Proposition 54K2599

Projet de loi portant des dispositions diverses en matière de santé.

General information ¶

Submitted by

MR Swedish coalition

Submission date

July 10, 2017

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Subjects

health care social security public health health insurance

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Discussion ¶

July 20, 2017 | Plenary session (Chamber of representatives)

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Mr Benoît Piedboeuf, rapporteur, refers to his written report.

The floor is yielded to Daniel Senesael.

I am not going to be too long because we have had the opportunity to exchange a fairly long time in commission. However, I would like to return to two important elements of this text, namely the opening of blood donation to men having sex with other men on the one hand, and the definition of criteria for future hospital programming on the other.

With regard to the amendments to the 1994 Law on Human Blood and Blood Derivatives, it has always been obvious for our group that transfusion safety must be guaranteed and that blood donation cannot be established as an enforceable and absolute right. However, the definitive exclusion currently subject to men having sex with other men was undoubtedly questionable. Stigmatizing a part of the population on the basis of their sexual orientation, feeding the myth of a community whose sexual practices would be systematically dangerous, risky, or even unhealthy, feeding the idea that homosexuality is necessarily a carrier of diseases, it posed a problem.

When donating blood, our group considers it essential that only the criterion of blood quality be examined and not the origin of the population from which it comes. In order to judge the risks of blood contamination by a sexually transmitted disease, it is essential to analyze sexual behavior, whether between persons of the same sex or of different sex, and not the sexual orientation of the donor. The PS had already submitted a draft resolution in this direction several months ago. The amendments made to the 1994 law were therefore expected. They were so much more so as we had to answer the judgment of 29 April 2015 of the Court of Justice of the European Union, which also ruled on the subject.

Today we feel that we are taking a step that I would call symbolic. It concerns, as I said in the committee, only men who have experienced occasional or accidental homosexual relations.

For homosexuals, the situation does not change. They will still be tomorrow, de facto, purely and simply excluded, a period of abstinence of twelve months being required to access the donation. Is this a good solution and is there any one? As the Higher Health Council notes, in the context of balancing the right to health protection and the principle of equality for candidate blood donors, it seems justified to have to give more weight to the first fundamental right than to the right to be allowed, like others, to donate blood.

For our group, a proper balance of these fundamental rights is necessary. We also recognize a willingness of openness on the part of the Minister, who today relies on the scientific and epidemiological opinions available to her. However, it is, in our opinion, essential that this issue be subject to a regular evaluation. At our request, a broad exchange of views will be organized at the entrance so that the members of the Health Committee can also have all the relevant elements, and to see in particular how new developments could emerge in this context. I would like to thank the Minister and the President of our Commission in particular.

I would like to return to this important chapter concerning the planning of the hospital offer. There is no doubt that our group can fully fit into a logic of hospital programming, in order to best meet the needs of patients by guaranteeing them affordable and quality care while using the available resources in the best way possible.

There is also no doubt that we are supporters of transparent, scientifically-founded, depolitized and evolutionary programming. On the other hand, where I raise serious doubts, it is about your capacity, Mrs. Minister, and that of the government, to implement such programming without giving in to the budgetary or even community sirenes.

You pretended in commission that you did not understand the parallel that we did, like other of my colleagues, with the files of the INAMI numbers. I will repeat my words in a different way. You say you want to be based on transparent scientific data. You had precisely, as part of the definition of INAMI quotas, these scientific data of the Planning Commission in your hands. Nevertheless, you have discarded these data to give in to your majority partners. An eminently political decision, this kind of decision you say you want to avoid today. We would like to believe you!

How can you then believe that a whole series of economy measures have been implemented in our health care and specifically in hospitals, without being based on scientific data taking into account the needs of patients? Here, it is the budget data that prevails. And then, if studies are to be used or carried out, they must be studies of good quality, published by academic researchers or by recognized national centers.

Mr. Minister, you will not have to choose the studies on which you will rely based on their results in order to guarantee the policy you want to conduct. The process must be done in the right direction. In this regard, I must admit that our group remains suspicious. It will also not be necessary to impose a vision, your vision, without consultation with the sector and specifically with the Federal Council of Hospital Institutions, without consultation with the federated entities that could obviously not agree with the distribution of this programming that you will set.

You have confirmed this in a committee – apparently unilaterally – if an agreement cannot be reached, we would then find ourselves in the same imbroglio as with the planning of the medical offer, an imbroglio that will penalize the health professionals concerned and that will go against the needs of the patients. Here too, the concertation to which you refer repeatedly in your text does not convince us.

Finally, you will allow me to remain dubious about what you call the “special power” that was entrusted to you until the end of the legislature.

Indeed, certain provisions relating to this programming are surprisingly limited in duration and will cease to produce effects at the end of this legislature. Misunderstanding on the part of the State Council and on the part of our group. In the course of the reform of the financing of the hospital landscape, it seems unlikely that the implementation of the programming we are talking about can be settled by the end of the legislature.

In conclusion, if we were able to obtain satisfaction on some points during the discussions in the committee, I have to admit that some responses of the minister have strongly interpelled us. For these reasons, as we have done in the committee, we will abstain from this text.

Mr. Speaker, Mrs. Minister, dear colleagues, it is my colleague Jean-Jacques Flahaux who will intervene on the chapter relating to the blood donation of men having sexual relations with men, in the same manner as Mr. Senesael just did. I will focus my speech on two very precise elements, which are Chapter 3 and Chapter 5.

Chapter 3 is about hospital reform. I would not want to repeat what has already been said in the committee or within this hemisphere, but there are for us a number of elements in this hospital reform that are extremely important and I cannot do otherwise than cite them.

This reform has the interest of improving the quality of care, it is a fundamental element that too often is forgotten to emphasize, and to offer care accessible to all and closest to the patient. Some are dubious, but it will be worth seeing, when things are in place, the interest that the patient will find in them. And above all, we are always talking about the viability of the future of hospital care, thanks to a system that wants to be sustainable. Obviously we must take this into account.

Programming aims at efficient management of supply. It is very interesting to look at the criteria used for this programming.

A fundamental element is the criterion of transparency, which is scientifically founded, even though I have heard that some doubt it. Another is the criterion of depolitization of the decision that will be taken, with proactive implementation. I didn’t quite understand why the parallelism was made with the INAMI numbers, but I think this debate should not be reopened as part of the current project.

I will also draw your attention, as I did in a committee, to the problem of access and availability of health care in rural areas. This is extremely important. I think specifically of the province of Luxembourg. I do not doubt your willingness to keep this in mind, but I think it is good to systematically remind you.

I come to Chapter 5. Ultimately, what we recommend, what you recommend, concretizes your negotiation with doctors following their denunciation of the medicomutualist agreement. We know that the climate was difficult and that the dialogue had to be resumed. Sometimes it is said that you do not make a concert. Here, it was indeed the proof of a willingness to dialogue, and that this results.

I would also like to recall that Articles 28 to 56 translate this negotiation to the benefit of healthcare providers. Two elements should be taken into account. On the one hand, the legal basis for allowing care providers who still carry out an activity after taking their actual retirement to benefit from social benefits. This necessary change was expected by the persons concerned. On the other hand, the legal basis for remuneration for the training of doctors in non-university hospitals. It has been suspended until now. We arrive at a result. This will ⁇ not be a luxury, while it will soon have to "absorb" the double cohort.

This is, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. Our group of MR will of course support your bill, Mrs. Minister.

Mr. Speaker, Mrs. Minister, dear colleagues, the project that is submitted to us today devotes a whole chapter aimed at ending, finally, the permanent exclusion of homosexuals from blood donation.

We have been waiting for progress in this area for many years. Ten years ago, when I became a member of Parliament, I had interrogated – I remember, it was in the Congress Hall – the Minister of Health, Laurette Onkelinx. At that time, I had referred, in one of my questions, to Sweden. The Swedish Christian Democrat minister had already accepted the blood donation of homosexuals. Unfortunately, Minister Onkelinx had not given a favorable response to my request.

Nevertheless, it is more important than ever to put an end to this discrimination, which is to exclude homosexuals from life-long blood donation. It was no longer acceptable. It will never be enough to recall: it is risky sexual behaviors that should be taken into account and not sexual orientation, both for homosexuals and heterosexuals.

What a long journey, Mr. Secretary. You took the problem hand in hand and I wanted to thank you for it.

In April 2015, the Court of Justice of the European Union ruled that Directive 2004/33/EC must be interpreted as meaning that the criteria for permanent exclusion from blood donation are not justified if, in compliance with the principle of proportionality, there are effective techniques for the detection of these serious infectious diseases transmitted by blood or, in the absence of such techniques, methods less compulsory than such contraindication to ensure a high level of protection of the health of recipients.

Then I know that you have convened an important roundtable with scientists, transfusion institutions, professors of ethics and sociology, and representatives of homosexual movements.

At the end of this round table, you have clearly expressed your willingness to end the lifetime exclusion of men having sex with men, based on new scientific notions.

You then instructed the Higher Health Council to study the issue to unleash, on the basis of scientific justification and the regulatory context, a number of procedures less compelling than the permanent exclusion of HSH but that guarantee and preserve the maximum safety of blood donation for any recipient.

By measures taken by our country, we are actually aligned with other countries such as France, the Netherlands, Canada and the United Kingdom. We also follow the Supreme Council on temporary exclusion for at least twelve months.

Is this completely satisfactory? Of course no! There is still criticism over the twelve-month period. I know them myself. We may not go far enough, but this is an important step. I will remind those who want to hear that we are moving from a permanent exclusion as applied by governments for a decade to a temporary exclusion.

I recognize and welcome your pragmatism. You plan on an evaluation every two years that could lead to a reduction, if necessary, of the reference period. This is what I advocate personally.

Therefore, we will support your actions that take into account the necessary safety of blood, the evolution of science and citizens who wish to donate blood in a responsible way to make a valuable contribution to health.

However, I still make a small proposal. One could also imagine that the document that is signed to homosexual men who want to donate their blood, attesting that they have not had relationships during the previous year, is by everyone, because there are also heterosexuals who have multiple sexual adventures as this may be the case for some male homosexuals.

This is my proposal, after this important step, in order to advance the debate and this already positive progress!

I will speak on behalf of the Ecolo-Groen Group on some aspects of this bill containing various health provisions.

I will begin with this first important chapter on the transformation of the appreciation of the ability of a blood donor to donate his blood according to the risky sexual behavior he has or does not have. What is important is that the current provisions bring a paradigm shift. A group of persons is no longer excluded based on sexual identity or permanently. In contrast, there is temporary exclusion of persons who adopt sexual practices considered to be at risk.

Like my colleagues, I obviously emphasize the progress that this represents and the way the work has been done. It refers to opinions that have also evolved. In fact, the scientific opinions of two or even three years ago were not identical to those formulated today. We realized the need to refer to practices and not to groups of citizens. Furthermore, the evolution of the tests that allow to detect and evaluate the quality of blood has been taken into account. We are therefore in an evolutionary process that must integrate the advances, which must continue, at the level of screening.

However, the process needs to define more accurately risk behaviors. Today, it is considered that a man who has sex with a man necessarily adopts risky behavior. However, one can have homosexual relationships without resorting to risky practices.

A much more intense policy of information and prevention will need to be carried out among the general population and young homosexuals in particular so that they are aware of what is a risky sexual practice, as well as ways to protect themselves and avoid the risks of contamination. The goal is to put an end to the exclusion that still affects men who have sex with other men, since they are deprived of sexual relations for twelve months. Asking someone not to have sex with another for a year is obviously illusory. The result will be either a false statement or you will not understand very well...

The [...]

At our age, Frédéric. But maybe you just discovered sexual practices that are not at risk! and laughing)

By interviewing older people, it may be possible to improve the quality of the questionnaire, so that risk practices can be accurately identified. Thus, we could implement an information and prevention policy to reduce the number of references to six or twelve months – or even remove them. In any case, it is important to know exactly what we are talking about. Sometimes it is useful to put words on practices.

That said, it is true that we did not spontaneously think of the elders as the guides and the wise; but it is an idea, Madame the Minister, that is suggested to you live.

I can thus establish a relationship with the need to work on this questionnaire. Senesael insisted in the committee on collective reflection to be carried out and on communication between scientific bodies, transfusion centers, questionnaire authors, but also associations representing donors. The goal is to find out exactly what this questionnaire is about – is it really interested in practices? - on its possibilities for improvement and on the criteria for assessing the quality of donated blood. It is not a question of seeking a balance between the quality/security of blood and respect – therefore, non-stigmatisation – of people. These two requirements are equally important and are also priority.

Taking into account this paradigm shift, the proposed assessment, the attention paid to these risky practices, we have supported these provisions in committee, Mrs. Minister, and we will continue to support them. In this regard, all work will have to be continued.

Finally, I invite you to begin a reflection with the Communities responsible for prevention and promotion of health. Indeed, collective work must be done, which will benefit all levels of power as well as all aspects of health.

It is known that today, sexually transmitted diseases are on the rise, that there is a decrease in the alertness of people who have risky behaviors or who have risky relationships. Therefore, a work must be done with the whole population and in particular with young people.

This bill includes other chapters on which we discussed in the committee.

As other colleagues have already done, I would like to highlight any concerns or questions you may have about the measures you are proposing, including hospital planning, equipment, the operation of heavy equipment, etc.

We can obviously only follow you when you want to establish transparent scientific criteria and methods for organizing this programming, in some way aiming to ensure that any funding for equipment is destined for the purchase of equipment that has been the subject of an authorisation as part of a programming. I can only share your concerns.

However, I still have questions despite the exchange we have had. Indeed, I really feel that the field actors are no longer able – and it is also complicated for us – to make the link between the programming stage that falls within the federal competence, the steps that are ongoing in the field of hospital landscape reform that fall, in some aspects, within your competence and the other aspects that fall within the competence of the federal entities. How is the geographical distribution of hospitals organized? How is the link between hospital structures and outpatient care?

Depending on the devices you put in place, it is necessary to take into account the evolution of hospital care with less and less care and more and more care.

To say this automatically means that, in federal-funded cure care, there is a transfer to care aid that would be more dependent on care and accompaniment and which, therefore, could escape federal funding. I would therefore not like that through a mechanism aimed at scientific programming, a transfer of care to other forms of aid and to skills and funding is organised, without that being said or resulting from a work with the Communities, from the federal to the federal entities.

I would also like to return to the delegation of benefits in dental care. I would like to recall this provision by which you authorize the dentist to delegate certain services to other providers, specialized nurses or paramedical providers. We will be able to recognize them, which is a good thing indeed.

I would like to draw attention again to the dentists. I am not an expert in the matter, but in the response you gave in the committee, you said something that appears in the comments of the bill, namely that one cannot delegate, in particular the placement or adaptation of removable prostheses. For me, this means that one cannot delegate to those who today have been trained to perform this kind of services, without being recognized as dentists, and who work precisely in the field of removable prostheses. Your explanation of the reasons shows that this cannot be done and that you officially exclude a category of people, who could become paramedics, and who are today dentists. I would like to emphasize that these providers exist.

It is true that we are witnessing an increase in implants, as you said in commission. Implants are expensive. This is not applicable to everyone. Many people, especially the elderly, use and will still use removable prostheses. These practices and care should be taken into account.

I would like to repeat what I said in the committee: if one wishes to apply higher skills and training requirements than today to service providers, to be able to recognize them and to be able to delegate benefits to them, there is no concern. It is worth considering it this way rather than excluding certain professions, ⁇ because others would be afraid of losing the hand on certain acts or losing certain benefits monopolies.

With regard to the provisions relating to conventions, there is a willingness to regulate denunciations. At the same time, I cannot help but link with the provisions aimed at changing the rules for financing health care in relation to the state budget. The healthcare budget is adjusted according to the federal budget and no longer according to an assessment of needs. Since the announced growth standard of 1.5% is not met despite the commitments made, it is ⁇ important that, in the way the INAMI consultative bodies will be integrated, the latter have their place.

What will be proposed to the government and to the Council of Ministers should not become a rule that is imperative due to overall budgetary policies or due to the taking into account of health care needs.

With regard to the transmission of data between mutual companies and INAMI, I share your concern that this data is transmitted automatically, without having to take any action. Nevertheless, I do not perceive sufficient vigilance on all the devices that are set up today to ensure the collection of data through computer tools. Data transmission between different structures involves coding and encryption, sometimes anonymization and pseudonymization. These methods are not always well-defined and the impact they may have on these data is not measured.

We are currently working on Big Data in health, within the Scientific and Technological Advisory Committee, which Mr. Foret chairs. Obviously, there are elements that lead to questioning, vigilance and the need to watch, whether in the software environment, in the management of platforms or in the editing of rules, that there are not only one or two people who control everything and who hold all the controls. There could then be a fear of challenging privacy protection and obtaining information that, although not desired, is accessible to unauthorized persons.

Despite the positive elements, there are also elements that are questionable and that is what explains our final abstinence on the bill.

Among the positive aspects, I would like to highlight the possibility of awarding bonuses for doctor candidate internships in non-university hospitals - this is important. I want to believe and I will be attentive, to your will, through the provisions of this bill, to make more transparent the budgets relating to the "Article 81" conventions for medicines.

Today, this is not clear. The members of the INAMI management committee can no longer find themselves there. They feel that the surplus in pharmaceutical care is greater than what was agreed in the pact with the pharmaceutical industry and that it is the other healthcare sectors that must make savings at their own expense. If the provisions presented here allow for greater clarity, transparency and understanding, this may help to correct this perception and these analyses.

Last positive: even if everything remains to be done, there will finally be a legal basis for defining new criteria expanding the status of palliative patients. I urge you to act quickly because we have been waiting for a long time and we are working in Parliament on this matter.

This is the reason why we abstained from this bill.

I have a small preliminary, if I can afford, and it is also at your attention, Mr. Speaker. I would like to remind you that this bill containing various provisions contains 500 pages that were sent to us on Monday evening for review and vote at no charge less than 48 hours later. I find that this is not serious in the head of government and not respectful, especially since in such a project with various provisions, there is a little bit of everything.

Among these, there is something good, Mrs. Minister, and at least good. First the good. I support the positive aspects of this dossier, even though I take advantage of it to send a number of messages. With the extension of the category of blood donors. My colleagues have already mentioned the new provisions concerning blood donation by persons with risky sexual behavior, provisions which were taken on the basis of the opinions of the Higher Health Council.

I will also allow myself to talk here about the extension of the categories for certain patients suffering from hereditary hemochromatosis, stable patients since when they are treated with bleeding, rather than throwing their blood, it can be extremely advantageous to be able to retain that blood.

Let me remind you that the challenge is not just to vote a piece of law. The point is to move to the act. Remember that it was in February 2016, so now eighteen months ago, that the law allowed it. Nothing has been done since then. You had to take royal decrees to enable these provisions to come into effect. We are always waiting. This is a shame because the periods of blood shortage most often occur during the holidays. We are now in the full season of holidays and maybe that blood would have been useful this summer. So I expect you to realize it all within the next three months.

Good also in the bill proposing various provisions on the delegation of acts by the dentist to the mondzorgassistent, provided of course that this can allow to increase the percentage of the population that will regularly consult the dentist, since the whole challenge of the prevention and especially the early screening of dental pathologies remains a major element and on which one is largely improved. Indeed, even today, more or less significantly, certain categories, especially the most precarious, escape all this early screening of dental pathologies.

Mr. Minister, on this aspect, I regret your position, or rather your discourse changing, depending on the circumstances, on the reform of the Royal Decree 78, which is the coordinated law of May 2015. On other topics related to the modification of this Royal Decree 78, you said you want to wait before working on a comprehensive reform. But when it works for you, that is, here, you do the opposite.

I look forward to the follow-up, namely that from now on we can actually move forward on the expected reform of Royal Decree 78. This has been trailing for a while already. You announced a comprehensive reform. You make an exception here. I dare hope that this global reform will finally happen.

Finally, I have something good to say about the third and last part, with the definition of the palliative patient. Here again, I expect from you that the actions will follow, especially with sufficient means, which is absolutely not the case today, so that palliative care can be provided to all patients who request it.

I just mentioned the good, but there is also at least good, and even clearly less good! The twelve articles of your bill that concrete the programming of care, heavy medical devices and authorized medical services included in the programming within the meaning of the law on hospitals really pose a problem to me. In other words, the terms and procedures on the reform of the hospital landscape pose a problem to me in your bill.

This is a problem for me because you decide, through this bill, to change the existing procedure. Remember that today you have the obligation, before any reform, to obtain first and foremost the opinion of the Federal Council of Hospital Institutions. You decide to remove the consultation with the actors represented within the Federal Council of Hospitals. For me, this is a real problem, since it transforms the mandatory consultation with health actors, and ⁇ the hospitals, into facade consultation, after all. The text of the law provides that you are simply subject to the obligation to send them your decisions. In other words, they cut the grass under their feet!

In addition, you stop the consultation with the federated entities because you establish a form of facade consultation: you provide for a simple two-month period between the initiation of the consultation and the decision taken in the Council of Ministers, without coercion and without even having a decision within the Interministerial Conference. You simply specify that the result must be indicated in the report to the King. This or nothing is the same thing.

So you have put in place a bad concertation, Mrs. Minister, while even in the reform of the hospital landscape, a system of co-decision between the federal and the federal entities seems indispensable to be effective.

I give you an example. If you decide on a series of programming changes, you know as well as I do that the federated entities will need to be able to follow the work of reconditioning or renovating the services whose activities are reoriented, in compliance with the new standards. In this matter, if you act without any concertation with the federated entities, you will have a shift in time that will really pose problems on the ground. We will not be effective in public health policy, nor on the ground, nor for patients!

Finally, with regard to the evidence-based approach regarding the criteria taken for the planning and reform of the hospital landscape, let me tell you how doubtful I am about your approach. You say that we will now use scientific criteria. I’m not going to remind you of the number of files where you disregarded scientific criteria. A colleague recently spoke of the planning committee for doctors. I can talk about tobacco, alcohol, so many cases for which there was an indisputable evidence-based, but you have decided not to follow scientific advice.

It is good to mention evidence-based medicine, but it is still necessary to act accordingly, and not only when it works for you. Here, you did not define what scientific criteria you were going to use, nor who would choose them, who would do the studies and who would eventually make the arbitrator if the studies were not convergent.

This scientific dress seems to me eminently political, Mrs. Minister. So for me it is everything except something that makes sense, everything except positive advances. I don’t see my colleagues from the MR, at least those who spoke just recently. Even 24 hours ago, we discussed on the basis of the opinions of the field actors: whether on the beds of pediatric psychiatry in daytime hospitalization, or on the services of pediatric and maternity, the decisions and arrangements of coordination that are ongoing go badly and the decisions are deleterious for patients.

You will understand that because of the choice of procedures, the terms you change here for the planning of hospitals, I will not support this bill. You impose these choices, Mrs. Minister, without effectively articulating them with the federal entities, by boycotting the National Council of Hospital Institutions and thus the health actors. This is a political strategy that I do not agree with at all, and which could be ⁇ detrimental to patients and healthcare actors. Therefore, we will not support your bill.

We support a number of measures in this bill containing various provisions. This is, among other things, the case for the historical decision to no longer permanently exclude men who have sex with men from blood donation. We are pleased that the lifelong exclusion is finally abolished, that the emphasis is placed on risk behavior and that an entire population group is no longer stigmatized.

In the new system, as in other risk groups, men who have had sex with men may not donate blood until 12 months after risk behavior. We support the demand of various LGBT organizations to further shorten the period of exclusion in the long term, in accordance with the new scientific insights that have come to us over the past months and years.

With regard to another measure in Chapter 3, in particular the new procedure for the programming of hospitals, we support that the programming is now based on a scientific analysis. At the same time, we have some serious questions regarding the proposed procedure. We fear that efficiency and quality will not be achieved as long as performance-based financing is in the way. However, this is an essential condition for us.

In the explanatory memo, on page 21, it says: “The service is almost entirely subsidized by the government and is also performance-driven. Hospitals often have no interest in decomposing an inefficient supply.” As long as the examinations and consultations will be remunerated by performance, the performance in each hospital network will be upgraded to collect their share of the budget. The more hospitals in financial difficulties come from savings, the stronger that effect threatens to become. We are in favor of abandoning that performance medicine and paying all doctors a reasonable salary, as in university hospitals.

Finally, the scientific studies underlying the new program will be conducted by university bodies or by the Federal Knowledge Centre for Health Care. For us, this must indeed be mandatory. After all, we want to avoid a situation, as is now the case with the district health centers, in which the study would be conducted by KPMG, an organization that is at the same time a large lobby for the privatization of healthcare.

For these reasons and given the fact that several laws have been incorporated into a law, we will abstain at the vote on this bill containing various provisions.

Mr. Speaker, Mrs. Minister, I did not have the opportunity to intervene in a committee on the problem of blood donation, being held in another committee.

Chapter 2 of the bill aims to respond to the judgment of the Court of Justice of the European Union of April 29, 2015, which found that “the criterion of permanent exclusion of blood donation as applied in Belgium, is not justified if, in compliance with the principle of proportionality, there are effective techniques for the detection of these serious infectious diseases transmitted by blood or, in the absence of such techniques, methods less compelling than such a contraindication to ensure a high level of protection of the health of recipients”.

It also aims to respond to the resolution proposal that I have had the pleasure to co-sign with the Socialist colleagues and which asks the government “to prepare a bill aiming to clearly reformulate the exclusion criteria of the law of 5 July 1994, so that the exclusion criteria of blood donation only concern risk behaviors and therefore contain no provision capable of systematically excluding a fraction of the population for reasons other than purely objective and justified by avoiding, for example, any exclusion due to the sexual orientation of a donor who, however, has an adequate behavior with regard to the prevention of risks of transmission of diseases”.

The Government therefore holds the opinion of the Higher Health Council which considers that "blood donation does not include among the rights and freedoms of individuals and that it is a voluntary civic gesture that can be refused, that the principle of equality in the head of candidates for blood donation must be respected, without prejudice to the protection of the right to health protection of blood recipients and above all, that a 12-month exclusion period can be justified, an option that the legislator wishes to take advantage of."

It is also based on current epidemiological data in Belgium that confirm that "sex between men involves a significantly increased risk of serious infectious diseases transmitted by blood, even if they are stable."

It would also show that the increased risk of HIV is most clearly present in donors whose HSH contacts date back less than one year.

Therefore, the government chooses an exclusion policy one year after the last HSH contact, which, according to it, guarantees for recipients a high level of safety of blood products, without taking into account another important precision of the Higher Health Council, namely that a period of less than twelve months can very well be held but on condition that a thorough study takes place.

LGBT associations rightly denounce this new temporary exclusion. According to them, it is not normal that people who have had sex with a new partner are excluded for four months, while men who have had sex with another man – who, by the way, may be a new partner – are excluded for twelve months.

In fact, while the bill provides for a temporary exclusion for each behavior of the donor or his sexual partner that involves a risk of contracting a serious infectious disease, transmitted by blood and therefore not only with HSHs, there remains a discrimination between them and heterosexual persons. For HSHs, the exclusion remains automatically for a period of one year, while, for the rest, blood transfusion establishments will take the effort to assess whether a exclusion is justified in the light of the principle of proportionality.

The project is, furthermore, stigmatizing in that it continues to put on the same foot men who have sex with men, men who have sex with exchangers, sex workers, people with multiple partners and intravenous or intramuscular drug users, considering that they have an increased and identical risk of contracting a sexually transmitted disease, which is of course wrong.

The project finally poses a problem of feasibility that is observed in countries that have adopted the same system, such as France and Great Britain. How to ensure a one-year abstinence period? Therefore, while it is pleased that the project provides for a biennial assessment of the criteria for temporary exclusion of blood donation, it remains regrettable that a more proportionate solution could not have been sought in advance. I believe, in fact, that if the project goes in the right direction, the 12-month exclusion period is too long and should therefore be replaced by a four-month period, largely sufficient because it covers all sexually transmitted diseases. I finally wonder about HSHs that have a rare blood group and for which there is really a shortage in our hospitals. Should the exclusion, in this case, also be automatic and for a period of twelve months?

With regard to the new procedure for the planning of hospitals, you promise a correct hospital offer established on the basis of undeniable criteria, scientifically grounded and depolitized. I would like to be able to believe you, but I remain cautious because I find that the scientific foundations are not respected by your majority when it comes to medical offer. We found this in the framework of the Commission on Planning of Medical Supply in view of the 40/60 ratio.

I therefore wish that political decisions will be effectively taken in compliance with scientifically-founded criteria, since the principle of subjecting programming to objective criteria is obviously a good approach in itself. Consultation with federal entities is, in our view, an essential aspect of this project. You only plan a concertation to distribute the programming between the federated entities and, if an agreement is not possible, the federal state will decide.

Like many colleagues, I have called in the committee for consultation at all stages, from the definition of criteria. In your responses, you merely recalled that the consultation with the federated entities within the framework of the Interministerial Conference was optional. This answer seems to me a bit simplistic in terms of the issues. In fact, it is necessary to be able to verify that the criteria elected take into account the regional realities. For example, to fix the programming of maternity and pediatrics, it is important to rely on the birth rate, which is significantly different from one Region to another.

Furthermore, the short time that this project reserves for consultation with the federal entities is not enough to reassure us.

Finally, more generally, this dialogue seems to me indispensable in order to ⁇ an optimal coordination between the curative and the preventive, with the aim of paying more attention to the latter – as you advise, by the way.

In conclusion, your project has positive aspects, but we will abstain for all the reasons mentioned above.