The History of EPSO
In 1996 the Dutch Inspection for Healthcare (IGZ), in close co-operation with the Norwegian inspection, initiated the start of a European Platform for Supervisory Organisations (EPSO). In the following years a number of activities was organised in several countries on different issues.
The first international meeting of EPSO was held in Noordwijk, the Netherlands, 12-14 June 1996. The aim of the meeting was to establish a European network of officials who have a duty to supervise and monitor the quality of health care in their countries. It was decided that a meeting of EPSO should be held once a year and that the Dutch Inspectorate for Health Care would provide the chair and the secretariat for five years (1996-2000).
The second international meeting was held in Lisbon, Portugal, 13-14 November 1997. The meeting had two aims: first: to give the representatives the possibility to present the situation in which they were working: responsibilities, tasks, etc. Second: to identify issues relevant to the international context of the supervisory organisations.
The third international meeting was held in Stavanger, Norway, 3-4 June 1999. Topics discussed were risk analysis and quality improvement. The meeting had a tragic end, with the sudden death of Jitze Verhoeff of the Dutch Inspectorate of Health Care, the founder of EPSO.
The next international meeting was planned for October 2000 but did not take place. The next EPSO meeting was held three years later in Norway (Gardermoen) 24-25 October2002. After that meeting there were no activities whatsoever, until 2007.
At the 8th Nordic Conference on Health Care Supervision in Helsinki in 2007 plans were made for re-establishing the European Platform for Supervisory Organisations (EPSO).
EPSO was meant to be an informal group of governmental or government related organisations in the field of law enforcement and supervisory activities related to health services in the European Community and the European Free Trade Area.
The objective was to set up a low profile accessible network for exchange of information and cooperation between colleagues in the EPSO states on a multilateral basis and eventually on the European level. This was meant among others to stimulate and encourage the adoption of good practises or discuss bad practises and more in general to facilitate the exchange of experiences in the field of healthcare supervision and control.
The above mentioned intermezzo in the EPSO activities had something to do with the tragic circumstances mentioned, but there was more. The inactivity during several years can also be attributed to a lack of time and working capacity to support the EPSO organisation on a more or less structural basis. This was partly because of a missing framework of co-operation, shared values and purposes, missing interaction and cooperation between the national partners in the field of health services. Also missing was a shared internet platform for communication (website and information database) and a missing forum for discussion and exchange.
In recent days new activities are being organised and new initiatives are being taken. In several Member States there is a growing number of cross-border activities on health care. The supervision on quality of health care seems to show starting signs of similarity and sometimes parallel developments. The EU is more and more involved in healthcare.
Also in the field of politics and politicians, signs of more collaboration and harmonisation are visible. This is not only because the collaboration in healthcare in Europe is growing (first steps towards a Directive on cross border (patients rights on) health care is in preparation at the EU department of SANCO), but also because a number of obstacles become visible when cross border initiatives are being implemented in national settings without European backing.
Realisation of cross border patient movement, Cross Border Hospital Cooperation, Cooperation by medical staff and realisation of level playing field without financial burdens and mutual approval of (re)payment and funding for healthcare are not without problems. On the different levels of government and administration in, and also between Member States of the EU, awareness of the necessity of more mutual information, co-operation and better understanding is growing. In the long run – and even on some issues in the short run - growing concern on better information and cooperation in the field of health services is visible.
To underline and support these above mentioned broader developments, it seems to be necessary that in the practical field of the daily work of inspectorates and government officials involved in supervising health services, existing contacts will be enhanced and widened.
Better cooperation and understanding of the mutual working methods and procedures, best practises, bad practises and experiences in the daily work and other content of the work and practical cooperation of these parties are essential building blocks for better future fine-tuning between inspectorates and other involved parties in the European context.
The Norwegian and Dutch organising parties at the meeting of EPSO in Bergen 2008 took into account that to support the above mentioned developments in the field of health care, it is absolutely necessary to start with a practical and small organisation and some concrete and commonly agreed on themes for discussion at EPSO meetings in the years to come.
So the members at the meeting of EPSO in Bergen agreed on the proposal of the organisation that in the years to come EURinSPECT will organise the meetings of EPSO. This will start after the next meeting in Copenhagen, Denmark.
The first meeting was held on the 22th and 23th of October 2008 in Kopenhagen, Denmark and organised by the participating member of the Danish Health Board in co-operation with the participating member of the British healthcare commission. After that, EURinSPECT took over (financially supported by the Norwegian, the Dutch inspectorates and the British Healthcare Commission). The Inspectorate in the Netherlands will co-ordinate this financial support.
EURinSPECT participated in this first meeting in Denmark and made a working start with the set up of the website and the support of the next meetings (two meetings in 2009 and one in 2010) with the intention of a follow up in the years to come.
EURinSPECT started with the organisation of one meeting of EPSO in de the first part of 2009 and another one in the second part of 2009.
After the third meeting in 2010 an evaluation will be held to see what kind of follow up is indicated and how this follow up can be best organised.
The attendants of the meeting of EPSO in Bergen in 2008 agreed as a starting point on the following themes for a broader co-operation in the years to come.
• In 2008 the central themes of discussion at the EPSO meeting was accreditation and certificating of organisations in health care and cure in relation to oversight and inspection;
• In 2009 the central themes of discussion at the EPSO meeting will be research on supervisory activities including evaluation of oversight in relation to the quality of health care and cure; training and apprenticeship of inspection and control officials.
The attendants took into account that to improve the impact of the EPSO meetings and to strengthen the basis of the organisation it is a good idea to invite - step by step - parties from other countries such as France, Germany, Switzerland and Spain (on a two to four persons per country basis).
The intention is to broaden the European co-operation without loosing the informal and loose organising structure of EPSO and without loosing the focus on content and discussion between colleagues in the field of supervision on quality of healthcare.
The participants agreed on inviting Germany, Switzerland, Spain (Catalonia) and France for the meeting of EPSO in Denmark on 22-23 of October 2008.
EURinSPECT is asked by the Dutch and Norwegian Inspection on Healthcare and the British Healthcare Commission, as working together in EPSO context, to give support to the above indicated outline and structural organisation of EPSO (hands on, in cooperation and with guidance of the IGZ (Dutch Inspection for Healthcare). In this starting document EURinSPECT gives a first scheme of ideas that can be specified later on in collaboration with the parties involved in EPSO.This implies a proposal in two parts for activities by EURinSPECT. It also gives an indication of the corresponding necessary budget.
The first part of the activities of EPSO will be loosely planned in the 2009-2010 period. The themes will be successively:
• Accreditation and certificating of organisations in health care and cure in relation to oversight and inspection;
• Research on supervisory activities including evaluation of oversight in relation to the quality of health care and cure;
• Training and apprenticeship of inspection and control officials .
The meetings will be successively held in and organised by Denmark (Copenhagen) on 22-24 October 2008; Ireland (Cork) co-organised by the Netherlands in May 2009; and Sweden (Stockholm) on 16 September 2009 and about a next one in 2010 is not yet decided.
The second part will - after evaluation of the first part - be planned in the years to come afterwards (after 2010) and will be more structured and based on the experience and results of the first period (2009-2010). In the second part a more structured organisation and finance will be also necessary to get continuity and organisational ‘body’ in the by then larger group of participating countries (supervising bodies).
This implies for the first period the following assumptions:
• The expenses related to travel and hotel accommodation will be covered by the participants themselves;
• The organising country-inspectorate takes care of the costs of the location and accommodation of the meeting and (if possible) including lunch and dinner facilities for the group of invited participants;
• The organising country-inspectorate, supported by the Dutch and Norwegian inspectorates, takes responsibility for the content of the conferences;
• EURinSPECT will organise the exchange of timely available papers and presentation and will organise content where necessary (given a substantial support of the organising parties to produce the content timely);
• EPSO agrees on a simple but effective website as means and channel of communication and information exchange. This might be linked or connected to EURinSPECT or if possible in terms of finance it might become over the next period of time a website of EPSO itself;
• The (organising) parties do agree on a permanent membership of ESPO existing of one permanent member from every EPSO participant (country, participating inspectorate or supervising health authority or other involved party);
• The organising parties do agree on responsibility for the organisational costs of EURinSPECT (see budget) for the first period (2009/2010) and will in co-operation with EURinSPECT set up a more permanent membership fee or other solid financial foundation, on behalf of the participants of the second period for the purpose of a more permanent status of EPSO;
• The organising parties will organise, in co-operation with EURinSPECT, the first evaluation of the EPSO activities before the last EPSO meeting in 2010.
Scope of Activities
EPSO focuses on inspection, supervision, oversight, law enforcement and political steering activities in the field of Health services (care and cure), medical and pharmaceutical products, medical instruments and medical devices in the European Community and the European Free Trade Area.
Planned Activities EURinSPECT/EPSO
1. EURinSPECT organises together with, and with guidance of the Netherlands and Norwegian inspectorate a network between “colleagues” in the EPSO states. The network acts as a kind of virtual soundboard for the preparation of the activities of EPSO. The network is a kind of ‘virtual Program Commission’ and is called EPSO Board group. The EPSO Board group exists of permanent members (one of every country or participant) and ad hoc members as editors and advisors on the specific themes and issues involved in the meeting.
2. The ESPO virtual board group is involved in the organisation and preparation of (to start with) 3 subsequent meetings in different member states on specific themes that affects:
The day to day work of inspectorates and the other involved EPSO parties, or
• specific subjects or themes interesting to people involved in the the daily work of inspectorates and the other involved EPSO parties, or
• exchange of ideas about specialised themes based on experience and good practises of inspectorates or the other involved EPSO parties in one or more member states;
• exchange of scientific information or scientifically based evaluation or monitoring that is interesting or useful to the inspectorates or the other involved EPSO parties;
• teaching about EPSO results and the outcome of the EPSO meeting activities and transfer of knowledge towards other parties in the different inspectorates;
• valorisation and diffusion of knowledge and expertise between members of EPSO.
The first central themes will be:
• accreditation and certificating of organisations in health care and cure in relation to oversight and inspection;
• evaluation of oversight and inspection on quality of health care and cure;
• training and apprenticeship of inspection and control officials;
3. EURinSPECT makes a proposal to EPSO to organise a multilateral database (virtual website connection and database facility) to use in the participating member states by inspectorates and the other parties involved in EPSO;
4. EURinSPECT makes after each meeting a proposal to organise and develop mutual teaching activities and mutual sharing of information between the inspectorates itself and the between the involved EPSO parties. This information sharing can be based on open source information or if possible on specific information sharing facilities between the member states;
5. EURinSPECT will – when asked - organise and support specific follow up research activities in co-operation with inspectorates and parties involved.
Proposed Deliverables of EURinSPECT to EPSO:
EURinSPECT will deliver in cooperation with the virtual board group and the support of the organising parties (Norwegian and Dutch) inspectorates:
1. Support and organise the facilities to realise the network between “colleagues” in the EPSO partner states;
2. Support and organise the facilities to realise the proposed three subsequent international meetings in the above mentioned countries;
3. Support and organise the practical organisational activities such as , production and circulation of practical information using a scenario planning of the meetings, producing a time schedule regarding national and public holidays;
4. Support and organise the production of the research and other papers and speaking notes necessary for the meetings;
5. Produce other information papers, contact and organise speakers, organise production of speaking notes and other necessary preparation of the meetings;
6. Support and organise the content of the meeting in co-ordination with the participants and the virtual board group;
7. Planning, timing and organising of the information, the location and the other facilities necessary for a smooth organised meeting;
8. Secretarial and reporting activities if necessary for the meeting;
9. EURinSPECT organises continuity in EPSO by keeping track on planning, decisions, arrangements and other data of the meetings.
Extra deliverables (not included in the budget)
EURinSPECT can on demand produce aggregated management information based on the outcome and results of the international meetings.
• Organises participant-support, newsletters and or website-information if necessary;
• PR activities in co-ordination with the virtual board group;
• Organises input and content for the conferences by organising brainstorm sessions, training and or research activities;
• Produces booklets and suchlike;
• Organises research and knowledge exchange.
Possible specific extra and not yet planned activities (in co-operation with the virtual board group and or other parties involved)
• Specific network meetings on more effective and efficient supervision for instance in terms of what instruments can be used to improve the quality of inspection;
• How can inspectors improve their skills on better inspection;
• How can “inter inspectorate variation techniques” be used to improve cooperation between inspectors in the same field of operation;
• How can inter professional and inter collegial cooperation with other professionals help to improve the quality of inspection;
• How can ‘protocolling’ be used to improve the quality of inspection, supervision and steering;
• How can exchange of expertise between parties help to improve the quality of inspection and supervision;
• How can risk management be introduced to improve quality and reduce burdens of unnecessary workload.
Timetable First Part
In continuation fromo the ference in Norway on 2/3 June 2008 and Denmark 22/23 October 2008, EURinSPECT will organise three meetings in the period 2009-2010 (two in 2009: 14/15 May and 16 September and one in 2010: Spring).
Number of participants
The intention is to start with a number of about 24-40 participants for the first meetings.
The initial involved parties in the Norway conference of 2008 were:
New participants are:
As new participants will be asked to participate:
Each delegation has 2-5 participants. The organising parties (Norway and the Netherlands and the organising country) will have a somewhat larger delegation. The secretariat of EURinSPECT and the permanent members of EPSO in Norway and in the Netherlands are also involved and will – if required- be present to support the organising country and to take care of continuity and organise feed back to the interested parties that cannot be present at the conference.
EURinSPECT and EPSO are thinking in terms of using a growth scenario for the meetings. The meaning of this growth scenario is that at every meeting one two or more new countries are invited to participate in the debate and are invited as guests at the meeting (in general on their own expenses). Finally when 14-16 extra countries have participated in 2010 and more countries have ‘joined the club’ the meetings can have a more ambitious, and a ‘large scale’ character, finally involving all 27 countries and the EFTA countries as well.
• If the above mentioned final intentions will come within reach will depend on the quality and usefulness of the outcome of the first three meetings. This will be set by evaluation in cooperation with the virtual EPSO board group.
• The organising parties will organise in co-operation with EURinSPECT the first evaluation of the EPSO activities before the last EPSO meeting in 2010 and present a questionnaire at the meeting.
• After this third meeting (in 2010) the evaluation results will be reported to the organising parties and the virtual board group.
• Then the virtual board group will decide what kind of follow up is indicated and how this follow up can be best organised.
The meetings and the reporting will be in the English language.