for the Romanian authorities, regardless of political colour, to establish a unitary strategy for the digitisation of health, a strategy that coordinates the institutions in the field and is connected to European directives.
The digitisation of the Romanian health system must allow transparent access to reliable data which must be published in formats suitable for secondary use, for epidemiological or health policy analysis.
Topics of interest for Romania in the field of digitisation of health can be (non-exhaustive list): European Cancer Knowledge Database; European Cancer Imaging Initiative; Cancer Management Inequalities Registry in Member States; Connecting e-prescribing and electronic patient record systems between Member States; Connecting and exchanging information between reference centres for rare diseases; Participation in transnational registries in the field of chronic diseases; National/transnational remote medical consultations and second opinion in imaging or pathology; Evaluation of health apps for reimbursement, etc.
Develop a government project covering the key issues for digitisation in health, needed
Prof. Dr. Adrian Streinu-Cercel, President of the Health Committee of the Romanian Senate, calls for a government project covering the key aspects of digitisation in health: “To be an integrated system it has to start from one head, i.e. the Romanian Government. If we don’t decide what we want this digitisation to look like, it will be everyone with their own database, everyone with their own application.”
- We have the opportunity to do a very good job from the beginning and for that we all have to sit around the same table, regardless of political colours, and discuss how we want this national digitisation programme to look like and how to integrate with other countries, if we want that.
Romania needs to establish a National Contact Point to align our country with European directives
Ștefan Busnatu, advisor for digitisation to the Minister of Health, set up a digitisation strategy for the health system a year ago, which unfortunately has not been integrated into the NRDP.
- We need to establish a National Contact Point, which will deal with the whole digitisation component in order to be aligned with the Brussels directives and all the European reforms. The National Contact Point is a three million euro project, which theoretically has to be taken on by someone. At the moment the CNAS have sent the assumption from a coordination point of view. It is important to decide where it would be most coherent to create the National Contact Point in Romania for digitisation and digital transformation.
The time has come for telemedicine to offer patients a better quality of life, while giving doctors new tools
Adela Cojan, President of the National Health Insurance House, reviewed the latest national milestones for the digital transformation of Romania’s healthcare system. A Memorandum has been signed at governmental level for tripartite participation to access European funds for the development of the project “IT systems for connecting to the electronic health record the providers of paraclinical services, specialist outpatient, rehabilitation, home care, providers of clinical services, palliative, medical devices or emergency consultations at home”, being basically an extension of the electronic health record, which was initially designed only on family medicine and hospitals.
- The societal and economic benefits of the widespread use of telemedicine are practically enormous. At the moment we are far from being fully in the middle of their use, but I believe the time has come for telemedicine to offer patients a better quality of life, while giving doctors new tools. It is a challenge, there have been reservations, but now in the areas where we have introduced remote consultations they have been widely accepted, which is why we have also extended them in the regulations for next year.
Lack of interoperability of databases in the healthcare system, one of the critical issues
Adrian Hatos, Chairman of the Committee for Science, Innovation and Technology in the Romanian Senate, says that one of the critical problems facing the entire public system in Romania, not only the medical system, but also the administration and education, is the interoperability of databases or the interoperability of data in general in the medical system, which makes it impossible to access and use data: “We have the possibility of datafication, big data techniques and remote communication in education or medicine. The problem in Romania is primarily institutional and human rather than technical.”
- So far there have been public and European financial resources for digitisation. We need to look at the problem of working with so many database systems that cannot communicate with each other. We have the opportunity of RRF funding, but also the implementation of a governmental Cloud to force the creation or implementation of a data infrastructure that is unitary, standardised at national level, so that we can communicate in the various structures and take advantage of the opportunities that telemedicine offers.
- The digital transition must also include changing the attitude of doctors and patients towards technology.
- The Committee on Science, Innovation and Technology of the Romanian Senate can initiate legislation and support legislation in this area. It can initiate debates in the Senate on digitisation in health.
Patient registers, the most important thing today when it comes to digitising health
Felicia Ciulu Costinescu, Director, Medical Technologies Evaluation Directorate, National Agency for Medicines and Medical Devices of Romania (ANMDMR), says that digitisation of healthcare has become a necessity for facilitating the patient pathway in the healthcare system and has become more important in the context of the pandemic.
- ANMDMR experts are active and present in Brussels working groups of the European Medicines Agency (EMA) or the European Commission, including in task forces dedicated to digital transformation: “This concern comes from the need to provide EU patients with innovative solutions and emerging technologies. All this can only be achieved by transforming and optimising regulatory processes, improving centres of expertise, providing digital solutions and building an e-learning ecosystem. All of this requires investment over time, but the process has been started and will bring the benefits it was designed to deliver.
- The digitisation paradigm is a complex one. Patient registries are the most important thing at the moment when we talk about digitising health. The need for these registries is even greater as very high-cost personalised therapies are knocking at the door. These registries will be useful when we want to have access to some data. Interconnecting them with both national and existing European health platforms. The main aim is to develop a common dataset to support the reimbursement decision as well as to support technicians to have easy access to medical data.
- Digital technologies, intelligent data collection and integration are the present and the future for patient access to personalised, effective and safe treatments.
The leadership of the Romanian Digitisation Authority (ADR) gave details of the objectives of the RegInterMed project in its message to the expert meeting on 14 December. According to the ADR, in October the Ministry of Health put the specifications of the RegInterMed project out to public consultation.
- The project will implement 100 disease registers for 18 specialities. These will be established separately during the implementation period. In addition, 4 specific registers will be implemented for the INSP (Register “reporting biocidal substances”, Drinking water quality register (RECAP), National operational computerised register of occupational diseases, Register on the management of waste resulting from medical activity).
- It will have a working meeting on Wednesday 15 December with the new management delegated by the Ministry of Health for this project.
The European Commission is exploring the possibility of European patient registers, but the condition is that national registers exist in all EU countries
Cristian Bușoi MEP, Chair of the Industry and Research Committee of the European Parliament’s ITRE Committee, as the European Parliament’s rapporteur for the EU health programme, EU4Health, insisted that one of the priorities of this programme is digitisation in health at European level and the creation of the EU Health Data Space, which is an initiative of the European Commission that he supports.
- We also advocated that money from this programme should fund interoperability between different e-health systems at national level, such as electronic patient registers to be interconnected and prescription, which is an e-health solution found in most European countries and this needs to be interconnected.
- The European Commission is looking at the possibility of European patient registries, but the condition is that there should be national registries in all EU countries, at least for cancer and rare diseases where the number of patients is not so large, it would be easier to manage these patients. At European level, digitisation in health is an essential component. EU4Health can only give a general outline, just as the EU Health Data Space will create some rules for governance, for interoperability.
- Romania needs to prioritise these projects in order to be able to use European funding.
Romania has all the necessary tools to digitise its health system and to offer Romanian patients European and quality conditions in terms of health and telemedicine. It is essential that decision-makers and politicians have forward-looking projects adapted to European requirements so that Romanian patients can benefit from the opportunities of the digital transition.
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