Proposition 51K2594

Projet de loi portant dispositions diverses en matière de santé.

General information ¶

Submitted by

PS | SP MR Open Vld Vooruit Purple Ⅰ

Submission date

July 3, 2006

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health care profession bio-ethics civil procedure doctor medicinal product young person cancer health costs hospital expenses infancy paramedical profession price index experiment on humans patient's rights insurance public health midwife medical institution illness health insurance

Voting ¶

Voted to adopt

Vooruit PS | SP Open Vld MR

Abstained from voting

CD&V Ecolo LE N-VA FN VB

Contact form ¶

Do you have a question or request regarding this proposition? Select the most appropriate option for your request and I will get back to you shortly.

Discussion ¶

July 13, 2006 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I also negotiated with a number of colleagues to keep it very short.

Or did they negotiate with you?

Almost everyone has begged me to keep it short. The Health Act covers about three hundred pages. We spent a few hours and a lot of sweat.

I will keep it very short. The first part of the report covers the meetings of 3 and 4 July. The second part is a supplementary report from a meeting held today in connection with an amendment to the same bill.

As for the first part, Mrs. Burgeon and I agreed to keep it fairly concise. There were many amendments and comments from various members of parliament. We think it is appropriate not to repeat all of this again, but to refer to the written report for that part. Members who want to say a few more things can do so in the plenary session anyway.

I will discuss the main points of the bill. It consists of fifteen chapters.

Chapter I provides for a regulation for midwives. The Minister pointed out that so far the profession of midwives has been described only very limited. The draft law aims to provide a similar legal basis for midwives as for other health professions. A chapter is assigned to them, which, on the one hand, describes the activities globally and, on the other hand, specifies the conditions for entering the profession.

Chapter II deals with the special exemptions for the exercise of certain acts of medicine – which is a very difficult part – so that the target group in Belgium can follow a certain clinical training and this in the context of medical and scientific cooperation with countries that are not members of the European Union. The articles designed aim only to clarify this article and to avoid ambiguity.

Chapter III deals with amendments to the Law on Blood and Blood Derivatives of Human Origin.

Chapter IV deals with the functioning of the Knowledge Centre and provides for a replacement for the senior officials of the FOD Public Health and Safety of the Food Chain, the FOD Social Security and the RIZIV in the board of directors of the Knowledge Centre.

Chapter V addresses the amendments to the Act of 1996 on social provisions and, in particular, the tasks of the technical unit.

Chapter VI deals with the registration of data and provides a legal basis for the organization of a registration system and the processing of data relating to cancer.

Chapter VII relates to the law on hospitals. It was also a very sensitive debate. I think it will be returned extensively soon. The provisions relating to the head of the nursing department are amended to align them with the other provisions relating to the structuring of the nursing activity. In this way, among other things, the training conditions are removed from the law. From now on, they will only be mentioned in the recognition standards. There is also a change in the rights of patients in the hospital. In addition, the provisions on room supplements and honorary supplements are amended to improve the transparency of invoicing and the access to care for all patients.

Chapter VIII relates to implants and medical devices. It aims to better protect rightholders against supplements associated with implants and invasive medical devices. This is achieved through a faster response to these benefits by the compulsory insurance. The other objectives include clarifying and better defining the conditions under which the compulsory insurance must meet, as well as clarifying the conditions for their financing.

Chapter IX deals with the rights of the patient. It is written in the law that this applies to both contractual and non-contractual legal relationships. The designation of a trust person is simplified for the right to information. For the right to access and copy the patient dossier, the appointment procedure shall be retained.

Chapter X deals with health hazards. For example, SARS, bird flu and dioxin have led to a new safety task, health safety. The bill provides for the establishment of a network and provides a legal framework for the management of information. It also establishes an alarm system that allows the Minister to take exceptional measures.

The draft also complements the measures to be taken in the event of urgent medical assistance.

Chapter XI relates to medicinal products. In addition to formal technical corrections or re-formulations of a number of articles, Article 71 also introduces a period of protection after a tender. Article 72 stipulates that from 2007 the medicinal products that are reimbursed on a flat-rate basis in hospitals shall be removed from the calculation basis used for calculating the fees paid by the pharmaceutical companies.

Chapter XII introduces major reforms to the law on the responsibility of healthcare providers.

Chapter XIII contains a series of various amendments to the RIZIV Act.

Chapter XV regulates the insurance of minors. The purpose of this chapter is to improve the coverage of health care for especially vulnerable minors, in other words, unaccompanied foreign minors and children in charge of self-employed persons whose insurance is not in order.

For the rest, I would like to refer to the written report.

As regards the second loop, the supplementary report of this morning, an amendment was introduced. 73 submitted with a view to repealing Article 49, the former Article 44. I would like to briefly explain the goal here because this morning it went a bit fast.

The aim of the article was to fill two gaps in the current legislation regarding the transition to recovery in order to ensure the continuity of the care provision. There is a gap for the exclusively public institutions with regard to certain categories of professions, and for the private and public sector in the event of health crises and disasters.

At the initiative of the Minister of Labour, a working group was established to fill these two gaps. The proposers of the draft wish to insist that the work of the working group should be accelerated. In anticipation of the completion of the work of this working group, it was proposed to withdraw Article 49 of the draft.

There have been a number of reactions, including from Mr. Goutry, who pointed out that the opinion of the Social Affairs Committee on the draft law was not sought. Article 49 is clearly a matter within the competence of the Social Affairs Committee. If the committee had been caught up by the draft, such a mistake would never have been possible.

Mr Mayeur clarified that he had asked the Chairman of the Committee on Social Affairs whether the committee would advise. The President did not stand on that.

Mrs D'hondt does not remember that a question for advice was submitted to the committee. If the committee had to vote on Article 49 it would never have been adopted. She is, like Mr. Goutry in the general discussion, of the opinion that it is impossible to properly and fully handle such an important bill in a week.

The vote then. Amendment No. 73 on Article 49 was unanimously adopted, hence the article was repealed. The amended bill was adopted with 8 votes in favor and 3 abstentions.

For the rest, I refer to the written report.

I suppose that, for the rest, Mrs. Burgeon, who is your co-rapporteur, refers to her written report.

With the agreement of the colleagues, for which I thank the opposition members, I will now give the word first to Mrs Dierickx, and then to Mr Drèze and Mr Goutry. Thank you, colleagues Drèze and Goutry.

Mrs Dierickx, do not abuse the favorable position I gave you. You have the word.

Mr. Speaker, Mr. Minister, colleagues, the topic that has dominated the discussion of this bill is undoubtedly the extended powers for midwives. When the law comes into force, midwives will have the opportunity to prescribe medications, take ultrasound and undergo pelvic floor reduction. Even in the professional group itself, this has caused a lot of controversy. We have heard through the media that the various associations of midwives defended opposing views. One group feared precisely that responsibility and that responsibility, which comes with the expansion of powers. The other group of nursing women’s associations wanted to expand their powers, including responsibility.

This makes it not easy for politicians to form an opinion and make a decision. The design ⁇ has the merit that it will legally regulate some acts that midwives today place in the illegality. In this sense, the VLD has no problem with the extension of powers.

However, there are still some difficulties for the VLD.

First, there is the problem of ultrasound. We acknowledge that today nurses in the laboratory do ultrasound to determine the position of the child. The fact that it is legalized now, of course, is not a problem for us. This is a functional ultrasound. But the original text went much further and also allowed midwives to make ultrasounds that would establish a pregnancy and thus determine whether there is an extra-or intra-uterine pregnancy and whether there is a high-risk pregnancy, which goes too far for the VLD. Morphological ultrasound falls under diagnosis and diagnostics requires medical training, which goes far beyond the training of the midwife. Gynecologists, after their training as a doctor, continue to pursue many years of specialization. Therefore, we should not simply freely transfer their diagnostic role to under-skilled people. After all, the diagnosis of a fetus with a pathology is too important, primarily for the mother and child, but also for the midwives, because if a problem arises, the responsibility should lie solely with the doctor; it cannot be a shared responsibility between the doctor and the midwife.

The VLD is therefore satisfied that the text has been adjusted in this restrictive sense.

A second concern is the pelvic floor reduction. Kinesists must undergo special training in order to be able to provide the aforementioned treatment. We will now simply allow the competence to be done by nurses. More caution should also be given here. After all, I have the impression that in recent years it has been lost from the eye that every doctor and paramedic have followed their own, specific training. The tasks each performs cannot simply be exchanged.

In terms of implants, there are some good things in the current Health Act.

First, it provides for a mandatory notification of implants. An ungenotified implant can no longer be charged to the patients later.

A new structure will also be established for the refund, which is comparable to the refund of medicines.

The CTI, the Commission on Implants and Invasive Medical Devices, is established. The provisions of the law follow the provisions of the CTG, the Commission on Medicines. That is a good thing. The time limits used by the CTG are also taken over by the CTI. However, I hope that when an evaluation takes place after a year, the deadlines can be shortened. This should be possible especially for the implants.

However, the text of the bill stipulates that if the CTI does not formulate a proposal within 180 days and the minister does not make a decision within 45 days, the application will be rejected. I understand the budgetary reasons behind the aforementioned provision. Nevertheless, it is not fair to the applicant, who can then restart the procedure from the outset, and that because the CTI and the minister have not performed their work properly. A positive response would be more stimulating here, both for the CTI and for the minister.

In the delicate theme of supplements, we have been concerned about the pediatricians, who are already among the least paid specialists. The VLD feared that hospitals would find it even more difficult to attract hospital practitioners.

Mr. Minister, you know that this is a big problem today. After all, most graduated pediatricians choose their own practice.

We are therefore pleased that agreements have been made that will ensure better remuneration of hospital practitioners. The question is, of course, whether the wage increase will be sufficient to compensate for the disadvantages of all recent measures taken by pediatricians, including those measures that limit the standards of recognition for children’s departments in hospitals.

Finally, I cannot fail to express my amazement over Article 123 of this Health Act. This article was not originally included in the preliminary design. It stipulates that the chairman of the Dental Mutualities Agreement Committee must be an official. This seems to me to be a provision relating to personal ambitions rather than inspired by good policy. It is, of course, easier to give the chairmanship of the dentomut to a civil servant than to grab the anger of the doctors in the medicine box on the neck. It is a pity that the dentists are sacrificed for this. Doctors are tolerant and tolerant. This does not prevent me from deeply regretting this policy.

I thank you for your attention.

The dentists are tolerant.

Mr. Drèze, you are entitled to 30 minutes, but you may not need it.

Mr. President, we will see.

This is the time you have at your disposal in the general discussion.

I will stay within the time provided.

It is perfect.

Mr. Speaker, Mr. Minister, dear colleagues, this bill contains a conglomerate of various, yet important provisions, on which one cannot make a general comment, but rather chapter by chapter.

Some chapters delight us; others, on the other hand, do not suit us. We have submitted amendments to these chapters. These amendments were rejected but we are submitting a part of them again today because the arguments of the minister have not always convinced us.

The first chapter reinforces the status of midwives and we are delighted because these midwives perform an indispensable first-line role. They have acquired, over the years, more and more striking skills and the bill comes to confirm this evolution. We will clarify that our concerns about the sharing of responsibilities between midwives and other health professionals, in particular doctors, have been mitigated in the committee through the submission of amendments clarifying the scope of certain provisions.

Chapter VII limits and prohibits certain supplements to the patient in the context of hospitalization. The CDH has been advocating, like the CD&V, for many years, for a ban on supplementary fees in common room and in double bedroom and for a ceiling on supplements in single room. Indeed, the continued increase in hospital supplements and patient expenses unacceptably reduces access to care, especially for the most disadvantaged. The differences found between hospitals break the equality of patients in the health care system.

The system proposed by the Minister today does not correspond to the measure we would have wanted to see applied. Indeed, it is limited to certain categories of patients: patients admitted to emergency services and patients accompanied by their parents. We are clearly in favour of measures that allow children to receive appropriate care, especially in a place such as a hospital. The measure lifts an additional financial barrier to allow parents to accompany their child more easily in such circumstances.

However, in our view, the measure should not have been targeted at a subgroup of patients because this creates discrimination against other subgroups of patients.

We wanted the prohibition and ceiling to be extended to all.

The limitation of the measure to accompanying children creates a distortion in the system of financing hospitals and remuneration of specialists. In fact, unfortunately, the system of hospital supplements has become a way to bypass the structural underfinancing that hospitals have to deal with by transferring the financial burden of lack of funds to the patient. However, the bill does not solve the problem. It even aggravates it since it penalizes a group of specialists — the pediatricians — who, unlike other specialists who will continue to receive supplements, will see their income limited. However, the situation of pediatric hospitals is already worrying.

Schematically, their problems are of two orders. First, the standard of living of pediatricians has been collapsing for years due, in particular, to the undervaluation of intellectual acts compared to technical acts. The indexation of their surveillance fees, provided for in the medical-mutuellliste agreement of December 2005, took place several months after the scheduled date, which deprived them of an income for the year 2006. Then, the evolution of the profession from a sociological point of view and, in particular, its very broad feminisation, added to the numerus clausus, makes their task even more difficult to assume. by

Therefore, we advocated in commission that the measure be compensated by a revaluation of the professional fees. by

In a committee, Minister Demotte said he shared this same vision and had reached an agreement with pediatricians on this subject. Nevertheless, we will allow ourselves to relay the concern of the Belgian Academy of Pediatrics because this agreement is, in principle, conditioned by the decision of the medico-mutuellist commission, which is, to date, not yet acquired. In other words, nothing is acquired and, meanwhile, the working conditions of the profession continue to deteriorate.

These are the reasons why we will support the amendment aimed at inserting in the law that the measure will not enter into force before 2007 and without such revaluation.

Finally, the bill leaves the ceiling of individual room supplements to the free judgment of each hospital, which will not solve the problem of differentiated rates from hospital to hospital and therefore that of the inequality of access according to the hospital chosen while the care provided is supposed to be of equal quality for all.

In view of the criticisms I have just mentioned, we maintain our amendment filed in committee and co-signed with CD&V. This amendment aims, on the one hand, to prohibit the claim of any supplement of fees to the patient when the patient is hospitalized in a common room or two beds this, for all patients and not only children and patients "urgent", and, on the other hand, to ceil the supplements of fees possibly claimed in case of hospitalization in a particular room. This latter ceiling must be fixed by reference to the tariff in the agreement and not left to the hospital’s judgment.

Our position, of course, goes hand in hand with an increasing revision of the budget, because everyone knows the problems of underfinancing facing our hospitals and the fees supplements targeted so far and unfortunately, in our opinion, to compensate. The nomenclature of health benefits must, too, be revised from the bottom to the bottom in order to carry out the necessary re-balancing, as you promised in commission ⁇ a year ago following the departure of Steve Stevaert, president of the sp.a at the time, when he highlighted the significant income differences between certain specialists such as cardiologists and general physicians or pediatricians.

Chapter VIII establishes a new procedure for the refund of implantable medical devices and implants. We are pleased because such a procedure can only promote objectivity in the insurance coverage of such products, very useful but also increasingly expensive.

Chapter IX deals with the rights of the patient. The bill introduces some highly targeted amendments to the Act of 22 August 2002 on Patient Rights, amendments that we support. However, the project passes along with significant corrections. That’s why we introduced five amendments, some of which are based on the Federal Ombudsman’s “Patient Rights” report of June 2005. Mr. Speaker, as I did yesterday, I will allow myself to summarize my amendments now, which will allow me not to come back to them sooner.

It is perfectly logical that you use them as a “pullover” to your argumentary.

Our amendment No. 10 aims to confirm in the law that it is up to the professional practitioner to prove that he has properly provided the patient with information about his health status and treatment. Indeed, there is now a controversy in practice since some judges believe that it is up to the patient to prove that he has not been informed, which is at least absurd. How to prove a negative fact? In addition, the Minister’s collaborator has acknowledged it in the commission.

Our 11 amendment aims to give the early declaration of refusal of consent a purely indicative value, once a period of three years has elapsed after the issuance of that declaration. Indeed, in practice, it happens that science evolves dramatically between the day a patient declares that he refuses treatment by anticipation and the day the situation appears. Today, the doctor is obliged to respect the refusal of treatment, even if medical science has evolved in the meantime, allowing adequate treatment.

Our 12th amendment repeals article 58 of the draft which aims to introduce a formal obligation for the patient: that of recording in writing his request to consult his file. We consider that this requirement is too formalist and that it undermines the relationship of trust between the caregiver and the caregiver.

Our 13th amendment aims to remove a contradiction existing, in our opinion, in the law. Indeed, in the current law, the professional practitioner can refuse to the patient to receive certain ⁇ sensitive information from his file (personal annotations and those which are the subject of the therapeutic exception), but he can, on the other hand, give them indirectly through another professional practitioner.

In our view, there are two things one: either this information is really too sensitive and you must keep it secret, or it is not and you must allow the patient to have access to it.

Our fifth amendment, amendment No. 14, aims to find a solution to the functioning problem of hospital mediation services. They have been criticized from the beginning for the appearance of neutrality and independence they give hospitalized patients in relation to the institution they depend on. How could the patient trust them serenely if he has the impression that the mediator is on the side of the hospital that rewards him? How would it not be otherwise in cases where the mediator occupies another function within the hospital, for example if he is a medical director?

Our 14 amendment aims to give hospital mediators the guarantees of independence, impartiality and confidentiality necessary for the performance of their duties. For this purpose, we rely on the recent law of 21 February 2005 amending the Judicial Code as regards mediation.

These amendments were submitted in the committee but were rejected by the minister on grounds that sometimes surprise us. Indeed, most of these amendments seemed to obtain the consent of the minister on the substance but were deemed premature, awaiting an opinion from the Federal Mediation Commission.

What surprises us is that, on the one hand, these problems are well-known for a long time and it is not very clear how an additional opinion can change the substance of the problem. On the other hand, the Minister, himself, presents, in his bill, some amendments to the law on the rights of the patient. Therefore, we do not understand why other changes should be rejected. by

Chapter X creates a network of health surveillance that enables the Minister to manage health-risk situations. We are in favor of these provisions because the crisis of avian influenza has demonstrated the added value of having a tool for rapidly implementing a coordinated policy in the event of a serious health crisis. Nevertheless, we repeat here the importance of ensuring that the competences of the Communities and Regions, as evidenced by the State Council, are respected in this regard, and the usefulness of establishing a concerted policy through cooperation agreements.

Chapter XII deals with the responsibility of care providers. This chapter aims to correct some of the negative effects of the current procedure of controls and sanctions applicable to prescribing physicians, updated in particular during the controls carried out on certain physicians in 2005, ⁇ in the Gouvy and Lierneux region. The CDH had been one of the first to react to these events by filing in January 2006 a bill aimed at humanizing controls.

In his bill, the minister provides concrete answers to the problems raised but leaves us hungry on some points and some others do not seem yet settled or partially settled.

Thus, firstly, the Minister establishes a double appeal procedure, a double degree of jurisdiction allowing the service provider to claim his means of defence, possibly assisted by a lawyer. The draft, however, is limited to relatively general provisions regarding the enunciation of the guarantees of the rights of defence, leaving the King the competence to regulate later the more concrete rules of operation.

To a question I asked in a committee, the minister replied that the other guarantees will be fixed in the royal decree: the right to receive a copy of the file, the right to be heard, etc. We will ensure that these commitments are fulfilled.

Secondly, we re-depose the last two amendments, no. 55 and 56, aiming to insert into the law that a behavior called "deviating", in comparison either to indicators or to common practice, can be justified for therapeutic reasons or by the state of necessity. In fact, some patients do not have the possibility to move to a hospital and therefore it is impossible to obtain the approval of a specialist. The state of necessity could here be invoked, just as it could be when the generalist is sure that treatment is urgent and that examinations in the hospital environment would be superfluous. Finally, I asked to dissociate my bill No. 2234 aimed at stabilizing the regulation in the field of medicines and humanizing the controls of health care providers.

On the one hand, as I have already indicated, because I await to know, Mr. Minister, your royal decree reprising the statement of the guarantees of the rights of defence. On the other hand, because I am not yet fully assured about the efficient access of health care providers to the regulation on medicines. by

Mr. Minister, you told me six months ago that doctors would be offered by the INAMI a GSM PDA allowing them to easily download and update an electronic version of the commented directory of medicines edited by the CBIP. I say easily because, after you showed it to me just recently, I tried to consult the CBIP site on my own PDA and it must be acknowledged that it is relatively slow and boring.

On this point, can you tell me, Mr. Minister, if your idea of offering an instrument to every doctor is still up to date? If so, why has it not yet been executed? When will it be?

Finally, as with the bill on the control of occupational pension institutions discussed recently, the minister will recognize that the opposition has shown a lot of flexibility and sense of the general interest. Indeed, the draft government was submitted to Parliament with delay and, even today, it had to be amended in committee to be adopted in the aftermath in plenary session.

We regret that the government has not taken the lesson from the health law passed around Easter last year. At that time, we had lost three weeks as a result of a mistake in a rushed and late vote in the committee. Mr. Minister, I hope that next time you will be able to deny the saying "Never two without three" and come in time before Parliament.

Thank you, Mr Dressed. You surprised me, that’s fine!

Mr. Speaker, Mr. Minister, colleagues, if I look at it this way, I will have to get rid of myself. If I count your supporters in the tribune, they are almost with more than my supporters here in the hall. It will soon be a bitter battle around the famous health law. Mr. Minister, in any case, the people of your cabinet on the tribune should not be too busy: we will not go searching this evening endlessly in technical washes. I think that the plenary session primarily serves to make a political statement, to say how we see the different parts of the legislation and that exactly the committee sessions serve to discuss the technical work.

A very good comment, Mr Goutry!

Mr. Speaker, I would like to ask for your absolute attention and, above all, help with a recurring chronic problem. You know that in public health there is nothing worse than having chronic diseases, because in the long run that goes out and everything gets sick. Everyone gets sick when certain things become chronically sick. Their

Colleagues, it has become a chronic disease among these purple governments that we always get this kind of laws in a way and in a procedure that is parliamentarily totally incorrect. The bill consists of almost 100 articles. We started the discussion on Monday on the basis of a pressure test, in which it was still flooded by the mistakes: we have helped to improve a lot. We finally conducted the discussion based on the documents officially on Tuesday: 125 articles completed in one day in the committee. Anyone can count: the preparation time for such a design was almost zero. Their

You can say that you could have worked on it for a long time. of course ! People from the majority probably have met in a majority consultation for a while before. They were able to follow all that well, were well briefed and were excellently prepared, though that was not always in proportion to their presentations. What we have had to experience has been underlined and I thank the colleagues of the majority that they finally — listen carefully, Mr. Speaker — have said that we are right and that this is not a way of working, no longer is, never has been. I call the President himself as a witness. Their

One could, of course, say that everyone plays their game and that it is said now, but what is the bet? The commitment is one hundred and thirty texts: articles, improvements we thought, in terms of health regulation, of which we were said to need them. We needed to work hard on this, we needed to know well what we were doing, we needed to have a democratic debate between the majority and the opposition, and then we had to decide with knowledge of affairs whether or not this socially means an added value for our people. That is the implementation of legislation, that is why Parliament is needed. Their

If, of course, we continue to act in such a way that even the opposition does not have the time to properly prepare and actually do not do good legislative work — which is excluded — then the democracy of this Parliament is, in my opinion, a step lower than would be desired.

My second prefix is the following.

Laws like these are like repair laws. These are laws made up of diversity. You’ve heard it: it’s about fourteen chapters with all different articles. These are collective laws. We could call it program laws in the field of public health, with all sorts of provisions that need to be corrected, for which it is not difficult to make a draft law for them. All these provisions are put and cours de route in the program law. It is assumed that Parliament is not immediately aware of this, and that is approved.

But what is shown today? That it is not true. There are essential things in it, in a summary of articles that as a whole have nothing to do with each other, which the government asks us to approve. There are important provisions on how we want to continue with nursing in our country. The following topics have been discussed. How do we continue with nursing? How do we proceed with maternity? What skills are required from people? How do we stand against this? How will we legally anchor this? How do we ensure a good liability scheme, because those people have responsibilities to bear? And so on. All this was put into a few articles, of which only afterwards was revealed — I will return to that later — which in fact is the full commitment of it. The same, idem dito, applies to the supplement scheme, which I will discuss further later. The supplement scheme is about essential things that can be good for the people, which can be very important for our people, for whom we ultimately work here and by whom we are chosen.

My conclusion is that this type of work is not a good job.

I wondered with honour and conscience what the added value of this law really is. I will not support your law. Assuming that I’m going home tonight, and would have supported your law, with what feeling do I go home? Would I, then, as a member of the majority, have felt that I have been important today, that I have passed an important law that I support and that I could defend everywhere tomorrow? What great added value would I have added?

The second question is the need for this law. In my opinion, everything in it could still be debated quietly, it could be the subject of further discussion. The law could have come to Parliament in a much more mature state.

The third question is what the ratio legis is. What should motivate us, legalistically speaking, to change things? If we cannot answer this question correctly, then we are actually not doing well on the legislative level.

However, those questions are not in question. The following questions were addressed. Who will be right, liberals or socialists? Who has the most influence in this majority? In this regard, we experienced an incredible battle that day, never seen. Who is the best here? Who is best prepared for the elections? Who gets the most out of the fire? Who gets the most inside? The question was not what makes people better, but what is our dada? How will we succeed in getting our dada in here today, against the rest in?

A majority of 20 amendments were submitted, all of which were withdrawn. never seen ! I thought an amendment should be well thought out. With us it is so. We discuss that, we ask ourselves what we can improve, we write it out, we let that check, we consult people and then we submit an amendment with a very high sense of responsibility and a sense of utility value. The majority has submitted 20 of such warrants with varying signatures. I have seen everything. I saw amendments with a signature and then the same came back with two signatures. The same amendment was signed with three signatures. A little later, there were six. At that point, we thought the amendment could create a chance and then we put the right while the other left. All amendments that we left, because they did not contain enough signatures, were all withdrawn. In total, 20 amendments were repealed: 4 from the sp.a and 16 from the MR/VLD.

I call that threat endings. That is threatening. This is not legislative work. That is to say, if we do not get the supplements for maternal and child care then we will submit an amendment on something else and then you will see again. That was the atmosphere in the committee.

What has this led to, colleagues? It has led to a nonsense molding game in which the meetings took place almost the whole day in the hall and not in the meeting room. As members of the opposition, we have had to constantly ask the president to call those people back in so that we could also talk. At certain times, the minister was asked to go to the toilet, read the walkways, go where then again legislative work was carried out. That is what happened to this legislation.

Colleagues, I will give you a few substantive comments that may be of interest to some people. It is more specifically about midwives. They are important in our medicine because they care about new life. We need that new life. The people who accompany that new life, the midwives, are also important. There is the KB of '78. That KB was improved by the KB of '91. It is better to describe what they all have to do. Suddenly one comes into this law with three things on the spot. Their

First, a midwife must be able to prescribe medicines from now on – as if there are no doctors anymore and we still have 35,000 in our country, so there are ⁇ none too short – without them being able to make a diagnosis or have an overall picture of the patient. I think, for example, of contraceptives, of which I am told that they can be determining for the blood of patients. In such a case, it is good that one knows the history so that one can take the medical responsibility to prescribe such things.

Second, nursing women are now allowed to take ultrasound. However, the minister goes a step further by giving them responsibility for detecting any abnormalities in pregnancy. The doctors who were sitting in the room at that time jumped right and said that such a thing goes too far. Giving female women to perform ultrasound means giving them too much responsibility. This cost us ten amendments again.

It went back and forth. A word had to be added, a word had to be deleted, and so on. In the end, it was included in the deal and it was approved. The question is whether this can be accepted with a calm mind. I ask myself big questions about this.

Something else is, for example, the rehabilitation of the pelvic floor muscles. This, of course, is not unimportant for women who have given birth. Today, this is commonly induced by every midwife. A beginning is made. They explain how it can happen. A Chineseist must continue, because those people have been trained for that. In this law, the authority to rehabilitate and establish all kinds of therapies around pelvic floor muscles will be entrusted to a midwife. Understand who can understand! What is the added value? No one has responded to me. When I asked what the value added is and why this is stated in the law, no one gave me an answer.

If they themselves prescribe contraceptives, they must not make themselves superfluous. Isn’t that the problem?

Per ⁇ this may result, Mr. Tant, that fertility pills will be prescribed rather than birth controls. Who knows. The answer is to the midwives. We have nothing more in our hands. That is clear.

Colleagues, what is the sad thing about this matter? I am very sad, Mr. Minister. We’ve asked you a long time ago what you’re going to do with obstetrics. Will you expand the training? The training is now three years in Flanders and four years in Wallonia. They do not complain about it. It is said that the quality is good and that there is sufficient knowledge in the midwives. Should we extend the study period?

In this regard, the Flemish ministers in charge of Education were questioned, formerly Mr. Van den Bossche, now Mr. Vandenbroucke. What did they answer? That they do not support it, that it is not necessary, that there is no problem and that they want to keep the duration of studies for midwives at three years. What does the Minister say? That he will change it. He writes in the law that 180 credits must become 240 credits. That means 60 per year, 240 divided by four, and therefore four years of study. On that comment, the majority says it doesn’t have to be so because we decide not to. They decide that the Minister himself will decide at KB whether it will come and, if so, when. Everyone is calm and goes home. This is the way laws are made here.

Colleagues, I would rather have that we submit such a draft, in its mature form, to hearings, that we confer on it inter-ministerial, that we also take the other competences, of Education, in full account, and that we look at nursing as a whole. Where do we want to go? What is too short? What are the gaps in the current education? Can we do it within the training period? These are the questions that are asked. One cannot answer it in a day, with a preparation of a few hours. For this one must take the time. These are debates that need to mature, such as the reform of the HOBU, of higher education. That requires time. People should be able to sit together. Both academics, technicians, doctors and nurses must sit together to be able to answer the questions where, qualitatively, one is now, where one wants to go and how one wants to work there.

They decide something like this on a draft. I don’t understand it, but I hope someone can explain it to me later.

Mr. Goutry, Mrs. Avontroodt wishes to interrupt you.

When Mr. Goutry is interrupted, he usually becomes a little more circumstantial.

Mr. Speaker, colleagues, I want to put the points on the i.

Mr. Goutry, if the debate were as unnuanced as you portray it from the speech table, you would be right. The truth — you know that too — is more nuanced. The list of what will be prescribed is to our satisfaction, also of the MR and the VLD and — I think — the whole majority, approved by the Royal Academy of Medicine. That I wanted to lose because, in my opinion, you should bring your story a little nuanced. Otherwise, Mr President...

Ladies and gentlemen, I thought about it. Mr Verhaegen also wants to intervene.

Otherwise, Mr. President, Mr. Tant may have many more fantasies than he already has.

There are limitations to the infinity and infinities in the limitations.

Mr. Speaker, Mrs. Avontroodt, I am pleased that you say that the situation is not as it should be. I know that CD&V has almost begged to organize hearings and hear people from the practice. That has not happened.

As for midwives, we have received a practical testimony from your colleague Germeaux. According to the report of Mrs. Detiège — not present at this time — Mr. Germeaux was drawn a MR label. This is on page 27. The report is what it is. According to Mr. Germeaux, the midwives will need to diagnose the pregnancies and will perform a functional ultrasound as systematically as possible because the morphological ultrasound is not suitable for them. This means that a doctor needs to appear. However, only three ultrasounds are allowed. This means that the woman will have to finance if more ultrasounds are done. In his practice testimony, Mr. Germeaux warned that pregnant women will react very poorly when midwives are authorized to perform ultrasounds. Trust in ultrasound is shifted to doctors. In short, we fear even more overconsumption because the midwife who invested in the device....

Mr. Verhaegen, you are registered on the speaker list. You hold your speech while Mr. Goutry stands on the floor.

Mr. Speaker, I just want to say that we have not received any practical testimonies. This is what colleague Goutry meant.

You say what he wants to say.

Someone of the colleagues knows what he is talking about, but at the vote he was sorry enough away.

Mr. Goutry usually knows what he is talking about here.

Here we need to conduct the debate in a broad way. We cannot discuss all of this.

It has affected me, however, that in those supposedly simple, shared and convinced by all, consensus-made texts on one article, a whole morning was discussed. Not we took the lead in this, but the people of among others the VLD, with long presentations of the doctors in the hall, with great circumstance and great caution. Their

Then one gives the impression — now again, but that is the game — that everything is ready and clear, and one asks me what I’m talking about here. It has taken almost four hours in a negotiated text — I hope it has been negotiated by the majority — to reach unanimous agreement on one article. My colleagues, that speaks for itself. Do not blame the opposition for warming ourselves here for a moment to say that in this way we do not decide on professional expansions and special vocational titles for such important paramedical powers. This is not about training and the duration of such training. We do not do this because of a program law. This is from the evil.

Colleagues, I limit myself to a few chapters, the one with the most political value. For the amendments to the law on blood and blood derivatives of human origin, we are ⁇ the requesting party. We also support the proposal — ask the majority, including Mrs Avontroodt — that the tracking of stem cells and the research on the compatibility of donors with patients would be reimbursed. This is a costly research. There are not enough donors for stem cells. If you have to pay 200 euros out of your own pocket to help people, it is difficult. This is an essential point. We would ⁇ want to insist on this.

For the first time, the Federal Knowledge Centre has been encrypted. I continue to warn. The Knowledge Center is a very useful tool, but it is absolutely over-demanded. I looked again through the site which tasks are all assigned to the Knowledge Center. That is too much. I fear that this will become an alibi center and that in the long run studies will be sent to the Knowledge Centre because they know that they will not return for a long time. This is the phenomenon of the Council of State. Go to the State Council, then you know at least that you are still a few years away.

Colleagues, as regards the amendments to the Social Provisions Act — the data related to the federal health policy — we are of course in favour of good data. This is policy information. We need them. Even in a much better crossed form, we need to have that data, too, for the further future.

Regarding cancer registration, the Minister first established the Cancer Foundation to provide the epidemiological data related to cancer and incurable diseases. This is scientifically of great importance. This is done in collaboration with all stakeholders. This is very important and we support this. It is only a pity that, of course, the horse behind the chariot has been strained by this, because the foundation was first established and now a legal basis has been requested from the Parliament to do so. This could still be seen as a very well-intentioned delay.

Mr. Minister, however, we dare to emphasize the need to work on cooperation agreements, especially for the cancer registration, which puts you with a leg in the community’s powers. If you want to come to a good registration with a good data build in connection with incurable diseases, then these cooperation agreements are very important.

We have a few articles related to patient rights. In fact, I think it’s a bit of knitting. I did not really want to speak about this. Even colleague Verhaegen did not do that and other colleagues have expressed very reluctance in this regard. You should know, colleagues, that the Patient Rights Act exists for three years. Every legislation has its implementation period. That means doing something with good intentions. They make a law. If that is a law with added value, which we cannot say today, it can count on our support. We supported the Patient Rights Act at the time, because we felt that there were a lot of points with added value. After entering, one should have his car inspected, to see if everything is still fixed properly. If then problems arise, it is better not to drive to the garage ten times, but to inventory all those problems at once. One can better go to the garage once and let the car turn a good turn. Then you have a good vehicle.

Well, we’re going the whole other way here. It has already begun. We go back to some sort of repair policy. Then we will need coordination texts to fit it all back. We will no longer read the points together and understand the coherence. We will make a law that should give rights to simple people like us all, the patients, in difficult circumstances. However, when they read those texts, they do not understand them. Then we will refer to loaded texts, later approved texts and again by law amended texts. People will no longer understand it. I warn that once again we are moving from an initially good legislation with a social added value to a corrected, ever-improved legislation, which takes place in phases or pieces, fragmentary. After a while, a cat will no longer find her boy there.

Following the discussion, I cannot fail to remind some colleagues of the period during which we discussed the law on the rights of patients in Parliament, I mean under the presidency of Mrs. Avontroodt in the committee. I still remember very well our comment in the discussion that the provisions on the responsibility of hospitals for the breach of the relevant law by the actors active in the hospital, regardless of their social status, were not correctly intertwined and that there were problems. Mrs. Avontroodt will undoubtedly remember that I have repeatedly asked questions on this subject. I submitted several written questions to the Minister. This is now “regulated”. It is, of course, too simple to say that a hospital is responsible for everything that happens in the hospital, if one does not want to immediately conduct the debate on how one can give guidance from such a hospital and take responsibility for what happens, of course with respect for the therapeutic freedom and a number of achievements. We do not conduct that debate. We are repairing a law that we said was not correct. I am only afraid that this will cause a lot of new discussions in the field again. We should have had a thorough discussion.

That is perfectly the point we have made. This is really common. Their

In addition, you have changed articles in the Patient Rights Act. At that time, we have created a committee by law itself that should evaluate this. That committee was working on it and then the minister said it would take too long. I asked him to take the advice into account before changing the law since we have installed that committee by law. And then it is said that one will not wait for it, that one will already change it one and another. Their

You have to imagine it. We make laws. In the law we install a repair, something that should constantly help us to improve the law. And then we do not give that repairman his advisory authority. They do not wait for that. It is said that one knows better and will change itself. Their

I will give you an example of this. There was one advice available. We asked for it in the session. We did a small test. It is funny. We have made an amendment to a certain text that we have transcribed from that opinion. It was about a text that was also in the design, but formulated differently. We have taken the literal text of the opinion. Our amendment was rejected and that of the government was approved. We literally transcribed the text from the advice. The Minister said that his text also looks like that and that his text was taken. If one makes legislation in this way, then I don’t understand it anymore, then I don’t have any sense of putting myself in for it, because then one really has the feeling that one is not doing well and that everything doesn’t make much sense. Their

Colleagues, the biggest and most delicate point is about the supplements in hospitals. This is one of the last points that should be prominently addressed. Colleagues, this is a story that I have to tell you, in all its lengths and widths, in as its truths and correctnesses, because I think our people have a right to it. Their

The prehistory is the following. There is a prehistory in that. Supplements should no longer be requested when parents remain with their children in the hospital while that child needs to be treated and when the parents want to stay with the child at night, to let him fall asleep and to repair a number of tasks for that child, to provide security, to remove the fear. That is a very good thing. A doctor should not charge supplements for this. Until then, that is a honourable goal. Their

However, it is only a small restoration of a measure that went much further in the past. This was previously decided in a government with socialists and CVP's. This measure applies to all circumstances. It was not just about children. It was also about dying people who are anxious and may need guidance. It was also about other people who need help.

We have created a uniform, non-complex scheme that says that supplements in double and multi-person rooms are no longer of this time, that we would no longer accept that. Hospitals need to be sufficiently funded so that they can get there without the supplements of doctors. One should just re-align the fees so that one should not and steamily alongside supplements try to bring about a kind of dual health care. Their

That was the position that was supported by the Chamber at the time. We have made legislation on this. It may be a little sad to have to say it, but it is late Jan Lenssens and his colleague Vermassen who worked hard on this, together with Mrs D'Hondt and myself, then in the Social Affairs Committee. We had a large majority for this. Everyone said that it was a good arrangement, that it had to come, that it was an improvement for the people and for the patients. Their

What happened then? Mr Vandenbroucke subsequently abolished it, among other things under pressure from the doctors.

They close you from everything, but you are still healthy. No agreement was reached in 2002 and it was then decided to put that into the deal and to cancel it. Now we are starting a restoration policy. So if we are not standing up for the abolition of supplements for children now, it is not because we are against it. We are for. We are very happy that this cannot be done anymore.

But we must be politically correct. One cannot bring a dead mouse and say that one has sold the cow and that we must already be satisfied with a dead mouse. That is what it is about. It is about restoration.

It will only make the legislation on the supplements more opaque. I had to read four articles to understand it. I had to read the Hospital Act, I had to read the Health Insurance Act in two or three papers and I had to get advice to understand how the current supplement scheme works. We believe that it is important that the patient is informed and well informed and we will strengthen that in the law.

Colleagues, what is the history? The Flemish and Wallish socialists wanted this necessarily and have submitted a bill on this. This was discussed in the Public Health Committee a few weeks ago. What happened then? The proposal did not reach the final meeting. There was clear resistance. It was not always so good to notice, but the liberals did not want to vote on it and wanted to postpone it.

The minister then took the lead and said that he would not vote on legislation on supplements if he did not have agreements from the Medicomut nor opinions from the Insurance Committee. We found that legitimate.

Mrs D'Hondt then submitted her proposal to return to the previous good arrangement. This was not accepted for the same reason. They said there were no advice and they were waiting. That is the plea I just held here. So we can perfectly fit into that context.

What is happening now? You won’t believe it, but when the Health Act reached us, we saw standing in it as key points: the supplements and mother-child care. That point had not passed a few weeks before the committee, despite a majority. This would now be voted by the majority. Then you feel that there is something. A point for which a majority could not be found weeks earlier, now suddenly gets it. This means that it was marshalled.

What happened? It became painfully clear when during the course of the day the amendments on the pediatricians began to flood, submitted by Dr. Bacquelaine, among others. Mr. Bacquelaine has constantly warned that the supplements should not be abolished and that the pecuniary condition of not only the pediatricians, but of all the doctors dealing with the sick child, would not improve, and so on.

I have been a member of Parliament for fourteen years and I have never experienced the following. This remuneration improvement has even been recorded in the law. This has never happened. The tariff agreement is a type of CAO that is concluded annually between doctors and the hospital funds and in which such a matter is negotiated. That was never regulated by law, precisely because the doctors never accepted that the supplements were abolished by the law. Now the same tactics are applied and it is said that the honorary improvements, quite vague, will be inscribed in the law.

The minister is not of yesterday. We have a wise Minister of Social Affairs and Public Health, who says that he does agree with that supplement scheme, but that he still has to negotiate on the fees. It thus introduces the date of 1 January 2007 in the law. For all children and parents, there is no solution yet. It may be there in 2007, as it is linked to the implementation of the other agreement.

In the meantime, the pediatricians were not silent. What have they done? They saw that the law was over and that they would receive a better reward. They decided to go back to the minister and his cabinet chief, which they also did last Friday. They negotiated their monetary situation. The minister told them that the provision had already been included in the law and that they could be sure of it. Parliament would approve the law a week after their talks. The minister promised them a better condition, but it would also cost them a bit.

After all, purple policy is not a policy of added value on the social level and of good legislation, which must be good for the people. It is a detective game that people play on vacation. Those who get bored can find out who has negotiated with whom and how the combinations fit together. Whoever first discovered it, won. This was approximately the commitment of the committee. I did not come out. I have not known how everything happened for a long time.

Colleagues, now you will be at your discomfort for a moment, I look especially to Dr. Bacquelaine, as well as to Mrs. Avontroodt, who have so often included it for the smaller regional hospitals and the smaller pediatric services. We all spoke out of one mouth to the minister, who wants to mandate four pediatricians per hospital. I have calculated that the profession of pediatrician in Flanders is still exercised only by about four hundred doctors. For the whole country, there are less than 1,000 pediatricians on 35,000 doctors. The reason is that they are not well paid, have to work too much and are called out of bed too often. We have asked the Minister to expand the regional services and provide a feasible permanentity, since there are not many pediatricians anymore. We also suggested that the recognition standards require that no more than three pediatricians are present in the regional hospitals.

This was pulled out of the fire. Everyone called the prostitute, because there was finally a draft royal decree that stipulated that pediatric services in hospitals could deal with three pediatricians.

You won’t believe it, but last Friday the King and the Minister signed a royal decree that included in the recognition standards that each regional hospital must have four pediatricians in order to have an independent, pediatric service. Colleagues, four pediatricians, that means the following. I’m not saying that; a study has already shown it. A journal ⁇ that in that case, half of the pediatric services would be threatened with closure. Of the 65 approved pediatric services in the Flemish hospitals, 31 are at risk of losing their recognition because they do not have four full-time pediatricians and will not be able to have them.

After all, colleagues, you should also not assume that pediatrics only deals with super-big, difficult cases. Eighty percent of the tasks of pediatrics consist of the treatment of polyps and tonsils and from other, smaller interventions. Thank God, this is the majority of the interventions in pediatrics. We will now find a specialist and make a specialism of it. We will impose recognition standards for them. Patients will have to turn to a large hospital, subregional or university, for such interventions. They will have to go past their own regional hospital, which provides basic care — pediatrics belongs to the basic care —.

Mr. Goutry, the Minister wants to interrupt you.

First, I will conclude my reasoning. After all, there is another important point.

Women like too. Childbirth is linked to pediatrics. Where there is no more pediatrics, there is no more maternity. They are also interconnected.

So, not only is pediatrics lost, motherhood is also lost. Colleagues, I really mean it now: I would be terribly sorry for you if in the coming time colleagues would be overwhelmed by their own hospital. You will still hear the bell ring; it’s still holiday now, people don’t read much and they don’t know much because they are happy to be busy with other things. However, I predict you, as soon as the holiday is over, this point will come to their ears and you will be under pressure and ask the minister if it really needs to be.

Mr. Goutry, let the Minister interrupt you for a moment. Mr. Minister, the questions are asked. Did you want to react?

I would like to say that several approaches are being analyzed at the same time and that they all relate to the same object.

I would like to make a comment concerning a criticism formulated, concerning the slightly dispersed, heteroclite framework of healthcare measures.

If we look at each of the measures that have just been recalled with some energy by Mr. Goutry – I also recognize this quality to him both in the committee and in the plenary session – we can see that this is always important themes. There is no theme that can be said to be accessory.

Furthermore, I would also like to draw attention to the fact that we break, by the technique used in this text, with a practice condemned by Parliament and according to which this kind of device appeared in the laws-programmes. Here, the measures were grouped into a bill containing various health provisions to give them a coherent framework — that was the goal — even though a number of provisions deal with different aspects. The problem of health care is extremely large. We will also – at least I hope – make other healthcare proposals before the end of the legislature.

Then comes the issue of pediatrics and pediatrics. There are two simultaneous discussions on this subject.

The first is the quality of pediatrics. You live in a small country like a pocket handkerchief — it must be remembered. It is not a big country even if it can be in our heart, where we sometimes find structures that belong to the same pillar and that will compete on the basis of services that will never have reached the standards of quality or the ability to frame enough.

Inspired by a report that you all know, the Casaer and Cannoodt report, we will remove the qualitative elements.

Mr. Goutry, you are right on one point and one could not say things more clearly than you did at the tribune: as long as one is concerned with the theoretical statement of a provision aimed at bringing improvements from a qualitative point of view, everyone agrees. But the day it is said that it will have consequences on the ground, things happen differently. We will agree or not, depending on whether or not it affects his region, his pillar, his sector.

not at all.

I can give you the example of members of CD&V, French-speaking and Dutch-speaking liberals, socialists of both ranks. Until now, I can’t mention members of Ecolo, but that would be the case if they were facing problems of this nature. When it touches their area, everyone comes to me and says that it is a problem for them.

(Protests on some banks) I do not want to show demagogy at all. I believe that when there are arrangements to be made for the quality of the service, for the defense of a quality pediatric, I must take my responsibilities.

I do not hold contradictory discourses as I sometimes hear them hold on quality without having the political courage to translate it into facts. by

The second issue concerns pediatricians. This is a two-level discussion, namely fees and supplements. In terms of fees, it has long been said that they should be revalued. I would like to point out that we made efforts for fees in the hospital framework in 2004, in 2005 and now in 2006. Many have spoken about it, but the concrete gestures, so far, it is mostly me who has put them up with the help of some of you who have interpelled on this subject. This is a consistent gesture in the perspective of a revaluation of intellectual services. I remind you of the debate that took place last year in the committee and which resulted in the demand for a comprehensive reflection on intellectual benefits. This is how we came to the revaluation of geriatrics and, on the other end of the age pyramid, pediatrics of which we are talking now.

Regarding the supplements, several parliamentarians, who do not necessarily belong to ideologically close groups, pointed out the importance of the possibility of accompanying children and to this end the need to avoid financial obstacles to this accompanying. I had said at the time that it was necessary to study the question of cost but also the reactions of the sector, like Mr. Goutry just reminded him. However, I have to add a nuance to the statements made at the tribune. I said that we were ready to work on this model of limiting the supplementary fees on the condition that no acceptable alternative model is proposed within the Medicomut instances.

The talks continue with a deadline. I will be more subtle than Mr. Goutry who can’t re-enter the whole debate at this tribune. It was useful to mention it here.

Mr. Drèze, you can speak but briefly in order not to create a debate in the debate.

Mr. Speaker, when the Minister reproaches Ecolo and the CDH for interpelling him when they have sub-regional concerns, I must remind first that all, including the Minister, we are born and live in a sub-region and, then, that the problems we put forward are transversal problems. When we talk about cardiology, pediatrics, fees supplements, we all talk about where we are but it is transversal problems. Therefore, the criticism of the minister is rather low for most cases.

Whoever feels sick, let him be sick.

The Bible says, “He who has never sinned let him throw the first stone.” I will not throw away much.

We can feel what this debate is going on. There is a vote on a law on which the debate has not yet ended. It has just begun. Their

The question is whether we should introduce quantitative criteria. The Minister says we need to get higher quality in pediatrics. However, a study has been conducted and what is the conclusion of the two professors and pediatricians Cannoot and Casaer? That we have no quality problem and that we have a good pediatric. This sector should have been left in peace. The only thing that could have been done, Mr. Minister, and rightly, is a recalibration. However, this is true in general. In this context, a proposal from Mr Vandeurzen was adopted to establish a committee. That is the work that must be done instead of lulling on the honor of one or another, for this will never be done without discrimination; it will give rise to precedents, it feels like that. In fact, the case is not treated in this way. This is a passport policy and it does nothing. Things must be done thoroughly. The honorary wages, the techniques and the criteria used to calculate and award honorary wages should be thoroughly reviewed. Only then can one do something for the pediatricians. Their

By the way, Mr. Minister, you had promised an improvement for the first five days of the supervisory fee by 100%. You promised it at the end of last year. It would have already been carried out for a quarter on 1 February. It was performed on 1 May and for the geriaters on 1 February. So you are already too late. What are you actually doing here? There is an agreement, it is on paper, it is not implemented and now it is included in the law. Colleagues, one really does not need to contain that matter in order to feel that this is foolish, that this is pasmunt work, that one has reached agreements between one another and that one and the other have had their dada. That was, by the way, so to be seen, only we did not always know exactly in which piece of the stage we were in. At the end, however, before the canvas fell, we saw all the actors. All who participated greeted the public for so much generosity and they gave each other a strong applause. Then the stage was over. The question is whether it is a good piece. I ⁇ ’t want to direct it. Whether or not it will be filmed is another question. Their

Mr. Speaker, I will decide. It makes no sense to technically tire colleagues at this time.

Implants are an important thing. That is a good thing, Mr. Minister. You use that law to set up a commission for the implants, so that there is clarity on that matter. I call that a good initiative. This gives people clarity about a problem that has long been unclear. Such legislation should consist of such matters, not the sudden establishment of major health problems with great consequences. Their

I don’t blame the people of the majority, because I sometimes felt sorry for them. Sometimes we are a little bit in a majority-minority fighting position and we are already trying to strike each other against the cheeks. Now there was actually a feeling of wanting to help those members a little because they are fools and they can do nothing about it. We decided to be kind to them so that on July 13 we could all go on holiday. After all, they have also not asked for it and are already so much tested in this purple majority. We were really sorry for the members of the purple majority!

After all, we succeeded this morning in approving another amendment to remove an article that we had discovered would have been a major imperfection in the law. In fact, it would have been a camel of size if it had been approved. We stretched our hand over our heart this morning and we also helped approve it. We helped approve the amendment because otherwise it would not have been affected. Their

Finally, my colleagues, maybe another slander. Mr. Lano, it decorates you and it makes me a pleasure that you have listened so carefully. There should be more colleagues like you, colleagues who struggle to listen to the debates.

The screener is the sectoral committee for health data, added to the privacy committee. The Minister has put this into law. That sectoral committee had to come. However, it is primarily about the composition of that committee because what they will do exactly is not immediately clear. It is mainly about who will sit in it.

What has happened? At some point this point is included in the bill and it is “amended” during the meeting. The Minister has asked not to discuss this point because of too early. However, the composition of the committee has not yet been determined. What has happened? What the Minister took from his draft law was later reintroduced through an amendment. This, however, only happened after the green light came, after white smoke came out of sight from the negotiations.

That sectoral committee was primarily a matter of the liberals. They said to the socialists, “Wait, we will also bully you.” They had initially submitted a counter amendment, but they still gave their signature to re-submit the original article through an amendment. It is a matter of some flexibility so that the game is closing.

In this way we have come to “useful” work. Colleagues, it is up to you to judge whether you find it really useful. I can only give my explanation. I can only say how I felt it, how I got a little sight of it in a short time. I will do it for myself a few times during the holiday. I think I’ll still have some inside pleasures. (Applause of Applause)

Mr. Speaker, I think Mr. Goutry will answer me from his bench.

I am not an expert in silver.

For how many appointments has this happened? You understand me very well.

We are not yet out of that, Mrs. D'Hondt.

The vacation will be long.

Maybe I can offer some solution. They are not 50 silver but 2 gold dukates and they are blue on both sides.

The golden dukates that are blue on both sides are something special.

Note, at the end of the ride those are thrown into the temple.

Mr. Speaker, Mr. Minister, dear colleagues, as the Minister just recalled, it is true that we have had the opportunity to examine a bill containing health provisions, independently of the other sectors that have been examined either in the program law or in the draft containing various provisions in a very general way. This was indeed a request from Parliament, all groups confused, by the way.

I am glad that it could have been so. In fact, it is sometimes damaging to discuss projects that cover a multitude of sectors, without being able, at a given time, to target a privileged sector, in this case that of Mr. and Goutry. The method we used this time is much better.

I do not want to repeat all the points discussed in this bill. I will just focus on one or the other subject.

First of all, the problem of wives. We have much discussed the possibility for midwives to perform a number of ultrasound or other examinations, prescribe medications, etc. There are several objections to the original project. We consider that, although the midwives have a quite prominent and interesting role at some point in the course of pregnancy, it seems to us, however, that the mastery of the set of techniques must remain the responsibility of gynecologists or radiologists in the field of ultrasound. In particular, the screening of pregnancy during the first ultrasound examination as well as risk pregnancies should remain the responsibility of the medical body. This is related to responsibility.

We know how gynecologists are facing the continuous growth of liability insurance premiums. We therefore found that putting midwives in a situation of having to take responsibility for the screening of a risky pregnancy on their own was not correct in relation to the distribution of responsibilities in the healthcare sector. As much as it is necessary to evaluate the abilities and skills of each according to their own training, so much it has appeared to us that the screening of pregnancies at risk should remain the responsibility of gynecologists, doctors. I think we have done well to choose this way!

by Mr. Goutry spoke of many amendments. It is true that there were many amendments, but they all converged towards a number of issues, including essentially the problem of midwives and the problem of supplementary fees. The set of amendments, on the contrary, allowed to open the debate, to make it possible to go to the bottom of the problem and, then, to synthesize the debate into common amendments of the majority that allowed to improve the text.

With regard to the problem of midwives, it seems to me that we have reached a good result: they will be able to perform functional ultrasounds and will have a revalued role, especially with regard to the time of work. It was important that this was the case. On the other hand, all guarantees are provided for the accuracy of the technical examinations necessary for the screening of risk pregnancies in terms of responsibility. It was useful that it was so.

I would like to briefly address a second point: that of the establishment of the Sectoral Committee on Health Data within the Privacy Protection Committee.

It was useful to introduce amendments to reintroduce this sectoral committee, which had appeared in the texts and then left. We are pleased that this sectoral committee is established by the bill.

This sectoral committee is empowered to authorise the disclosure to third parties of personal data from hospitals. These include minimum clinical summaries. In addition, this committee obtains certain powers related to the recording of cancer data. These include the authorization agreement for the coupling of personal data, the transmission of the encrypted copy of the data relating to the registration referred to the Federal Centre of Expertise, the INAMI and the Inter-Mutuelliste Agency. This is, in my opinion, an improvement in the protection of privacy. This will enable the Privacy Protection Commission to operate more effectively in the healthcare sector.

Then comes the issue of additional fees.

I would like to address the issue more thoroughly. What exactly do we want in this regard? If it comes to eliminating globally any possibility of making distinctions based on the commitments of practitioners in relation to their practices, we are headed towards the disappearance of the conventional system. This is the real question: do we want to stay in a conventional system or not?

If the government or parliamentary assemblies take, in an authoritarian way, drastic positions regarding the abolition of fee surpluses, the conventional system is no longer needed in hospital medicine. We must be able to take into account the medical committees, the participation of all the actors in the sector to determine how the allocation of the health care budget is organized. There is a difference between the conventional doctor and the unconventional doctor. Otherwise, I think the convention is useless.

If there are no more conventional doctors and non-conventional doctors, if there is no more distinction between the two categories, I really do not see the interest of continuing to work within the framework of a conventional system. But I am practically convinced that it is our conventional system that has allowed to create a quality of care as we know it in Belgium, at a cost as we know it in Belgium. Without this conventional system, we would probably face the problem that most other systems in other countries face and which is significantly less acute in our country.

Therefore, I advocate for the maintenance of a conventional system. Doctors who do not wish to contract for the whole of their activity should be allowed to benefit from certain supplementary fees. by

On the other hand, everyone — I hope — agrees to want to guarantee every patient the possibility of receiving treatment at the conventional rate, that is, at the rate of conventional doctors, without additional fees. All situations where the patient has no choice must be resolved.

This is the case of emergency services where we logically remove the supplements requested since the patient has no choice of appearing or not to the emergencies. by

A child hospitalized should have the right to be accompanied by his or her parents, regardless of their financial situation. Therefore, there is no question of penalizing certain children for this financial reason. by

So we had to find a system. We have decided to remove the fee supplements for children accompanied by their parents, as long as someone finances this system. It is, of course, easy to decide on a generous measure, but nothing is more demagogical politically than promising gratuitousness. Unless a financing has been planned: it is essential to have established a mode of financing. It seems to me that the logic meant that the abolition of these supplementary fees would take place on the condition of a revaluation of the pediatric surveillance fees. No one should be hurt by such funding that we would have wanted to assume under the effect of great generosity and solidarity. by

The planned system allows to condition the abolition of the fee supplement to the revaluation of the intellectual acts of pediatricians. This seems to me essential. Demanding an irreproachable quality of pediatrics in Belgium can only be conceived thanks to pediatricians; this is the minimum requirement. Without a pediatrician, the quality of pediatric care will decline sharply. Under the pretext of generosity, solidarity and creativity, it is possible to advocate major reforms resulting in the abolition of supplements or certain fees, but the problems will appear when we no longer have a pediatrician. by

However, this question is not entirely illusory. Our country suffers a major risk of lack of attractiveness of certain health-related professions.

This is the case with research. It is known that, very often, our researchers leave the country — which is very good because they can bring back interesting experiences — but, unfortunately, many never return. We also have problems with large hospital doctors who sometimes find in other countries significantly more favorable conditions and who leave Belgium. The attractiveness of the profession is therefore essential. If we take the risk of removing this attractiveness, we are heading towards major problems that will first suffer patients and, in this case, children who require high-quality pediatric care. We should be very careful when dealing with these issues.

Removing supplements for children accompanied by parents is a good thing but financing pediatric activity in hospitals is essential.

Furthermore, when Mr. Goutry poses the general problem of removing supplements, I understand it. I also understand that representatives of major mutualist organizations have some problems with this. Why Why ? First, because they have set up hospital insurance with great advertising support and that, of course, when the insurance premium is paid, it is interesting that the amount to be paid for the hospital supplements of the contributors is not too high, otherwise there is a risk of a deficit in the mutual.

I understand well the conflicts of interest that are being talked about a lot at the moment and this one is a wonderful one.

Those who are linked to the mutual lobby actually have an interest in advocating for the complete removal of supplements. This is “bingo” for mutuals: they collect bonuses and they no longer spend to repay the supplements to patients.

I believe that Mr. Bacquelaine raises an important debate. Are supplements really a form of financing? It talks about the cost of a complementary health care coverage by mutual partners. We could also mention private insurance. I can tell you about a recent mail from DKV ⁇ interesting in this regard.

The question is also whether Mr. Goutry asked the question just recently – they are not there to address structural shortages in hospital financing.

The debate is interesting. The government has effectively, in tranches of 33 million structural, and by repaying backbacks in an accelerated way, tried to answer this question. But it remains true today that the debate is not just about fees. The debate must be held from both angles. Service providers should be kept in hospitals whenever possible.

For example, I say it from memory, there are approximately 600 pediatricians in hospitals out of a total of approximately 1,400 pediatricians in the country because there is an imbalance between the remuneration of benefits inside and outside hospital sites. This leads us — Mr. Bacquelaine, you know it too — to the debate about the permanence due to this element.

My second reflection on the question of supplements is that today we need to have a logic of identification – a debate that we started last year but did not continue this year – of the different sectors that, in the hospital specialties, pose problems in terms of remuneration, often linked to an abnormal distinction.

I have to say. Medicomut is struggling, for the moment, to overcome this problem; it is the overpayment of a number of purely technical services in relation to the underpayment of intellectual services. For my part, I believe that this re-balance must be the object of consensus between us, knowing that it is difficult. Indeed, once one has acquired a right in terms of fees, a re-balancing is always felt in a negative way, unless the new means that will be injected do not obey the old means already injected. But obviously in the context that is ours, with the growth standard that is ours and our financial means, it would be to dream high than to think that one can do everything at the same time. by

This is not contradictory; it complements the reflection. This demonstrates that we are not in a mediocre trading game as it was said at the tribune a few moments ago. Pretending that you pay better in exchange for better quality is not true. In reality, as I just recalled, you get better paid because there have been shortcomings in the alignment of a certain number of fees. This effectively helps to maintain, in the hospital framework, a number of providers.

I listened with interest and attention to all the development of Mr. President. Bacquelaine that holds the road pretty well.

However, I cannot accept that he considers the CD&V and cdH’s proposal on supplements as demagogic.

It seems that mr. Goutry and myself were clear in our words. Of course, this measure must be compensated financially speaking, in particular through the budget of financial means. In addition, it should be known that today, in fact, some patients do not have access to conventional and non-supplemental services, either because these services are not easily accessible in their area, or because they are told that the deadlines will be different depending on whether they take a room with a supplement or a room without a supplement.

Let us go!

This is the reality, you know it better than me!

I add that, in recent years, the costs of patient hospitalization — figures from both Christian mutualities and Socialist mutualities — have increased by ⁇ 40% and that, in fact, there is a dualization in access to health care that must be counterable by all means. There is no demagogy here.

Mr. Drèze, I dare nevertheless hope that, in Christian hospitals, one does not go so far as to postpone access to the necessary care according to the financial capacity of the patient. If so, you are asking me.

The [...]

In my view, the issue of financing healthcare is fundamental. We will probably one day really have to look at the overall revision of our nomenclature because care is evolving, that the very landscape of medical care and scientific advances make, every day, benefits become obsolete and others more needed. Therefore, a fundamental revision of our nomenclature is a necessity.

We will have to do it. by

The issue of global financing must also be addressed. And the question of the second pillar will come one day. This issue cannot remain taboo. This pillar already exists through complementary mutual insurance and private insurance. Currently, there are accessory funding, annexes, additional funding, which covers a certain part of the care. The mutualists are actively involved, both socialists and Christians. Private insurance companies are also involved. by

But this is not a criticism. I only point out that there is sometimes a confusion of roles between the control body which is naturally the mutual and the provider of capitalist-type benefits that have become the mutual in matters of hospital insurance. In my opinion, conflicts of interest may arise because the private insurer himself, who sometimes becomes the mutuellist, participates in the medical-mutuellist convention to manage public money. At some point, there are conflicts of interest that can create problems. I’m not saying that we can’t solve them, but I think we need to look at this issue.

Mr. Speaker, this is rightly a very interesting debate on supplementary insurance, on the tasks of the health funds and of the private insurance. In my opinion, this is somewhat out of the context we are dealing with.

However, we must keep ourselves from passing over to statements that are sold as truth. First, there are not only socialist and Christian, but also liberal health funds. You accidentally forgot that. Second, the supplements, the implants and the largest additional costs incurred by the patients are not included in the mandatory insurance, not even in the hospitalization insurance, which are offered optional by the health funds, but are privately insured. A la limite one could say that with the restriction of supplements one gives the most gift to the private insurance institution. Until the next order, you are more in favour of private insurance than of solidary insurance. You are undermining your own market.

I will be very brief.

For a few weeks now, I do not know which member of parliament asked Mr. Bacquelaine if he knew how to distinguish between his deputy hat and his doctor hat, he said yes and I believe it! Therefore, mutual companies that are, a fortiori, non-profit also know how to distinguish when they wear two hats.

To conclude, I would say that what may hurt here is the fact that the mutual hospital insurance that, I recall, are non-profit, compete with the private insurance companies that also have their relay in this assembly.

We should look at the cross-sharing shareholders of certain structures in our country. This is another discussion that could be very interesting. We will see where many multinational companies are currently located in the sector.

Answering the question of Mr. Goutry, I would simply say that there should be no taboo, it seems to me, with regard to the techniques to be implemented to ensure the financing of health care tomorrow that will probably be more expensive than those of today. This seems to me inevitable, and it also corresponds to a scale of value: health has an ever-increasing value in the collective mind. Therefore, it would be useful to hold a debate to look at how to finance in the future a sector that will cost more and more expensive.

The concept of the second pillar is not a taboo subject for me. The inventors of the second pillar are first and foremost mutual. They were the ones who invented the concept of complementary insurance. Progressively, it will be necessary to see to what extent the concept of the second pillar is expanded and to study the techniques to be used to favor a second pillar (tax incentives, group insurance in companies). I think all these debates are important and necessary and that we will not make the economy of it.

I don’t want to be long, but I think the intervention of Mr. Bacquelaine, the member, is excellent. I like when the right speaks to the right. It is clear. We know where we are going: privatization, second pillar, etc. We are looking for allies: mutual allies, etc.

I appreciate that we are looking for allies for a classical right-wing liberal discourse. Therefore, it is necessary to continue Mr. and Bacquelaine. All his arguments are to be countered when we say that we want a solidary health system that allows everyone to get care.

This is a petition of principle. She is interesting. Everyone can do it. We are all for a solidary system where everyone can be treated.

Is anyone against? and no. I think everyone agrees. It seems to me to be of a very high content and this strongly fuels the debate.

You are the only one who has spoken the word privatization. I take note of it.

We will ⁇ have the chance one day to address the substantive debate. As chairman of the Health Committee, I counted on you to put on the agenda an interesting debate on overall health care funding beyond the decision to remove from time to time one or another supplement, without really integrating into a substantial reasoning on the issue. I will address a last topic that I think is important, namely the reform of the assessment service and the medical check.

I was especially committed to advancing in this sector. I myself had submitted a more maximistic bill, I agree with it. I am in favour of the abolition of medicines. Chapters II and IV seem to me somewhat obsolete by these categories; besides, at present, they no longer correspond at all to the spirit that prevailed when they were set up. by

For me, it is mainly about tracking overconsumption, which is not acceptable in terms of quality of care. From the moment when a real overconsumption is found, it is necessary to establish a control, necessary and in this case effective: it will result in the removal of a source of overconsumption, which will make it beneficial for the whole of society and will allow to feed solidarity, ⁇ dear to Mr. Mayeur, President of the Commission. This research into controlling overconsumption is indispensable in my view.

How should these controls be carried out? Of course, in respect of the rights of defence. by Mr. Drzeze has fought a lot on this subject. In my opinion, this project brings notorious improvements to defence rights, and I look forward to that.

Just recently I talked about the attractiveness of the medical profession, and more specifically of pediatricians, but it is clear that this attractiveness also concerns the whole profession. By continuously subjecting the profession to ⁇ subtle controls, we risk generating an administrative fear, anxiety, anxiety with regard to these controls, sometimes unreasonable, due to their multiplication and their modus operandi. Additional administrative burdens and excessively careful controls should be avoided with regard to this profession, which would risk turning back to what appears less and less to be a true vocation. Let us be attentive!

The project we will vote on tonight brings several improvements in these sectors. I am ⁇ pleased with this as it is true that the events of Lierneux and others were detrimental to the attractiveness of the medical profession and risked to contribute to this shortage highlighted by some, even though it is not yet effective on the ground. We cannot talk about shortages yet, but the risk exists if doctors continue their emigration, as is the case for the 1,700 Belgian doctors working in France and the 700 Belgian doctors in the Netherlands. This massive exodus should worry us about how to feed the administrative burden and the controls of the profession.

I can only be ⁇ pleased to see that this problem is addressed without too many taboo, that advances are made in the rights of defence of doctors and that a system is put in place that focuses on the problem of overconsumption rather than on barriers to therapeutic freedom, sometimes through a high number of controls.

Mr. Minister, Mr. Speaker, these are the few remarks I wanted to make on the occasion of this debate on the bill containing various health provisions, being convinced that we will not stay there and that we will have other opportunities to discuss the issue, which I look forward to in advance.

Mr. Speaker, Mr. Minister, colleagues, there have been quite denigrating comments on the present law so far, and that is actually ⁇ regrettable. We think the health law that is here is actually good. There are a number of important things in which we attach a warm heart. I would like to briefly highlight three points during this presentation.

First and foremost, there is the revaluation of the first line in the context of the midwife debate. Second, it is about binding the supplements, an important item. Third, the strengthening of patient rights. I will go into this point by point a little deeper. So I will not be concerned with holding a conference like certain parties apparently do behind this microphone. I am not concerned with political politicians or party political haircuts. What matters to us is what is good for people. That is where we will now stop.

First, the maternity debate. It is in our country a well-known phenomenon that childbirth is considered a disease. This is a ⁇ peculiar phenomenon when one sees what is happening in the countries around us and elsewhere in the world. It was deadly normal. In our country, however, it is medicated and that is actually a pity. Therefore, we find it ⁇ important that the midwife again, also on the legal level, gets the place she deserves.

What is stated in this law is that midwives get a better status. In fact, we do nothing but follow the definition of the World Health Organization. We actually do nothing but de facto consecrate what the midwife in 90% of cases already does in most hospitals. It involves prescribing drugs from a very limited list, doing certain ultrasounds, not to mention the morphological, and reduction of pelvic floor. These are all things that are already happening and that now get a more legal framework.

As a result, we do nothing but make the profession of midwife more attractive, give more future opportunities, give an upgrade and show more respect. We actually make sure that midwives get the recognition they deserve. I think what is in this law is very good. It is simply a reinforcement of what is already happening in most cases. It provides a reinforcement of the first line and, last but not least, it saves money.

So I want to fundamentally oppose the image that is hanged here by certain speakers as if midwives are a kind of knives acting as the maid of the gynecologist. Nothing is less true, nurses are actually specialized professionals who are very well placed in their job to address a number of shortcomings in our medicine in terms of accompanying pregnancies.

Recall a recent establishment of the Intermutualist Agency. It states that in our country pregnant women from lower social classes are subject to medical underconsumption. This is an important given.

We believe that midwives are very well placed to play a good intermediary role in this, in order to do something about underconsumption among socially weak women.

Second, a supplementary discussion.

Mr. Speaker, I would like to intervene. Thank you for giving me the word. I waited until my good colleague De Meyer closed the chapter about midwives.

She speaks about the expansion of tasks, which she says is already happening, that it has been legally adjusted a little, and so on. Everything is not so important. They are actually paying more attention than necessary.

Mr De Meyer, you also approved that the number of credits will be extended from 180 to 240. Is the sp.a in favour of extending the training from three years to four years?

We find it ⁇ important that in the training of midwives more attention is paid to the interpretation of ultrasounds. This was one of the important discussion points. We are absolutely in favor of this. It will have to be evident from the discussion, in consultation with the Communities, how we can best complete that in the program offered to the midwives. I do not want to make any statements about this at the moment. This will be shown in the discussion on the subject.

You can say that it is de la politique politicienne and that we should not do politics here, but Parliament is of course there to do politics. I’m very sorry. There are other consultative bodies for consultation, but here we are doing politics. Here we vote on things, for or against. You can be for or against. I would only like to point out that if you subsequently pass the law which lists 240 credits, it is only a matter of entry into force. Then you consecrate—to use your term—that the training will now last four years and not three years. You will approve that. That is actually the essence of the story. That extension is already being done. You say it yourself; that’s a little arrangement. I just wanted to show that through that task expansion, which no one is very interested in, as you rightly said, one wants to come to an argument for a four-year training. It is important that you know that. This is actually the use of the vote: from three to four years. The SP is behind, because they will approve it.

We will indeed approve this, Mr. Goutry, because we ensure that midwives receive a very good and proper training, with special attention being paid to the interpretation of ultrasounds, which are essential for the further course of the child’s life and for the further follow-up of the birth.

As for the supplement discussion, whoever enters a hospital today holds his heart and wallet. The average cost per entry is now more than 450 euros. This is, of course, a significant amount for more and more people. It is becoming increasingly difficult for more people to pay the hospital bill. It’s a sign on the wall that a lot of OCMWs see their post “intervention in hospital bills” rising and unpaid hospital bills have long been no longer a rarity.

We all know that there is currently a supplement jungle in hospitals. It is extremely important to keep these supplements under further control. Not to mention the problems associated with the admission form, invoicing and so on. We believe that the legislation that is now in place takes a number of very important steps to further restrict those famous supplements, because we are indeed convinced that today, in terms of supplements, the limit of decency has been exceeded.

Indeed, we also dream every day of the ideal world of Vermassen-Lenssens. We would very much like to see it realized, but we must also take into account the reality and the social support. We believe that it is very important to give a place to social consultation in our health care. This is the basis for our Belgian society. It is ⁇ important that the social support level is as broad as possible in order to implement certain measures in the field of health care. So we think we need to go step by step in the supplement discussion. The additional steps that are put into the law, we are therefore very pleased.

First, there is the prohibition of any supplement when admitted to the intensive care or emergency department. This is especially important because no one chooses intensive care. No one chooses to go to the emergency department. This is not a free choice. Therefore, it is no more than normal that no supplement can be requested here.

Second, the back door of the fee supplements that were still requested for day recordings in double rooms and common rooms for certain categories of people is closed. In many hospitals this has been done quite creatively. In order to be able to account for certain supplements that were forbidden in a classical hospital admission, people were quickly channeled to the day admission. The back door is now closed definitively. That is a good thing.

Third, maximum supplements for individual rooms, regardless of whether or not the doctor is conventional, are also ⁇ good. Anomalies, such as supplements up to 300%, finally go out of the world.

Finally, last but not least, the ban on the honorary supplements for children accompanied by parents, of course, delights us tremendously. Indeed, it should not be that the presence of a parent with a deadly ill child depends on the thickness of the wallet. This is absolutely unacceptable for us. Therefore, we have signed the bill of colleague Mayeur concerning children accompanied by the parents. We are very pleased that the Minister has included it in his draft.

Mr Goutry, I would like to point out that this is possible thanks to an amendment approved by a majority in the committee. The debate gave a lot of parliamentary animosity. That is a fact; that is important and that is also a good thing. Therefore, the amendment was adopted so that the entire scheme on supplements for children in hospitals will enter into force by 1 January 2007 at the latest, along with the urgent revaluation of pediatricians.

For sp.a, this piece by piece is very good. We would have liked to have something more, in this case the famous prohibition of charging honorary supplements in the common chambers. This is still happening in four-person rooms. We have submitted an amendment. The Minister has stated that he wants to resolve this in a different way. He wants to accelerate the transformation of the four-person rooms into two-person rooms. There are attempts to give this a much higher funding up to 90% for the transformation of the four-person rooms. This is a very good thing to eventually get to double and single rooms, which is much more the current reality and desire of society. With regard to implant supplements, the mandatory notification as a condition for the refund is a good thing. In this way we come to a sort of register as we have always advocated. Remember the famous breast implants. At that time, we already advocated such a register. Another measure is the mandatory reporting obligation for companies to notify the RIZIV when products are withdrawn from the market, changes are made, dysfunctions or side effects occur. All very good things to follow everything properly so that there can be immediate action in case of problems with implants.

The last important element in the Health Act for sp.a are the patient’s rights. We are very pleased with the improvement of the admission form. There was work there. It is good that there is better information about the various costs. Remember the OIVO study on this subject that at the end of last year accused the famous post "different costs" because it is an entry on the admission form and the invoice that makes everything possible and makes the invoice completely opaque. It is a good thing that both on the withdrawal form and on the final invoice the item "different costs" will be much better described and explained, so that control on that invoice becomes much easier.

In terms of patient rights, there are also fewer formalities for the trust person. The fact that the contractual and out-of-contractual legal relationships, which colleague Vandeurzen had discussed earlier, are taken into account, is a good thing. A maximum cost price for copying the patient dossier also indicates a difference in the patient’s wallet. More opportunities for relatives to lodge complaints are, of course, also well taken into account.

Finally, we regret that the patient rights amendment has not taken into account another item, which we consider to be extremely essential and that is also one of the demands and aspirations of patient organisations, namely the fact that the ombudsman services in hospitals are insufficiently independent.

Mr. Minister, that is a very old one. You know that the ombudsmen are now paid by the hospitals. Often it is difficult for an ombudsman, who is in employment of a hospital and who often also has another function there in addition to the function of ombudsman, to assess certain files truly independently. We think that is a problem.

We advocate for an independent Ombudsman. We regret that this has not been included in the current draft, but we have understood that the opinion of the Committee on the Rights of the Patient reached you a little too late, that you received it only on 23 June 2006. So it was a little too late to incorporate the point into the existing law. We have also prepared a bill on this subject.

Mrs. De Meyer, on this point, I believe that we will not have to wait for your bill, given that your amendment no. 64 on mediation has been resubmitted. I hope that we will have the courage to vote for it right now and make it pass right away, without waiting any longer.

Mr. Speaker, the opposition has submitted the amendment again because we strongly support incompatibility and independence.

However, I would like to emphasize something else.

Mrs. De Meyer, your words prove the importance of being careful in discussions on patient rights. You say that in the event of death the right of the relatives to lodge a complaint is extended. You think this is well taken into account.

But did you know that the Order of Doctors is constantly pushing forward a very difficult problem? In fact, it turns out that many people, at the end of their lives, still change their will, which, if they are willing, is, by the way, their full authority. Many relatives sometimes find it unpleasant that the testament is still being changed. What do they do, not because they are saddened by the patient’s death, but because they feel offended by the inheritance? They ask a doctor – otherwise it can’t – to check the file and verify whether at the end of the day no narcotic pill was given, causing the deceased to sign something without realizing it.

As the procedure was facilitated, the Order of Physicians is now facing a rain of complaints, in which the Order no longer wants to participate. The Order gives a negative advice and advises the doctors not to be used and abused in such files.

Therefore, one must be careful. This is a point that I have already mentioned in questions and during the discussion. It is not enough to extend the right of complaint and other matters to resolve everything. Politics can also organize so many complaints that it no longer knows where it will come out.

That is exactly the fine discussion that should be held about patient rights. Your statement proves that my statement is correct, although you think I played too much cabaret. If you later analyze my words, you will see that there is a lot of truth behind my theater school. It was not a cabaret that I performed, but a thriller.

Mr. Speaker, I am surprised that Mr. Goutry, during his explanation, stated that there are doctors who are used by relatives to re-interrogate wills. This does not advocate for the doctors in question and for their deontology.

I do not know such doctors. I assume that our doctors in Belgium are still in good faith and do not allow themselves to be abused for such pecuniary conditions. I hope that we have not ended up in a society where doctors are paid for such services.

The purpose of the law is to ensure that, for example, children can also check what happened or didn’t happen at the end of their parents’ lives or what happened wrongly at the end of their parents’ lives. It is important to be able to do so in the context of strengthening the rights of patients.

Finally, I would like to thank the opposition for the adopted amendment. According to the opposition, it is regrettable that so many amendments were submitted by the majority and subsequently repealed again. It was very sympathetic from the opposition that such a good amendment was taken over from us.

We also support this amendment, but we also understand the position of the Minister. By the way, I meant that you, colleagues Goutry and Drèze, said exactly the same thing. I thought you could find yourself in the Minister’s statement that he would submit the prepared report of the Patient Rights Committee to the Public Health Committee for discussion in order to examine how its conclusions could be addressed. You said at the time that you would like to see the report.

I think it is important to look at everything in its entirety. In any case, we continue to strive for the establishment of this independent Ombudsman’s office as soon as possible.

Mr. Speaker, Mr. Minister, colleagues, for us, this Health Act is definitely a step forward, because it strengthens the primary health care, binds the supplements and strengthens the rights of patients.

Mr. Speaker, Mr. Minister, dear colleagues, I will also come back on a few points of this important health bill that has been dissociated from the law-programme. This has already been said many times, but it is worth repeating. For parliamentary debates, we were demanding to have this type of configuration when it comes to considering projects.

I will review one or the other of the points, return to what I consider essential and make reference to the current situation, in particular on the taking of the position of the Flemish government. I will come back.

The first aspect concerns the mother-in-law. The profession of midwife was only very summarily described in the Royal Decree of 1967. This profession is now attributed to new skills, both in terms of activities and conditions for the exercise of the profession. I will remind, as some have done, that the amendments introduced are also on the initiative of the National Council of Parenting.

The debate we conducted led to a balanced solution, namely limited skills for ultrasound, which devotes the need for further training and guarantees in relation to the finding of risk pregnancies. I think we have reached a balanced agreement in the committee. This is all the usefulness of parliamentary work. This development is not unprecedented, as it is already seen in many European countries. The description of activities is therefore adapted to the tasks and responsibilities of midwives, i.e. to provide more autonomous care for the mother and child in the perinatal period, to provide care requiring the fulfillment of increasingly technical acts and to accompany young parents in the care of newborns. All this, without forgetting the essential role of doctors, especially gynecologists. I think this is a good reform.

The second point I would like to address is the issue of supplementary fees. Like Mrs. De Meyer, I am pleased that our bill has finally been incorporated into this project as it aimed to eliminate the fee supplements for children hospitalized with an accompanying parent. This is a good thing because illness, convalescence after an accident, hospitalization are a difficult challenge to face. The parent can play an essential role; it is an ideal partner in this hospitalization situation for caring staff. Of course, there can obviously be no discrimination between children based on financial considerations.

Despite the quality of the care provided in our country, health care obviously has a cost, including through the costs of hospital stay, sometimes very high for many families. Patient-care intervention remains considerable for households who have economic difficulties or because serious illness or specific treatments result in hospital spending that exceeds the capacity of the family budget.

The amendments made by the bill allow to ensure a complete parallel between conventional hospitalization and day hospitalization in terms of supplementary fees for patients. Similarly, no supplement can be requested from the patient when admission is made in an intensive care and emergency care unit. In fact, I believe that there is no choice and there should not be any additional fees on this occasion.

Finally, a clarification is made as regards the prohibition of supplements on fixed fee on admission. These are small advancements regarding the regulation of fees supplements but they are obviously essential for us, as we sometimes limit access to care. With regard to the revaluation of the surveillance fees of hospital pediatricians, extended to other specialists and introduced by the majority amendment, it seems to us, in the PS group, that this is a measure that goes in the right direction. This is a measure of fairness when you know the difficulties of the sector. We will not be able, anyway, we have said, but I want to repeat it, to avoid, in the long run, a thorough reflection on the revaluation of the intellectual benefits of doctors compared to the payment of technical acts as they are doing today. I think this is an essential key to the conditions of medical practice in our country and its financing.

In fact, the difficulties that exist with neighboring countries must be reduced. I was last week in southern France. The difference in treatment between a doctor practicing there and a doctor from a university clinic in our country is 1,500 euros net per month in favor of the French doctor. This wage difference, even though the cost of living is higher there, is likely to attract practitioners in the south. This poses a problem in this country: there are fewer practitioners in northern France than in the south where rates are higher. They are also looking for incentives to encourage the installation of doctors in the north.

It is true that we will have to re-examine the method of financing the intellectual benefits of doctors. I believe that this is the path to be followed if we want to address, in the future, the problem of shortage that we will face, given the numerus clausus.

Better protection of the beneficiary against supplements generated by implants and invasive medical devices is also sought through faster coverage by compulsory insurance. The aim is also to clarify and better define their budget support for the financial resources of hospitals. This is a good measure that we applauded in the committee. by

Progress in patients’ rights – administrative simplification and other – should also be welcomed, but this is constantly evolving. It must adapt to the realities of the field. The entire work on the profession must also be submitted there: an objective assessment of the application of the law on the rights of patients must be made. I was one of those who feared the enforcement of this law. It presents excellent aspects in terms of information, communication with the patient, the proactive role that he plays in treatment and care. However, an objective assessment of what is happening on the ground needs to be undertaken in order to further improve its application, ⁇ in large hospital centres. by

Another topic I would like to address is that of health risks. The latest news in recent years has shown us that increasing health risks occur in the form of pandemics, such as SARS or avian influenza, or as crises that hit the food chain (dioxin, mad cow disease), and that public health problems are of this order of magnitude. It has become indispensable and urgent that the law confers a legal framework to the management of relevant, critical information, to the management of crisis situations, the establishment of a warning system that authorizes the responsible minister to take exceptional measures, limited in time as said.

The management of health risks, in the absence of an express assignment, has remained – in my opinion – within the competence of the federal legislator and is, of course, limited to what the urgency requires. In this regard, I am surprised by the intervention of the Flemish government, although I do not find it totally useless. He referred to the Federal Government Consultation Committee Communities-Regions on this issue indicating that it was essential and that the Communities should have a role in this matter. It is ultimately a good thing to have referred to the Conciliation Committee to demand a role of the Communities in this matter.

There is a need for a cooperation agreement so that each institutional actor plays his or her role. If this is the meaning of the referral to the Conciliation Committee, I agree. If the purpose of this petition was to prevent the federal government from managing the problem of health risks, considering that it falls within the competence of the Communities because it is about prevention, it would be a mistake. We should not follow this logic. In fact, when you are faced with the problem, it is the federal minister who is called. He is asked to provide a similar solution for the whole country. It is even believed — and the minister has been questioned several times about this — that solutions to the problem of health risks must also be found at European level. I understand that community or regional ministers may fear that they will be deprived of one of their powers to return it to the federal. There are health risks to the population. I think that responsibility must be taken at the level where one can act appropriately. As it has been said in the Health Committee – we have also made recommendations on this subject – there is only one way of information. Information to the public should not be disturbed. Things need to be structured and coordinated and not confronted with antagonistic discourse between health officials at different levels that would be contradictory, which would only poison the problem rather than contribute to solving it.

The Federal Minister informed the Conciliation Committee that we were strictly within the framework of federal powers. The law concerns only the federal powers. This is not a special law that imposes measures on the Communities.

That said, we must not be mistaken: the responsibility also lies at the federal level and it must of course not be discharged from it. We might have a federal minister who will charge the communities to deal with the problem, but I’m not sure that’s the right solution.

The powers are not removed from the Communities, but the federal capacity is strengthened to act quickly and properly in relation to these matters, as has been the case recently with regard to the problem of avian influenza. I think the government and the minister have fulfilled their role in a quite adequate way to try to manage this problem.

Therefore, it is not necessary to change the position for this type of matter, even if one day it will be necessary to debate whether medical prevention should remain within the domain of the Communities or return to the federal. The Socialist Group and I have also submitted a special bill to make healthcare action more coherent by bringing this competence back to the federal level. Indeed, we believe that the Communities do not really have the capacity to act on this matter.

Article 49 of the law was removed, which allowed the recruitment of staff to ensure the continuity of care in times of crisis. It had to be removed because the reaction of the trade unions was virulent. They compared the article to a ban on the right to strike. This is not the ambition of the minister. In any case, it was not the commission when we voted the original article. Since an interpretation problem arose, I think it would be better to remove the article, as we wisely did this morning.

However, this issue will need to be addressed because the gaps in the legislation must be filled. One cannot not be able to recruit the necessary personnel when faced with a crisis situation. It must, of course, be done correctly and without compromising the rights of workers and organizations that represent and defend them, but it must be able to react in this situation. After a consultation with the trade union organisations, one must be able to come back with an appropriate proposal on this subject, so as not to be confronted, on the one hand, with a legal vacuum and, on the other hand, with a field vacuum in case of a critical situation. There is no question of allowing difficulties to develop when the health of the population is at stake.

In terms of accountability of care providers, in order to better guarantee the respect of the rights of defence, the project seeks to recreate in the INAMI a double degree of jurisdiction. Therefore, it will no longer be a parity committee, but an administrative court with professional magistrates. The mechanism established by the law of 24 December 2002 to empower dispensers in the practice of consumption and prescription that deviates from the recommendations of good practice has not, so far, worked well. This situation had to be corrected. It is necessary to allow the official in charge of the Health Assessment and Control Service to now have the exclusive competence of sanctioning in respect of infringements and incitement to overconsumption or overprescription. Action must be taken in this regard. It is also a guarantee of good management of public health funds.

The last point is the safety of minors. We talked a lot about the problem of refugees, the reception of asylum seekers, etc. I would like to emphasize that, in this health bill, a chapter aims to improve the coverage of health care for especially vulnerable minors.

In particular, we target unaccompanied foreign minors (MENA) and children cared for by self-employed persons not covered by social insurance. This measure is essential for the dignity of these children.

These issues concerning foreign or refugee children are often discussed in terms of controls, flows and difficulties related to immigration and asylum rules. Here, the measure is positive and it should be noted. Recognize that very concretely, as in health care for these MENAs, this bill provides for beneficial measures.

The Socialist group can only look forward to voting this text, even if it still contains at least good. We had a text dedicated only to health care, which is a good thing. It was not a loiprogram with other subjects: we could discuss it, correct it, amend it and everyone participated.

The difficulty is that it has been debated quite late and that the conditions of parliamentary work have not always been the most adequate. I hope that this can be corrected in the future. The main thing is that the subjects discussed and the projects under construction are positive in our eyes and beneficial for the population. We will vote on this project.

I would like to comment briefly on the previous point mentioned by Mr. Mayeur, concerning the withdrawal of Article 49 on the recovery.

We are delighted because, for us, especially in the field of hospital care, the basis, which fully respects social concertation, is the law of 19 August 1948 concerning the services of public interest in peacetime. The Minister of Employment and Labour, Mr. Vanvelthoven, working on this topic, at our repeated request a year ago. Through this, we hope that we can make progress, ⁇ in the field of health care. I am pleased to see that today, Mr. Bacquelaine, de facto, adheres to this path rather than to a somewhat more authoritarian recovery from the political environment and that the path of the law of 1948 respects more social concertation.

Mr President Mr. Drèze gives me a decisive role in the drafting of the Health Care Act. No, I am not at the basis of the introduction of Article 49, so reassure yourself.

It was removed by the committee this morning, it appears to be unanimous. There is no controversy on the subject. On the other hand, I think that requests generally took place in structures that are especially expensive to you.

Mr. President, I have to apologize. Dressed, he wasn’t there this morning in the commission. He joined the unanimity of the committee this morning in which there was no one from the CDH. I think he should be allowed to do it.

I do not find this a sympathetic comment. If you counted the hours we had to wait until the majority was in quorum, that would be long.

You said it later; I have heard it well.

Dear colleagues, let us try to be quite concise, so that we can finish this plenary session at a decent time! The Minister has already answered a lot and I have a lot of amendments to address. You will be entitled to a brief response at the end of the debate.

I will be concise. However, I would like to take some time to express myself on the context. As much as I find interesting the fact that I have had a health bill independent of other various provisions and have had a document, a "brick", which concerns important projects with not negligible consequences for the actors concerned, as much I regret that we have not been able to work in the best conditions. I find it a pity that the finalised, official version (with its small number) still does not exist on the House website while we started the work on Monday. I am probably impatient. Personally, I am for prevention, anticipation: I like things to be prepared in advance.

What really annoys me about how this happened is that I am not a doctor. I am not part of the mutual associations or the board of directors of hospitals. A network of people, actors in the field of Health helps me to understand, read, analyze things. However, it was impossible to have opinions. I couldn’t tell them: “This is in this text”, “I’m going to send it to you by email” where “go see on the site”. As a result, I have not been able to properly consult people who usually know how to give me opinions, even though sometimes they are divergent. Then, two days later, these texts were adopted.

It is therefore not surprising that reactions to Article No. 49 occurred only this morning. However, trade unions are organizations that are usually quickly informed of what is going on here. This is a first “contextual” reaction, in some way.

An important chapter in the bill concerns the mother-in-law. I find it important to recognize the status of midwives, to recognize their skills and to validate the increased medical skills and acts that they can perform, including accompanying pregnancies and births.

However, I have a few comments to make. The interest of wise women is that this allows them to demedicalize the monitoring of pregnancy and childbirth. Now, I feel that the way in which this recognition has been organized consists of a record of the medical acts that they may make.

In fact, this recognition and status of the midwife is always part of a medical view of pregnancy and childbirth. This does not prevent the recognition of their competences and the exercise of them. by

However, I believe that this project does not address a whole series of problems encountered in practice. These are issues that also affect other health actors who are also involved in the monitoring of pregnancies and births.

Some midwives denounce the fact that many hospitals and many gynecologists prohibit them from accessing the plate because they work as independent outdoors. This is a real problem. Indeed, it is impossible to choose the person who will intervene during childbirth; moreover, these women are prohibited from exercising their profession. Birthwives also complain about problems in collaboration and complementarity with general practitioners and gynecologists. This is a situation that must also be taken into account. General physicians tell us that they are in favor of the recognition of midwives and in favor of the demedicalization of the follow-up of pregnancies and births, but they feel blurred by how to ⁇ this. In fact, according to them, these skills are recognized to midwives while they still cannot perform certain acts that their training would allow them to perform. In addition, all these decisions are made without being notified beforehand. by

In conclusion, there has been a lack of "cross consultations" between the different actors, which is regrettable. In fact, for the proper exercise of their mission, the midwives need to be recognized and supported by other health actors. This is probably due to the precipitation in which the text was examined so that it could be voted before the holidays.

Another important point for ecologists. This is the registry of cancers, the recording of all pathologies. It is true that we limit ourselves here to cancers, but let’s start with them. It is necessary, in our opinion, to be able to "cross" disease data and conduct epidemiological studies with environmental or activity data.

I continue to say that I regret that it is not a public body such as the Scientific Institute of Public Health that has been charged with fulfilling this mission and that it has been preferred to entrust it to a private body through the Foundation "Work for Cancer" in connection with mutual associations. We have missed the opportunity to value a tool at our disposal and people who could have accomplished this mission for the benefit of the entire population.

What worries me about the measures concerning the Cancer Register is that we have adopted a text that is not yet completed in many aspects, both in the cooperation between the federal and the Communities, in the method, how to collect data and cross it, and in respect of privacy. There are still many points to conclude. There was also a noticeable delay in the preparation of the bill. It is true that the difficulty of collecting data on this subject dates many years. by

Another important element, the measures concerning implants: both a specific commission, both a nomenclature, both a faster refund and which avoids supplements charged to patients placed in the hospital. These measures are interesting but, there too, many concrete arrangements need to be taken and are not specified in the bill.

Regarding the right of patients, I appreciate the fact that it is improved by the transparency of the fees that will be charged to it, by the fact that the fees and room supplements for accompanied children as well as for hospitalizations where there is no choice made, that is, for emergencies and intensive care. However, once these improvements have been introduced, before I have the report of the Patient Rights Committee, I find it regrettable that the committee has rejected the amendments submitted by others than me on the independence of mediators. From the moment when we reject the amendment on the independence of mediators because we are waiting for the report, I find it curious that we do not do the same for everything. The more I can be satisfied with the progress and improvements, the more I see inconsistencies in the way I work and a lack of respect for the speakers.

Regarding room supplements, I share the goal and I’m in favor of removing supplements in general: I don’t see why one should resort to this technique. This raises the broader question of the valuation of the intellectual acts of care providers and in particular pediatricians who, at the time of ensuring their stays, are ⁇ financially ill-treated, despite being important actors in health. by

We are in phase 1, i.e. in a more comprehensive debate, which goes beyond this context. by

Several have already cited the need to have this debate in order to keep our doctors in the country. It should be added to the need to keep specialists in hospitals rather than in the private, which is not easy given that, in the private, they can demand higher fees than those of hospitals. We will have to review the valuation of intellectual acts, but also the financing of hospitals: it is also not normal for hospitals to finance themselves through the services of their doctors and technical acts, with the consequence of a devaluation of the intellectual service and time spent with the patient. The last two positive aspects.

We are witnessing an improvement in the rights of defence as part of the accountability of doctors, in particular with regard to prescriptions. In the months that preceded, we realized the importance of this respect for doctors.

I would add that, in my opinion, it will be important to re-evaluate the revaluation of the financing of medical benefits. I am indeed convinced that much of the overconsumption of medicines and sometimes of technical acts is due to the lack of time spent by the doctor with his patient. Better funding for this meeting would allow for better listening and a more comprehensive approach and fewer medications.

Finally, the improvement of the coverage for vulnerable minors (MENA) and children of self-employed non-contributors is a major step forward in this project.

There are many positive provisions. Among them, many remain to be realized through decisions, through cooperation agreements, through negotiations, through opinions from the Privacy Commission. In fact, a lot of projects can become very positive, but they can also become anything. by

Some elements therefore leave me confused and the way I work has not allowed me, as an opposition group, to properly analyze these texts before they are adopted. And I really regret this, Mr. President. I would like to repeat this at the end of my speech.

Mr. Speaker, Mr. Minister, Mr. Colleagues, I can’t be silent about this, I have to start with it. Their

It is gradually becoming a bad habit to hand over the documents to the committee members. This is a 268 page valve with 130 articles. We get that by urgent order in the bus, the weekend for the commission. Fortunately, I have been able to clear it and get it out. I see that valve with 130 articles and the next day we should discuss it in the committee. I think it is below all levels. With all respect for municipal councillors, but they are given at least three days to view documents. Even that we did not get. That disappoints me. Their

The delay also automatically caused rush. The health law was suddenly hunted over again. For me, this testifies to inappropriate parliamentary work. The legal work suffers from this, as my colleague also said. We regret that. It is striking that also colleague De Meyer — currently not present — of the majority literally said that this method prevents commissioners from expressing their expertise with knowledge of matters. I find that sad. That is, we sat there together and talked about a number of things, without touching the core of the matter. As a result, a number of amendments — I thought 19 — were introduced and withdrawn by the majority, and even a chapter was deleted and reintroduced through an amendment. Ultimately, there was in extremis the somewhat sluggish recovery that was wiped out this morning. This is what is happening in the field of work. Their

Overall, we find good health policy important, which is why we have continued to cooperate constructively and have continued to express our ideas. The discussion of this health law has begun with more than half a day due to the expansion of the powers of midwives and the extension of the duration of training. We are, of course, opposed to that expansion, because there is resistance from the sector itself, because there is resistance because of the specialized kinesiotherapists, because there is resistance because of the gynecologists and because there is resistance, not least, from the Department of Education. I find it striking what Mrs. De Meyer says here today. Collega Detiège is still here alone, so I will not blame her. In any case, it was said that whatever the Flemish Minister of Education says, it will be four years. I think this is a famous disapproval of the powers of the Flemish Minister of Education. I think there should be a word on that too internally. Their

Our fear for midwives is therefore that the new scheme now proposed could lead to high insurance premiums being closed and that a number of midwives in second instance will refer to a gynecologist to cover themselves from a number of possible errors. This will ⁇ the opposite effect of what is considered, namely an even higher medicalization of pregnancy and childbirth. For us, this chapter offers no added value at all. There is no demand at the moment, ⁇ not in Flanders. There is no legal vacuum. We think it is best to remove this chapter or at least reintroduce it after a deeper discussion, after everyone has heard it. Otherwise, everyone will be on the complaint wall.

Regarding blood and blood derivatives, Mr. Minister, there was a question from both colleagues Goutry and Avontroodt in connection with the refund of the stem cell therapies. You did not respond to that. You may be able to answer it later. How about that reimbursement? Is it okay or not? This question was asked by both colleagues Avontroodt and Goutry.

The establishment of a legal basis for cancer registration is indeed an important matter, but this should have been done by the Communities for a long time. The Flemish Cancer Registry Network works well. The French Community has always failed to do so properly. That’s why we get the classic story: let’s just federalize. We find that wrong. I have therefore expressed my concern, even for a possible cooperation agreement with the Communities, as we have a lot of questions about this. I used the word skepticism in the committee because we have experiences with a number of other cooperation agreements that don’t go well. I refer to drugs and tobacco. You say that this will ⁇ succeed, Mr. Minister, because it is not such a sensitive topic. It is, in any case, an exceeding of powers.

In connection with the structural approach to healthcare costs, we see a lot in a number of savings. These may be less noticeable measures, but they are a change in the system. I mean the standardized electronic file per patient, which we have been advocating for a long time. Everyone needs to communicate with everyone. That is profit. Without computer science, nothing can be done today. Therefore, we have another question about the BHealth project. How far is the draft law? We had thought that this bill would also be hidden somewhere in this health law, but that has not happened. It is important to know how far it is. In fact, hospital costs have increased by 33% in five years. Our proposed approach goes far beyond that of the government. We say that both conventional and non-conventional doctors must only, within certain flat-rate limits, charge honorary remuneration supplements to patients who, if so, at their own request, stay in a single room. That is our amendment. The Minister asked how we would finance it. Structural measures are needed. The financial resources of the hospitals must be increased, which is undoubted. The medical specialties should be analyzed with a view to a re-equalization of honorary wages. This will eliminate dissatisfaction between different specialties.

We also find that the mixed hospital policy of the federal government and the governments of the states still lacks some cohesion. I will give an example. Today, the Communities are competent for the recognition of hospitals, the Regions are competent for infrastructure payment and the federal government has remained competent for operating subsidies. Well, such a arrangement does not honor an austerity policy by the Communities. We regret that.

We consider the provisions on the commission for the refund of implants and medical devices a positive thing. Colleague Goutry also said this. We have asked a few questions, which I will repeat here. Will enough medical devices be reused? How does the Minister deal with the reuse of medical devices, provided that there are a number of clear hygiene instructions? I mean cleaning, disinfecting, packing, re-sterilizing. In this context, the Working Group Reprocessing was established in the FOD Public Health. How is it with it?

In the Health Act the health-threatening situations were registered. I clearly have a different view on this. Mr. Mayeur is not there. The goal is to build a kind of health surveillance network that detects, identifies and controls health threats. Now the Minister of Health receives a legal anchoring of the precautionary principle, which also allows him to take temporary measures. According to our party, there is actually no need for additional federal law in order to take emergency measures in times of crisis. Through a number of ministerial decrees, KBs and letter of notice, the Minister can today impose temporary measures quickly and accurately on a federal level. So where is the ratio legis of the proposed system?

Furthermore, the definition of health-threatening situations is so vague that the entire area of the health inspection is fished, while that is clearly a community level. Our proposal aims to ensure that, in the event of a disaster, in the event of civil protection intervention, of course, the services of the Communities, which are ultimately responsible for health policy, act according to clear timetables, codes of conduct and acts. These services also know the practice.

Mr. Goutry gave the example of the provincial inspections and the milt fire, where apparently locally there could be some indications that the aforementioned phenomenon could occur in certain industries. That is, in our opinion, much better than making a new regulation and a new cooperation agreement again, which will only increase the complexity. This will also allow for double use and promote a parallel circuit. This is in no way a contribution to an efficient threat policy.

In addition, the Flemish Region has the Prevention Decree of 21 November 2003, which defines the preventive health policy. In addition, in Flanders, a kind of facet policy is implemented step by step.

Mr. Minister, your associate has also acknowledged that the Flemish decree is an example of completeness. That can count.

In this case, therefore, we have once again the impression that Flanders is doing well, but that, since Wallonia and ⁇ Brussels – I would have liked to hear Mr. Mayeur in that connection – remain behind, however, the whole issue in the health law in question will be again republicalized. Of course, we deeply regret this.

We cannot let it. Mr. Mayeur also showed in his maps when he declared that a number of matters should be carried out again at the federal level. We have heard of them. A few days after the difficult agreement on the payment of the vaccination of infants against pneumococcal pneumococcal, the Minister de Flamingen is hunting the trees again. I cannot interpret it otherwise.

Mr. Minister, after all, there is an expansion of your campaign on healthy nutrition, aimed at the municipalities. For several years, municipalities have been assigned a role in the nutrition programs. In Flanders, this is through the logos. Their

You also write them as follows – so I also feel invited –: “Dear Mayor, I am pleased to invite you to participate in the action ‘Communities in Shape’, and so on.” .So you invite the mayors to play and participate in a prevention campaign on healthy nutrition and fitness. You also write that it has to go quickly. In September, the mayor should submit a project, apparently a few weeks before the municipal council elections. The ten best Flemish projects, the ten best Wallish projects and the five best Brussels projects will soon be honored with a sum of 5,000 euros.

I do not want to discuss the distribution key. Much more importantly, the state states with this plan are being hunted up the curtains again. It is again a blow to the preventive health policy. In the end, the minister wants to get the mayors over the bridge in this way.

It is also regrettable, Mr. Minister, that in the brochure you also mention a number of institutions at the Flemish level. I consulted the stakeholders.

I asked the Flemish Institute for Health Promotion or VIG and Child and Family what they thought about the action. According to them, it is really not necessary, regardless of whether it is a federal or Flemish matter, because such action needs to be planned in the long term.

Therefore, it is not about taking such action quickly and giving it some resources. If one wishes to succeed in such an action, i.e. to bring about a change in behavior, then this must be done in the long term. It does not happen so quickly. I think it is again an action that has to do with the next elections. I only regret that the Flemish level is counted out once again.

Finally, Mr. Minister, I can also refer to the Tobacco Fund. In the meantime, I have received the distribution of the funds and it shows that indeed this year — I admit this scourgeously — some Flemish projects are also being supported. In 2004 and 2005, however, only Walloon and national projects were supported with funds from the Tobacco Fund. For us, however, the Tobacco Fund is a matter of preventive health policy. In the end, it is the communities. I couldn’t help adding that.

I have been brief, Mr. President. Because of what precedes and from respect for everyone who needs care and is or becomes sick, from respect also for the institutions in our country, we cannot approve this Health Act.

There are several points on which I have not intervened recently, so I will not return to what has already been said.

One of them is the protection of patient rights. To make independent the person in charge of the ombudsman, a royal decree is being prepared. It should be available, and I am responding in particular to Mrs. De Meyer who asked the question, in the course of the second half of this year.

I would like to come to the question asked by Mr. Dress on revaluing the role of doctors in their prescription function through the provision of tools. We talked about PDAs with documentary sources related to prescription. On the CBIP website, there are already today, apart from comparative tables, files that can be downloaded. This can be done on the PDA. To the question of whether PDAs have already been provided to doctors — it was said that we would have a procedure for providing PDAs — I can answer that I regularly insist on the organs of the Medicomut for this to be implemented. I have the budget resources reserved, I also recall this here. I hope this will be realised in the weeks and months to come.

Health crises have also been raised. I would like to be quite clear: there is no conflict of interests of power levels here. We are facing a situation related to crises. When we talk about crises, regardless of considerations about their ⁇ ined, strengthened communitarianization or refederalization — this is another debate — we are not talking about preventive medicine. Preventive medicine refers to diseases that are predictable in their evolution, against which strategies can be put in place. We are talking about crises. If we enter tomorrow into a serious pandemic-type crisis for the country, those who will do legal-type arrogance on skills levels will mislead public opinion about the reality of dangers. Today we need to have tools that allow us, in these circumstances, to be able to respond to the necessity and to do so in the emergency. For this, it is necessary that the federal level, in the precise circumstances I have just mentioned, has the power to implement these policies.

I also point out that the Ad hoc Chamber committee actually recommended the same thing. I am therefore not only responding to a resolution voted in the plenary session, but I am also implementing a problem that has been the subject of a discussion in committees on tools to respond to crises.

Many comments have been made on the question of the recovery. We started from a conclusion that was partially inaccurate, namely that the tool did not exist. It is true that the law of 1948 allows for requiring in the private sector. But this is not possible in all situations. So the situation I just mentioned does not open this door. Therefore, an ad hoc arrangement had to be found. This is also true for the public sector where there is a legal vacuum. The most elegant way to do this is in consultation with social interlocutors.

Consequently, I think, Mr. Speaker, that the right solution is to withdraw Article 49 and submit it again as part of a procedure that will take a little longer, but which, in my opinion, will give better results. After that, we will have a text that we will be able to discuss in this assembly.