1. Enforcement in a Europe without Borders EPSO working towards a Europe without borders EPSO European Partnership for Supervisory Organisations in Health Services and Social Care An introduction to the EU-NL 2016 workshop on supervisory co-operation in Europe by Jooske Vos (general -secretary) and Mari Murel (policy and research officer)

2. Who and What and Where we are; 1-2 Where we came from (short history); 3 What we aim for; 4-6 What we do; 7 Some of the issues discussed; 8 Common dilemma’s; 9 Benefits of cross-border co-operation; 10-13 What to learn from us: - 3 Conditions for success; Lessons learned; Do’s & don'ts; 13-15 - Challenges and obstacles to overcome;16 Why ask Europe for support; 17 What can Europe do (10 points); 18-21 Impact of the EPSO working group on Freedom of restriction (restraint and coercive methods in health and social care ). 22-23 OVERVIEW of the presentation EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 2

3. Who and what we are ? slide 1 EPSO is: a Network of supervisory organisations (members); in Health, Social, Mental and Youth Care; 24 members from 20 European countries/ regions: Worldwide connections: International Society for Quality in Healthcare (ISQua) - Australia - New Zealand - Abu Dhabi; Public health and Government related; Members are more or less independently operating; Members use Sanctions and Enforcement; Members use various inspection and supervisory methods; EPSO is working from a small office in The Hague (NL). EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 3

4. Where we are ? EPSO Members and Partners slide2 E E E E E E E E E E EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 4

5. Where we came from - short history slide 3  1996 the Dutch IGZ and Norwegian Board of Health initiated EPSO -to establish a European network of officials who had the duty to supervise and monitor the quality of health care in their countries; - to give the representatives the opportunity to present the situation in which they were working, responsibilities, tasks, etc. -to identify issues relevant to the international context of their supervisory organisations.  In the following years -until 2002- a number of activities was organised in various countries on different issues but... the third meeting in 2002 had a tragic end, with the sudden death of the Dutch inspector general and founder of EPSO(Jitze Verhoef).  It took until 2008 to re-establish EPSO.  The EPSO secretariat started in 2008 and organises since (twice a year) conferences in the various member countries (3 participants max. per country);  EPSO is growing and flourishing.  21 st conference in Prishtina in June 2016,next conferences in 2016 and 2017 in Stockholm and Reykjavik. EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 5

6. Main Aim of member organisations slide 4 Main aim of most of our members is to guarantee: -a basic level of safety and security in health and social care to the public and, - support improvement of the quality of care. EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 6

7. Members seek to achieve goals by… slide 5 –checking quality and safety of healthcare in the various institutions- usually risk based; –reporting back on findings and giving feedback; –presenting good or bad practices –using strict measures such as closing institutions, fines, sanctioning individuals and institutions (hospitals or wards): –using public opinion and interacting with healthcare professionals EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 7

8. Aims of EPSO slide 6 To connect between supervisory organisations and its individual members; To improve exchange of ideas, outcome of research information and good practice; To promote cooperation on topics such as education and dissemination of knowledge. Make cross-border friends and get inspired professionally EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 8

9. Small Conferences twice a year; Small debating-group interaction during conferences; Pre-conference meetings; Working groups in-between conferences (virtual or real); Shared research; Shared activities such as Peer evaluation; Assistance in exchange of research questions, outcome, good practices- Training sessions organised by EPSO; Masterclasses; Brainstorm session by phone What we do slide 7 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 9

10. Some of the issues discussed slide 8 Topics such as: 1. Risk indicators; 2. Complaints; 3. Quality Indicators / Quality standards; 4. How to deal with the media; 5. Effectiveness of inspectorates; 6. Inspection methods such as:Observation / Discretion / Minimum reporting standards; 7. Restriction of freedom: Restraint and Coercive methods*. * Mari Murel will at the end of this presentation elaborate on the impact of this working group EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 10

11. Common dilemma’s slide 9 Risk based (indicators) vs Incident driven; Improvement vs Basic minimum level; Pure health or including economics and financial aspects of health care; Complaints and user participation vs Highly professional; Open to the media vs Professional insiders high level knowledge centre; Variety of Methods of inspection: what inspection methods are the best ? Discretion ? Blame free reporting? Standardised Observation? How to organise excellence - what are the choices ? EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 11

12. Why cross-border co-operation is beneficial to supervisory organisations? 1.Enthusiasm starts with sharing your own daily practice and looking in the kitchen of your colleagues; 2.Freely sharing ideas for improvement of supervisory practice can be very inspiring; freely sharing ideas is much easier cross border; 3.Open debate based on your own daily practice confronted with experiences of colleagues cross-border is worthwhile and inspiring; Benefits of cross-border co-operation slide 10 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 12

13. Why cross-border co-operation is beneficial to supervisory organisations? 4.The political environment of regulation is more ‘tolerable’ if you recognize reflexes with colleagues cross-border; 5.solutions are easier to discuss cross- border; no fear for negative reactions from colleagues. Benefits of cross-border co-operation slide 11 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 13

14. Why cross-border co-operation is beneficial to supervisory organisations? 6.Shared opinions between peers cross border are worthwhile in addition to discussions with colleagues ‘next door’; 7.In the cross-border debate it’s easier to avoid formal objections and arguments; easier to go for content instead of looking into formalities; Benefits of cross-border co-operation slide 12 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 14

15. 3 Conditions for success; Lessons learned; Do’s & don'ts 1. Topics to select Selected topics for EPSO must have: Common interest – shared urgency; Momentum; Enthusiasm about a topic. What to learn from us ? slide 13 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 15

16. 3 Conditions for success; Lessons learned; Do’s & don'ts 2. Selection of people The participants must qualify by being/ having:  Open and curious;  Sufficient level of skills incl. language skills;  A feeling of excellence;  ‘The idea ‘within EPSO everything is possible’;  sharing concerns without being negative. What to learn from us ? slide 14 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 16

17. 3 Conditions for success; Lessons learned; Do’s & don'ts 3. Adequate organisation -Positive inspiring atmosphere; -Freely sharing ideas; -Shared workload; -It must be fun ! -No formal hierarchy and no signing-off culture; -Some money; -Sufficient backing at the top; What to learn from us? slide 15 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 17

18. Challenges and obstacles to overcome: Continuity of People; Changes in political environment; Keep everyone involved; Sustainable financial context; Keeping the website and information updated; Organising successful implementation of results Europe-wide. What to learn from us slide 16 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 18

19. Why should the EU Commission (Secretariat-General) support successful co-operation between supervisory organisations? Effective enforcement of National rules should not stop at the national borders; national enforcement should be complemented by effective cross-border arrangements. Subsidiarity – as a good and leading principle in the EU – should not hamper harmonious cross-border co-operation between supervisory bodies; as is now often the case. Effective enforcement of EU rules should not remain the exclusive prerogative of the Member States and their national inspectorates / regulators alone; EU has an important complementary role and additional options. Why ask Europe for support? slide 17 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 19

20. Programme of requirements for successful partnership in Europe What could be done by the EU Commission (Secretariat-General) to support successful co-operation between supervisory partners in various fields (10 points)? 1.Organising support for successful co-operation between supervisory partners in various fields; 2.Building a framework of regulatory content as building blocks for national legislation of supervisory activities; 3.Support for continuity of people -not only countries - who want to work together cross- border on these topics; What can Europe do?slide 18 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 20

21. Programme of requirements for successful partnership in Europe What could be done by the EU Commission (Secretariat-General) to support successful co-operation between supervisory partners in various fields? (10 points) 4.Organise a European Focal point for cross-border co- operation between supervisory organisations e.g. in Brussels for instance at the Secretariat-General of the EU Commission; 5.Support those partner organisations interested in building a cross-border framework for successful co- operation between supervisory organisations; What can Europe do? slide 19 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 21

22. Program of requirements for successful partnership in Europe What could be done by the EU Commission (Secretariat-General) to support successful co-operation between supervisory partners in various fields? (10 points) 6.Support long term cross-border projects; 7.Support a sustainable financial context for co-operative projects (not primarily by paying all costs but by financial support for those organising financial partnerships); 8.Organise and support interactive information exchange by keeping information flows updated in cooperation with national and crossborder partners. What can Europe do ? slide 20 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 22

23. Programme of requirements for successful partnership in Europe What could be done by the EU Commission (Secretariat-General) to support successful cooperation between supervisory partners in various fields? (10 points) 9.Keep websites and information flows at EU level updated; 10.Organising Europe-wide voluntary -not mandatory- implementation of best practices by supporting EU cross-border working groups (including national partners) on implementation (European building blocks in National legislation). What can Europe do? slide 21 EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 23

24. Impact of the working group on Restriction of Freedom by Mari Murel slide 22 Start working group Restraint &Coercive Methods was a Question of Estonian Health board to EPSO: How do other supervisory bodies in Europe handle the topic of Restraint and coercive methods in health and social care ? Results: -Questionnaire; -Working Group (5 countries); -Pilot Study in Estonia (Peers); -European Framework adopted; -Promotion of adoption of good practice; -Report; -Attention at European and national level EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 24

25. Impact of the working group on Restriction of Freedom by Mari Murel slide 23 Impact in Estonia: -Inspectorate supported by international colleagues; -9 health institutions /hospitals involved; -Minister Soc. Affairs debate; -Ombudsman debate; -bringing different parties together (volunteers and others; -Start of national network. Impact for EPSO: Co-operation between colleagues; Good practise available to other EPSO countries i.e. Finland; Co-operation with Vilans (leading knowledge centre in NL). EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 25

26. Thank you for your attention EPSO European Partnership for Supervisory Organisations in Health Services and Social Care 26