ACCOMPANYING DOCUMENTS. Meeting of the Secretaries General and Directors of the national sections and associate members. Prague, February 2009

Transcription

1 COUNCIL OF EUROPEAN MUNICIPALITIES AND REGIONS EUROPEAN SECTION OF UNITED CITIES AND LOCAL GOVERNMENTS Meeting of the Secretaries General and Directors of the national sections and associate members Prague, February 2009 ACCOMPANYING DOCUMENTS

2 ACCOMPANYING DOCUMENTS TABLE OF CONTENTS Related document n Page n 11.2 CEMR Response to the Green Paper on migration and mobility CEMR Response to the public consultation on Next Generation Access (NGA) networks Message to the United Nations Climate Summit COP14 in Poznan Conference of the parties to the convention on climate change CEMR position on the proposal for a Directive on the application of patients rights in cross-border healthcare Strategic paper for CEMR twinning coordinators concerning the future of the programme after Draft guide to producing an equality action plan Suggested indicators for the preparation of an equality action plan...42

3 11.2 COUNCIL OF EUROPEAN MUNICIPALITIES AND REGIONS CONSEIL DES COMMUNES ET REGIONS D EUROPE CEMR Response To the Green Paper on migration and mobility: challenges and opportunities for EU education systems Brussels, December 2008 Conseil des Communes et Régions d'europe Council of European Municipalities and Regions 15 Rue de Richelieu F Paris 1 Square de Meeûs B-1000 Bruxelles tel : cemr@ccre.org - Tel :

4 CEMR Response to the Green Paper on migration and mobility: challenges and opportunities for EU education systems (COM (2008) 423 final) Summary On 2 July 2008, the European Commission launched the so-called Renewed Social Agenda, a package of initiatives and reports in the areas of employment and social affairs, education and youth, health, information society and economic affairs. It aims to ensure that the EU and its citizens are better equipped to tackle today s new social realities shaped by globalisation and technological and demographic change. One of the initiatives is the Green Paper on Migration and mobility: challenges and opportunities for EU education systems. The consultation opens a debate on how education policies can address the challenges posed by immigration and internal EU mobility and how EU level support could help Member States develop policies to improve equity in education, accommodate linguistic and cultural diversity, adapt teaching skills and build bridges with migrant children and families. Integration of migrants concerns municipalities and regions in their unique role of service providers and planners, as well as local employers. For this reason, the Council of European Municipalities and Regions (CEMR) have elaborated the present response to express our members views on the proposals outlined by the Commission in its Green Paper. The Council of European Municipalities and Regions (CEMR) is the umbrella organisation of local and regional authorities federated through over 50 national associations of towns, municipalities and regions in 38 European countries. 2

5 Key points of CEMR s response 1. Integration takes place at the local and regional level. Municipalities and regions have to take into account the special needs of migrants. 2. Migration is a very complex phenomenon. Immigration patterns differ very much from one region to the other and therefore require tailored policies and measures. 3. The role of education is of utmost importance for integration. In this context education should be understood as a concept that is not limited to schools only, but include day care facilities for children, family centres, cultural and sport centres, etc. 4. Language knowledge is crucial to integration and children should get all the support they need to learn the host language and, where possible, to strengthen their knowledge of their language of origin. 5. Every child, regardless from its socio-economic status or origin, has the right to receive good education and should be supported according to its needs. 6. Migrant children and their parents might have extra needs, including other social services and care. 7. For education institutions it is a challenge to meet these special needs and support migrant children without neglecting the other children. 8. Successful integration of migrant pupils requires additional financial means for education institutions, local and regional authorities. 9. Exchange of good practice and networks or partnerships should be promoted to help local and regional authorities and education authorities to learn from each other. 10. The context of migration and integration changed considerably since the 1970s. Therefore the Directive on the education of the children of migrant workers from 1977 should no longer be the basis for future integration policies. Instead, especially the teaching of pupils language of origin should be based on voluntary arrangements. 3

6 Introduction 1. CEMR welcomes the Green Paper, which stimulates the debate on the importance of education for the integration of migrant children. 2. Integration takes place at the local level. Municipalities and regions are providing a wide range of services and need to take into account the special needs of migrants. Even when the content of education is not within the responsibility of local and regional authorities, these are responsible for the operation of educational institutions and as a consequence are very much affected by the challenges of integration of migrants to the education system. 3. Education is a key factor of integration. CEMR would like to stress that although schools are a major part of a country s education system, education should be seen in a wider perspective. Education is more than schools; other institutions such as daycare facilities for children, family centres, cultural and sports centres are part of the system. 4. Every child, regardless from its origin, has the same right to education. However, studies show that in many Member States the socio-economic status still decides about the children s success in the education system. CEMR would like to stress that all these children, migrant children as well as others, should get the support they need to receive good education. The policy challenge What are the important policy challenges related to the provision of good education to children from a migrant background? In addition to those identified in this paper, are there others that should be taken into account? 5. The Green Paper gives a reasonable overview of the policy challenges associated with educating and integrating migrant children. CEMR would like to add that immigration differs very much from one region to the other; in some municipalities and regions the challenge is the lack of experience in dealing with the integration of migrants because migration is a recent phenomenon, in other parts the challenge consists of the number of different (cultural) backgrounds. 6. Schools and other institutions such as kindergartens are in the front line in responding to migration. When a new child arrives at a school, he or she needs to be welcomed, assessed, offered appropriate support and integrated into the school and school life, without adversely affecting the education offered to all the other children in the school. 7. It is important to note that due to several waves of migration, schools are having to deal with increased numbers of children from different countries. 8. Some migrant children have extra needs due to traumatic events in their recent lives (i.e. war and violence). Specialist staff is needed to deal with this. These children and their families might also need other social services and care. 9. Schools with many migrant pupils face additional costs such as those arising from additional language teaching or staff training. Also the local and regional authorities 4

7 concerned have additional expenditures for example for learning support services, health services etc. It has thus to be ensured that educational institutions as well as local and regional authorities will have the necessary financial means to provide the support to migrant children and their families needed to better integrate them. The policy response What are the appropriate policy responses to these challenges? Are there other policies and approaches beyond those listed in this paper that should be taken into account? 10. Language knowledge is of utmost importance to integration. CEMR and its members would like to support the statement in the Green Paper that migrant children should be included in the prevailing education system and that they should be given additional support to adapt to the society of the host country and where possible they should get support to strengthen their knowledge of their language and culture of origin. 11. Teaching in a cultural diverse environment should be included in the teachers training and should be offered for professional development. 12. To receive good education, children need the support of their parents. For migrants, it might be difficult to give this support due to unfamiliarity with the education system. It is therefore of major importance to better include families into the education of their children, for example via specialised staff acting as contact persons between the institution and the family. 13. Educational institutions and local authorities can learn from other institutions and authorities. CEMR welcomes the exchange of good practice and partnerships or networks between the actors. The role of the European Union What actions could be undertaken via European Programmes to impact positively on the education of children from a migrant background? How should these issues be addressed within the Open Method of Coordination for Education and Training? Do you feel that there should be an exploration of possible indicators and/or benchmarks as a means to focus policy effort more strongly on closing the gaps in educational attainment? 14. CEMR welcomes the dissemination of good practice and information in the context of the Open Method of Coordination for Education and Training. 15. Funds and programmes can also be a way in which the EU can help to support the development of new measures to ensure that more migrant children and young people receive a good education. 16. There is also a role for the EU to strengthen initiatives which directly benefit local authorities, schools, teachers and pupils which promote the creation of voluntary networks and exchanges, for example professional development opportunities for teachers working in culturally and linguistically diverse schools. 5

8 The future of Directive 77/486/EEC How can Directive 77/486/EEC, taking into account the history of its implementation and bearing in mind the changed nature of migration flows since its adoption, play a role in supporting Member States policies on these issues? Would you recommend that it be maintained as it stands, that it should be adapted or repealed? Would you propose alternative approaches to support Member States policies on the issues it addresses? 17. The directive from 1977 on the education of the children of migrant workers outlines that Member States should: Ensure free tuition in their territory, adapted to the specific needs of such children, in particular the teaching of an official language of the host state; and Promote the teaching of the mother tongue and culture of the country of origin, in co-ordination with normal education, in co-operation with the Member State of origin. 18. Migration patterns, numbers and profiles have changed considerably since the 1970s. Member States have also developed their own approaches to and policies to the teaching of the host language during this time. This has rendered many parts of the directive either irrelevant or redundant. Another present day limitation is that the directive only applies to EU citizens and not to third country nationals. 19. Local and regional authorities are strongly committed to respect and promote cultural and linguistic diversity. Notwithstanding, CEMR considers that the teaching of the pupils language of origin should not be implemented via legislative instruments, but that such principles should be promoted via voluntary arrangements. Schools and education authorities should retain the flexibility and freedom to assess the feasibility of, and decide upon, whether and how they provide this in the education system. * * * * 6

9 11.3 COUNCIL OF EUROPEAN MUNICIPALITIES AND REGIONS CONSEIL DES COMMUNES ET REGIONS D EUROPE CEMR Response To the public consultation on Next Generation Access (NGA) networks Brussels, 14 November 2008 Conseil des Communes et Régions d'europe Council of European Municipalities and Regions 15 Rue de Richelieu F Paris 1 square de Meeûs B-1000 Bruxelles tel : cemr@ccre.org - Tel :

10 Draft Commission Recommendation on regulated access to Next Generation Access Networks (NGA) 1 Response by the Council of European Municipalities and Regions (CEMR) Key Messages 1. Local and regional authorities have a key role to play in the promotion and facilitation of roll-out of the future high-speed broadband networks, including the fibre-optics NGA networks. These networks play an important role, as the strategic use of ICT is a crucial enabler of regional and local development, in both economic and social realms. 2. One of the irreplaceable roles of local governments is the coordination of engineering works, which constitute up to 80 % of the total roll-out costs of NGA networks. 3. Together with ensuring competitiveness of the telecommunications sector, it is equally important to assure fair access, where the market fails to address the public interest and to serve the needs of businesses and the citizens. 4. Notwithstanding the development and deployment of modern fibre-optics networks, legacy copper-based broadband networks should be included in the scope of the Universal Service Directive among the services of general interest. 5. It is necessary to enhance competition by functional separation of infrastructure and services in all types of networks as well as to endorse "open infrastructure" and "open networks". 6. Local and regional governments need to be empowered in their capacity to pursue these new issues policies, by increasing their competencies and available skills in the changing reality. 1 Draft Commission Recommendation on regulated access to Next Generation Access Networks (NGA) [ 8

11 Introduction 1. CEMR welcomes the opportunity to provide its views on the above document, presented by the Commission for consultation by the public and the stakeholders. 2. CEMR also welcomes the intent of the Commission to provide regulatory consistency, aiming to maximise the benefits and minimise the costs related to the regulation of Next Generation Access networks at European level, agreeing with the views that the coming years will be crucial for the migration to high-capacity networks. Role of Local and Regional Authorities 3. The conference Bridging the Broadband Gap organised by the European Commission in 2007 underlined, that the strategic use of ICT can support regional and local development and infrastructure, overcome geographical obstacles, and make less-developed regions, rural and remote areas more attractive to business and individuals alike. 2 The conclusions of the conference emphasised the "fundamental belief in the importance of ICT to the local economic and social development, as well as to improving life quality and redress the balance between urban and rural areas" Local and regional governments find themselves as prospective users of the new technologies and on the other hand having in mind the public interest and the wellbeing of their citizen they also see their role in promoting the deployment of the new information and communication technologies. 5. In view of these facts, and in view of the Commission's Communication on future networks and the internet 4, we see a clear role of local and regional authorities in the promotion and facilitation of roll-out of the future high-speed broadband networks, including the NGA networks. 6. As noted by the Commission, civil engineering works represent up to 80 % of the total rollout costs of NGA. 5 Local and regional governments might therefore be involved in better spatial and temporal coordination of the works (e.g. road construction or repair, utilities installations, etc.), in mapping of existing ducts and other infrastructure, in the provision of access to public ducts or even in public investments in open ducts, in dark fibre or in networking infrastructure and passive and power grid systems. Free market versus public interest 7. CEMR supports the Commission in the position that efficient access remedies have proved to be crucial to the competitiveness of the telecommunications sector. Yet we would also like to reiterate, that care should be taken in cases, where a competitive market fails to address issues of public interest. 2 Bridging the Broadband Gap: Benefits of broadband for rural areas and less developed regions, Brussels, May 2007 [ 3 [ 4 Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: Communication on future networks and the internet. COM(2008)594 of Draft Commission Staff working document: Explanatory note accompanying the draft Commission recommendation on regulated access to Next Generation Access Networks [ 9

12 8. Already the deployment of broadband access is characterised by market failures in serving rural, remote or sparsely populated areas and we are afraid that NGA access will be concentrated even more in areas of dense population, where telecommunication operators may anticipate high investment return. 9. Therefore CEMR deems indispensable to strengthen the role of public authorities in cases where the market forces do not address key issues related to strategic development goals. We see a role of public authorities in addressing the problem of disbalanced deployment of broadband and possibly NGA networks in underserved areas, whilst leaving determination of operational issues to market players. The use of structural funds or other public funding could be appropriate in cases, where public authorities aim to facilitate balanced and universal deployment of future technologies. Protection of legacy infrastructure and services 10. CEMR agrees with the need to establish policies as well as financial instruments to promote the roll-out of NGA networks and NGA-based services and would urge the development of new types of public services enabled by these NGA network bandwidths at all levels of public administration. 11. At the same time, however, there is also the emerging need to provide mechanisms of continuous protection of legacy infrastructure and services based thereon for a period enabling smooth, secure and affordable transition to new infrastructure. This is especially important in cases, where existing (copper) infrastructure is deployed as carrier of public, universal or even mission-critical (e-health) services. 12. With the growing deployment of NGA networks, legacy broadband network access should be included in the scope of the Universal Service Directive 6 among the services of general interest, which would ensure both the protection of affordable infrastructure and services as well as the fair access coverage of underserved areas, which are currently ignored by the market players. Reiteration of important aspects 13. CEMR also considers important to reiterate the key role of open infrastructure and open networks, which enhance competition but are at the same time a prerequisite to fair access to Internet connectivity and access to public electronic services. CEMR therefore advocates functional separation of infrastructure and services in all types of networks, bearing in mind both the competition on the market and the public interest. 14. Last but not least, we reiterate the need to empower local and regional governments in their capacity to undertake a comprehensive policy approach in the area of future and NGA networks, including long-term strategic planning, needs assessment, infrastructure mapping or procurement, development and delivery of new services. With the emerging new technologies, public administration is in need of new skills and competencies in order to be able to respond adequately to the changing reality. * * * * 6 Directive 2002/22/EC of the European Parliament and of the Council of 7 March 2002 on universal service and users' rights relating to electronic communications networks and services (Universal Service Directive). OJ L 108/51 of

13 Message to the United Nations Climate Summit COP14 in Poznan 13.1 Climate Change Global challenges - Local solutions Local and regional authorities are well aware of the global challenges that lie ahead and are already developing solutions to weaken their impact on society. Over the years, they have implemented a multitude of actions to both combat climate change and adapt to its impacts. As the level of government closest to citizens, municipalities and regions are in the best position to raise awareness and mobilise people, to promote energy efficiency, decentralised energy production and a new mobility culture. They can act as a role model to encourage other stakeholders and individuals on how to take own action. Climate protection and adaptation at local and regional level has the potential to dramatically reduce climate change, but can also create jobs and enhance social cohesion. The current financial and economic crisis should not undermine the fight against climate change. Instead, it should be but one of the multitude of arguments for paving the way towards a low-carbon economy. Responsibilities must be taken now; failure to do so will result in unprecedented costs. Findings in the 2006 Stern Review on the Economics of Climate Change suggest that 1% of annual GDP invested today could avoid up to 20% of climate-induced damages tomorrow. On the occasion of the United Nations Climate Summit COP14 in Poznan, Poland on 1-12 December 2008, the Council of European Municipalities and Regions (CEMR), Climate Alliance, Energie-Cités and EUROCITIES request that national governments negotiating the post-2012 climate agreement: 1. Recognise the role of local and regional authorities in climate mitigation and adaptation policies and involve them in the international, European and national debates and policy making processes. 2. Take into account the reduction of greenhouse gas emissions that local and regional authorities are achieving, thus contributing significantly to national reduction plans 3. Create and improve legal, financial and fiscal frameworks at the appropriate level and in partnership with local and regional authorities in order to secure strong local and regional mitigation and adaptation actions and investments. 4. Encourage and enable local and regional authorities to engage the necessary human resources for energy and climate management and to promote further innovative solutions. We therefore request that a chapter highlighting the prominent role of local and regional authorities be integrated into the post-2012 agreement. European local and regional authorities through their European networks and organisations Support local and regional CO 2 reduction commitments in line with the European energy and climate targets (20% reduction of CO ² emissions, 20% increase in energy efficiency and increase the share of renewables up to 20% by 2020). Support integrated approaches e.g. mainstreaming climate protection into policies and climate-proof legislation and ensuring coherence with mitigation and adaptation policies at all levels. Mobilise local actors and citizens to raise awareness and take action, exchange experience and learn from each other. Support solidarity and political and technical cooperation between local and regional authorities all over the world to mitigate and adapt to climate change. 11

14 Local and regional authorities can make a difference! As the level of government closest to citizens and local stakeholders, local and regional authorities have the competence in their roles as planners, consumers, service providers and motivators to act in an integrated way on several key policy areas: 1. Sustainable spatial planning for enhanced quality of life: 74% of European population lives in cities Via sustainable urban and land use planning, local and regional governments make strategic decisions concerning spatial development. Adequate planning and improvements in infrastructure design are crucial to minimising urban sprawl, optimising the use of natural resources and minimising the risks of climate change. 2. Energy efficiency: in Europe, 40% of energy is consumed in buildings Through policies and financial schemes, local and regional authorities directly manage the energy performance of public buildings and influence the performance of residential and tertiary buildings. The European Display Campaign [ engages over 300 municipalities to calculate and display the energy performance of buildings. Raising users and decision-makers awareness has helped to considerably reduce the energy consumption of public buildings. 3. Urban traffic is responsible for some 40% of CO ² emissions in Europe By implementing integrated long-term mobility strategies, local and regional authorities can strongly influence the choices that individuals make and encourage a modal shift towards more sustainable transport modes. Campaigns such as the European Mobility Week [ which count on the participation of around 2,000 cities, encourage local authorities in Europe to increase the availability of car free areas, development of public transport systems and promotion of walking and cycling. 4. Decentralised energy production and renewables: multiplying the conversion efficiency Local authorities are providers of services such as district heating and cooling, and combined heat and power. Decentralised energy production based on the use of local renewable energy is a safe, clean and affordable option, and enhances both energy security and local prosperity. 5. Sustainable procurement to influence the market Local and regional authorities are major purchasers of goods and services. They play a key role in opening up markets for more energy efficient products. Ambitious and measurable sustainable public procurement can provoke a change in production and consumption patterns. 6. Reinforcing social cohesion to the benefit of the most vulnerable citizens The poorest are often hit hardest by the negative impacts of climate change and fluctuations of energy prices. And it is the poorest who will find it hardest to adapt. Local and regional authorities are best positioned to reach out these people and help households to deal with unaffordable energy costs. Furthermore, climate change is already the cause for migration of large populations. Cities are the places where migrants settle and the likely social and economic impacts of this must be addressed. Efforts are also needed to adapt infrastructure in the countries of origin to prevent such migration. Contacts: CEMR: Jeremy Smith, Secretary General, Climate Alliance: Ulrike Janssen, Executive Director, Energie-Cités: Gérard Magnin, Executive Director, EUROCITIES: Paul Bevan, Secretary General, 12

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16 Draft Text for a UNFCCC COP Decision suggested by United Cities and Local Governments, ICLEI-Local Governments for Sustainability, World Mayors Council on Climate Change, C40 Climate Leadership Group, Metropolis. Local Government Climate Sessions, Poznan 9-11 December 2008 OPEN FOR COMMENTS (climate-roadmap@iclei.org) CONFERENCE OF THE PARTIES TO THE CONVENTION ON CLIMATE CHANGE CITIES, LOCAL AUTHORITIES AND CLIMATE CHANGE Acknowledging that by 2030, two thirds of humanity will live in urban centres where more than 75% of all energy is consumed today; Understanding that all cities are highly vulnerable to the impacts of climate change, especially fast-growing cities in developing countries; Recognising that cities and local authorities are critical when it comes to practical climate actions and that if genuinely empowered and resourced, they have the potential to lead emission reductions to ensure that ambitious targets for the reduction of global greenhouse gas emissions are met. Recalling the Decision on Cities and Biodiversity adopted by the Conference of the Parties on Biodiversity in its 9th meeting; Drawing lessons from the success of the implementation of the Rio Agenda through Local Agenda 21 and the successful measures that are being implemented by cities around the world on sustainable energy economy through energy savings and the application of new and existing renewable and high efficiency technologies, to reduce dependence on fossil and nuclear fuels and aim for lowestcarbon options; Recognising that cities and local authorities play a critical role in designing and implementing energy and infrastructure guidelines, investment promotion, and consumer awareness campaigns, all of which have direct effects on energy consumption, and in particular on water, energy biodiversity and Communication, Education, and Public Awareness; Welcoming the commitment demonstrated by the World Mayors and Local Governments Climate Protection Agreement by reaffirming the will of local authorities to accept the challenge and co-responsibility to take action to prevent the dangerous effects of climate change; Noting that, while responsibilities for implementation of the Convention rest primarily with the Parties, there are multiple reasons for promoting the engagement of cities and local authorities and fostering collaboration with the global local government associations as key partners to the UNFCCC. The Parties: in accordance with and respecting national constitutions and legislation, recognise the role of cities and local authorities in the implementation of National Climate Change Strategies and Action Plans, and shall therefore facilitate the adoption by cities and local authorities of practices that support the implementation of these strategies and action plans, as well as support the consistency between local climate change strategies and action plans with National Strategies and Action Plans; are committed to engage with the local authority leadership and/or their local authority associations to provide enabling structures and effective framework conditions for climate cooperation with cities and local authorities; shall empower cities and local authorities so that they have the abilities, the capacities and the resources required to take necessary action at the local level and to support the Parties in their efforts to meet the agreed targets and to implement local climate mitigation and adaptation strategies; shall include local authority delegates in the national delegation to the Conference of the Parties and relevant decision making processes hereafter. The Conference of the Parties: commits to include the development and implementation of local policies in the agenda of the UNFCCC requests the UNFCCC Secretariat to strengthen cooperation with cities and local authorities and facilitate their meaningful contribution to the conference decisions 14

17 14.1 COUNCIL OF EUROPEAN MUNICIPALITIES AND REGIONS CONSEIL DES COMMUNES ET REGIONS D EUROPE DRAFT CEMR position Proposal for a Directive on the application of patients rights in crossborder healthcare Brussels, January 2009 Conseil des Communes et Régions d'europe Council of European Municipalities and Regions 15 Rue de Richelieu F Paris 1 Square de Meeûs B-1000 Bruxelles tel : cemr@ccre.org - Tel :

18 CEMR position on the proposal for a Directive on the application of patients rights in cross-border healthcare Background of the Commission s proposal On 2 July 2008, the European Commission published its proposal for a Directive on the application of patients rights in cross-border healthcare as one of the initiatives of the Renewed Social Agenda. Even though most Europeans prefer to receive healthcare in their own countries, there are situations when patients may seek healthcare abroad. In recent years a number of cases have been brought to the European Court of Justice (ECJ) that assert patients rights to reimbursement for healthcare provided in other Member States. Since 1998, the ECJ has consistently ruled that patients have the right to have their healthcare costs reimbursed in cases where it has been received abroad. According to the European Commission, the directive should clarify patients rights in crossborder healthcare and the limits Member States can place on such healthcare abroad and the level of financial coverage that is provided for cross-border healthcare. It should also prepare future practical European cooperation on healthcare. 16

19 Key Points of CEMR s position 1. In many EU Member States local and regional authorities act as healthcare providers and are responsible for the organisation and financing of hospitals. They are therefore concerned by a directive on the application of patients rights in crossborder healthcare. 2. CEMR questions the legal basis, article 95 of the EC Treaty, of the directive and thus applying the internal market concept to the provision of healthcare. We believe that the directive should be based on article 152 of the EC Treaty, public health. 3. We would like to underline the responsibility of Member States for the well functioning of healthcare systems as described by article Patients should in general be treated in their Member State of affiliation, according to the principle of proximity. Under certain conditions they might seek treatment abroad. 5. The organisation and delivery of cross-border healthcare should be provided according to the legislation of the Member State of treatment, including liability and aftercare in case of problems. 6. The Member State of treatment should be reimbursed the costs incurred as a result of the treatment. In cases where the costs are higher than in the Member State of affiliation, a provision should clarify the compensation of the extra costs, whilst not imposing an unfair burden on the Member State of affiliation. 7..The Member State of affiliation should have the possibility to establish a general system of prior authorisation for hospital and specialised care. 8. Hospital and specialised care include a broad range of treatments, and different from one Member State to the other. Therefore, hospital and specialised care should be defined by the Member State of affiliation. 9. Member States have to facilitate the cooperation in cross-border healthcare at all levels concerned; hence local and regional authorities should be consulted on the transposition and participate in the implementation of the directive. 10. CEMR recommends that detailed information concerning the organisation or administration should not be included in the text of the directive, but in form of guidelines or as an annex. 17

20 Introduction 1. In a number of Member States local and regional authorities are responsible for the organisation and / or financing of hospitals and are therefore concerned by a directive on the application of patients rights in cross-border healthcare. 2. We understand that the European Commission basis its initiative on the fact that several rulings of the European Court of Justice on individual cases necessitates clarification and a common legal framework. 3. Since the Commission s first intention to include provisions on the application of freedoms to receive and provide health services in the directive on services in the internal market in 2004, was not accepted by the European Parliament and the Council, the Commission prepared this specific directive for a Community framework for cross-border healthcare. 4. The proposal especially concerns cross-border healthcare for planned treatment and hospital and specialised care. 5. The draft directive does not address healthcare, which becomes necessary on medical grounds during a temporary stay of insured persons in another Member State. This is covered by Regulation (EC) 1408/71 on the application of social security schemes to employed persons and their families moving within the European Union. 6. CEMR welcomes a European framework on cross-border healthcare and the clarification of patients rights whose main objective is to provide legal certainty for those patients that receive treatment in another Member State, provided that certain conditions, which we express in this position paper, are met. 7. Organising and financing health infrastructure, especially hospital and special care as targeted with the directive, includes long-term planning and investment and therefore these services cannot be considered as ordinary market services. 8. We believe that the main objective of a European framework should not be the unconditioned free movement of patients to seek treatment in another country than their own and their free choice of a healthcare provider. This could have a negative impact on the health infrastructure of the countries concerned. 9. The Commission aims with this proposal at providing a general framework for the provision of safe, high quality and efficient cross-border healthcare. However, we believe that the draft directive goes beyond this target and implicitly follows the idea of creating a market for hospital and special care. 10. CEMR does not agree with this approach, which could be an incentive for Member States to reduce their investment in healthcare services, including hospital and specialised care for their citizens on their territory. 11. We wish to stress that the directive must respect the principle of subsidiarity and the repartition of the competencies between the European Union and the Member States in the field of healthcare. 18

21 CEMR comments on specific provisions Legal basis (recital 2; article 1) 12. The European Commission bases the draft directive on article 95 of the EC Treaty and thus chooses the establishment and functioning of the internal market as its main objective (recital 2). 13. The directive aims at establishing a general framework for the provision of safe, high quality and efficient cross-border healthcare (article 1). 14. CEMR questions article 95 of the EC Treaty being the right legal basis and would prefer the public health article (article 152 of the EC Treaty), which retains the Member States responsibility for a well functioning public healthcare system. A legal framework based on this article would better serve the objective of accessible, available and sustainable cross-border health services. 15. Article 152(2) of the EC Treaty states that the Member States should coordinate among themselves their policies concerning public health. The role of the European Union is to encourage and promote this coordination. Article 152(5) refers to the responsibility of the Member States: Community action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care ( ). 16. In line with the Treaty we want to stress that while a European directive should provide the legal framework, it has to respect the Member States competencies in this area. 17. CEMR would like to refer to the European Commission s Communication Services of general interest including social services of general interest: a new European commitment from 2007, which also includes healthcare. It points at article 152 EC Treaty and states the importance to respect the responsibility of the Member States: Health Services are also part of the wider framework of services of general interest. Article 152 of the Treaty makes clear that Community action in the field of health services must respect the responsibility of the Member States for the organisation and delivery of health services and medical care. Responsibilities of the Member State of treatment (article 5) 18. CEMR agrees with the Commission that in the case of cross-border healthcare the Member State of treatment should be responsible for the organisation and delivery of healthcare. However, we advocate for clearly indicating in the directive that healthcare is provided according to the legislation of the Member State of treatment. 19. The Commission s proposal also calls for Member States to assure the existence of systems of professional liability insurance. CEMR would be in favour of clearer provisions on liability and aftercare in the case of problems, with special regard to the responsibilities of the Member State of treatment. * 1 CEMR proposes to amend article 5(1) to clarify responsibilities of the Member State of treatment. 1 Paragraphs marked by * correspond to an amendment in the annex. 19

22 Reimbursement and prior authorisation for hospital and specialised care (articles 6 and 8) 20. The proposal of the European Commission signifies an unconditioned free movement of patients to seek treatment. CEMR believes that patients should in general be treated in the Member State of affiliation in proximity of their home and with timely treatment. However, there might be conditions under which patients seek treatment abroad. 21. The Commission s proposal states that the Member State of treatment will be reimbursed by the Member State of affiliation up to the level of costs in the Member State of affiliation, without exceeding the actual costs. However, there is no provision for cases where the costs of treatment would be higher than in the Member State of affiliation. This raises difficult problems of how to balance the budgetary interests of the Member State of affiliation with the financial interests of the provider in the Member State of treatment. 22. CEMR seeks clarification on this issue, aiming that the Member State of treatment gets compensation for the costs incurred, without imposing an unfair burden on the Member State of affiliation. An agreement could for example in many cases be made as a compulsory part of the prior authorisation, ensuring that the patient would cover the extra cost. 23. The Commission would allow Member States to establish a system of prior authorisation under certain conditions (e.g. where the application of the directive would be likely to undermine the financial balance of the social security system or the planning and organisation of hospital capacities). Member States would only be allowed to establish a system of prior authorisation that is proven necessary and proportionate, and only if their situation meets the conditions laid down in the directive. 24. CEMR advocates that Member States should be able to establish a general prior authorisation system for hospital and specialised care. This system would enable Member States and hospitals, to better plan and finance their services according to the needs of the patients respecting the sustainability of healthcare systems. It would also ensure patients and healthcare providers with a guarantee of reimbursement. * 25. Hospital and specialised care comprise a broad range of treatments and the definition of hospital and specialised care differ very much from one Member State to the other. Therefore, Member States should be able to establish a prior authorisation system for hospital and specialised care as defined by the Member State of affiliation. CEMR proposes to amend article 6(1) with regard to timely treatment, to add a new paragraph 6(6) to ensure the reimbursement of full costs and to amend article 8(3) to allow Member States to introduce a general system of prior authorisation for the reimbursement of the cost of hospital and specialised care provided in another Member State. Subsidiarity in the cooperation on healthcare (articles 12, 15,17) 26. CEMR supports the provision laid down in the proposed directive that Member States shall facilitate the cooperation in providing cross-border healthcare at regional and local levels. In line with this provision, we would like to stress the importance of consulting these levels during the transposition of the directive. 27. According to our understanding and with reference to the European Union s objective for better regulation, we advocate for a less prescriptive directive with less detailed 20

23 provisions. This would help to reduce bureaucracy and respect the responsibility of the Member States to organise healthcare, in line with article 152 of the EC Treaty. 28. The European Commission proposes that Member States designate national contact points to better inform patients. We wish to underline the importance for patients to obtain necessary information on their rights related to cross-border healthcare, but we would prefer fewer details on the content of the information that should be provided by the national contact points. In this context the role of the Commission should also be limited in the management of the national contact points leaving any necessary measures to the Member States. * 29. The draft directive defines objectives for European reference networks of healthcare providers such as sharing knowledge and providing quality and safety benchmarks. We believe that these networks might be very useful, but their objectives and the Commission s role should not be laid down in detail in the directive, but be provided as an annex or in the form of guidelines. * 30. CEMR agrees with the principle of cooperation on management of new health technologies, but we consider it unnecessary to lay down in detail the objective of a network. Again, we advocate for a provision of the objectives in an annex or as guidelines. * CEMR proposes to amend the following articles in order to have a less detailed directive respecting the principle of subsidiarity: article 12(2) on national contact points, article 12(3) on the European Commission s role regarding national contact points, article 15 on European reference networks article 17(2-4) on a health technology assessment network. * * * * 21

24 Annex CEMR proposal for amendments Document of reference: COM(2008) 414/3 Recital 10* 2 Text proposed by the Commission (10) For the purpose of this Directive, the concept of cross-border healthcare covers the following modes of supply of healthcare: - Use of healthcare abroad (i.e. a patient moving to a healthcare provider in another Member State for treatment); this is what is referred to as `patient mobility ; - Cross-border provision of healthcare (i.e. delivery of service from the territory of one Member State into the territory of another); such as telemedicine services, remote diagnosis and prescription, laboratory services; - Permanent presence of a healthcare provider (i.e.: establishment of a healthcare provider in another Member State); and, - Temporary presence of persons (i.e.: mobility of health professionals, for example moving temporarily to the Member State of the patient to provide services). Amendment (10) For the purpose of this Directive, the concept of cross-border healthcare covers the following modes of supply of healthcare: - Use of healthcare abroad (i.e. a patient moving to a healthcare provider in another Member State for treatment); this is what is referred to as `patient mobility ; - Cross-border provision of healthcare (i.e. delivery of service from the territory of one Member State into the territory of another); such as telemedicine services, remote diagnosis and prescription, laboratory services; Article 5 paragraph 1 1. The Member States of treatment shall be responsible for the organisation and the delivery of healthcare. In such a context and taking into account principles of universality, access to good quality care, equity and solidarity, they shall define clear quality and safety standards for healthcare provided on their territory, and ensure that: 1. The Member States of treatment shall be responsible for the organisation and the delivery of healthcare on their territory. In this context and taking into account principles of universality, access to good quality care, equity and solidarity, they shall define clear quality and safety standards and ensure that: Justification: Article 152 of the EC Treaty, the article for public health; paragraph 5 states that it is the competence of the Member States to organise and deliver the health services and medical care. Article 5 paragraph 1a d* (a) mechanisms are in place for ensuring that healthcare providers are able to meet such (a) when healthcare is provided in a Member State other than that where the patient is an 2 Amendments marked by * are taken from the report of the leading parliamentary committee ENVI (environment, public health and food safety), drafted by MEP John Bowis; CEMR supports these amendments. 22

25 standards, taking into account international medical science and generally recognised good medical practices; (b) the application of such standards by healthcare providers in practice is regularly monitored and corrective action is taken when appropriate standards are not met, taking into account progress in medical science and health technology; c) healthcare providers provide all relevant information to enable patients to make an informed choice, in particular on availability, prices and outcomes of the healthcare provided and details of their insurance cover or other means of personal or collective protection with regard to professional liability; (d) patients have a means of making complaints and are guaranteed remedies and compensation when they suffer harm arising from the healthcare they receive; insured person, or in a Member State other than where the healthcare provider resides, is registered or established, such healthcare is provided according to the legislation of the Member State of treatment. (b) healthcare referred to in paragraph 1 (a) is provided according to standards and guidelines on quality and safety defined by the Member State of treatment ensuring that: (i) patients and healthcare providers from other Member States can be provided with information on such standards and guidelines, including provisions on supervision, inter alia by electronic means; (ii) patients and healthcare providers from other Member States can be provided with information on availability, prices and outcomes of the healthcare provided and details of the healthcare provider s insurance cover or other means of personal or collective protection with regard to professional liability; (d) patients have the means of making complaints when they suffer harm arising from the healthcare they receive and are guaranteed remedies and the right to seek compensation; Article 5 - Paragraph 3* 3. In so far as it is necessary to facilitate the provision of cross-border healthcare and taking as a basis a high level of protection of health, the Commission, in cooperation with the Member States, shall develop guidelines to facilitate the implementation of paragraph In so far as it is necessary to facilitate the provision of cross-border healthcare and taking as a basis a high level of protection of health, the Commission, in cooperation with the Member States, may develop guidelines to facilitate the implementation of paragraph 1. 23

26 Article 6 paragraph 1 1. Subject to the provisions of this Directive, in particular Articles 7, 8 and 9, the Member State of affiliation shall ensure that insured persons travelling to another Member State with the purpose of receiving healthcare there or seeking to receive healthcare provided in another Member State, will not be prevented from receiving healthcare provided in another Member State where the treatment in question is among the benefits provided for by the legislation of the Member State of affiliation to which the insured person is entitled. The Member State of affiliation shall reimburse the costs to the insured person, which would have been paid for by its statutory social security system had the same or similar healthcare been provided in its territory. In any event, it is for the Member State of affiliation to determine the healthcare that is paid for regardless of where it is provided. 1. Subject to the provisions of this Directive, in particular Articles 7, 8 and 9, the Member State of affiliation shall ensure that insured persons travelling to another Member State with the purpose of receiving healthcare there or seeking to receive healthcare provided in another Member State, will not be prevented from receiving healthcare provided in another Member State. The treatment in question must be among the benefits provided for by the legislation of the Member State of affiliation to which the insured person is entitled. Finally, treatment should be conditional on the Member State of affiliation not being able to provide it in time. The Member State of affiliation shall reimburse the costs to the insured person, which would have been paid for by its statutory social security system had the same or similar healthcare been provided in its territory. In any event, it is for the Member State of affiliation to determine the healthcare that is paid for regardless of where it is provided. Article 8 paragraph 3 3. The Member State of affiliation may provide for a system of prior authorisation for reimbursement by its social security system of the cost of hospital care provided in another Member State where the following conditions are met: (a) had the healthcare been provided in its territory, it would have been assumed by the Member State's social security system; and (b) the purpose of the system is to address the consequent outflow of patients due to the implementation of the present Article and to prevent it from seriously undermining, or being likely to seriously undermine: (i) the financial balance of the Member State's social security system; and/or (ii) the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member State. 3. The Member State of affiliation has the possibility to provide for a general system of prior authorisation for reimbursement by its social security system of the cost of hospital and specialised care provided in another Member State. deleted deleted deleted deleted Justification: The provision on prior authorisation (paragraph 3) goes beyond the Commission s competence as referred to in Article 152 EC Treaty. At present, patient mobility across Member States accounts for only a tiny proportion of all patients in the healthcare system. Under the directive however, one would 24

27 expect patient mobility to increase, especially in border regions and for certain types of treatment such as elective surgery. We therefore recommend that a general system of prior authorisation for hospital treatment be set up giving Member States the possibility to control and plan their entire healthcare systems. Member States of treatment would thus be more likely to receive payment for the services they provided, since patients would have received prior authorisation for the treatment from the Member State of affiliation. Article 12 paragraph 2 2. The national contact point in the Member State affiliation shall, in close cooperation with other competent national authorities, and with national contact points in other Member States, in particular in the Member State of treatment, and with the Commission: (a) provide and disseminate information to patients in particular on their rights related to cross-border healthcare and the guarantees of quality and safety, protection of personal data, procedures for complaints and means of redress available for healthcare provided in another Member State, and on the terms and conditions applicable; 2. The national contact point in the Member State affiliation shall, in close cooperation with other competent national authorities, (a) provide and disseminate information to patients; on their rights related to cross-border healthcare Justification: It is important for patients to be able to obtain the necessary information on treatment options in other EU countries. The requirement for Member States to provide information, however, is very sweeping and would prove extremely difficult to implement in practice. Moreover, it is not clear what the Commission means with "legally binding as regards dispute settlement". The role and competences of national contact points should be more clearly defined. Article 15 paragraph Member States shall facilitate the development of the European reference networks of healthcare providers. Those networks shall at all times be open for new healthcare providers which might wish to join them, provided that such healthcare providers fulfill all the required conditions and criteria. 2. The objective of European reference networks shall be: (a) to help to realise the potential of European cooperation regarding highly specialised healthcare for patients and for healthcare systems from innovations in medical science and health technologies (b) to help to promote access to high quality and cost-effective healthcare for all patients with a medical condition requiring a particular concentration of resources or expertise. (c) to maximise cost-effective use of resources by concentrating them where appropriate; (d) to help to share knowledge and provide training for health professionals; (e) to provide quality and safety benchmarks and to help develop and spread best practice within and outside the network; 1. The European Commission may support Member States in facilitating the development of the European reference networks of healthcare providers. deleted deleted deleted deleted deleted deleted 25

28 (f) to help Member States with an insufficient deleted number of patients with a particular medical condition or lacking technology or expertise to provide a full range of highly specialised services of the highest quality. 3. The Commission shall adopt: deleted (a) a list of specific criteria and conditions that the deleted European reference networks must fulfil, including the conditions and criteria required from healthcare providers wishing to join the European reference networks, in order to ensure, in particular, that the European reference networks: (i) have appropriate capacities to diagnose, to follow-up and manage patients with evidence of good outcomes so far as applicable; (ii) have sufficient capacity and activity to provide relevant services and maintain quality of the services provided; (iii) have capacity to provide expert advice, diagnosis or confirmation of diagnosis, to produce and adhere to good practice guidelines and to implement outcome measures and quality control; (iv) can demonstrate a multi-disciplinary approach; (v) provide high level of expertise and experience documented through publications, grants or honorific positions, teaching and training activities; (vi) provide strong contribution to research; (vii) are involved in epidemiological surveillance, such as registries; (viii) have close links and collaboration with other expert centres and networks at national and international level and capacity to network; (ix) have close links and collaboration with patients associations where such associations exist. (b) the procedure for establishing European deleted reference networks. 4. The measures referred to in paragraph 3, deleted designed to amend non-essential elements of this Directive by supplementing it, shall be adopted in accordance with the regulatory procedure with scrutiny referred to in Article 19(3). Justification: European reference networks may be useful and might be further developed, but they should not be dealt with in a directive, but for example in guidelines or in an annex. Article 17 paragraph The objective of the health technology assessment network shall be: (a) to support cooperation between national authorities or bodies; (b) to support provision of objective, reliable, timely, transparent and transferable information deleted deleted deleted 26

29 on the short- and long-term effectiveness of health technologies and enable an effective exchange of this information between national authorities or bodies. 3. Member States shall designate the authorities or bodies participating in the network as referred to in paragraph 1 and communicate to the Commission names and contact details of those authorities or bodies. 4. The Commission shall, in accordance with the procedure referred to in Article 19(2), adopt the necessary measures for the establishment and the management of this network and specifying the nature and type of the information to be exchanged. deleted deleted Justification: We support cross-border cooperation and the cooperation with regard to health technology assessment, since this will create added value for Member States. However, it is not necessary to use a directive to regulate cooperation on highly specialised treatment and on the management of new health technology via a directive; this would create a legal obligation for Member States to cooperate. The provision is thus not considered to be amongst the objectives set out in Article 1. 27

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31 THE FUTURE OF THE TWINNING PROGRAMME STRATEGIC PAPER FOR CEMR TWINNING COORDINATORS CONCERNING THE FUTURE OF THE PROGRAMME AFTER annex During the consultation meeting held in Brussels on 16 December 2008, the European Commission outlined a certain number of issues relating to the current functioning of the twinning programme and proposed discussions to reflect upon strategic changes to be adopted in the second half of the current programming period ( ). The CEMR Secretariat has taken the initiative of compiling in this document the proposals made by the twinning officers of CEMR s national associations in view of sending them to the European Commission. The Secretaries General of CEMR, who will be meeting on 19 and 20 February 2009 in Prague, will need to debate this issue first. The present document will therefore be distributed on this occasion. As the European organisation promoting town-twinning, it is part of CEMR s mission to contribute relevant ideas and suggestions to adapt the programme to the needs and expectations of European citizens and current realities. In this context, we would like to recall that the twinning programme is an integral part of the Community Programme Europe for Citizens to be carried out during the period This set of reflections has been formulated in accordance with the framework proposed by the European Commission at the consultation meeting, namely: - Further increase and diversify the participation in the programme - Broaden the geographical coverage of the programme - Improve the quality of its programming, including its results and impacts - Strengthen the participation in the support measures - Encourage mobility through twinning We would also like to recall that half of the budget allocated to town-twinning (215 millions euros for the programming period , 45 millions euros of which are for 2008) is to be used for citizen exchanges. The other parts of the programme involve the organisation of conferences and seminars under the twinning framework or to the activities of the thematic networks of twinning towns.. The following points concern in particular the exchanges between citizens from twinned towns. 1. Participation in the Programme Diagnosis: The current implementation of the programme reveals a strong loyalty to the programme and a lack of renewal in terms of participants, which is harmful to the potential impact of the programme. According to the statistics of the Commission s Executive Agency, the programme too often funds the same municipalities, year after year, and there is a high proportion of the same participants promoting the action within the municipalities as well. The same statistics also show that a substantial number of participants scheduled to take part in the exchange end up cancelling their participation and that a significant number of planned activities are cancelled by the project leaders (between 12 and 15%), which leads to the budget set aside by the Commission for these activities not being used (a loss of around 33% each year). 29

32 Objective: The greatest number possible of people from municipalities benefitting from Community funds should participate in the action in order to guarantee the local impact of twinning. Likewise, the programme should benefit the highest number possible of municipalities in order to ensure the European dimension of the programme. Proposals from CEMR s twinning officers A. Encourage greater cooperation between the municipalities with associations and NGOs in order to expand the participation at local level B. Create synergies between the Twinning Programme and other Community programmes aimed at European citizens so as to facilitate the access of citizens of twinned towns to the European programmes which may be of interest for them in the different sectors (professional training, education, culture, etc.) C. Facilitate and promote the use of the programme for exchanges of best practices, training or for study trips for elected representatives, local civil servants staff or experts from a specific sector related to local affairs. In concrete terms: remove the current maximum ceiling currently set out for the participation of elected representatives, as they can play an important role to increase the impact of such actions locally D. Grant a bonus (during the selection process of the projects) to those applicants who take care to include a certain percentage of newcomers in the action E. Encourage the opening up and the publicising of a twinned town s action amongst neighbouring towns to increase the impact and the attractiveness of the twinning project F. Allow and encourage the organisation of an activity outside of the city hosting the twinning exchange, namely giving the project holders the possibility of organising study trips to the European Institutions (in Brussels/Strasbourg) or to other European Union agencies G. The Commission should request that project holders demonstrate the added value of a twinning project for each of the participants as well as highlight the value of their participation in order to discourage them from cancelling (e.g.: involve people exercising the same professions from both cities in order to increase the usefulness, commitment and sustainability of the twinning exchange) H. CEMR recognises the positive impact of the new programme initiative to grant a bonus to the project holders who apply for the first time I. The national associations of CEMR can help publicise these new programme options through all the different means of communication at their disposal 2. Geographical coverage Diagnosis: The figures of the European Commission (table attached in the annex) show the breakdown of participation in the programme by country. It can be seen that, currently, five countries use 80% of the twinning programme funds: Germany, France, Italy, Poland and Hungary 30

33 Objective: The programme should benefit all the countries of the European Union more proportionally. Proposals from CEMR s twinning officers A. Create categories of countries according to their level of participation in the programme (e.g.: high, medium and low) and encourage each project holder to involve the participation of countries belonging to different categories in the action B. Grant a bonus (during the selection process of the projects) for actions involving countries located far away from each other or requiring long travel times (e.g.: islands, etc.). C. Promote the publicising and use of Twinning best practices amongst nearby towns or countries that are not participating in the programme. D. Encourage project holders to invite observers from neighbouring towns (which do not not have a twinning link yet) to raise the interest of potential newcomers for their twinning action or for the twinning programme itself. E. Make the twinning agreement between towns more flexible: grant eligibility to shortterm partnerships (under the condition that the agreement is official); the twinning partnership can consist of a one-off project or event (under the condition that it is intended for citizens); these partnerships can then be evaluated after, for example, three to five years. F. Grant a bonus for interpreting costs when there is a language barrier. G. The national associations of CEMR have a major role to play in promoting the programme in their own country though the different channels of communication at their disposal 3. Quality / Results and impact of the actions Diagnosis: Around 2000 projects are filed each year, but only a very limited number of them are the focus of an evaluation or a follow-up study to determine their impact. The final reports sent to the European Commission by the project holders widely vary and are sometimes insufficient for the purposes of evaluating their true added European value of the project Objective: The programme should support quality twinning actions, which have a strong impact and which make it possible for the citizens to experience the European Union and appreciate its role and its importance. For each citizen, the twinning exchange should come across as an experience of intercultural dialogue, of active citizen participation and of European citizenship. Proposals from CEMR s twinning officers A. We consider that proposal A in section 1 (cooperation with civil society organisations) also has an impact on quality. B. We consider that proposal B in section 1 (synergies with other community programmes) undoubtedly has an important impact on the quality of the actions and their actual results. C. We consider that proposal C in section 1 (participation of elected representatives and municipal civil servants) has a significant impact on the content of the programme and on the projects which can be supported in this regard 31

34 D. Encourage municipalities to plan their twinning project from a long-term political perspective (any concrete methods used to this end could be rewarded during the selection process of the projects) E. We consider that proposal F in section 1 (study trips) contributes to giving a valuable innovation to the content of the programme. F. We consider that proposal G in section 1 (added value for each participant) is very important in being able to ensure a better quality of the projects as it obliges the project leaders to better prepare their actions, and to commit more strongly to the implementation of the actions in accordance with what was submitted to the European Commission. This proposal also aims to ensure that the actions have a more lasting impact G. Encourage the project leaders to use the twinning programme as a test or starting point for a town s participation in community programmes. CEMR can in this context play an important catalyst role vis-à-vis its members. Similarly, the Commission should ensure greater co-ordination of roles between CEMR s twinning officers and the programme s Information Points which were established in each country with a view to facilitating public access to information. Provisions should be made to keep the citizens of twinned towns informed about the different European programmes available to them and thus respond to their questions regarding the different opportunities offered by the European Union. This system would undoubtedly contribute to showing citizens the added value of town-twinning H. The projects submitted under the framework of citizens exchanges should, as is the case for all actions funded by the twinning programme, include a part dedicated to observations or, a discussion of a European issue or one that is analysed from a European perspective I. The study trips proposed under point F in section 1 should always plan for the participation of one or several members of the European Institutions or organizations in order to ensure familiarity or analysis of a European topic or with a European perspective. Moreover, with regard to all other actions of exchange, even at local level, the presence of a speaker/european expert in the project s programme will result in the grant of a bonus during the selection phase of the projects J. A fact sheet should be disseminated to the project holders to encourage them to report on their activities and results and therefore better highlighting their value. These reports could be gathered on a yearly basis in a catalogue classified by country, which could be very useful for the dissemination of best practices (this fact sheet could be available to the project holder through CEMR s twinning officers and/or through the twinning.org website and/or by the European Commission as an annex to the final report) K. In addition to the fact sheet, an evaluation form should be distributed so that the project holders and the participants can demonstrate the added- European value of their twinning project (this evaluation form could be annexed to the final report ) L. The project holders can be encouraged to share the content of the actions and their results (e.g. through the Internet); this could positively impact on the continuity, the follow-up and the lasting effect of the action M. The national associations of CEMR will have a major role to play in bettering the quality of the projects as well as in publicising/highlighting the results of the actions and their impact at national level. The national associations could work in collaboration with the Info-points set up in each country to communicate the results and impacts of the projects and of the Twinning programme at national level. 32

35 4. Support measures Diagnosis: With regard to the Twinning programme, the European Commission took the initiative, in 2008, to dedicate part of the programme to support measures. Support measures should help improve the quality and the content of the programme. CEMR s national associations will be able to benefit from this support to strengthen their capacities in the twinning sector. They carry out actions to provide information and training relating to the twinning programme as well as more specific activities which are important for the content and the follow-up of the programme. The national associations often do not have the means necessary to carry out effective work. Yet, only a limited number of associations benefited from this new measure set up by the European Commission in 2008 (Belgium, Bulgaria, Latvia, Finland, France, Poland). Objective: The national associations of CEMR are encouraged to use this part of the programme to reinforce their capacities and consequently improve the quality of the programme and its impact though, for example, information or training sessions or providing of advice, sharing of best practices, European debates, etc. Proposals from CEMR s twinning officers A. The national associations of CEMR are behind many initiatives (some of which are already implemented by certain associations) such as: - organisation of information/training sessions - use of communication means to inform about and highlight certain initiatives - ensure an effective follow-up of the twinning actions and provide advice to the municipalities in this regard - ensure proper dissemination and use of the best practices - etc. B. Tthe twinning officers of CEMR can play a widert role in supporting the actions of the networks not only as far as their organisation and activities are concerned but also regarding local policy issues, which may be developed under the twinning framework, and to which the CEMR Associations can give input on the content (e.g., environment, social inclusion, transport, gender equality, etc.). In fact, the European Commission encourages twinned towns to work in networks on specific issues 5. Mobility Diagnosis: Mobility is not itself an objective of the Twinning programme but can be an important aspect according to its impact to the extent that twinning can encourage the mobility of citizens in Europe. An important link exists between mobility and twinning, but it is not currently used as an impetus or emphasised enough. Objective: Twinning is an important means to encourage mobility of citizens. In this regard, twinning can be an effective tool in reinforcing the feeling of belonging to the European Union and of contributing to the implementation of the Lisbon Agenda concerning employment and competitiveness in Europe. 33

36 Proposals from CEMR s twinning officers A. Proposal B in section 1 (synergies with other community programmes) encourages citizens mobility B. Proposal F in section 3 (encouragement of participation in the programme) also aims to support mobility of European citizens C. The European Commission should establish a concrete and effective link between the twinning programme and the e-twinning programme, which fosters exchanges between schools (students and teachers) D. The National Associations and Secretariat of CEMR will have a major role to play in better informing citizens on this issue (e.g., through the website twinning.org). Annex (see below): Town twinning figures Geographical coverage Sources: 1. =PORTAL

37 From the host countries' perspective Country CM selected Nr of municipalities/country (2006)¹ see source ratio Participants Million Inhabitants/country (2007)² see source AT ,51% ,3 715 BE ,21% ,6 171 BG ,52% 454 7,7 59 CY ,00% 0 0,8 0 CZ ,18% ,3 314 DE ,75% , DK ,02% 200 5,4 37 EE ,20% , ES ,26% ,5 224 FI ,46% 102 5,3 19 FR ,70% , GR ,48% ,2 21 HU ,74% , IE ,51% 267 4,3 62 IT ,10% ,1 900 LT ,00% ,4 366 LU ,00% 0 0,5 0 LV ,57% ,3 813 MT ,82% , NL ,13% ,4 29 PL ,27% , PT ,95% ,6 46 RO ,60% ,6 498 SE ,38% 220 9,1 24 SI ,48% 27 2,0 14 SK ,17% 925 5,4 171 UK ,29% ,8 101 Total ,98% , From the participating countries' perspective Countries Municipalities participating as invited towns/country Number of municipalities/country (2006)¹ ratio Mobility (number of travelling participants )/co untry million inhabitants/country (2007)² ratio (mobile participants per million inhabitants) AT ,15% 933 8,3 112 BE ,62% ,6 146 BG ,06% 447 7,7 58 CY ,79% 104 0,8 130 CZ ,80% ,3 139 D ,01% ,3 182 DK ,18% 242 5,4 45 EE ,05% 225 1,3 173 ES ,99% ,5 72 FI ,33% 351 5,3 66 FR ,90% ,4 243 GR ,45% ,2 32 HU ,69% ,1 424 IRL ,42% 695 4,3 162 IT ,46% ,1 125 LET ,61% 365 2,3 159 LIT ,00% 580 3,4 171 LU ,59% 36 0,5 72 MT ,82% 136 0,4 340 NL ,32% ,4 53 PL ,03% ,1 162 PT ,52% ,6 53 RO ,97% ,6 159 SE ,59% ,1 130 SK ,94% ,4 447 SLO ,19% UK ,65% ,8 57 Total ,12% , ratio

38 36

39 19 annex COUNCIL OF EUROPEAN MUNICIPALITIES AND REGIONS EUROPEAN SECTION OF UNITED CITIES AND LOCAL GOVERNMENTS EUROPEAN CHARTER FOR EQUALITY OF WOMEN AND MEN IN LOCAL LIFE Draft Guide to Producing an Equality Action Plan INTRODUCTION This Guide will help signatories to the Charter to identify practical and realisable actions which they can take to make a real difference to the equality of women and men in their local area. It has drawn on the experiences and comments of the national associations of local and regional authorities members of CEMR. The Guide can be used as a tool to elaborate your action plan and monitor change over time. CEMR recognises that signatories have different competencies, resources and priorities but also that the Charter gives all local and regional authorities the opportunity to make a real difference to the lives of women and men. It is understandable that it is difficult for signatories to implement the whole Charter. Therefore it is better to have a smaller number of clear but achievable objectives than a large number that do not lead to any change. STEP 1 Understanding the gender equality issues for your local / regional authority This is a vital initial stage which allows the signatory to look at a wide range of information to gain a better understanding of the gender equality issues which arise in relation to the whole range of its competences and activities. Information To help you to understand the current situation regarding equality for your authority, and also to identify where there are gaps in your information which need to be filled: Look at the existing information you have which is broken down on a gender basis under the headings in the Charter and identify relevant information. For example: - The General Framework: social and demographic information for the local area - The political role: number of women/men elected; women/men holding office (deputy mayors, members of executives etc.) - The employer role: number of women/men employed in different roles ; pay of women/men; number of complaints of sexual harassment - The service delivery role: number of women/men using specific services; number of women/men satisfied with services provided; resources allocated to women/men s activities e.g. sport/health promotion - Planning and sustainable development: users of public transport by gender; women/men in poverty 37