Ref. Ares(2013)3217522 - 10/10/2013
1st Meeting of Ad Hoc Expert Group on Institutional Care Reform (on Long-Term Care
Reform), 10 March 2009
The Ad Hoc Expert Group meeting was attended by the following Members: Jan PFEIFFER
(Chair), Carlotta Besozzi (accompanied and later replaced by Ask ANDERSEN from EDF),
Ines BULIC, Geert FREYHOFF, Anne-Sophie PARENT, and Luk ZELDERLOO. Josee VAN
REMOORTEL represented Mental Health Europe (replacing Mary van Dievel). The
European Commission was represented by Jan JAŘAB (Cab Špidla), Silvio GRIECO
(secretariat) and Trude ELIASSEN (both DG EMPL), Jorge PINTO ANTUNES (DG SANCO)
and Anna ZITO (DG JLS).
Programme
1. Introduction of the group, opening statements by Chair and Members
Members of the Expert Group and Commission representatives (secretariat, observers)
introduced themselves. Jan JAŘAB representing Commissioner ŠPIDLA, explained why the
Commissioner had wished to create such a group, namely to
link the four existing and
distinct "narratives of de-institutionalisation" (with regard to persons with disabilities,
children, the elderly and the mentally ill) together, drawing common lessons from them
which can be generalised and summarised in the form of recommendations. The Chair, Jan PFEIFFER, delivered an opening statement on the phenomenon of large
residential institutions, their historic role (of control and containment), and on the
development of policies towards a more person-centred approach which values
individual dignity, autonomy and community living. He emphasized the staff who work in
large institutions are often dedicated and well-intentioned people; however, the structures in
which they work largely determine their modes of behaviour. Citing an estimate of some 10
million people in residential institutional care (in the EU), he pointed out the urgent need to
use available instruments - e.g., EU Structural Funds - as instruments for change, rather than
allowing them to support and enlarge the existing institutional frameworks, particularly in
new Member States. Statements of other Members followed:
• Anne-Sophie PARENT argued that the key issue was
quality and its control rather
than any particular relationship with size and format of institutions, their settings, or
buildings that they use. She mentioned that even small-scale services may replicate the
paternalistic culture of large institutions, while buildings previously used by large
institutions can undergo a beneficial transformation into inter-generational
communities.
• Geert FREYHOFF warned that old models of institutional care should
not be seen as
being mainly the problem of Central and Eastern Europe. While such institutions
in Western Europe may provide far better conditions in material terms, this fact may
paradoxically result in their better acceptance by the politicians and the public, - yet
they, too, tend to isolate the persons rather than include them in the community.
• Carlotta BESOZZI raised the issue of the different legal frameworks in Member States
as regards legal capacity. People living in institutions in many countries do not enjoy
legal capacity on an equal basis with others, and do not have the right to redress.
• Ines BULIC emphasized the need to perceive the issue
from a human rights
perspective, using the existing human rights framework.
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• Josee VAN REMOORTEL confirmed that major investments in refurbishment of
large residential institutions, or indeed in building new ones, are under way in a
number of Member States, with the
EU Structural Funds being one of the main
sources of investment into this build-up.
• Luk ZELDERLOO spoke about the way in which staff tend to gradually adapt to
institutional frameworks ("boiled frog phenomenon"), emphasized the importance of
financing rules, and argued for an approach which would
establish well-generalised
models of institutional reform while simultaneously cutting the "supply line" to
anachronistic institutions. A crucial element in establishing such a reform would be to
provide training for decision makers, staff working in the services, but also users
(empowerment).
There was an overwhelming agreement that the Expert Group itself should not work only on
reform of "institutional care" but rather on that of "long-term care" in general, or indeed that it
should define its goal in positive terms as "promoting autonomy, dignity and independent
living" (also mainstreaming education and employment) . Jan JAŘAB promised to explore
whether this could be done in the process of formalisation of the group's status; he pointed out
that this could be in the title of the final report, which would be probably more visible than the
name of the Expert Group itself.
2. Debate on instruments
The opening statements were followed by a debate on instruments which can be used to
support change. The following were mentioned:
•
Open Method of Coordination in the field of Social Protection and Social
Inclusion - improving the reporting by Member States through more focused
coordination, precise guidelines (as regards the issue of ensuring equitable access to
long-term care, that is among the common objectives Member States have agreed
upon under the OMC) (A.-S. PARENT)
•
EU Structural Funds Regulations - guidelines, potentially even a proposal to change
the Regulations in the future (Ask ANDERSEN and Ines BULIC pointed out that there
is already a non-discrimination clause which should be used, but others were not
convinced that it would be easy to persuade key stakeholders about such an extensive
interpretation of discrimination which would make institutional care - as a means of
segregating and excluding people from communities - unacceptable)
•
Social Impact Assessments - guidelines (A.-S. PARENT)
• Bringing the debate into the context of the
internal market. A.-S. PARENT argued
that provision of services (by public, not-for-profit as well as for-profit actors) is
becoming part of the internal market, yet without the protection which is offered in
other circumstances (e.g., to consumers in the circulation of goods), and this needs to
be addressed with
guarantees for the quality of services, and systems of control
thereof. The response from other participants was cautious. Luk ZELDERLOO, in
particular, advocated caution on this point, warning that the Expert Group should not
be seen as trying to address the issue of SSGI (social services of general interest)
through a back door.
•
Public procurement rules - more and more Member States "procure" social and
health services, therefore procurement rules could become a very important tool when
developing community based services (L. ZELDERLOO).
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• Using and promoting the
existing international human rights instruments, e.g.,
International Convention on the Rights of the Child (Anna ZITO), International
Convention on the Rights of Persons with Disabilities.
•
High Level Group on Disability: Member States have chosen independent living as a
priority for exchange of good practices in the implementation of the UN Convention
on the Rights of Persons with Disabilities. The Ad Hoc Expert Group could make use
of this reporting exercise and asking further support from the HLGD. Possibilities of
further cooperation will be explored by J. Pfeiffer on the next meeting of the HLGD
on 1 April (Silvio GRIECO).
• The
new EU Disability Strategy from 2010: outcomes of the Expert Group work
could feed into the new Disability Strategy (to be probably launched in the second part
of 2010), in particular as regards the priority of independent living (S. GRIECO).
• The
new EU Strategy on the Rights of the Child from 2010 (A. ZITO).
• Initiatives within the context of the
European year for combating poverty and
social exclusion (2010) and the
European year of volunteering (2011) (A.-S.
PARENT).
• Follow-up initiatives to the French Presidency Conference on combating Alzheimer
and
COM Communication on a European Initiative on Alzheimer's and other
dementias (Jorge PINTO ANTUNES).
3. Expert Group Report and ways to get there
Jan JAŘAB outlined that the Commissioner envisages a report from the Expert Group which
would be handed over to him in October at the latest. The report should be relatively short,
easy to read, summarizing ("distilling") the key messages from the experience of the
respective Members. It should contain:
•
A general descriptive part
•
A set of broad policy recommendations applicable to all four categories of end
users ("Common Basic Principles")
•
A set of specific recommendations addressed to the Commission (as in part 2,
above)
There was general agreement on this structure. As to the process, it was agreed that there
would be two meetings before summer:
• No 1 - end of April or early May 2009, with first contributions sent by the Members at
least 7-10 before the date of the meeting, to be compiled/summarised by the
Secretariat);
• No 2 - early or mid-June 2009, to discuss first draft of the Report.
Several other conclusions were also made:
• The Report should not aim at providing new research, but it should contain
references
to key existing studies in all the fields concerned.
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• The Report could/should also deal with
identified knowledge gaps - particularly in
the recommendations of the second type, those addressed to the Commission for
further use, where proposals for future research would be made1.
•
If particular processes (in the European institutions) need to be entered already
during the phase in which the Report is being prepared, it can be done in parallel - i.e., if the Group agrees on a particular recommendation which should appear in the
Report, it can already feed it into parallel processes several months earlier.
•
Optional ad hoc meetings on more specific subjects can be arranged during the
period of activity of the Group, ideally on the same dates as the regular meetings. (
The
brainstorming with Heads of Units from DG EMPL and DG REGIO and their
geographic desk officers on the use of ESF and ERDF in Bulgaria, attached to the 1st
meeting of the Ad Hoc Expert Group, is one such example.)
• It appears useful to contact and involve as observers also representatives of DG
INFSO ("ICT for inclusion" Unit) and possibly DG MARKT (there was not full
consensus on the latter).
• Contacts with projects financed elsewhere by the Commission, namely from the
SANCO health programme (projects PROMO and ITHACA) and DG INFSO (ICT
and Ageing projects and AAL projects), should be encouraged.
The proposed dates for the April/May meeting and for the June meeting will be circulated
ASAP by the Secretariat.
Jan JAŘAB, Silvio GRIECO
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In this context, Luk ZELDERLOO made the first proposal already, namely to carry out a legal analysis
on Member State legislation which promotes institutionalisation (even though it may not be wholly intentional,
e.g., in creating security criteria which other forms of care than large residential institutions cannot possibly
meet). Jan JAŘAB suggested that similar proposals can be made already during the year, though it is not very
likely that any new study could be launched before the end of the mandate of the current Commission.
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