Conference Report (English)

High Quality Education andLabour – The future of the Baltic Sea Region25th Baltic Sea ParliamentaryConferenceBaltic Sea Parliamentary Conference25High Quality Educationand Labour – The future of the Baltic Sea Region25th Baltic Sea ParliamentaryConferenceRiga, Latvia28 – 30 August 20162High Quality Education and Labour –The future of the Baltic Sea Region25th Baltic Sea Parliamentary Conference© Baltic Sea Parliamentary Conference, 2016T ext: Kim KleineEditing: Bodo BahrLayout: produktionsbüro TINUSPhotos: Reinis Inkens, Ernests DinkaBaltic Sea Parliamentary Conferencewww.bspc.netBodo BahrHead of the BSPC Secretariatbodo.bahr@bspcmail.netBSPC Secretariatc/o Lennéstraße 119053 SchwerinGermanyPhone (+49) 171 5512557The Baltic Sea Parliamentary Conference (BSPC) was established in 1991 as a forum for political dialogue between parliamentarians from the Baltic Sea Region. BSPC aims at raising aware-ness and opinion on issues of current political interest and relevance for the Baltic Sea Region.It promotes and drives various initiatives and efforts to support a sustainable environmental, social and economic development of the Baltic Sea Region. It strives at enhancing the visibility of the Baltic Sea Region and its issues in a wider European context.BSPC gathers parliamentarians from 11national parliaments, 11 regional parliaments and 5 parliamentary organizations around the Baltic Sea. The BSPC thus constitutes a unique parliamentary bridge between all the EU- and non-EU countries of the Baltic Sea Region.BSPC external interfaces include parlia-mentary, governmental, sub-regional and other organizations in the Baltic Sea Region and the Northern Dimension area, among them CBSS, HELCOM, the Northern Dimension Partnership in Health and Social Well-Being (NDPHS), the Baltic Sea Labour Forum (BSLF), the Baltic Sea States Sub-re-gional Cooperation (BSSSC) and the Baltic Development Forum.BSPC shall initiate and guide politicalactivities in the region; support and strengthen democratic institutions in the par-ticipating states; improve dialogue between governments, parliaments and civil society; strengthen the common identity of the Baltic Sea Region by means of close co-operation between national and regional parliaments on the basis of equality; and initiate and guide political activities in the Baltic Sea Region, endowing them with additional democratic legitimacy and parliamentary authority.The political recommendations of theannual Parliamentary Conferences are expressed in a Conference Resolution adopted by consensus by the Conference. The adopted Resolution shall be submitted to the governments of the Baltic Sea Region, the CBSS and the EU, and disseminated to other relevant national, regional and local stake-holders in the Baltic Sea Region and its neighbourhood.3INTRODUCTIONLadies and Gentlemen,I had the pleasure and honourto host the 25th Baltic Sea Par-liamentary Conference (BSPC) in Riga, a metr opolisthat blends timeless traditions and vibrant modernity. The newly opened building of the University of Latvia – Aca -demic Centre of Natural Sciences – right in the city cen -tre, was an appropriate setting for the confer ence whose aimwas to discuss and pass a reso -lution on developing the Baltic Sea Region (BSR) as a rolemodel for future high quality education and labour.The Baltic Sea Region is a dynamic, innovative and competitive partof Europe. However, we cannot achieve much in our development without high quality education and modern labour market. There -fore, the Baltic Sea Parliamentary Conference has underlined the necessity to define high quality education and equal access to thelabour market as the main priorities. The integration of research,higher education and industry should be a priority of the BSR par -liaments’ efforts. Therefore, this year’s conference focused on improv-ing labour mobility and combating youth unemployment.The 25th BSPC gathered more than 200 politicians, experts and rep -resentatives of partner organisations. The BSPC is thus the leadingannual ar ena for political exchange and debate among parliamentar -ians from the BSR. The BSPC resolution is the main tool for announcing the BSPC calls for action to the go vernments of theRegion. I could not be happier that every year more and more gov -ernments respond to the implementation survey and the number of implemented r ecommendations is growing. Therefore, for the firsttime this report includes, according to the decision of the BSPC Standing Committee in Liepāja, the feedback of the BSR govern -ments about the implementation of the 24th Baltic Sea ParliamentaryConference in Rostock.4The Silver Jubilee of the BSPC recalls that it was 25 years ago, in Jan -uary 1991, at a time of fundamental political change when Mr KaleviSorsa, then Speaker of the Finnish parliament, opened the first BalticSea Parliamentary Conference and laid the foundation for parlia -mentary cooperation among all the Baltic Sea States. Since then, cooperation in the B altic Sea Region has become much more intenseand has developed positively at all levels. In the current period, coop -eration at the parliamentary level across the entire Baltic Sea Region is ofparamount importance, as it is based on long-standing cooper-ation and established structures. The 25th BSPC is the link in thechain of our fruitful cooperation.Therefore, I would like to thank all the speakers and participantswho have contributed to the great success of the conference. I thank H.E. Mr Raimonds Vējonis, President of the Republic of Latvia, for his warm welcome given to the conference participants; H.E. Ms Ināra Mūrniece, Speaker of the Saeima of the Republic of Latvia, for greeting all participants on behalf of the Latvian parliament; as well as Mr Valdis Dombrovskis, Vice-President of the European Com -mission, for his informative speech.I also thank the administration of the Latvian parliament for thesmooth preparation and hosting of the conference. Special thanksgoes to Ms Ingrida Sticenko for her supreme efforts during the entirePresidency. Finally, let me express my gratitude to Mr Bodo Bahr, BSPC Secretary General, for his profound expertise and engagement as well as for his close and excellent cooperation.Entrusting the BSPC Presidency to Ms Carola Veit, President of theBSPC in 2016–2017,I wish her a lot of success and satisfaction. I very much look forwardto our future encounters and the 26th BSPC in Hamburg.Prof. Dr Jānis VucānsPresident of the Baltic Sea Parliamentary Conferencein 2015–20165 ContentsContentsOpening of the 25th BSPC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Session oneCooperation in the Baltic Sea Region. . . . . . . . . . . . . . . . . . . . 13Session two How to develop competitiveness in the Baltic Sea Region by linking education and the labour market. . . . . . . . . . . . . . . 33Ceremonial Session in honour of the 25th anniversary of the BSPC:yesterday, today and tomorrow. . . . . . . . . . . . . . . . . . . . . . . . . 47Session three Realising employment opportunities: Improving l abour mobility and combating youth unemployment. . . . . . . . 55Contributions by the BSPC Working Group and Rapporteurs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Closing of the 25th BSPC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69AnnexesAnnex I – Resolution of the BSPC . . . . . . . . . . . . . . . . . . . . . . 73Annex II – Programme. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102Annex III – List of Attendees. . . . . . . . . . . . . . . . . . . . . . . . . 108Annex IV – Feedback. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1206Opening of the Conference7 Opening of the ConferenceOpening of the 25th BSPCDr Jānis VucānsPresident of the BSPC“Introductory remarks”The president of the BSPC found himself to be truly honoured todeclare the 25th Conference of the BSPC open and welcomed par-ticipants and guest to Latvia. He then extended an especially warm welcome to Mr Vējonis, the President of the Republic of Latvia, Ms Mūrniece, Speaker of the Saeima, and to Mr Dombrovskis, Vice-president of the European Commission. He then surrendered the floor to Mr Vējonis for his welcome address.8Opening of the ConferenceH.E. Mr Raimonds VējonisPresident of the Republic of Latvia“Welcome address”The president commemorated the events that took place 25 yearsago, which had led to the freedom and independence of the Baltic States. For more than a decade, the Baltic States had been full-fledged members of the EU and NATO, during which the states had worked hard to regain economic stability and security. This had led to strong ties with especially the Nordic States, and proved fer-tile ground to develop into one of the most dynamic, IT and inno-vation driven regions in the world.Current international tensions had led to the announcement ofdeployment of multinational battalions in Latvia, Lithuania, Esto-nia and Poland by NATO, in Warsaw this summer. Mr Vējonis reit-erated that this was in full compliance with international law and commitments, and called upon Russia to uphold its international commitments in turn. He then stressed the importance of regional cooperation and communication as a pathway to end a difficult security situation.The President argued that further development of Latvia would notbe possible without high quality education and equal access to the labour market, and considered them crucial for the future of the region. He was delighted to see that the newer generations preferred entrepreneurship over leaving the country in search for employ-ment elsewhere. Supporting them in this was crucial, the president concluded.9Opening of the ConferenceHe finally remarked that sustainable tourism was a promising eco-nomic area, and that cross-border cooperation would not only develop it further, but ensure that it would be done in an environ-mentally friendly way.He concluded by wishing the attendees a successful conference.H.E. Ms Ināra MūrnieceSpeaker of the Saeima of the Republic of LatviaAfter welcoming the attendees, Ms Mūrniece pointed out the sym-bolism of the meeting place: The University of Latvia Academic Centre of Natural Sciences. A place where quality education was the lynch pin of everything and where future competitiveness and pros-perity were already being fostered.She then took stock of 25 years of Baltic cooperation, and con-cluded that the region, with its open economies, was at its strongest when it worked together in peaceful cooperation. She referred to the words of Uffe Ellemann-Jensen, who described the purpose of forming the BSPC 25 years ago as a “peaceful return to freedom and prosperity around the Baltic Sea”.Ms Mūrniece admired the achievements of the BSPC and describedthe successes in boosting competitiveness, improving the ecological state and maritime safety and combatting human trafficking. She continued that if the BSPC hoped to continue its message of peace in turbulent times, it should aspire to build bridges and tear down10 Session onewalls. She regarded the continuation of the dialogue on democraticvalues especially important, and pointed to Estonia, Latvia and Lithuania as prime examples, as they represented the first three ranks on the Freedom House indicator list for democratic develop-ment amongst the post-communist nations.11Opening of the ConferenceParliaments covered and defended a large spectrum of political,civil, economic and social rights in their work, and in doing so, became more and more active on the international level. Ms Mūrniece valued the joining of efforts in defence of an international rules-based order, and called upon the Baltic Sea Region to con-tinue its good and peaceful neighbourliness.12 Session one13 Session oneSession oneCooperation in theBaltic Sea RegionDr Jānis Vucāns –President of the Baltic Sea Parliamentary Conference“Report from the President”During the year of Latvia’s presidency of the BSPC, three issues struckthe outgoing President, Mr Jānis Vucāns: The BSPC had a very clear thematic focus and was guided in its work by expert opinions; The members of the Standing Committee had travelled to Minsk in April to discuss common issues with the National Assembly of the Repub-lic of Belarus; and the BSPC had revised the way in which it had approached the respective governments, leading to a more compre-hensive response to the 24th BSPC resolution than ever before.The first Standing Committee meeting under the Latvian Chairman-ship had taken place in Riga. Here, the Parliamentary Secretary of the Latvian Ministry of Education, Mr Edvards Smiltēns had spoken about the priorities of the ministry regarding education, especially concerning vocational training as part of the innovation system. The country deemed the enhancement of creativity and entrepreneurship to be the goal of higher education, and thereby boosting the national and global labour market. The President of the Latvian Chamber of Commerce and Industry had argued that the Baltic Sea Region should position itself as a global hub for education and innovation.The winter meeting was held in Brussels, as per tradition. Here, theissue of labour mobility was discussed. The EU Commission’s 2016 Work Programme would include a labour mobility package, which would contain proposals for a targeted revision of the Posting of Workers Directive, as well as the revision of the social security coordi-nation rules. The aim was to deliver a balanced approach to labour mobility, combining the protection of mobile workers and the fight against social security abuse. At the end of July, after a re-consider-ation and discussion with the national parliaments, the Commission had agreed to a re-examining its proposal for a revision of the direc-14 Session onetive, and concluded that such a matter did not constitute a breach ofthe subsidiarity principle. The winter meeting had furthermore been a productive ground for liaising with BSPC partners, such as the CBSS.The final meeting had been held in Liepaja, where Ilya Ermakov ofthe CBSS Secretariat had provided the Committee with information about the Baltic Sea Labour Forum and the activities of the CBSS. Dr Uwe Sassenberg had informed the Committee about the Baltic T ram Project, which was a cooperative venture involving leading universi-ties, research centres and regional development partners in the Baltic Sea Region to turn scientific discoveries into innovations more effec-tively.A thread throughout these meetings had been the continuing andgrowing concern for the state of the refugee crisis in the member states, and Mr Vucāns expressed himself hopeful that the members would find inspiration in each other’s solutions.The President of the BSPC then continued informing the memberstates about the progress of the newly formed Working Group on Sustainable Tourism. It had had three meetings so far, which had resulted in a promising Midway Report. The President expressed himself happy with the efficiency and progress.The topic of terrorism had been in an increasingly bright spotlightunder the Latvian Presidency. Mr Vucāns underlined the need to both defend the member states’ security and their fundamental val-ues. He declared it of fundamental importance to condemn terrorism in all its forms; to deplore the loss of innocent lives and express soli-darity with victims and their families; and to express the need to jointly combat the major threat against any of the member states soci-eties in the 25th BSPC resolution.Finally, the President of the BSPC informed the member states that the Belarussian National Assembly had requested observer status for the BSPC. The Standing Committee had had thorough exchanges on the matter and had been briefed by the Chair of the European Parlia-ment’s Delegation for Relations with Belarus. A working visit to Minsk had been organised, where both members of the government and the opposition were heard. This had led to the issuing of an invi-tation to representatives of the Belarus Government to join the 25thBaltic Sea Parliamentary Conference. The discussion on the observer status of Belarus was still ongoing, bearing in mind the outcome of the upcoming parliamentary elections in Belarus.15 Session oneValdis Dombrovskis –Vice-President of the European CommissionMr Dombrovskis called the foundation of the BSPC 25 years ago apremonition of the growing importance of national parliaments, par-liamentary dialogue having been one of the most democratic ways of strengthening ties between countries. He complemented the Region on being one of the major generators of economic activity, and for being a benchmark for other countries on many fronts.He then turned toward the global and regional economic situation.Growth had been slow and varied among different regions of the globe. Europe had benefited from a combination of favourable factors, such as low euro exchange rate, which were in turn partially offset by geopolitical tensions and security issues. The EU economy was fore-cast to grow by 1.8% this year, and the Eurozone at 1.6%. Over the past years, the Commissioner explained, the Baltic States had been frontrunners in growth, but the loss of Russian markets had hampered their continued success. Regardless, the Baltic States had quickly found other export opportunities.He reminded the attendees that the aggression surrounding theUkraine conflict had no place in 21st century Europe. He also remarkedthat, like most surrounding countries; the Baltic States had had to deal with struggles such as an ageing population and a shrinking work-force. He urged to face these challenges by increasing rather than decreasing the momentum on reforms.In order to boost this development, the European Commission hadput investment at the core of its agenda. Using the €315 billion Euro-16 Session onepean Fund for Strategic Investment, a large myriad of projects couldbe funded, from education to energy and from innovation to trans-port.The EU Strategy for the Baltic Sea Region had been the first of itskind, with social and economic development at its centre and with a strong environmental dimension. In order to achieve its goal of improving the lives of its citizens, an investment would have to be made in the economy and human capital. The Commissioner then invited the members of parliament present to ensure that the Com-missions New Skills Agenda was energetically followed up in their respective countries, in order to boost employability, competitiveness and growth.With one in five European adults having difficulties with reading andwriting, and even more with poor numeracy skills, a risk existed for unemployment, poverty and social exclusion. On the other hand, the continent dealt with an increasing number of people stuck in a job that did not match their talent. Employers complained they could not find workers with the right skills. This formed a large barrier to invest-ment. The New Skills Agenda would focus on developing basic and higher skills and making it easier to use and understand qualifications earned inside and outside the classroom.First, it strived to improve skills levels, giving everyone the literacy,numeracy and digital skills needed to succeed at work and in life. Sec-ond pathways had to be created for those who fell through the net. Secondly, it was key to make vocational education and training a first choice option, not a fall-back in case one could not go to university. Thirdly, allowing people to use their skills by making these skills visible and understood would be key to success. In order to achieve this, the EU would have to reinforce cooperation in comparing and recognis-ing qualifications.Finally, the Commissioner supported further regional integration bymajor interregional projects. He stressed that funds, available in for instance INTERREG and the CEF , could and should be used to carry out regional projects.Mr Dombrovskis concluded by wishing the Parliamentary Conferencegood luck in its future endeavours.17 Session oneQuestions and Answersfor Mr DombrovskisMr Veiko Spolītis: Mr Spolītis commented that Mr Dombrovskiswas known in Latvia for speaking his mind quite bluntly, which didnot always gain the appreciation of the voters. He asked the Com-missioner about his vision on the reforms in the higher education sector. In order to compete with regions such as China and Singa-pore, Europe would have to have both the best higher education and the vocational education. He then asked if the Commission supported the vision that the stronger universities would have to survive, and the weaker would have to merge with the surviving, stronger schools?Answer from Mr Dombrovskis: Mr Dombrovskis answered that themain focus was not on the educational system itself, but rather on the link between education systems and the labour market. The output of the educational system had to be in line with the require-ment of the labour market. On the job training and a dual educa-tion system were of great interest, and BSPC member states such as Germany could provide a good example. Studies which were inte-grated in practical experience had great success rates. He finally reit-erated that second chance pathways were important for those who fall through the net.Mr Franz Thönnes: Mr Thönnes remarked that since 2009, theBSPC had received strong support from the EU to support the Bal-tic Sea Labour Network. The aim of the project had been to estab-lish a political body of unions, employer organisations and the political sphere. It was a unique body, with high attractiveness and over 30 representatives from the unions and employer organisa-tions. However, the EU had since changed the criteria for eligibility. He asked Mr Dombrovskis if he saw any opportunities for promot-ing this work, especially in the field of labour mobility, youth unem-ployment and fair labour conditions.Answer from Mr Dombrovskis: Mr Dombrovskis agreed that it wasan interesting initiative, and although he was not personally con-nected to the development of the EU budget, he would keep the issue in mind. He would raise the attention of his colleagues in the Commission to this topic.18 Session oneMr Michal CzyzOutgoing CBSS Chair,Committee of Senior Officials, Ambassador of P olandThe CBSS and the Baltic Sea Area were being confronted with the big-gest challenges since the end of the Cold War, some of them internal, the others external, Mr Czyz warned his audience. More important than ever, the CBSS would have to recall and confirm its core responsibilitiesof stability, prosperity and multilateral intergovernmental coopera-tion. A failure to do so would lead to a diminishing level of trust and confidence in the region, which would result in the CBSS no longer being able to perform its statutory duties adequately.As such, securing and consolidating a high level of cooperation hadbeen a high priority during the Polish presidency. Within the frame-work of long-term priorities of the CBSS, the Polish presidency had outlined Sustainability, Creativity and Safety as key priorities for their Chairmanship.In the area of sustainability, the CBSS had worked on a new agendafor sustainable development, encompassing a variety of fields including climate change and regional implementation of the UN Agenda 2030 and its sustainable development goals. Many activi-ties had covered this great variety of topics, including the first ever meeting of CBSS ministers of science on June 16 in Krakow, the 8thBaltic Sea Tourism forum with ministerial level participation on September 22-23 in Malbork and the adoption of the Declaration 2030 on the political level.Establishing culture as a driving force for social and economicdevelopment in the region had been a key priority for the Polish Presidency, Mr Czyz explained. This part of the Presidency had already been launched the year prior with a ministerial session on culture in Gdansk, followed by a conference on culture as a tool for social and economic growth. The seminar on the potential of the computer gaming industry was named by the outgoing President as a highlight.19 Session onePoland had aimed to emphasise the importance of cooperation incivil protection as a measure to strengthen resilience against major emergencies and disasters in the Baltic Sea Region. Focus lay on the cooperation of civil protection services through improved interop-erability and environmental monitoring. In light of the current migration crisis, Mr Czyz found the CBSS well-positioned, since the already existing Task Force against T rafficking in Human Beings and the Expert Group on Children at Risk had already gained sig-nificant experience in their respective fields. The CBSS also played a significant role in the organisation of the Conference on cities and refugee flows by the Union of Baltic Cities in Rostock in March.The outgoing President then reminded the member states of theBSPC about the continued importance of funding, amongst other for the Project Support Facility. He then supported the existing pro-posal for the Baltic Sea Cooperation Fund. In light of enhanced synergy, cohesion and coordination, which the Polish Presidency deemed as excellent tools for achieving greater Baltic Sea coopera-tion, the Polish had set a good example by combining their two overlapping presidencies and coordinating meetings together. The debate on how to best build a “Common Space of Baltic Sea Coop-eration” and the internal reflection on the future of the CBSS were encouraged by Mr Czyz, as was a close cooperation with the Rus-sian Federation, for instance in the exchange and debate on the EU Strategy and the redesigned Strategy for the socio-economic devel-opment of the North-West Federal District.Finally, the outgoing President was heartened to see that the War-saw Declaration was adopted by the Deputy Ministers and believed it evidence that the CBSS member states were ready to uphold regional commitments, despite current challenges. He concluded by wishing the incoming Icelandic President the best of fortunes.Mr GuðmundurÁrni StefánssonCommittee of Senior Officials,Ambassador of IcelandThe incoming Chair of the CBSS pointed out that the EU as a whole and the Baltic Sea Region in specific faced a number of threats, which had20 Session oneto be dealt with, both with compassion and decisiveness.Ukraine was a source of instability, which was reflected in the surrounding political discourse. The number of refugees, never larger since World War II, was a challenge Europe was not pre -pared for. The additional problem of terrorism had to be faced with an open mind and a r esistance to hatred.Mr Stefánsson pointed out that Baltic Sea cooperation rose from the desire for liberty and optimism 25 years ago, a desire which had pulled in a large part of the continent. It was in this spirit that Iceland would approach its heading of the 25th anni-versary meeting. It would organise a ministerial meeting or a summit for the occasion.The focus of the Icelandic Presidency would lie on Children,Equality and Democracy.Democracy had been the founding ideal of the Council, and a continuation of its debate would be fruitful, for instance to explore new ways of including people and improve youth par -ticipation. Equality too had been a cornerstone of shared views within the CBSS member states. E limination of discriminationwould be submitted to further scrutiny, as well as gender equal -ity and women’s rights. Finally, a holistic approach would be applied to the rights of the child. The Icelandic Barnahus modelwas increasingly established in the region, as it promoted child-friendly and multidisciplinary mechanisms for preventing and responding to child abuse. Under this heading there would be special attention for unaccompanied minors amongst the refu -gees.Ms Dr ZandaKalnina-LukasevicaParliamentary Secretary of theMinistry of Foreign Affairs of LatviaThe parliamentary secretary con-gratulated the member states on the 25th anniversary of the BSPCand reminded them that since the restoration of its independence,21 Session oneLatvia had been actively involved in regional frameworks suchas the BSPC because it believed them crucial for unlocking development potential and sustainable growth in the region. She reminded that the members of the BSPC had managed to build one of the most intensive cooperation networks in Europe. The different regional frameworks had provided a structure for broad level discussion, such as during the Sixth Annual Forum of the European Union Strategy for the Baltic Sea Region, which Latvia had had the honour to host.Ms Kalnina-Lukasevica admired the productivity of the CBSSand expressed her support of the incoming Director General, Ms Mora, in achieving the long term goals of the CBSS. She also admired the ability of her Polish colleagues to combine two Presidencies in order to create more synergy.She then pointed out the valuable input of the CBSS in highereducation, with programmes such as “Bridge it” and “Baltic Lab”, which were supported by the organisation’s Project Sup -port Facility. It forced the member states to remind themselves about the v alue of high quality education, about the art ofteaching. It was designed to facilitate growth, to encourage the hunger for knowledge and the desire for excellence, but also to help people think for themselves.The secretary then continued that all member states were awareof the challenges the region was facing. The question was: what steps could be taken in order to ensure an open and secure region? The migration crisis could not be managed by the countries on their own. Border guards and other law enforce -ment agencies would have to cooperate closely to be successful in combatting human trafficking. The only answer to thesequestions was close cooperation and building trusted partner -ships. Ms. Kalnina-Lukasevica saw room for improvement and further development here. Close cooperation, however, wouldhave to rely on respect for human rights, freedom, democracy, self-determination and the rule of law.She concluded with a quote from George Bernhard-Shaw:“The people who get on in this world are the people who get up and look for the circumstances they want and if they can’t find them, make them themselves.”22 Session oneMs Carola VeitVice-President of the BSPCMs Veit sought to inform the mem-ber states about the implementa-tion of the 24th BSPC resolution.For years, the BSPC had made an effort to comprehensively analyse the implementation of past resolu-tions, in order to evaluate what had been successfully achieved and what would need more future attention. She lauded that the received feed-back from the respective governments had been increasingly com-prehensive.Nineteen parliamentary delegations had adopted the 24th resolutionthus far. However, the follow-up reports had varied in comprehen-siveness and thematic depth. Therefore, the Standing Committee had decided to send a joint letter, in order to achieve better compa-rability. Unfortunately, the responses had varied so significantly, that reliable conclusions about actions in certain policy areas could not be derived from them. They did, however, illustrate which pol-icy areas had been of most and least importance for the respective member states. It also illustrated the high variety of policy activities the member states had been active in.In total, the 24th BSPC resolution had listed 57 calls for action,most of them regarding health-related issues. Surprisingly, the clas-sic chapter on “Cooperation in the Baltic Sea Region” had received significantly less attention. For the governments, the most import-ant call had seemed to be paragraph 8, which had called for upgrad-ing the reception facilities for sewage in passenger ports. By far the most responses had been for four calls to action: early intervention to strengthen public health, transnational emergency care, transna-tional co-operation in the treatment of rare diseases and strategies to address demographic change.Early intervention by social investment into for instance vaccineprogrammes and the reduction of alcohol, tobacco and illicit drug consumption were widely supported. With regard to transnational emergency care, agreements and arrangements were already at hand or in active preparation. There seemed to be no need for further measures in this area.23 Session oneMs MonikaStankiewiczExecutive Secretaryof HELCOMMs Stankiewicz thanked the BSPC for its support to HEL-COM and added that it was in everybody’s interest to protect the Baltic Sea. Healthy marine ecosystems were needed to ensure a thriving maritimeeconomy and the well-being of people. The HELCOM Baltic Sea Action Plan of 2007 was still the guiding light for all contracting parties, and although its deadline was not until 2021, Ms Stankie-wicz could already report concrete achievements, such as the reduc-tion of excessive nutrients. The proposal to make the Baltic Sea a NOx Emission Control Area (in tandem with the North Sea coun-tries) had been the start of HELCOM providing studies and nego-tiations for its final submission. The measure provided a cost-effi-cient way of reducing around 7000 Nitrogen input in the Baltic Sea per year.Another milestone was the ban to discharge untreated sewage frompassenger ships. This year, the contracting parties had fulfilled the formal conditions for the ban to be enforced, and it was set to take effect in 2021. It was now a task to ensure the necessary improve-ments to port facilities.Such actions were examples of successful regional cooperationacross sectors in order to implement global regulations. It also boosted competitiveness, technological development and innova-tion. A result of such cooperation was the HELCOM Recommen-dation on sustainable aquaculture, which had provided criteria for best practices regarding minimising and preventing negative envi-ronmental impact of aquaculture. Ms Stankiewicz added that all straightforward solutions had thus far been taken into use in the Baltic Sea. It was now time for the more complex and holistic approach, which required new, innovative approaches.HELCOM had existed for over four decades, in which it haddemonstrated its progress and added value. However, this did not mean that critical reflection was not necessary. As such, the Execu-tive Secretary asked: “does HELCOM as a whole stick to its deci-sions?” Overall, she showed, approximately 60 percent of agreed24 Session oneregional actions had been accomplished, but 40 percent remainedonly partially implemented. As such, she concluded that the mem-ber states were quite far from reaching a good environmental status for the Baltic Sea. Areas of concern included marine litter, underwa-ter noise and sustainable fisheries.Finally, ending on a positive note, Ms Stankiewicz showed that theinputs of phosphorus had steadily decreased since the early 1980s, and she asked the community for support in reaching its target set for 2021.Ms Daria AkhutinaCoordinative Committee Member, Baltic Sea NGO Forum and Network, Russian Platform ChairpersonThe Baltic Sea NGO Coordinative Committee members had pre-sented the NGO Forum’s partici-pants views on current develop-ment and existing challenges cru-cial for the future stability of the Network.Firstly, it was important to boost interaction, coordination and synergy between the Network and other cooperation platforms in the Baltic Sea Area, preferably in a people-to-people manner. All platforms in the region were experiencing a lack of resources, which was why synergy with the aim of consolidating resources would be more crucial than ever.Ms Akhutina underlined that it was important to strengthen thenational platforms of the Network by facilitating NGO coopera-tion between the annual fora, and by encouraging common proj-ects and activities. For this, it would have to be able to rely on a stable source of funding, which was still difficult at times and caused a lack of permanent support.The roundtable of the Baltic Sea NGO Forum in Gdansk this yearhad been aimed to openly discuss the potential, possibilities and most relevant subjects of the wide scale cooperation on the peo-ple-to-people level involving municipalities, universities, culture institutions, businesses and NGOs. Its participants had empha-sised that:25 Session one- Cooperation in the Baltic S ea Region was increasingly movingtoward relations on a people-to-people level- Despite existing tensions, citizens of neighbouring countriesstrived to maintain stability and development through dia-logue.- Cooperation between civil societies harnessed a vast potentialfor creating a favourable social climate and stability.- Tackling existing threats was only possible by consolidatingforces from all sectors of society.Finally, Ms Akhutina informed that the participants had been encouraged by the upcoming Icelandic presidency of the CBSS, whose priorities aligned with the spheres of activity of many NGO activities. She then announced that this would be her last speech in her current role, and that she would start her new job at the CBSS secretariat in September. She handed over her duties to Ms Magda Leszczyna-Rzucidlo.Ms MagdaLeszczyna-RzucidloBaltic Sea NGO Network 2016Forum CoordinatorMs Leszczyna-Rzucidlo informedthe delegations that during the 14th Baltic Sea NGO Forum inGdansk over 150 representatives of civil society organisations, the Council of the Baltic States andother public authorities, had gathered for a cross-border and cross-sec-tor dialogue. Within the theme “Solidarity as a new dimension in the Baltic Sea regional cooperation”, the guests participated in plenary sessions, workshops and panel discussions to focus on three underly-ing themes:- Culture and social innovation- Civic sector and social problems – self-independent youth- Migration processes in EuropeAll topics had been discussed in the light of social economy, with an additional workshop on youth social entrepreneurship develop-ment, which had gathered great attention. Partners from Poland,26 Session oneLatvia, Lithuania, Estonia and Denmark had gathered in a projectknown as “BSR youth social entrepreneurship”, or “BYSED”, which was supported by the EU Strategy for the Baltic Sea Region Priority Area Education Coordinator. As such, the possibilities to foster the entrepreneurial mind-set of youth as an answer to youth unemployment had been thoroughly discussed.Future activities of the Network would also head in this direction,amongst which a seminar during the 7th EUSBSR Forum in Stock-holm in November. Cooperation on a regional level, including regional stakeholders and policy makers was crucial. Ms Leszczy-na-Rzucidlo then expressed hope that the voice of NGOs would be heard and that its activities would become even more visible.Ms Maja Gojkovicresident of the Parliamentary Assembly of the Black Sea Economic Cooperation (PABSEC) and Speaker of the National Assembly of the Republic of Serbia.Ms Gojkovic was honoured to be addressing the BSPC and congratu-lated the organisation on its 25thanniversary. She welcomed the topic of the conference, recognising the need to connect the labour mar-ket, labour mobility and youth unemployment in the 21st century.She clarified that PABSEC is a forum for inter-parliamentary dia-logue, bringing together 12 states from the greater Black Sea Area to deal with contemporary challenges. Its core values of democracy and the rule of law combined with the furthering of economic development, peace and stability, which were important for the region and the wider European community. During the General Assembly in Moscow in June 2016, it discussed important interna-tional issues, such as the political, economic and social aspects of the migration crisis. It discussed and strongly condemned terrorism in all its manifestations.During the Serbian presidency, more cooperation between memberstates had been encouraged, as well as a closer relation with the European Union. The National Assembly of Serbia would host an event from the 30th of November to the 1st of December 2016 inBelgrade, to which Ms Gojkovic cordially invited the representa-27 Session onetives of the BSPC. She reminded that the parliamentary componentwas crucial in addressing current issues. Being the direct representa-tives of citizens they would have the ability and duty to directly rep-resent their viewpoints. Working together to secure a common, prosperous future was paramount. PABSEC believed that closer interaction between regional and international parliamentary assemblies would pave the way for the effective implementation of common goals. Ms Gojkovic expressed hope that cooperation between PABSEC and the BSPC would be continued in the forth-coming period.Mr Vitaly BuskoChairman of the Commission on International Affairs of the House of Representatives of the National Assembly of the Republic of Belarus.Mr Busko was honoured to be allowed to address the BSPC, and thanked the Saeima for the wonderful organisation and cooperation which helped con-struct a mutually beneficial par-liamentary dialogue. He argued that Belarus was closely linked with the Baltic Region because of its common roots, and shared security, social and economic issues. The Republic of Belarus had established a permanent delegation to stay in contact with the BSPC, the Nor-dic Council, and the Working Groups to enable cooperation with 19 European parliaments. It was keen to exchange on issues of mutual interest, based on equality, respect and partnership.The Republic of Belarus considered quality education and labouras main priorities, having established a programmes to promote its progress and further youth development from 2016-2020. Fur-thering quality education was in line with fostering a solid, inno-vation based economy, making it a strategic task of the country. Mr Busko pointed out that higher education was the preferred road for many in his country. Belarus numbered 43 higher educa-tion facilities and 9 private higher education facilities. There were 400 students per 10.000 inhabitants in Belarus. In 2015 Belarus had joined the Bologna project, an important step in the develop-ment of its education system, and of integrating into the Euro-pean education space. An important factor here, according to Mr28 Session oneBusko, was the increase of professional academic mobility, toencourage the exchange of both students and professors. As such, Belarus State University had actively participated with the BSPC University Network, in order to exchange ideas and best practices. Covered fields included energy and environment, but also alterna-tive conflict resolution mechanisms. Cross border projects included the Erasmus programme and Horizon 2020.Belarus was very keen to cooperate both with the BSPC, and withits individual member state parliaments. Mr Busko expressed hope that the Belarussian observer status to the BSPC would soon be granted, creating a framework for fruitful cooperation and fos-tering parliamentary diplomacy. He hoped to soon continue the dialogue29 Session oneDiscussionsMr Petr Riabukhin: Mr Riabukhin congratulated the BSPC on its sil-ver jubilee and pointed out that the CIS-IPA would celebrate thesame 25th jubilee in 2017. He thanked the conference for all the yearsof cooperation. The Russian parliament and the CIS representatives had always been active in the BSPC and considered the relation very important, especially because the CIS was seated in St Petersburg, so close to the Baltic Sea. Many topics were shared by the two organisa-tions, including environmental protection. The Russian parliament had established an ecological convention, which would take place in St. Petersburg. Mr Riabukhin invited to contribute to the outcome of this congress and underlined the willingness and the readiness to cooperate with the BSPC.30 Session oneMr Wille Rydman: Mr Rydman argued that parliamentary coopera-tion had been an essential part of regional cooperation. The NordicCouncil had been grateful for the cooperation opportunities granted since the Cold War. Unfortunately, lasting peace and democratic development could not be taken for granted, not even in Europe. With chaos in Europe, for instance in Ukraine, the continent faced a dramatically changed situation. It should not accept war or conflict in Europe, but unite against extremism and terror, Mr Rydman stressed.The Nordic Council had recently been more active in seeking dia-logue with parliaments in different Baltic Sea Region countries. It had celebrated 25 years of close cooperation with one of its closest part-ners, the Baltic Assembly. For instance, it had arranged joined annual conferences on the situation in Belarus since 2007. On the back-ground of the problems in the Crimea, it had tightened the bonds between Nordic and Baltic cooperation and included more partners, such as the Benelux countries and Poland. A delegation from the Nordic countries had visited the Bundestag in Berlin, which shared many similar challenges, like the waves of migration.Under the circumstances of the annexation of Crimea, and the con-sequentially strained relations between Russia and Ukraine, open dia-logue became more necessary than ever. Mr Rydman stressed that the Nordic Council was not satisfied with the current situation, but will-ing to continue dialogue. Pragmatic cooperation in areas of mutual interest should not be stopped, regardless of underlying tensions. As such, a Russian delegation visited Sweden and an Arctic Conference in June 2016. He expressed hope for a positive development, even under challenging circumstances. All delegates would have to con-tinue to be united in common themes.Mr Andre Brie: Mr Brie expressed great interest in the presentation onBaltic 2030, fostering a sustainable development of the Baltic Sea Region and making it a priority. He subscribed to the approach and made a suggestion to contribute: making an action plan for the sus-tainable development of the Baltic Sea and an inclusive approach of the CBSS would be very important. The CBSS had invited represen-tatives to participate in the implementation of the integrated mari-time policy action plan, and Mr Brie would be very pleased if the cur-rent working group would accept this invitation, intensifying the cooperation with the CBSS. It would be paramount to continue Pan-European communication in times of challenge.Ms Jette Waldinger Thiering: The target of the resolution had to dowith training, education and the future of the Baltic Sea Region. In the light of current challenges, it was important to talk about educa-31 Session onetion and training. In the light of security, she urged the delegates totalk about social justice. T raining, education and work had to be guar-anteed for young people in the region. The Region had good univer-sities, and its students should contribute to sustainable labour mar-kets, for many reasons including the prevention of radicalisation in society. Peace was not for granted, not even in the Baltic Sea Region. Only if the state could include everybody, it could create social justice and only then could it guarantee security. Ms Waldinger Thiering then thanked the organisers for the wonderful draft and for the organ-isation of the conference.Ms Cecilie T enfjord-T oftby: Ms Tenfjord-Toftby remarked on therequest of Belarus to become an observer in the BSPC. She under-stood the wish to become an observer, because the BSPC was an important plaza for the exchange of thoughts on democratic ideas. Ms Tenfjord-Toftby argued that it was necessary for the Belarus opposition should also be represented in the BSPC, in order to make a sincere overture by Belarus believable.32 Session two33 Session twoSession twoHow to develop competitivenessin the Baltic Sea Region by linking education and thelabour marketMs Līga LejinaState Secretary of the Ministry ofEducation and Science of LatviaMs Lejiņa stressed that the depart -ment believed that the key to the competitiv eness of the Baltic Regionlay in the investment in human cap -ital. This could be generated when standar deducation traditions werebroken and the manner in which higher education was approached was re-evaluated, matching the demand in the labour market. New skills were demanded by this labour market, Ms Lejiņa stressed, which required the adaptation of the educational system. In order to ensure that students could con -quer the labour market and be fitted with the necessary skills, flexi -bility and analysis were crucial. The ministry tried to forecast the changes on the labour mar ket, and then implement the requiredchanges in the educational system. This task was quite difficult in the middle and long term, but it was critical not only that it happened, but that it happened on all levels of education: general and voca -tional education, the overall learning environment and the life-long education system.An important priority for Latvia for 2020 would be to increase the proportion of vocational education. In order to build a successful sys-tem of learning by working, a systemic approach would be vital, in addition to close cooperation with social and sectoral partners and employers. Discussions started under the Latvian Presidency of the EU Council to determine the responsibilities of such partners. The34 Session twominister cooperated with over 200 enterprises in pilot projects. Theoutcomes resulted in a legal framework which involved making amendments to educational law, which allows for an increase involve-ment of employers in the educational process.Dialogue with unions and employers had resulted in twelve sectoralcouncils and sub-councils. The exchanges of best practices occurred in these councils, and ensured raising the level education. Latvia had been successful in cooperating with other countries in the region on this matter: through Erasmus Plus, by exchanging best practices with Germany and through a Baltic Apprenticeship Alliance. Future plans included relations with Finland through Erasmus Plus and other Bal-tic countries. Ms Lejiņa reminded the delegates that the proportion of people with higher education degrees in Latvia was above the Euro-pean average. In order to nurture this, Latvia focussed on so-called STEM study programmes (Science, Technology, Engineering and Mathematics), which coincided with the demands of the 21st century.As such, students increasingly chose for the Baltic Sea Region as their study destination.The strategic development of education had the goal of innovationand future economic development. Research and innovation in spe-cialised areas could be deemed strong suits of Latvia, and would ide-ally form the basis of continued development. Reaching out through the INTERREG supported Baltic Science Network was one of the examples through which Latvia was reaching out to share its efforts and supporting the growth of competitive human capital. The minis-ter finally expressed hope for further, close cooperation.Ms Jadwiga ParadaDirector of Vocational and Continuing Education Department from the Ministry of National Education of PolandMs Parada reminded the delegates that vocational training was very specific. On the one hand, it was linked to the economic environ-ment, fluctuating and influenced by the tendencies of the labour market. The task of the vocational trainingsystems in Poland, Europe and all over the world was to keep adjust-ing the offered trainings to the needs of the labour market. Employ-35 Session twoers complained that they lacked the professional manpower to workwith, which in turn negatively influenced the future ability to train the next generation of working professionals. Poland had therefore taken measures to modernise their vocational training and to make it more attractive.Employers needed professionals, Ms Parada reminded the room,but these professionals also had to be versatile enough to meet changing needs. Poland had had a national debate on this issue this year, throughout which opinions were collected. The question was now, what needed to be changed? For Poland the employer would have to be given a central role, hence there was a lot of work done in cooperation with commercial chambers and the organisations of employers. The result of this debate had affected and would affect legislation.Changes to the vocational training system were proposed. Firstly,the graduate had to be well-prepared, and equipped with a com-plete set of professional skills as well as soft skills. He or she would have to be able to continue professional training, both at work and at university. A project, which was being supported by the Euro-pean Union, was launched to improve the cooperation between vocational schools and universities. A number of syllabi were devel-oped to be used by both vocational schools and universities. Another important factor was the career development for teachers, allowing them to update their knowledge.For success to be possible, employers would have to be involved.The ministry of education had to function as a lynchpin between other ministries, employers and stakeholders, building a training system which is adequate for the new challenges. It would have to consider how training would be provided, how a good offer for employers could be developed, how people could earn and provide for their families. In order to make this cooperation between stake-holders successful, the ministry would have to disseminate knowl-edge on the potential benefits.How could the ministry look forward in order to predict futureneeds? In cooperation with the EU, the project ‘Partnership for vocational training’ was founded to find experts in order to divine the needs of the labour market, and to create the studies that would be needed, but were currently still lacking.A new project that had just begun was the development of a newexamination system. Employers would be involved in the examina-tion tasks, and would act as examiners, and they would assess them-36 Session twoselves if the skills that would be examined would indeed be the skillsthat would later be required.Ms Parada finally remarked that this dual educational system thatwas coveted, existed in Poland for a number of years now, and the ministry was ready to evaluate if its popularity had increased over the last years.Mr Poul NielsonFormer EU Commissioner and Danish Cabinet Minister, Author of announced strategic review of the Nordic Labour MarketMr Nielson stated that it was very relevant to broaden the debate based on the report on the Nordic labour market he had written for the Nordic Council of Ministers. Mr Nielson had had approxi -mately 120 conversations with dif-ferent stakeholders, which had made it possible to have high level, serious and discreet discussions with employer organisa -tions. The former Commissioner explained that although the labour side had been traditionally outwar d oriented through itsunions, few people realised that the employer side of the debate was equally well organised, just more discreetly. They too had constructive discussions amongst each other. Mr Nielson showed himself very optimistic about this fact, and believed that it was essentials that both sides of the labour market should have a seri -ous and professional organisation, or the government could not deal with both par ties equally or depend on what the two sideshad decided.The secret of the success of the so-called Nordic Model was thebalance between the government, the labour side and the employ -ers side of the debate. This system did not grow over night, but had taken o ver a hundred years to grow and develop itself. Thedifferent types of Nordic Models – there being variations across the region itself – had all successfully managed to develop what Mr Nielson called “compromise competence”. He explained that during his time in the European Commission, Mr Nielson had been given a taste of how unions function south of Bremen: hys -terical and unable to come to a reliable compromise. In the Nor -37 Session twodic Model on the other hand, the union leader was not consid -ered a failure when he came with an imperfect but workable com -promise. This paradox, where the Nordic countries are wealthyand successful despite high taxation and str ong unions, contin-ued to baffle.Within the legislative processes of the EU, Mr Nielson advisedproactivity and cooperation early in the process in order to gain influence. He believed there was room for more European respect for this type of honest negotiation. In 1954, a single Nordic Labour Market had been created, which had been quite an achievement for its time, but it was ready for its next step within the EU, Mr Nielson stated.Mr Nielson had been tasked with finding 10-15 cases where bet -ter coordination and cooperation could be achieved within ten tofifteen years. The proposal that had gained most attention was theintroduction of mandatory education for everyone on the labour market, including seniors. The general idea to shape labour for the future would not be to work harder, but to work smarter. Educating people to the limits of their capabilities in the first years of their lives made little sense if one would then stop edu -cating them, especially because future generations would have to work for an even greater part of their lives. Technology changedso quickly that society could not afford to stop educating itself. The state had had an obligation to educate students for over a hundred years, but it had to be expanded to the fact that people should have the right to education in their working lives too.Mr Nielson warned against the urge to forecast the upcomingtrends. States ran the risk of getting lost in the gritty details, and missing the wider scope. The process needed freedom for creativ -ity and judgement. Mr Nielson agreed that economisation was necessar y, but believing that it could be reduced to an exact sci -ence was an illusion. He underlined this with the example of the erosion of membership figures of classic labour unions andemployer organisations. Many people worked without having one real employer, without building a pension and without hav -ing certain rights. This way, the two sides of the labour market dialogue woulderode. Maintaining the validity of this dialoguewas what the Nordic Model was about.38 Session twoMr Jan GuzOPZZ President and theCo-President of the Baltic Sea Trade Union NetworkWhen parliamentarians, business and employers gathered, it was hard for unions not to follow suit, Mr Guz opened. The trade union network of the Baltic Sea was there to exchange information, ideas and best practices in order to improve efficiency. He congratulated theconference with its 25 years, and encouraged them to take the energy of any twenty-five-year-old and stretch that energy until the 100th anniversary. Discussions on competitiveness, innovationand technological progress were difficult to hold, Mr Guz offered, because the different member states were all at different stages of development and progress. A need to learn was therefore all the more urgent, a topic discussed at length at Bastun and the Euro-pean Confederation of T rade Conferences.Competitiveness usually resulted in cost cutting, which generallymeant laying off staff and cutting down wages. In a single labour market that caused difficulties, and the national parliaments and EU Parliament were now busy liquidating these irregularities. Europe needed expenditure on education and R&D, Mr Guz stated, not forcing young people into an education but encourag-ing them with a good work environment and fair rewards. As such, trade unions were necessary to structure this type of invest-ment in social capital. T rade unions should not be treated as a nec-essary evil but as a partner, also in the quest for education. If life-long learning really was a goal, then infrastructure had to be put in place, such as kindergartens and schools, in order to free the hands of the adults long enough to learn and not worry about their children.Leaders of progress were vital in this matter. The plan of PresidentJuncker to realise equal pay for equal work in different places was met with loathing, and Mr Guz wondered why. The elimination of dumping in prices, allowing innovation to result in higher wages than was currently being received for manual labour, was crucial, and combining the education system with the labour mar-ket would be positively perceived in society. Mr Guz saw a lot of opportunity for improvement on this front, such as rewarding people for getting educated and giving them time off to achieve39 Session twothis. Employers, Mr Guz pointed out, wanted their employees towalk through the door ready-made and were often not interested in shaping them to their liking. Germany was a good example of a best practice scenario; they had achieved a lot in this field already with their dual study system.Mr Guz finally pushed that the member states had to improvecooperation, because education protected against joblessness. However, it was crucial to distribute investment over Europe, and not let the east be the assembly line of big business in the west. He was eager to cooperate and invest, but he needed a reliable partner on the other side of the table to develop a concept that would be profitable for the Baltic Sea Region.Dr Martin SauerBaltic Sea Labour ForumIn an increasingly globalised world, the competitiveness of regions was of ever growing importance as an economic policy instruments for job secu-rity, Mr Sauer opened. All par-ties should try to achieve a bal-ance of interest by consen-sus-building, or social partner-ship. The Baltic Sea LabourForum was an organisation where politics, unions and employers came together to create sustainable regional labour markets within the Region. 17 unions, 11 employers’ organisations and 2 interna-tional organisations endeavoured to promote social dialogue and implement the EU Strategy for the Baltic Sea Region and the EU 2020 Agenda.The Baltic Sea Region was populated by approximately 90 millioninhabitants, 76 percent of which were citizens of the EU. The pop-ulation density was higher than the EU average, which could be surprising considering the low population density of the Nordic countries.The Baltic Sea Labour Forum worked to capture the impulses ofjoint self-government, encourage public relations activities, encouraging women to participate and to get the European40 Session twodimension to the forefront. This for instance, to counteract theyouth unemployment rate which troubled many countries by pro-viding proper work and training. Calling on government for investment promotion was an important part of this task, for instance at the CBSS. Mr Sauer encouraged the delegates to join similar projects. Organising busses to inform young students about their options were an eagerly used tool in achieving this, and were handed on to Latvia and Lithuania for the same pur-pose.Mr Sauer urged the CBSS to contribute to social dialogue by financ-ing a proportional permanent position at its offices in Stockholm.Mr Vatanyar YagiyaProfessor of the St. Petersburg State University and Counsellor to the Chairman of the St. Petersburg Legislative AssemblyThe Baltic Sea Region was often referred to as an exemplary region in the global system with regard to good neighbourliness and peacefulness. It was diverse and known for its development in education. Education was asought after tool in the search for interstate cooperation. The quality of education was of great importance to the population and the economy of a region, it was the cornerstone of develop -ment in the 21st century. Culture had always been an importantstimulus for the economy, but it should not be forgotten that culture embraced science too.Education in the Region was competitive, and compared well toother regions in the world. The modernity, the level of teaching, the quality of the students and the affordability of schooling all made the Region stand out relatively well. The international aspect, with its cross border courses and exchange programmes also added to attractiveness.Mr Yagiya then offered another topic: what to do with universi -ties that are not performing too well? The Russian minister ofeducation pr eferred pairing high performing universities with41 Session twoones that were perhaps struggling a bit more, rather than shut -ting them down. Mr Yagiya was more in favour of closing strug -gling universities, in light of the survival of the fittest.St Petersburg was proud to be part of the Baltic University Net -work. The Baltic Federal University, where 9,000 students wereenrolled every year, and many successful programmes and activ -ities were planned. The north-western universities had a com -bined international student number of 270,000 and in St Petersburg, many students from the Baltic Regions were matric -ulated. Here, they would also be in a position to develop a Bal -tic mentality and understand each other. Cooperation with Finnish, German and Latvian universities were excellent exam -ples of such relations. A joined master programme between Hamburgand St Petersburg awarded students a certificate fromboth, giving them a strong position in a globalised world. St Petersburg, after all, was one of the best in the world.Mr Yagiya wished for a closer exchange of expertise, of teachingand research. The quality of this cooperation was more import -ant to the professor than the quantity, and he suggested adding such language to the BSPC r esolution.DiscussionMs Ingrid Johannson: Ms Johannson requested the floor to promotethe importance of adequate child care in achieving the goal of link-ing educated women to the labour market. Presently, the delegate argued, there were two significant trends: more women achieved a higher education, and most women took responsibility for the household. The representative argued that in order to successfully support a sustainable labour market, highly educated women should not be confined to the home. Ms Johannson further argued that equal pay for equal work was paramount, and that typically female jobs should not be compensated less than typical male jobs. She encouraged her colleagues to work harder on gender equality issues in their respective parliaments.42 Session twoMs Silke Gajek: Ms Gajek thanked Ms Johannson for her contribu-tion and concurred. The representative from Mecklenburg-Vor-pommern informed the participants of the conference that her state had recently ordered an enquiry about the relation between educa-tion and labour and recommended to them the accompanying web-site with the results. In the light of this enquiry, they had discussed the role of women and labour, and discovered that especially the older generation had been trained vocationally, often in the GDR era. Their qualifications had not always proven sufficient after the fall of the Wall, which had regularly resulted in broken careers and poverty in old age. Ms Gajek wondered how they could make sure a dual educational system work in rural areas, for nurses and kinder-garten teachers. She also argued that a paradigm shift in income was necessary in order to let the labour market function in the future, and that a serious discussion had to be held regarding an uncondi-tional income. Ms Gajek believed that from a feminist perspective, this debate had to take place. Too many people were coming up without success.Ms Regine Lück: Ms Lück argued that it was very important tomake a major contribution to higher employment rates. For this, it was necessary to join EU efforts and strengthen programmes for mobility. Summer schools and language programmes as well as international exchange programmes were a key tool in achieving more mobility, but were insufficiently visible. Ms Lück argued for a push for such programmes that encouraged mobility, already at a ground school level.Mr Veiko Spolītis: Mr Spolītis offered a question to Mr Sauer andMr Guz regarding the difficulties in the labour sector. It was neces-sary, Mr Spolītis believed, to speak of convergence of the EU labour market. The new economies were still at about 75 percent of the EU average. The representative therefore wondered what mechanisms were in place to ensure that Polish workers were paid the same wage as local workers in for instance Belgium. Because in a way, the low wages of the labourers from the newer economies were also under-mining the wages in the western states. He then asked Mr Sauer about his position on the directive from the EU, which Mr Spolītis believed to be quite neo-liberal, namely that everything would trickle down and that the market would regulate this issue. The rep-resentative offered that if such processes were not managed, nothing would trickle down, and societal problems would form in Latvia because people moved to Ireland and the United Kingdom to work. Finally, he asked Mr Yagiya how he saw Russia competing if they did not modernise their economy.43 Session twoMr Franz Thönnes: Mr Thönnes agreed that it was important tohave a close link between education and business, and that it wasimportant to educate people as self-reliant in their professional lives. The representative wondered, how Poland ensured the inte-gration of businesses in the process of getting people onto the labour market. He also asked the representative from Poland how they handled the integration of teachers, and suggested that teachers could take an active role, and should be offered internships at com-panies in order to be able to teach what is expected in the work place, and offer personal insight into the process. Mr Thönnes then proposed that the Northern Dimension could start a partnership in education.Mr Herbert Behrens: Referring to the speech by Mr Nielson, MrBehrens believed one was in the position to look into the future. Staying connected would allow for the construction of a solid edu-cational system, and at the same time allow the member states to be more competitive, winning the struggle for the most talented peo-ple, and not just the high level education students. Europe was talk-ing of industry 4.0 and the human resource challenges it was faced with. In order to come close to a solution, its member states would have to look beyond narrow, specialised education and widen its scope to include vocational training too. In the past, Germany too had had a close bond between unions and employers, and this had resulted in a strong educational system. Today, however, Germany was witnessing a race to the bottom in the labour market. He there-fore asked Mr Nielson about the role of competition in creating better standard and a better environment for the future.Mr Bernd Voß: Mr Voß agreed with Ms Johannson that a bettereducation system needed to be created for both sexes. He also agreed with Mr Spolītis that the market could not solve every problem. In Schleswig-Holstein and Hamburg they had made an effort to include everyone, for instance by creating youth vocational training and offer a single spot where a solid training could be acquired and youth unemployment could be avoided. He then wondered how many people had used the extended Erasmus programme to go abroad within the framework of vocational training. He also won-dered how far other states had gotten in achieving the goal of better dual vocational training. Mr Voß argued that although it was true that more university graduates were needed, it was also crucial to have those who could actually produce the ideas dreamt up by these university graduates.44 Session twoMr Vatanyar Yagiya: Mr Yagiya concurred with Mr Thönnes that apartnership in education would be a good idea. He was optimisticabout the state of education in the Baltic Sea Region. Regarding the question if Russia would be capable of modernising its production processes, Mr Yagiya informed the delegates that in Russia the Strat-egy 2030 was currently being developed and that St. Petersburg had been involved in its strategic development. Stepping up production had already been started and had borne fruit. In May, a Commis-sion had been set up that linked employer organisations and educa-tion. This model would ideally soon be used in other regions of the state and other universities.Mr Martin Sauer: Mr Sauer was asked about the difficulties causedby the freedom of movement and labour and he acknowledged that it was indeed an issue, not just between countries, but also between states within countries. He pointed to the significant social problem for Mecklenburg-Vorpommern. Hamburg had become so attractive for many, that they left the state, with significant brain drain as a result. He argued for the promotion of the region and a significant investment for infrastructure, including its kindergarten network. He considered it crucial to create lasting contacts with social part-ners, and to make the region so attractive that people would stay. This also included offering attractive salaries.Mr Jan Guz: Mr Guz argued that work was one of the foundationsof life, and therefore had to be well organised. In religion, he argued, work was there to serve the people and not the other way around. Organisations should function the same. Mr Guz furthermore argued that equal rights for women, and equal work for equal pay deserved a real discussion. He argued in favour of spreading the burden of responsibilities within the family, for instance by involv-ing kindergartens more. Many Poles had left the country in search of work, tearing families apart. He ardently stated that a country is not an assembly line, and that the market should not be given com-plete liberty to shape society to their liking. The hand of the market, Mr Guz argued, would not solve all problems.Ms Dorota Arciszewska-Mielewczyk: Ms Arciszewska-Mielewczyksupported the claim that after Poland joined the EU, many of the skilled labourers, masters and university graduates left the country in order to work elsewhere. This left Poland in a difficult position while it tried to rebuild its economy and its labour market. This lack of professionals had hit the economy very hard.45 Session twoMs Līga Serna: Ms Serna praised Erasmus Plus as one of the driversof labour mobility, and it had been successfully implemented inLatvia, making it a catalyst for development. She further argued in favour of equality in employment and household tasks. In Latvia, she stated, women were especially active regarding adult education, forming a positive trend despite modest numbers. She finally argued that technological advances were putting pressure on education demands. It was important to make general and secondary educa-tion more skill-oriented, which Latvia was actively pursuing.Ms Jadwiga Parada: Ms Parada wondered how to help young peoplewho were in need of extra support, for instance by offering manda-tory classes on entrepreneurship, vocational counselling for stu-dents and a push in the back for those at the start of their careers. She also supported a stronger link between the labour market and vocational schooling. In Poland, employers directly inform the minister of education of their needs, and regulations are swiftly introduced. For this, schools must and do possess a certain level of flexibility. Employers were furthermore not only involved in exam-ination, they also took students and teachers under their wing to guide them and support them. Finally, teachers would soon be offered courses about managerial skills within companies, and be provided more in-depth knowledge about how companies oper-ated. Adult education was offered on the same level as regular voca-tional training, but it was possible for adults to fast-track their learning, which proved very popular, also for university graduates.Mr Nielson: Mr Nielson warned against underestimating the valueof sharing experiences, indeed it should be stepped up and that dif-ferent sectors should share experiences across the board, not just amongst each other. He praised the broad interaction, which was soft-footed but very effective. Furthermore, Corporate Social Responsibility was a wonderful concept but it often remained a concept only. Preventing the race to the bottom was only possible by thinking out of the box, by being ambitious and reaching for high goals, for example in the way our forefathers opened up schools for all children. Making such cooperation mandatory was key, in order to force the different institutions to get organised. Mr Nielson finally warned that it was necessary to have another look at those within society who saw the necessity of education as a threat, and not a gift. They deserved to be noticed.46 Ceremonial Session47 Ceremonial SessionCeremonial Sessionin honour of the 25th anniversaryof the BSPC: yesterday, todayand tomorrowMr Trivimi VellisteFormer President of the BalticAssembly, Former member of the Standing Committee of the BSPC from EstoniaMr Velliste described a scene from a well-known Estonian book, “The Silverwhite”, in which the main characters, upon arriving in Esto-nia, wondered if the Baltic Sea was going to be divisive or uniting. Throughout history, be it the VikingAge, the Hanseatic Age or the Cold War, the Sea has been both. Even in times of division, it was a sea of peace, although peace had been stone cold at times. After the fall of the Berlin Wall, a sense of hope and promise had spread across the Baltic Sea Region. It was in this mood that the BSPC had been founded. Now, 25 years later, cooperation and open debate between Parlia -ments and other bodies within the Baltic Sea Region has been thoroughly established. A window of opportunity had beenopened, and this road had led to increased stability and prosper -ity for its citizens.Although not all challenges could be faced in cooperation, the BSPC had contributed to considerable progress in some policy areas, such as the environmental protection of the Baltic Sea which connected them. It had substantially contributed to cross-border and interregional economic cooperation and social integration. In doing so, it had leaned on its fundamental objectives: strengthen-ing the common identity and guiding new political activities,48 Ceremonial Sessionendowing them with additional authority. The fact that represen-tatives from both national and sub-national parliaments were involved only made the construct more heterogeneous and added another dimension to democracy: the dialogue between different political levels.Mr Velliste concluded that the best the Baltic Sea Region couldoffer is its identity: the historical, the geographical and the cul-tural. Preserving it would mean to preserve the bridge between nations.Mr FranzThönnesChairman of the delegation ofthe German BundestagMr Thönnes congratulated Latvia and Estonia on their 25 years of independence, which so wonderfully coin-cided with the anniversary of the BSPC. He then remarked that a journalist had askedhim about the common identity of the Baltic Sea Region. A shared identity, Mr Thönnes remarked, was not an easy thing to achieve in a Region where there were more than nine ethnicities, eleven lan-guages, seven currencies, three different types of Christianity and even more political cultures. Still, common ground could be found. Maritime history and activity was at the foundation of all nations around the Baltic Sea. Its red brick architecture could be found throughout the region. More recently, wind farms and cruise ships, but also a love for herring and amber connected the people that lived by the Baltic Sea.What united most was the diverse cooperation structures along theshores of the Sea that had proven themselves exemplary. Following the fall of the Berlin Wall, national and regional parliaments had met in Helsinki in 1991, upon the invitation of the Speaker of the Finnish Parliament, Kalevi Sorsa. They had discussed how good neighbourly relations and stable democracies could be fostered, and they had had a chance to uncover common interests and enter into trust-based partnerships.49 Ceremonial SessionA quarter of a century later, Mr Thönnes underlined, it was justifiedto ask what had been achieved. The BSPC had gained autonomy; it had built a Standing Committee that worked with a consensus based model. Its collaborations had intensified, and systems for sur-veying governments on the implementation of conference resolu-tions had been put in place. Themes, which in the early days had been limited to democratic stabilisation, broadened and spread to common ground regarding maritime policy, green growth, educa-tion and employment amongst others. Starting at its 16th confer-ence, it had started to garner attention in Brussels, which was the start of the first regional strategy, the EUSBSR.By now, almost 95 percent of Baltic shores fell within the EU, com-pared to only five percent in the early years. Largely due to the Northern Dimension policy and the Northwest Russian Strategy, Iceland, Norway and Russia had become full-fledged BSPC mem-ber states.Although the annual conference and the concrete political workwere shining examples of international cooperation, Mr Thönnes still believed it valid to ask, “what good does it all do?” Celebrating one’s successes would be justified: the wish to protect the Baltic Sea marine environment had led to the IMO prohibiting new passenger ships from discharging untreated waste. Imposing stricter controls on eutrophication had also been partly due to the efforts of the BSPC. The BSPC had campaigned to declare the BSPC a Particu-larly Sensitive Sea Area, and had made principle shipping lanes safer. It has also pushed for the Clean Ship Concept, aiming for zero-emission from shipping.In line of the EUSBSR, partnerships had arisen between states, edu-cational systems, research facilities, companies and trade unions. The Baltic Sea Labour Forum, with its roots in the Baltic Sea Labour Network, had grown into a permanent body for social dialogue with over 30 employers’ organisations, unions and other partners. The 21st BSPC conference in St. Petersburg had responded to thehigh level of youth unemployment, for which EU funding now approximated 6 billion euro.Dark times, Mr Thönnes acknowledged, had been known. In 2014,the CBSS ministerial meetings had been cancelled, based on the tensions surrounding Russia’s involvement in Ukraine. The BSPC had appealed to its member states to make every effort to ensure that the Baltic Sea Region would continue to be a region of intense cooperation and peaceful neighbourliness. Under the Polish Presi-dency, the council-level talks were continued.50 Ceremonial SessionMr Thönnes wondered what the future would bring for the BSPC.He believed it would have to mean an international approach to the challenges of our time. It would mean putting key future opportu-nities and questions on the common agenda and working on them together, for instance by developing the “Green growth for a bluer Baltic Sea project.” It would mean being united in the common duty of protecting refugees, the Baltic Sea Region being one of the most prosperous regions in the world. It would mean placing more emphasis on multilateral cultural networks and schools. Finally, it would mean strengthening common security together, protecting citizens from threats and disaster and doing so without military or rhetorical provocation.Encouraging citizens, and especially youth to articulate theirpolitical ideas would be crucial in letting the Baltic Sea Region flourish, Mr Thönnes believed. NGOs and civil society should play an increased role here. Finally, the way in which the Region treated its minorities should be exemplary. The transition from hostility to co-existence proved to be a difficult one, the German Member of Parliament claimed. Although looking back on history may have invited some to proclaim that thing used to be easier, Mr Thönnes reminded that nothing happened by itself. Dialogue, compromise and cooperation were needed. The Baltic Sea Region needed each other.Ms Anna AbrahamssonPresident of the Nordic Youth CouncilMs Abrahamsson thanked the dele-gations for the opportunity to speak, and introduced herself as the Presi-dent of the Nordic Youth Council, a platform where political youth organisations across the board gather to discuss issues that bring them together. Ms Abrahamsson was encouraged to see the lively debategoing on, and underlined that mutual understanding and solu-tion-seeking was of the utmost importance in current times.A core issue on the mind of the Nordic Youth Council was educationand employment. Although her generation was the most healthy, wealthy and educated of all time, there was still great concern about51 Ceremonial Sessionthe developing of the economic situation, education and job oppor-tunities. Pushed by economic turbulence, increased globalisation and growing technological development, the division between winners and losers had been made disturbingly sharp. Unemployment had hit young people especially hard; uncertain careers had become the new normal, and such insecurities had resulted in young people turning on each other.The second issue was the pressure of the global footprint catching upon the next generation. Our welfare had caused a great threat to well-being and our planet, which could be witnessed upon the shores of the Baltic Sea. Intense cooperation, unity above self-interest was paramount, Ms Abrahamsson argued, in order to succeed at all.In order to succeed on all levels, strong parliamentary cooperationwas necessary, but it would only succeed if the democratic foundation it relied on was strong. Involving all members of society, especially those who had trouble making their own voices heard should not be forgotten. Youth was becoming a demographic minority, and its underrepresentation was making them apathetic. Such facts could fuel radial and extreme ideas brooding in society.Ms Abrahamsson concluded that multinational cooperation was theroad to walk, isolationism could not be the answer. She expressed her-self hopeful that many possibilities had not yet been exhausted, and that amongst the member states in the room were those leading in innovation, in competitiveness and championing sustainability. As such, they should be able to find new paths for inclusion and partici-pation. The trick would be to learn from each other.52 Ceremonial SessionDiscussionMs Carola Veit asked Mr Velliste how, in light of his experience withinthe BSPC, he believed the relationship between the member stateshad changed over the years.Mr Trivimi Velliste replied that he believed the cooperation hadbecome more concrete over the years, and that the hope for the future had been more considerable at the beginning. This was not unusual, Mr Velliste added, since day dreams tend to be more beautiful than the best possible reality. Regardless, he believed that the very real progress that had been made was very significant. The iron curtain, which was very solid in the past, had become a historical notion. An example could be found in Finland, which due to its linguistic and cultural similarities had become a great asset to Estonia, but also a curse, because many young Estonians left. As such, young people were becoming a minority in many societies, particularly in Estonia. If there was absolute freedom, many would use it to leave their coun-try, which was of course a paradox.Ms Veit wondered how the current security issues, for instance the sta-tioning of NATO troops in the Baltic States, would influence the work at the BSPC.Mr Franz Thönnes agreed that there was still some conflict within theBSPC, but that a close cooperation that had already lasted 25 years was a great fundament to discuss different points of view. It had cre-ated a certain level of trust amongst the delegates, even though the last few years this trust had been put under pressure by the violation of international regulations. It would be in everybody’s interest to behave in a calculable way, and to re-establish this trust. With big powers such as the EU, Russia and NATO, it was crucial to cooper-ate, because security and trust could not live without such coopera-tion. The EU could only function with Russia, and Russia could only function with the EU. As neighbours, the two powers would have to come to terms with this. In that, Mr Thönnes was in full agreement with Ms Abrahamsson.Mr Jörgen Pettersson thanked the hosts for a wonderful welcome. TheBaltic Sea was a common castle that had to be defended and strength-ened by all present, for them to be able to continue to enjoy it. This was challenging, as cultures and languages and daily lives did not overlap one hundred percent. The BSPC had been founded to achieve exactly this protection. The challenges had made the organisation stronger. Open discussions among friends and neighbours was important, because it led to mutual understanding. The day had been53 Ceremonial Sessionan inspiration to Mr Pettersson, who believed that it required allhands on deck to manoeuvre a ship as grand as the BSPC.Mr Vatanyar Yagiya had been present at the second BSPC conferencein 1992 in Oslo, and resumed this in 1998. In 1992 Mr Yagiya had given a presentation on behalf of the mayor of St Petersburg, regard-ing the city in a new dimension. Mr Yagiya reminded the attendees to not just speak about the accomplishments, but also about the tasks ahead. In 1992 he had brought up the necessity of a procedure to decontaminate the Baltic Sea from unexploded remnants of the World War II. Unfortunately, the subject was only rarely touched upon. In 1992, the Soviet Union had just collapsed, leaving new states to be born from its ashes, including the Russian Federation. Mr Yagiya agreed with Mr Thönnes that there were many opportunities to create dialogue and confidence.Mr Detlef Müller lauded the speakers who took the delegates backinto the history of the BSPC whilst also discussing the future, which the representative from Mecklenburg-Vorpommern believed to be very appropriate. It was a special conference for the speaker, since it would be his last. He had attended over ten times, and was grateful to his colleagues for contributing so helpfully to his work as a represen-tative and a politician. The work on the resolution always included topics that concerned all represented countries, and allowed their del-egates to offer demands to their regional and national governments as well as the EU. When the going got tough in Europe, it was import-ant to have this organisation. A good format had been established, where it was possible to resolve issues. Mr Müller declared himself honoured to be part of such constructive surroundings and wished the attendees a successful continuation of cooperation.Mr Sören Schumacher admitted that although this was only his sec-ond conference, he was very pleased with the concept. Looking at the future, he believed the idea of a youth conference to be an excellent notion. He then offered that having youth delegates within the BSPC would be an alternative idea, and thought it would be wonderful to if every delegation would bring a young delegate as they often provided a richness to any discussion.Ms Angelika Ber g subscribed to the words spoken already. Sheremarked that trust and confidence could become empty words, and that they were often not enough. She believed success could only be achieved with a good balance between confidence and mutual respect. Confidence alone would never bring anyone through a crisis in one piece.54 Ceremonial SessionMr Veiko Spolītis reminded that the restoration of Baltic indepen-dence touched upon the Baltic Sea Parliamentary Conference. In1991 many would not have believed that today the Baltic States would be members of NATO and the EU. This membership had not come out of thin air, the representative reminded. The Baltic States and Poland had actively searched to move closer into the European circle. Mr Spolītis expressed his happiness to see representatives from Belarus, the Russian Federation, St Petersburg and Kaliningrad, because it enabled those present to have discussions similar to those of 1975, when the Helsinki accords were discussed. It had been an opportunity to speak about the importance of human rights, and thus slowly chip away at the USSR. Mr Spolītis believed that renewed discussions could have similar results in the present day.55 Session threeSession threeRealising employmentopportunities: Improving labour mobility and combating youth unemploymentMr Jānis ReirsMinister of Welfare, LatviaThe minister argued that althoughthe Baltic Sea countries faced a large variety of issues, they also faced common challenges, such as the link between the labour mar -ket and education and labour mobility .Latvia had always hadhighly successful cross-border cooperation experiences with its direct neighbours Estonia and Lithuania. They had exchanged information on their respective labour markets, mutual learning, had had joint job fairs and cross-border workshops. The European Network of Public Employment Services had played a significant role here, and had supported over twenty events promoting labour mobility. The learning process had spread beyond the Baltic states, and Latvia had learned valuable lessons from the German employ -ment services. Mr Reirs proclaimed that Latvia was honoured bythe recognition from Europe; it had served as a best practicesexample at the European Network of Public Employment Ser -vices.The minister reminded that although there was a lot of causefor hope, it was still necessary to stay alert. For instance, inmaking sure that social security and the taxation system were synchronised, resolving problems regarding tax compliance and the payment of benefits. Regional unemployment differences56 Session threewere more pronounced in Latvia than with its direct neigh -bours, and it was necessary to also draw attention to domesticlabour mobility , which could benefit the individual in finding ajob, and the state in reducing its unemployment numbers. In 2013, Latvia had introduced a programme encouraging people to move to more fruitful areas of the country. Although it had helped over 600 people it was still difficult to convince people to leave the region they were rooted in, especially if they were of a pre-retirement age.The alternative to domestic mobility for many had been interna -tional mobility, which had led to a significant population decline.Mr R eirs argued that it was of high importance for the state tomaintain a close relationship with its citizens, and to encourage their sense of belonging and their willingness to return home, taking their newly learned skill and abilities with them. The other path would be to attract foreign talent to Latvia by relaxing any possible integration and immigration barriers that existed. Mr Reirs did stress, that the country should ideally be selective in attracting mainly those foreigners that would fill the gaps of Lat -via’s own existing labour capabilities.He concluded that labour migration policies had always tendedto attract public scrutiny, but that the Baltic Sea Region seemedto move down a promising path.Ms AlgimantaPabedinskieneMinister of Social Security andLabour of LithuaniaMs Pabedinskiene maintained that well-balanced youth mobility was a good measure helping the labour market to match demand and supply, since the mobility of 24-29 year olds was the highest compared to other groups inEurope. Although this helped in filling vacancies in some places, it also caused issues for countries like Lithuania, which had a negative overall net migration balance which not only caused problems for the labour market, but to the sustainability of the entire social system.57 Session threeLithuania dealt with the emigration of both low-qualified andhighly qualified personnel, which was difficult to stem without offering all the necessary conditions to work, earn a living and live with dignity within the country. By crafting a legal framework that allowed for a flexible and modern regulation of industrial relations that would both benefit business and employees, the state aimed to create and maintain jobs in a number of sectors. Changes included a greater variety in employment contracts and a better regulation of the work-life balance. Secondly, achieving a higher population rate included the attempt to remove social, eco-nomic and other reasons for leaving, but also to encourage EU and non-EU labour to migrate to Lithuania and to encourage the EU to balance the movement of EU citizens. The minister saw room for improvement in the EU’s ability to react to the demand on high-skilled third country nationals. She also believed that the ability for citizens and companies to offer services in other coun-tries should be ensured. The posting of EU citizens could contrib-ute to well-balanced migration. Any additional restrictions to pro-vide services for other countries at the national and EU level could further encourage emigration.She summarised that migration was a positive phenomenon inthat it brought in fresh knowledge and language skills obtained abroad, returned income and investment and provided fresh air to cross-cultural life. On the other hand, for small countries such as Lithuania, the decreasing population meant loss of intellectual potential, of the investment of people and a deceleration of tech-nological advancement.Youth unemployment especially was a tough battle to fight. Thestate was confronted with skills that mismatched the labour mar-ket, a lack of qualification and skills generally, and a lack of exist-ing measures to combine work, education and family life. How-ever, Lithuania had set itself new objectives for 2016. It wanted to ensure a high quality implementation of the Youth Employment Initiative, which supported young people in developing the needed additional skills and knowledge to find employment, or start a business. A part of the Initiative included integrating inac-tive youth, by forming a network of 57 partners to reach out to these youths on the streets and provide them with opportunities. Another part of the initiative helped youth obtain new qualifica-tions by participating in vocational training, or encouraged them to start on their own by providing loans to start-ups, consultations on business plans by successful entrepreneurs, or by encouraging employers to hire newcomers on the labour market by compensat-ing part of their salary.58 Session threeThe minister concluded that such investments were crucial toimprove the employment system, which in turn was necessary to keep up the pace with the changing world.Ms Anette KrammeParliamentary State Secretary of Labour and Social Affairs, GermanyMr Kramme offered that she was fully committed to the free move-ment of workers, also after the UK’s decision. It helped people to embrace the idea of the EU in modern times. She wondered if it was easier for Germany than for other countries, because for them it meant a brain drain. Germanyhowever, had had an excellent employment situation for years. Its unemployment rate was 4,6 percent, versus a European average of 9,4 percent. Youth unemployment was also doing well compara-tively.Migration from inside the EU and outside the EU was subject toa differentiation, which Ms Kramme was sorry about, since the acceptance of people coming from outside the EU was signifi-cantly lower. Why did Germany have such an excellent employ-ment situation? The country had learned a lot from Scandinavia, back in the 1990s, when Germany’s labour policies were uncoor-dinated. A construct like the BSPC had made this learning from best practices possible. It had since re-evaluated its policy tools. The labour situation was also good because of the prosperous eco-nomic growth, and the overcoming of the economic crisis. Finally, demography was an important factor. Germany was shrinking, its gainfully employed people were shrinking with it, with up to 11 million people less in 2060. Because of this demographic factor, it had become easier for Germany to come to terms with the neces-sity of migration. A lack of skilled labour meant a necessity to open up to non-EU migrants, because the EU member states were hesitant to lose their labour force. Germany also had a list of voca-tions where the state felt there was a lack. It mostly consisted of crafts and the healthcare sector professions.Furthermore, it was possible for migrants to go anywhere in Ger-many where employment was available. For six months they were59 Session threeallowed to stay and look for employment, during which they werenot entitled to social benefits. Unskilled labour did still come to the country, potentially to use the social system. As a result, a bill was in the making that would exclude people from social benefits for a period of five years if they did not find employment. For ref-ugees and other migrants, the labour agency offered counselling services which were linked to job centres. The project “Fair Mobil-ity” offered counselling services in migrant’s mother tongues, to overcome the initial thresholds. It allowed young people from all over the EU to come to Germany, where language courses and liv-ing facilities were provided for them, for instance youth from Spain.Youth unemployment was low because of dual vocational train-ing: a close combination between practical training and studies. It helped young people overcome a barrier upon entering the labour market. To prevent people from entering the labour market with too few skills, the German government had come up with Assisted Vocational T raining, a programme designed to support troubled youth who were in the danger of dropping out of school or failing their exams.Integrating refugees would take a long time, Ms Kramme esti-mated. Germany being an industrialised nation, the refugees would have to speak the language perfectly before they could be fully integrated in the labour market, especially because their overall qualifications were not good.Mr Thor KleppenSaettemState Secretary of the Ministryof Labour and Social Affairs, NorwayMr Kleppen Saettem hoped to share the Norwegian story of immigration with the delegates. The country had seen a large economic growth over the last 20 years, for which the oil andgas industry had to be thanked at least partially, but also because of immigration. Norway had had 30,000 people coming to the country every year, on a population of approximately 4,6 million. Sweden,60 Session threeLithuania and Poland were the most important sources of immigra-tion. Although it had not benefitted these countries too much, it had greatly helped Norway.Norway had been able to be quite lazy about helping people withproblems to get onto the labour market, like people with disabilities. Youth unemployment was a problem that was not being solved too actively either. Rather, the country had hidden the problem, by put-ting youth on social benefits, which made entering the labour force after a period of time even more difficult.Norway strived to create an employment oriented economic policy. Afacilitation of a dialogue between labour and employers by the gov-ernment was also very important. Furthermore, Norway aimed to fulfil the following strategies: active and mainstream labour market policies; a priority towards youth, the long term unemployed, immi-grants and the disabled; a universal and fair social security system; and the ability to balance work and family life.Norway focussed on youth by tailoring support programmes to themand through local pilot projects. Unfortunately, it had not been the silver bullet yet, but until that was discovered, these programmes formed a suitable placeholder. In answering what could really help, the Norwegians had compared the Nordic countries to Germany, the UK and the Netherlands. Education (including vocational educa-tion) had proven most important. Youth guarantees, although they were politically interesting, only had a weak or even uncertain effect. Active labour market policies however, did play an important role. Wage subsidies and on-the-job training programmes seemed to have the most positive effects, however generally it could be concluded that there were great variations in documented outcomes and effects.Mr Kleppen Saettem concluded that the most important was to makesure that a state had an open and inclusive job market, which allowed people to find their own job, without help.Ms Egle KääratsDeputy State Secretary General on Labour and Employment Policy, EstoniaMs Käärats opened by arguing that the overall labour situation in Estonia is relatively good, but not satisfactory. Although the Esto-nian economy had bounced back from the recent economic crisis61 Session threerelatively well, the general GDPgrowth was still not optimal. The demographic challenges, which faced many European countries, were felt even more starkly in a state that only had 1,2 million inhabi-tants.Regarding labour migration, MsKäärats mentioned that Estonia had never been high on the ranking of favourite labour destinations. Migration to Estonia existed, but as her colleagues from Latvia and Lithuania had also explained, migra-tion from the country formed a very significant challenge for the country. Many Estonians had moved to Finland, but lately, many Finnish had also moved to Estonia to work in its IT sector, slowly building up a structural balance in the movement of labour across European and Baltic Sea borders.Estonia further suffered from a significant mismatching of skills.It dealt with a significant level of unemployment in its general population, while at the same time it had to cope with a lack of qualified labour for its booming IT sector. In order to improve this situation, Estonia planned to loosen its regulations, crippling bureaucracy being one of the breaks on development. It also hoped to attract more investment this way. A bundle of amend-ments would be presented to the Estonian Parliament in a matter of days. Additionally, it was to implement new policy to boost internal labour mobility.Regarding youth unemployment, Estonia was doing better than theEuropean average, but Estonian youth was still doing worse than the general population of the country. Approaching youth in the correct manner was a difficult task, and although Estonia was aim-ing to implement the Youth Guarantee, and initiate a project called “My First Job”, the state was still struggling to successfully reach the targeted youth. Estonia had therefore designed an information sys-tem to help local authorities find unemployed and uneducated youth and offer the necessary services.Ms Käärats concluded that although there were serious demo-graphic and migration challenges, the labour market in Estonia was doing well. In order to maintain this optimistic future however, a brain drain or a lost generation had to be prevented at all costs.62 Session threeDiscussionsMr André Brie: Mr Brie called the freedom of labour – an importantpillar of the European Union – a great good, and underlined thatGermany had done a lot in the past to support the lowering of unemployment. However, the representative argued, Germany had to stay critical. The delegates at the conference had heard concrete examples of how the free movement of labour had impacted states like Poland and Lithuania. Germany had initiated an integration programme for young people from Spain to find employment, but its implementation, amongst others in Mecklenburg-Vorpommern, had shown that it also comes with problems. As a result, the EU had announced changes to improve the weaknesses in the programme. Mr Brie then stated his believe that wages should be paid according to national tariffs, and suggested to Mr Thönnes that it could be put on the agenda for the 26th Baltic Sea Parliamentary Conference inHamburg.Mr Daniel Riazad: Mr Riazad offered that he wanted to discuss asensitive issue: migration and refugees. This was a personal subject for him, having fled from Iran 16 years ago. He urged the delegates to remember why people flee en masse: because of war and repres-sion. Yet many countries in Europe sold weapons to T urkey, which was in the process of becoming a de facto dictatorship. He passion-ately reminded that people, not countries, were the victims of the refugee issue. It had taken Mr Riazad four years to get a permit, and another nine to acquire citizenship. When the state did not come through for his family, a solidary community stepped in to support them. Mr Riazad was tired of being diplomatic, and underlined that these issues concerned real people. He called upon those present to stop selling weapons to dictatorships.Ms Annette Holmberg-Jansson: Ms Holmberg-Jansson argued thatit was paramount to recognise foreign exams and qualifications in order to make immigration and integration smoother, increase labour mobility and address youth unemployment. Language, she argued, was the key to labour. Highly skilled people were currently working in restaurants and cleaning companies because they were confronted with a labour market gap they could not bridge. She realised it was not the type of brain drain that had so far been the topic of the conference, but Ms Holmberg-Jansson believed it was a waste of brain power nonetheless.63 Session threeMr Jānis Reirs: Mr Reirs thanked his German colleague for bringingup the posting of workers directive, as it had proven quite controver-sial. Latvia had sent a letter that the figures referred to in the directive had been wrong in their case, and that they could be wrong for other member states too. Mr Reirs expressed his outrage about the matter. The real concern should be for people working without contracts, working undeclared, getting paid under the table. He concluded with a case of Belgian construction companies paying foreigners according to where they originated, and not where they worked, and called this behaviour unacceptable and urged that it be corrected.Ms Annette Kramme: Ms Kramme argued that during her speech,she did not have enough time to address all issues. She expressed her support for the posting of workers directive, pointing to two exam-ples. T ruck drivers passing through Germany, living an almost undignified life, was upsetting to her. She also mentioned the exam-ple of people working in slaughter houses in short shifts, so their employers would not have to pay social benefits. Ms Kramme con-cluded that if people came to Germany, they should be in a finan-cial position to live a full and well-adjusted life.Ms Ulrike Sparr: Ms Sparr wanted to draw attention to the fact thatsustainability was crucial for the future, not just to keep nature alive, but also to keep the economy and labour market viable. Cruise ships did not just bring in tourists, they also brought employment and profit with them. However, it was crucial that they would emit less pollutants and cause less algal bloom. The Baltic Sea, Ms Sparr argued, already had dead zones, where no more life or oxygen could be found.Mr Poul Nielson: Mr Nielson concluded that the examples providedduring this session had shown the different approaches in different member states with regards to labour market legislation. However, from a Nordic viewpoint, legislation in itself could prove problem-atic, for the Nordic states had over a long period of time established a system, in which employers and employees were in a position to solve most – if not all – problems concerning the labour market on their own. Brussels-steered legislation might impede this system. Balance highly valuable, enables societies to do things that is very difficult to agree on to carry out in many other countries. Against this background, Mr Nielson urged for understanding for Nordic opposition to any sort of European minimum wage. Mr Nielson urged the parliamentarians to focus instead on addressing the ques-tion of labour market fragmentation and self-employment.64 Contributions by the BSPC Working Group and Rapporteurs65 Contributions by the BSPC Working Group and RapporteursContributions by the BSPCWorking Group and RapporteursMs Sara KemetterWorking Group Vice-Chairman“Interim report by the BSPC Working Group on Sustainable T ourism”The midway report was meant as a strategic overview of the first ses -sions of the Working Group, Ms Kemetter reminded the attendees.Since the last annual conference in Rostock, the Working Grouphad met three times, in Rostock, Helsinki and Petrozavodsk respec -tively. Its objective was to elaborate political positions and recom -mendations pertaining to sustainable tourism. As such, the Working Group invited respected experts, to inform them about themes suchas: Baltic Sea Tourism Forum and the policy field ‘tourism’ in the context of the EU Baltic Sea Strategy, but also national tourism strategies, such as cycling tourism in Europe, and the Iron Curtain T rail. By casting the net wide, the Working Group hoped to achieve a comprehensive overview. A result of establishing new contacts could be witnessed in the fact that the next meeting would be back-to-back to the 9th Baltic Sea Tourism Forum in Pärnu in October,where it would contribute to the proceedings.66 Contributions by the BSPC Working Group and RapporteursWith intensive discussions, the Working Group had elaborated onits Programme, which was based on its Mandate. The scope of the work would have to cover, but not be limited to issues such as:- The state of sustainable tourism in the Baltic S ea Region- Cooperation of actors on all levels-Knowledge- and competence-building in sustainable tourism, including in the curricula on all levels of the educational system-Promoting the image of the Baltic Sea Region as a travel destina-tion-Promoting sustainable tourism as a competitive advantage forthe Region, for instance by developing attractive seasonal prod-ucts, but also as a business advantage for SMEs, for instance by offering tax incentives- Collecting best practices in sustainable tourism- Sustainable transport and infrastructure opportunities-The importanceof currently unresolved Baltic Sea environmen-tal issues.Ms Kemetter finally made an appeal. The Working Group had been informed by relevant actors in these fields that the Steering Com -mittee for the Priority Area Tourism of the EU Strategy for the Bal -tic Sea was not being equally supported by every respective govern -ment. She therefore wanted to remind everyone to do so.Sonja MandtBSPC Rapporteur on Cultural AffairsMs Mandt pointed out that for her first report, she had chosen to focus on culture and maritime heritage. She had studied the work of the Baltic Sea Monitoring Group on Heritage Cooperation and observed that the national representation and participation varied a lot, most likely due to budget restraints.67 Contributions by the BSPC Working Group and RapporteursEducational programmes that spread cross-border knowledge abouttraditional handicraft, should be supported. She further underlined that it is necessary to educate craftsmen and increase knowledge and competence in the communities that safeguard buildings. Light-houses made a wonderful example, since finding a new use for an old lighthouse could successfully preserve many of them.She drew furthermore to a large issue: Since 40 percent of the BalticSea was divided into economic zones, there was no way to effec-tively apply heritage legislation to underwater heritage. She urged to BSPC to take initiative. Coasts too, were endangered by cultural damage because of a crisis in coastal industries.Regarding the EU Strategy; Priority Area Culture, she reminded theconference of the importance of strong parliamentary support and urged the BSPC to consider observing the work of the Steering Group.68 Closing of the 25th BSPC69 Closing of the 25th BSPCClosing of the 25th BSPCMr Jānis VucānsChair of the BSPCMr Vucāns thanked the attendees for the energetic, productiveConference. He reminded the delegations that everyone had received a first draft of the resolution in early July, and were given until August 19 to send in additional proposals. Any proposals received after the deadline had not been taken into consideration. He then reminded the delegates that decisions could only be taken by unanimous consent.The 25th Baltic Sea Parliamentary Conference then agreed to thenew Rules of Procedure and the Work Programme for 2016-2017. Mr Vucāns then thanked the Drafting Committee for their hardwork. The distributed resolution included matters related to the title of the 25th conference. Point 19 said that partners agreed tostrengthen the contact between schools, universities and businesses in order to make sure that education would be closely and con-cretely oriented towards the labour market. Point 25 supported continuous cooperation between business and education, for instance through a systemic exchange of expertise in the labour market and educational sectors.The delegates then voted in favour of adoption the 25th resolutionof the Baltic Sea Parliamentary Conference.70 Closing of the 25th BSPCMr Vucāns then informed that the Standing Committee had agreedto give the honour to the Parliament of Åland to preside over the BSPC in the year 2017-2018 and the Parliament of Norway the ses-sion following. It also decided that the BSPC President would be Ms Carola Veit, with Mr Jörgen Pettersson and Mr Jānis Vucāns as Vice-Presidents.Carola VeitIncoming Chairman of the BSPCMs Veit warmly invited all the delegates to the 26th BSPC Confer-ence in the Free and Hanseatic City of Hamburg. She believed it to be excellent timing, shortly after the G20 summit planned to be held two months prior to the annual meeting.She underlined that Hamburg had always been close in spirit tothe BSPC, which was one of the reasons it had joined the organi-sation upon its formation in 1991. It shared a history and a tradi-tion with its Baltic Sea partners from fighting pirates together to achieving economic success together, in which the Port of Ham-burg was one of the lynchpins. Architects who offered their wis-dom, travelled around the area and had built both the St. Katha-rinen in Hamburg and the St. Peter in Riga. Hamburg had been connected with the Baltic Area for centuries, and it would stay important to its citizens.Today, Hamburg was an attractive place for work and life, and itfelt a strong responsibility towards nature. It was the only city in Germany to have made the top ten of ‘most attractive cities in the71 Closing of the 25th BSPCworld’. It was also home to a large port, a leading place for avia-tion industries and renewables, and a key creative hub in Ger-many.Considering this background, Hamburg had decided to focus onthree themes for its work programme for 2017:- Democracy and participation, in connection to youth exchange- Science, education and youth- Sustainable tourismShe then announced that she looked forward to welcoming the del-egates to Hamburg..Mr Jānis VucānsOutgoing Chair of the BSPCMr Vucāns symbolically handed over the relay baton, underliningits power of good thoughts and wished for the new Presidency. He asked all Germans to support Ms Veit in her upcoming duties.The Latvian Presidency had strived to reach an agreement on jointpolicy as implemented by the legislature and the executive power in order to provide all citizens with the sense that they lived in a secure, open and unified region.He finally thanked the organisers and declared the Conferenceclosed.72Opening of the ConferenceAnnex73 Annex IAnnex 1Conference ResolutionAdopted by the 25th Baltic Sea Parliamentary Conference (BSPC)The participants, elected representatives from the Baltic Sea RegionStates*, assembling in Riga, Latvia, 28-30 August 2016,taking into account a significant number of acts of international ter-rorism that have occurred since the last BSPC in Rostock, August 2015,- condemn terrorism in all its forms as a common threat for our cit-izens and our shared values,- deplore the loss of innocent lives, express sympathy and solidaritywith the victims of all terrorist attacks, their families and all those who suffered in these inhumane attacks,- express the crucial need for the joint fight against this major threatto our societies and to uphold our democratic values, while stressing that this fight has to respect the rule of law and civil and human rights,discussing Cooperation in the Baltic Sea Region, Innovation andCompetitiveness in the Baltic Sea Region by linking Education and Labour Market, Employment Opportunities, Labour Mobility and Youth Unemployment, and Sustainable Tourism,- against the background of the BSPC’s Silver Jubilee recognizingthe Baltic Sea Parliamentary Conference’s model character as a* *Parliaments and parliamentary institutions: Baltic Assembly,Free Hanseatic City of Bremen, Denmark, Estonia, European Parliament, Federal Republic ofGermany, Finland, Free and Hanseatic City of Hamburg, Iceland, Kaliningrad Region, Latvia,Lithuania, Mecklenburg-Vorpommern, Nordic Council, Norway, Poland, City of St. Petersburg, Council of Federation of the Federal Assembly of the Russian Federation, State Duma of the Federal Assembly of the Russian Federation, Schleswig-Holstein, Sweden, Åland Islands.74 Annex Iplatform for inter-parliamentary cooperation in the region in theface of the current political climate;- committed to adapting experiences from the past to a commonfuture so that the integration of the Baltic Sea Region shall be car-ried on while preserving regional identities;- convinced that respecting the rights of minorities would provide abenefit for all regions in the Baltic Sea Area;- welcoming that the implementation of the Baltic Sea Parliamen-tary Conference resolutions has progressively become more com-prehensive;1- affirming the importance of the United Nations 2030 Agenda forSustainable Development that is devoted to the people, the protec-tion of the planet, prosperity in harmony with nature, peace and partnership, and believing in the necessity of the implementation of the 17 Sustainable Development Goals, especially Goal 14 which targets to conserve and sustainably use the oceans, seas and marine resources for sustainable development;- welcoming the adoption of the Warsaw Declaration: RegionalResponses to Global Challenges at the Meeting of Deputy Foreign Ministers of the Council of the Baltic Sea States (CBSS) in Warsaw on 8 June, 2016;- welcoming the adoption of the Declaration Baltic 2030: Renew-ing the Commitment to Sustainable Development in the Baltic Sea Region adopted by the high representatives of the CBSS govern-ment institutions responsible for sustainable development on 6 June, 2016;- welcoming the acceptance of Chair’s Conclusions of CBSS Sci-ence Ministers’ Conference called Baltic Science: Renewing the Commitment to Science/Research Joint Actions in the Baltic Sea Region in Kraków, on 16 June, 2016;- welcoming the International Maritime Organization’s (IMO)decision that the Baltic Sea special area for sewage discharges from passenger ships under Annex IV or the MARPOL Convention will take effect by latest 2021 for IMO registered passenger vessels, in line with previous BSPC resolutions;call on the governments in the Baltic Sea Region, the CBSS and theEU,75 Annex IRegarding Cooperation in the Region, to1. welcome mutual cooperation and peaceful solutions of interna-tional disputes taking into account best practises for example in the Baltic Sea region;2. take further steps to re-establish mutual trust and dialogue in theBaltic Sea Region, in particular within the Council of the Baltic Sea States in order to ensure the most efficient use of the organization’s potential as a forum for multilateral intergovernmental cooperation as well as political and policy dialogue in the Baltic Sea Region;3. further enhance regional synergy and cohesion through deepen-ing collaboration and structured dialogue between organizations and cooperation formats in the Baltic Sea Region;4. further promote and encourage public-private practical interac-tion as a tool for cross-border cooperation, economically viable actions and projects for the benefit of the Baltic Sea Region, taking into account and advancing the success of the Saint Petersburg Ini-tiative and encouraging fuller use of the CBSS Pilot Financial Ini-tiative, if the situation permits;5. build on success of the CBSS Project Support Facility as a tool forsupporting the strategically important project activities in the Baltic Sea Region, taking particular note of Russia’s and Finland’s volun-tary contribution to the Facility for 2016, and to explore the possi-bilities for a continuation of the CBSS funding facility in a form of the Baltic Sea Cooperation Fund after 2016;6. further strengthen and develop HELCOM as the main coordi-nating body in the effort to protect the Baltic marine environment, and to strongly support and encourage a fast implementation of the Marine Litter Action Plan, as well as the implementation of the NOx emission control area Roadmap for the Baltic Sea, and to stress the importance of the Baltic Sea Action Plan (BSAP) as one of the environmental pillars of the EU strategy for the Baltic Sea Region;7. discuss mutual definitions regarding sustainable developmentthroughout the Baltic Sea region and to support innovations within green and blue technologies as well as to create a joint web portal for the Baltic Sea region for sharing good examples regarding research, education and environmental best practices;76 Annex I8. take the lead and coordinate development of a new regulationsframework for autonomous vessels with the aim to make proposals to IMO as well as to support research, technology development and standards for autonomous vessels;9. continue cooperation between each other in areas where mutualbenefits and synergies can be achieved among relevant regional strategies and action plans;10. against the background of the general competitive situation inthe tourism economy as well as the current tense situation in Europe to encourage transnational strategies and long-term commitments for fostering cross-border approaches primarily in the field of sus-tainable tourism in the Baltic Sea Region;11. closely work together in coping with the ongoing challengesconnected with the refugees in the region and to continue to ensure the decent treatment of and the right to safe asylum for these refu-gees in the countries of the Baltic Sea Region;12. foster closer cooperation and, as far as necessary, following EUrespectively UN declarations in tackling illegal and irregular migra-tion;13. foster cooperation in the field of research and innovationtowards more competitive and sustainable region;14. pay greater attention to the issue of ensuring predictability thatcould be strengthened through reciprocal transparency and risk reduction measures. This is important in order to avoid any unnec-essary risks and tensions, including with regard to the movement of military vessels and planes in the Baltic Sea Region;Regarding Competitiveness in the Baltic Sea Region by linking Edu -cation and Labour Market, to15. recognize the need to link education and the labour market more closely;16. against this background to support the New Skills Agenda forEurope;77 Annex I17. provide vocational training and skills development opportuni-ties to young people which are geared to the needs of industry and which, by way of generally recognized formal qualifications, form one of the most important prerequisites for workplace success;18. strengthen the contacts between schools, universities and busi-ness in order to make sure that university education and vocational education and training are closely and concretely oriented towards labour market and to identify as well as to prevent labour market mismatches;19. build on success of the CBSS EuroFaculty programme as anexample of long- term project-based cooperation in higher educa-tion and science for the benefit of the people of the Baltic Sea Region and to explore the possible steps forward for this pro-gramme;20 foster the further development and upgrade of skills (basic andspecialized) and employability through establishment of a right for lifelong learning;21. improve transparency and comparability of qualifications, andthereby to further develop the mutual recognition of formal quali-fications;22. facilitate anticipating labour markets’ skills needs;23. explore the need for a Northern Dimension Partnership forLabour Market and Education to further develop education and labour market in the Baltic Sea Region;24. support business and education cooperation for a sustainableeconomic area in the Baltic Sea Region, especially a systematic exchange of expertise in the labour market and education sectors;25. strengthen the cooperation between social associations, thesocial partners and governmental organisations in a social dialogue;26. support research and standardization within cyber security, withfocus on maritime context and applications and to foster data gov-ernance in order to enable a fair and fertile environment for new data driven services that will capitalize our regions technology excel-lence and trigger high skill job creation;27. implement the Baltic Sea Region as a leading learning region;78 Annex I28. call for more intensified “bottom-up” collaboration and net-working in order to pursue development and synergies in specific areas of science, research, innovation and clusters collaboration;29. facilitate continuous dialogue and collaboration in science,research, innovation and higher education using existing political and regional formats and initiatives;Regarding Employment Opportunities, Labour Mobility and Youth Unemployment, to30. work towards the creation of a joint, collaborative labour mar-ket in the Baltic Sea Region;31. support a common jobs platform and to raise its awareness inorder to harness its full potential for the labour force of the Baltic Sea Region;32. bring together national employment services and privateemployment agencies, including the social partners, in order to boost job seekers’ chances;33. use and further develop good approaches such as the EU’s YouthGuarantee scheme in order to develop sustainable and broad-based concepts for tackling youth unemployment and promote the tran-sition from school to working life;34. provide targeted measures to NEETS to integrate them success-fully into training and work;35. promote the integration of the long-term unemployed in thelabour market, using tried and tested methods based on a coordi-nated and individualized approach which includes employers;36. also use for this purpose good approaches such as the recom-mendation of the Council of the European Union on the integra-tion of long-term unemployed into the labour market;37. pursue the goal of stepping up efforts to encourage in particularlow-skilled, long-term unemployed and older employees to take part in continuing vocational education and training;79 Annex I38. further develop the promotion of continuing training andimprove the conditions for continuing training provision geared to the acquisition of vocational training qualifications, including for young adults;39. facilitate mobility especially in cross-border regions and to pro-vide information services to frontier workers who are subject to dif-ferent national practices and legal systems;40. utilize cross-border capacities for commuters in education andstudies thereby understanding cross-border commuting as a means to reduce the risk of unemployment;41. make better use of the resources of an ageing society;42. facilitate cooperation between education and business to enableyoung people to find work and employers to fill vacancies;43. rigorously and continuously pursue the goal of reducing youthunemployment and opening up job prospects and life chances for all young people, to use financial funds by the European Union to this and to monitor results;44. intervene at an early stage to inform young people making thetransition from school to work about pathways and possibilities with respect to career development and promote successful entry into the jobs market;45. strive to ensure fair wages and to work towards the reduction ofsubcontracted, temporary agency work and temporary service con-tracts where permanent jobs are possible;46. educate and integrate refugees into the labour market as soon aspossible and to exchange experiences with best practice examples within the Baltic Sea Region. And also embed the social partners comprehensively and at an early stage in these efforts;47. promote the participation of people with disabilities in workinglife, where possible in business in the general labour market, having regard for the principle of inclusion in the meaning of the UN Con-vention on the Rights of Persons with Disabilities;48. support their public labour administrations to promote themobility of their citizens in the entire Baltic Sea Region;80 Annex IRegarding Sustainable T ourism, to49. against the background of the unique natural environment ofthe Baltic Sea and the vulnerability of many habitats, to work on cross-border strategies in order to minimize existing conflicts between tourism, marine and coastal protection;50. strengthen the rural development and agricultural productionin accordance with the environment in such a way, that the natural landscape and sound environment as precondition for a sustainable tourism in rural areas are protected and restored;51. support transnational strategies which promote the develop-ment of tourism in the Baltic Sea Region and to include the cre-ation of synergies between projects and a communication strategy for the Policy Area Tourism;52. ensure the better inclusion of all Baltic Sea countries in jointprojects and strategies as well as of the private sector to improve direct economic impact;53. work towards increased coherence with regard to approaches toSustainable Tourism in the region;54. in order to help mobilize the full potential of Sustainable Tour-ism to establish the Baltic Sea Region as a common and coherent tourism destination;55. jointly work towards a common understanding of SustainableTourism and to strive to establish joint marketing and joint labels;56. support the Baltic Sea Tourism Forum and its newly-establishedproject for a permanent platform for information and know-how exchange – the Baltic Sea Tourism Center – as coordinator for the implementation of activities on Sustainable Tourism in the region;57. especially support the application for the 2nd call by the BalticSea Tourism Center for financial support via the EU-INTER-REG-Programme South Baltic 2014- 2020 to achieve the establish-ment of an operational service unit for Sustainable Tourism cooper-ation and permanent platform for information and know-how exchange at transnational level, the so-called “Baltic Sea Tourism Center”;58. support the objectives of the Policy Area Tourism in the EUStrategy for the Baltic Sea Region to facilitate and strengthen the81 Annex IBaltic Sea Tourism Forum process as well as to facilitate coordina-tion with stakeholders through joint workshops;59. facilitate the networking and clustering of tourism stakeholders;60. reinvigorate and update existing but untapped knowledge in theBaltic Sea Region about Sustainable Tourism, for instance the Agora Strategy for Sustainable Tourism Development in the Baltic Sea Region;61. work towards creating longer-term impacts and benefits, thusincreasing public acceptance;Furthermore, the Conference Decides to62. welcome with gratitude the kind offer of the Parliament of the Free and Hanseatic City of Hamburg to host the 26th Baltic Sea Par-liamentary Conference in Hamburg on 3 - 5 September 2017.82 Annex I83 Annex IRezolūcijaBaltijas jūras parlamentārās konferences dalībnieki – Baltijas jūrasreģiona valstu* vēlētie pārstāvji –, sapulcējušies Rīgā, Latvijā, 2016. gada 28.–30. augustā,ņemot vērā daudzos starptautiskos teroristu uzbrukumus, kas noti-kuši kopš pēdējās BJPK sesijas Rostokā 2015. gada augustā,- nosoda terorismu jebkurā tā izpausmes formā kā visu mūsu pil-soņu un kopīgo vērtību apdraudējumu;- piemin nevainīgos bojā gājušos cilvēkus, izsaka līdzjūtību un aplie-cina solidaritāti ar teroristu uzbrukumu upuriem, to ģimenēm un itin visiem, kas cietuši šo necilvēcīgo uzbrukumu dēļ;- norāda uz neatliekamu nepieciešamību kopīgiem spēkiem cīnītiespret šo būtisko mūsu sabiedrības apdraudējumu un aizstāvēt mūsu demokrātiskās vērtības, bet arī uzsver, ka šajā cīņā ir jāievēro tiesis-kums, civilās un cilvēka tiesības;apspriezoties par Baltijas jūras reģionā attīstīto sadarbību, inovācijuun konkurētspējas sasaisti ar izglītību un darba tirgu, darba iespē-jām, darbaspēka mobilitāti un jauniešu bezdarbu, kā arī ilgtspējīgu tūrismu,- BJPK 25 gadu jubilejas kontekstā atzīmējot, ka Baltijas jūras par-lamentārajai konferencei pašreizējos politiskajos apstākļos ir liela nozīme kā reģionālai starpparlamentu sadarbības platformai;- apņemoties pagātnē gūtās mācības izmantot kopīgas nākotnes vei-došanā tā, lai, turpinoties Baltijas jūras reģiona integrācijai, tomēr tiktu saglabātas reģionālās identitātes;- uzskatot, ka minoritāšu tiesību ievērošana nāk par labu visiem apBaltijas jūru esošajiem reģioniem;* *Parlamenti un parlamentārās organizācijas:Baltijas Asambleja, Brīvā Hanzas pilsēta Brēmene, Dānija, Igaunija, Eiropas Parlaments, Vāci-jas Federatīvā Republika, Somija, Brīvā Hanzas pilsēta Hamburga, Islande, Kaļiņingradasapgabals, Latvija, Lietuva, Mēklenburga-Priekšpomerānija, Ziemeļu Padome, Norvēģija, Polija, Sanktpēterburgas pilsēta, Krievijas Federācijas Federālās sapulces Federācijas padome, Krievijas Federācijas Federālās sapulces Valsts dome, Šlēsviga-Holšteina, Zviedrija, Ālandu salas.84 Annex I- atzinīgi vērtējot to, ka Baltijas jūras parlamentārās konferencesrezolūcijas kļūst aizvien aptverošākas;- atzīstot, cik lielā mērā cilvēki, planētas aizsardzība, labklājība undzīve saskaņā ar dabu, kā arī miers un partnerība ir saistīti ar Apvie-noto Nāciju Darba kārtību ilgtspējīgai attīstībai līdz 2030. gadam, un būdami pārliecināti par nepieciešamību īstenot 17 ilgtspējīgas attīstības mērķus, it sevišķi 14. mērķi – saglabāt un saudzīgi izman-tot okeānus, jūras un ūdens resursus, bez kuriem nav iespējama ilgt-spējīga attīstība;- atzinīgi vērtējot Baltijas jūras valstu padomes (BJVP) ārlietu minis-tru vietnieku sanāksmē Varšavā 2016. gada 8. jūnijā pieņemto dek-larāciju par reģionāliem globālu problēmu risinājumiem;- atzinīgi vērtējot apņemšanos nodrošināt ilgtspējīgu Baltijas jūrasreģiona attīstību, kas no jauna tika apliecināta Baltijas deklarācijā 2030. gadam, kuru pieņēma BJVP par ilgtspējīgu attīstību atbildīgo valsts institūciju augstie pārstāvji 2016. gada 6. jūnijā;- atzinīgi vērtējot Krakovā 2016. gada 16. jūnijā pieņemtos BJVPzinātnes ministru konferences priekšsēdētāja secinājumus “Baltijas zinātne: atjaunota apņemšanās nodrošināt kopīgus zinātnes/izpētes pasākumus Baltijas jūras reģionā”;- atzinīgi vērtējot ar iepriekšējām BJPK rezolūcijām saskanīgo Starp-tautiskās Jūrniecības organizācijas (IMO) lēmumu par MARPOL konvencijas IV pielikumā ietvertā noteikuma par Baltijas jūru kā īpašu zonu saistībā ar pasazieru kuģu notekūdeņu noplūdināšanu stāšanos spēkā līdz 2021. gadam attiecībā uz IMO reģistrētiem pasazieru kuģiem,aicina Baltijas jūras reģiona valstu valdības, BJVP un ESattiecībā uz reģionālo sadarbību1. atzinīgi vērtēt savstarpēju sadarbību un starptautisku strīdu mier-mīlīgu risināšanu, ņemot vērā labās prakses paraugus, piemēram, no Baltijas jūras reģiona;85 Annex I2. veikt nākamos pasākumus savstarpējās uzticības un dialoga atjau-nošanai Baltijas jūras reģionā, it sevišķi Baltijas jūras valstu padomes ietvaros, lai nodrošinātu organizācijas kā daudzpusēja starpvaldību sadarbības foruma potenciālu, kā arī veicinātu politisko dialogu Baltijas jūras reģionā;3. turpināt reģionālās sinerģijas un kohēzijas veicināšanu, padziļinotBaltijas jūras reģiona organizāciju un sadarbības formātu savstar-pējo sadarbību un strukturētu dialogu;4. arī turpmāk veicināt un atbalstīt praktisku publiskā un privātāsektora sadarbību kā garantiju visa Baltijas jūras reģiona interesēm atbilstošai pārrobezu sadarbībai, ekonomiski dzīvotspējīgiem pasā-kumiem un projektiem, ņemot vērā un tālāk attīstot Sanktpēterbur-gas iniciatīvas sasniegumus un atbalstot pilnvērtīgu BJVP finanšu pilotiniciatīvas izmantošanu, kad vien tas iespējams;5. paplašināt BJVP projektu atbalsta instrumenta lietošanu Baltijasjūras reģionam stratēģiski svarīgu projektu veicināšanā, īpaši ņemot vērā Krievijas un Somijas brīvprātīgās iemaksas, kas veiktas 2016. gadā, un apsvērt iespējas šo finanšu instrumentu uzturēt arī pēc 2016. gada, pārveidojot par Baltijas jūras sadarbības fondu;7. tālāk nostiprināt un attīstīt HELCOM kā galveno Baltijas jūrasvides aizsardzības koordinācijas iestādi, stingri atbalstīt un veicināt Rīcības plāna jūru piesārņojošo atkritumu jomā ātru īstenošanu, kā arī Ceļa kartē Baltijas jūrai ietverto ar NOx emisiju kontroles zonu saistīto noteikumu īstenošanu un uzsvērt, ka Baltijas jūras rīcības plāns ir nozīmīgs kā viens no ES Stratēģijas Baltijas jūras reģionam pamatā esošajiem vides aizsardzības pīlāriem;8. diskusiju rezultātā panākt vienotu izpratni par ilgtspējīgu attīs-tību visā Baltijas jūras reģionā, atbalstīt t. s. zaļās un zilās tehnolo-ģiskās inovācijas, kā arī izveidot kopīgu Baltijas jūras reģiona inter-neta portālu labās prakses piemēru apmaiņai pētniecības, izglītības un vides aizsardzības jomās;9. uzņemties iniciatīvas un koordinācijas funkcijas jauna likumdo-šanas ietvara izstrādē attiecībā uz autonomas vadības kuģiem, lai iesniegtu priekšlikumus IMO izvērtēšanai, kā arī atbalstītu pētnie-cību attiecībā uz autonomas vadības kuģiem, to tehnoloģiju un standartu izstrādi;10. turpināt sadarbību jomās, kurās iespējami savstarpēji ieguvumiun attiecīgo reģionālo stratēģiju un rīcības plānu sinerģijas;86 Annex I11. ņemot vērā vispārējo konkurenci tūrisma nozarē, kā arī pašrei-zējo saspringto situāciju Eiropā, atbalstīt pārnacionālas stratēģijas un ilgtermiņa pasākumus pārrobezu pieeju īstenošanai, galvenokārt ilgtspējīga tūrisma veicināšanai Baltijas jūras reģionā;12. cieši sadarboties joprojām aktuālo ar bēgļiem saistīto problēmurisināšanā reģionā, arī turpmāk Baltijas jūras reģiona valstīs nodro-šināt pienācīgu izturēšanos pret šiem bēgļiem un cienīt viņu tiesības uz drošu patvērumu;13. veidot ciešāku sadarbību nelegālās un nevienmērīgās migrācijasjautājumu risināšanā, tiktāl, ciktāl tas nepieciešams, ievērojot ES un ANO deklarācijas;14. ciešāk sadarboties pētniecības un inovāciju jomā reģiona konku-rētspējas un ilgtspējas veicināšanai;15. pievērst lielāku uzmanību jautājumam par paredzamību, kopalīdz nodrošināt vispusēja caurskatāmība un riska mazināšanas pasākumi. Tas ir svarīgs priekšnoteikums nevajadzīgu risku un sprie-dzes mazināšanai, citstarp attiecībā uz militāro kuģu un lidmašīnu pārvietošanos Baltijas jūras reģionā;attiecībā uz izglītības un darba tirgus sasaisti Baltijas jūras reģiona konkurētspējas veicināšanai16. atzīt nepieciešamību ciešāk sasaistīt izglītību un darba tirgu;17. šajā kontekstā atbalstīt Eiropas darba kārtību “Jaunas prasmes”; 18. nodrošināt jauniešiem konkrētām nozarēm atbilstošu arodap-mācību un iespējas attīstīt prasmes, kuras kā vispāratzītas oficiālas kvalifikācijas garants ir viens no galvenajiem priekšnoteikumiem veiksmīgai integrācijai darba tirgū;19. stiprināt skolu, universitāšu un uzņēmumu savstarpējos kontak-tus, lai nodrošinātu akadēmiskās un profesionālās izglītības un apmācības ciešu sasaisti ar darba tirgu un orientāciju uz to, kā arī identificēt un novērst prasmju neatbilstību darba tirgus vajadzībām;87 Annex I20. attīstīt BJVP Eirofakultātes programmu kā paraugu Baltijasjūras reģiona iedzīvotāju interesēm atbilstošai uz projektiem balstī-tai ilgtermiņa sadarbībai augstākās izglītības un zinātnes jomā un apsvērt iespējamos nākamos šīs programmas posmus;21. veicināt prasmju (pamata un specializēto) attīstību, uzlabošanuun nodarbinātību, nostiprinot cilvēka tiesības uz mūzizglītību;22. uzlabot kvalifikāciju pārskatāmību un salīdzināmību, tādējāditurpinot attīstīt oficiālo kvalifikāciju savstarpēju atzīšanu;23. veicināt darba tirgū pieprasīto prasmju prognozēšanu; 24. izvērtēt nepieciešamību Ziemeļu dimensijas ietvaros izveidotpartnerību darba tirgus un izglītības turpmākajai attīstīšanai Baltijas jūras reģionā;25. atbalstīt Baltijas jūras reģiona pārvēršanai par ilgtspējīgas eko-nomikas zonu nepieciešamo uzņēmējdarbības un izglītības sektoru sadarbību, it sevišķi sistemātisku zināšanu apmaiņu darba tirgus un izglītības jautājumos;26. stiprināt pilsonisko organizāciju, sociālo partneru un valsts ies-tāzu sadarbību sociālā dialoga ietvaros;27. atbalstīt pētniecību un standartizāciju kiberdrošības jomā,uzsvaru liekot uz jūrniecību un attiecīgu pielietojamību, un veicināt datu pārvaldību, lai nodrošinātu godīgu un auglīgu vidi tādu jaunu uz datiem balstītu pakalpojumu ieviešanai, kuri veicinās mūsu reģiona tehnoloģisko izcilību un augsti kvalificēta darba vietu raša-nos;28. izvirzīt Baltijas jūras reģionu avangardā izglītības jomā; 29. aicināt uz aktīvākas horizontālās sadarbības un kontaktu izvēr-šanu, lai veicinātu attīstību un sinerģiju konkrētās zinātnes, pētnie-cības un inovāciju jomās, kā arī attiecīgo klasteru sadarbību;30. veicināt nepārtrauktu dialogu un sadarbību zinātnes, pētniecī-bas, inovāciju un augstākās izglītības jomās uz jau iedibināto poli-tisko un reģionālo sadarbības formātu un iniciatīvu pamata;88 Annex Iattiecībā uz nodarbinātības iespējām, darbaspēka mobilitāti un jau -niešu bezdarbu31. veidot kopīgu, uz sadarbību balstītu Baltijas jūras reģiona darbatirgu;32. atbalstīt vienotas pieejamo darba vietu platformas izveidi unpopularizēšanu, lai pilnībā izmantotu Baltijas jūras reģiona darba-spēka potenciālu;33. stiprināt reģiona valstu nodarbinātības dienestu, privāto nodar-binātības aģentūru un sociālo partneru sadarbību, tādējādi vairojot darba meklētāju izredzes;34. izmantot un pilnveidot tādus labus instrumentus kā iniciatīvaES “Jauniešu garantija”, izstrādājot ilgtspējīgas un visaptverošas jau-niešu bezdarba mazināšanas koncepcijas, kas atvieglotu pāreju no skolas uz darba dzīvi;35. izstrādāt un īstenot mērķtiecīgus pasākumus to jauniešu iekļau-šanai apmācības programmās un darba tirgū, kuri šobrīd nemācās, nestrādā un neapgūst arodu;36. veicināt ilgstošo bezdarbnieku iekļaušanos darba tirgū, šainolūkā izmantojot pārbaudītas, koordinētas un individualizētas metodes, tostarp sadarbību ar darba devējiem;37. izmantot šai nolūkā arī citu paraugpraksi, piemēram, ES Pado-mes rekomendācijas par ilgstošo bezdarbnieku iekļaušanu darba tirgū;38. veltīt lielākus pūliņus mazkvalificētu darbinieku, ilgstošu bez-darbnieku un vecāka gadagājuma darbinieku iesaistīšanai arodap-mācības programmās;39. turpināt tālākizglītības popularizēšanu un tālākizglītības pakal-pojumu pilnveidi, tādējādi palīdzot, īpaši jauniešiem, iegūt profe-sionālo kvalifikāciju;40. veicināt mobilitāti, īpaši pierobezas zonās, un nodrošināt darba ņēmējiem tajās nepieciešamos informācijas pakalpojumus, tādējādi palīdzot viņiem labāk orientēties atšķirīgā darba vidē un tiesību sistēmā;41. pilnveidot svārstmigrantu pārrobezu izglītošanu un apmācību, tādējādi pārvēršot svārstmigrāciju par bezdarba riska mazināšanas rīku;89 Annex I42. optimizēt novecojošas sabiedrības rīcībā esošo resursu izlieto-jumu;43. sekmēt izglītības iestāzu un uzņēmēju sadarbību, tādējādi palī-dzot jauniešiem atrast darbu un darba devējiem aizpildīt vakances;44. neatlaidīgi turpināt jauniešu bezdarba mazināšanas pasākumus,radot jaunas darba izredzes un piedāvājot izvēles iespējas ikvienam jaunietim, šai nolūkā izmantot ES fondu līdzekļus un kontrolēt panāktos rezultātus;45. laikus sagatavot jauniešus pārejai no skolas uz darba dzīvi, iepa-zīstinot viņus ar iespējām attīstīt karjeru un sekmīgi iekļauties darba tirgū;46. censties nodrošināt taisnīgu atalgojumu un samazināt ārpakal-pojumu, pagaidu darba un īslaicīgu pakalpojumu līgumu izmanto-šanu, ja tos pašus rezultātus iespējams panākt ar pastāvīgām darba vietām;47. pēc iespējas ātrāk nodrošināt bēgļu apmācību un iekļaušanosdarba tirgū, kā arī attiecīgās paraugprakses piemēru apmaiņu Balti-jas jūras reģionā, šajā procesā iesaistot sociālos partnerus jau sākot-nējos tā posmos un visos tā aspektos;48. veicināt cilvēku ar invaliditāti iesaisti darba dzīvē, ja vien tasiespējams, uzņēmējdarbībā un vispārējā darba tirgū, ievērojot ANO Konvencijā par cilvēku ar invaliditāti tiesībām noteikto iekļaušanas principu;49. atbalstīt valstu nodarbinātības aģentūru centienus veicināt pil-soņu mobilitāti visā Baltijas jūras reģionā;90 Annex Iattiecībā uz ilgtspējīgu tūrismu50. ņemot vērā Baltijas jūras dabiskās vides unikalitāti un vairākudzīvotņu apdraudējumu, izstrādāt pārrobezu stratēģijas, kas mazi-nātu pretrunas starp tūrisma attīstību un jūras, kā arī piekrastes aiz-sardzību;51. veicināt lauku un lauksaimnieciskās razošanas attīstību saskaņāar vides prasībām un tādā veidā, lai dabiska ainava un veselīga vide lauku apvidos tiktu saglabāta un atjaunota kā ilgtspējīga tūrisma priekšnosacījumi;52. atbalstīt pārrobezu stratēģijas, kas vērstas uz tūrisma attīstībuBaltijas jūras reģionā, un tūrisma politikā ietvert projektu un komu-nikācijas stratēģiju sinerģiju;53. nodrošināt visu Baltijas jūras reģiona valstu, citstarp arī to pri-vātā sektora, pilnvērtīgāku iesaisti kopīgajos projektos un stratēģi-jās, tādējādi palielinot tiešo ekonomisko ieguvumu;54. labāk saskaņot uz ilgtspējīga tūrisma attīstīšanu reģionā vērstospasākumus;55. pozicionēt Baltijas jūras reģionu kā kopēju tūrisma galamērķi,lai pilnībā izmantotu ilgtspējīga tūrisma potenciālu;56. panākt vienotu izpratni par ilgtspējīgu tūrismu, kā arī izstrādātkopīgas mārketinga stratēģijas un zīmolus;57. atbalstīt Baltijas jūras tūrisma forumu un tā jaunizveidoto pastā-vīgas informācijas un pieredzes apmaiņas platformas projektu – Bal-tijas jūras T ūrisma centru, kas koordinēs ilgtspējīga tūrisma veicinā-šanas pasākumu īstenošanu reģionā;58. īpaši atbalstīt Baltijas jūras T ūrisma centra pieteikumu finansē-juma saņemšanai ES INERREG programmas “Dienvidbaltija 2014-2020” otrajā kārtā, lai izveidotu struktūrvienību sadarbības koordinēšanai ilgtspējīga tūrisma jomā, kā arī pastāvīgu starptau-tiska līmeņa informācijas un pieredzes apmaiņas platformu – t.s. Baltijas jūras T ūrisma centru;59. atbalstīt ES Stratēģijā Baltijas jūras reģionam ietvertos tūrismapolitikas mērķus, sekmēt un nostiprināt Baltijas jūras tūrisma foruma darbību un labāk saskaņot iesaistīto pušu darbību, rīkojot kopīgus seminārus;91 Annex I60. sekmēt tūrisma aģentūru sadarbību un klasteru veidošanu;61. atjaunināt un aktualizēt Baltijas jūras reģionā pieejamās, betnepilnīgi izmantotās zināšanas par ilgtspējīgu tūrismu, piemēram, projektu AGORA – ilgtspējīga tūrisma attīstības tīklu Baltijas jūras reģionā;62. tiekties pēc ilgtermiņa rezultātiem un ieguvumiem, tādējādipanākot iedzīvotāju atbalstu;turklāt konferencē tiek nolemts63. atzinīgi novērtēt un pieņemt Brīvās Hanzas pilsētas Hamburgas parlamenta piedāvājumu 26. Baltijas jūras parlamentāro konferenci rīkot Hamburgā 2017. gada 3.–5. septembrī.92 Annex I93 Annex IKONFERENCIJOS REZOLIUCIJAPriimta 25-ojoje Baltijos jūros šalių parlamentinėje konferencijoje(BJŠPK)Konferencijos dalyviai, Baltijos jūros regiono valstybių* išrinktiejiatstovai, 2016 m. rugpjūčio28–30 dienomis posėdziavę Rygoje (Latvija), atsizvelgdami į daugybę tarptautinio terorizmo aktų, įvykdytų popaskutinės BJŠPK, vykusios 2015 m. rugpjūčio mėn. Rostoke,– smerkia terorizmą ir visas jo formas kaip bendrą grėsmę mūsųpiliečiams ir mūsų bendroms vertybėms;– apgailestauja dėl nekaltų zmonių zūties, reiškia uzuojautą ir soli-darumą visų teroristinių išpuolių aukoms, jų artimiesiems ir visiems, patyrusiems šiuos nezmoniškus išpuolius;– pabrėzia būtinybę kartu kovoti su šia didziule grėsme mūsų visuo-menėms ir saugoti demokratines vertybes, kartu akcentuodami, kad ši kova turi būti vykdoma gerbiant teisinės valstybės principą, pilie-tines ir zmogaus teises;aptardami Baltijos jūros regiono bendradarbiavimą, inovacijas irkonkurencingumą Baltijos jūros regione ir sieję tai su švietimu ir darbo rinka, įsidarbinimo galimybėmis, darbo jėgos judumu, jau-nimo nedarbu ir tvariuoju turizmu;– BJŠPK švenčiant sidabrinį jubiliejų, suvokdami Baltijos jūrosšalių parlamentinės konferencijos modelį kaip tarpparlamentinio bendradarbiavimo regione platformą dabartinės politinės padėties sąlygomis;1 *Parlamentai ir parlamentinės institucijos:Baltijos Asamblėja, Laisvasis Hanzos miestas Brėmenas, Danija, Estija, Europos Parlamentas,Vokietijos Federacinė Respublika, Suomija, Laisvasis Hanzos miestas Hamburgas, Islandija,Kaliningrado sritis, Latvija, Lietuva, Meklenburgas-Priešakinė Pomeranija, Šiaurės T aryba, Norvegija, Lenkija, Sankt Peterburgas, Rusijos Federacijos T aryba, Rusijos Federacijos Valstybės Dūma, Šlėzvigas-Holšteinas, Švedija, Alandų salos94 Annex I– įsipareigoję remtis patirtimi bendros ateities labui, kad Baltijosjūros regiono integracija vyktų išsaugant regionų tapatybę;– įsitikinę, kad pagarba mazumų teisėms būtų naudinga visiemsBaltijos jūros valstybių regionams;– dziaugdamiesi, kad Baltijos jūros šalių parlamentinės konferenci-jos rezoliucijų įgyvendinimas palaipsniui tampa labiau visa apiman-tis;– pabrėzdami Jungtinių Tautų 2030 m. darnaus vystymosi darbo-tvarkės, skirtos zmogui, planetos apsaugai, klestėjimui gyvenant darniai su gamta, taikai ir partnerystei, svarbą ir manydami, kad būtina įgyvendinti 17 darnaus vystymosi tikslų, ypač 14-ąjį tikslą – išsaugoti vandenynus, jūras, jūrų išteklius ir juos tausiai naudoti darniam vystymuisi;– pritardami Baltijos jūros valstybių tarybos (BJVT) uzsienio rei-kalų ministrų pavaduotojų susitikime Varšuvoje 2016 m. birzelio 8 d. priimtai Varšuvos deklaracijai „Regiono atsakas į globalius iššū-kius“;– pritardami 2016 m. birzelio 6 d. aukštų uz darnų vystymąsi atsa-kingų BJVT vyriausybių pareigūnų priimtai „Baltijos deklaracijai 2030: atnaujinti Baltijos jūros regiono darnaus vystymosi įsiparei-gojimai“;– dziaugdamiesi, kad buvo pritarta 2016 m. birzelio 16 d. Kroku-voje pirmininkaujančios valstybės priimtoms BJVT švietimo minis-trų konferencijos išvadoms „Baltijos mokslas: atnaujinti įsipareigo-jimai dėl mokslo ir mokslinių tyrimų ir bendri veiksmai Baltijos jūros regione“;– pritardami Tarptautinės jūrų organizacijos (IMO) sprendimui dėlIMO registruotų laivų, kad speciali Baltijos jūros zona keleivinių laivų nuotekoms išleisti, remiantis MARPOL konvencijos IV priedu, būtų pradėta naudoti ne vėliau kaip iki 2021 m., atsizvel-giant į ankstesnes BJŠPK rezoliucijas;ragina Baltijos jūros regiono, BJŠPK ir ES valstybių narių vyriausy-bes:95 Annex Idėl bendradarbiavimo regione:1) pritarti tarpusavio bendradarbiavimui ir taikiam tarptautiniųginčų sprendimui, atsizvelgiant į geriausią praktiką, pavyzdziui, Bal-tijos jūros regione;2) imtis tolesnių veiksmų siekiant atkurti tarpusavio pasitikėjimą irdialogą Baltijos jūros regione, ypač Baltijos jūros valstybių taryboje, siekiant kuo veiksmingiau panaudoti organizacijos, kaip daugiašalio tarpvyriausybinio bendradarbiavimo forumo, taip pat kaip politinio dialogo ir dialogo politikos klausimais Baltijos jūros regione, poten-cialą;3) toliau stiprinti regionų sinergiją ir sanglaudą, stiprinant Baltijosjūros regiono organizacijų bendradarbiavimą bei struktūrinį dialogą ir bendradarbiavimo formas;4) toliau remti ir skatinti viešojo ir privataus sektorių praktinęsąveiką kaip tarpvalstybinio bendradarbiavimo, ekonomiškai pers-pektyvių veiksmų ir Baltijos jūros regionui naudingų projektų plė-tojimo priemonę, atsizvelgiant į sėkmingą Sankt Peterburgo inicia-tyvą ir toliau ją plėtojant, taip pat skatinant, jeigu padėtis tam palanki, visapusiškiau naudotis BJVT Bandomąja finansine inicia-tyva;5) remtis sėkminga BJVT projektų rėmimo priemonės, kaip strate-giškai svarbių Baltijos jūros regiono projektų paramos priemonės, patirtimi, ypač atsizvelgiant į savanorišką Rusijos ir Suomijos paramą 2016 metais, taip pat išsiaiškinti BJVT finansavimo prie-monės, kaip Baltijos jūros bendradarbiavimo fondo, pratęsimo gali-mybes ir po 2016 metų;6) ir toliau plėtoti bei stiprinti Baltijos jūros aplinkos apsaugoskomisiją (HELCOM) kaip pagrindinį koordinuojantį organą, sie-kiant saugoti Baltijos jūros aplinką, ir labiau remti bei skatinti grei-čiau įgyvendinti Veiksmų dėl jūros taršos planą, taip pat įgyvendinti Veiksmų dėl išmetamo azoto oksido kontrolės zonų Baltijos jūroje planą, pabrėzti Baltijos jūros regiono veiksmų plano svarbą kaip vieną iš ES Baltijos jūros regiono strategijos aplinkosaugos srityje ramsčių;7) aptarti bendras Baltijos jūros regiono tvaraus vystymosi apibrėz-tis ir remti inovacijas pasitelkiant zaliąsias ir mėlynąsias technologi-jas, taip pat sukurti bendrą Baltijos jūros regiono interneto portalą, skirtą dalytis geraisiais mokslinių tyrimų, švietimo ir aplinkosaugos geriausios praktikos pavyzdziais;96 Annex I8) imtis iniciatyvos ir koordinuoti naujos autonominių laivų regu-liavimo sistemos kūrimą, siekiant teikti pasiūlymus IMO ir remti mokslinius tyrimus, technologijų plėtrą ir autonominių laivų stan-dartus;9) tęsti tarpusavio bendradarbiavimą srityse, kuriose abipusė naudair sinergija gali būti pasiekta įgyvendinant atitinkamas regionines strategijas ir veiksmų planus;10) atsizvelgiant į bendrąjį konkurencingumą turizmo ekonomikoje,taip pat į įtemptą dabartinę padėtį Europoje, skatinti tarpvalstybines strategijas ir ilgalaikius įsipareigojimus taikant tarpvalstybinius meto-dus Baltijos jūros regione, visų pirma, tvaraus turizmo srityje;11) glaudziau bendradarbiauti kovojant su nuolatiniais regionekylančiais iššūkiais, susijusiais su pabėgėliais, ir toliau uztikrinti tin-kamą elgesį su pabėgėliais ir teisę į saugų prieglobstį Baltijos jūros regiono šalyse;12) skatinti glaudesnį bendradarbiavimą ir, tiek, kiek būtina, atsi-zvelgti į Europos Sąjungos ir atitinkamas Jungtinių Tautų deklaraci-jas, kovojant su nelegalia ir nereguliaria migracija;13) skatinti bendradarbiavimą mokslinių tyrimų ir inovacijų sritysekuriant konkurencingesnį ir tvaresnį regioną;14) skirti daugiau dėmesio nuspėjamumo uztikrinimui, stiprinanttarpusavio skaidrumą ir rizikos mazinimo priemonėmis. Tai svarbu siekiant išvengti nereikalingos rizikos ir įtampos, įskaitant įtampą, susijusią su karinių laivų ir lėktuvų judėjimu Baltijos jūros regione;dėl konkurencingumo Baltijos jūros regione, atsizvelgiant į švietimo ir darbo rinkos sąsajas:15) pripazinti glaudesnių švietimo ir darbo rinkos sąsajų poreikį;16) remti Europos naujų įgūdzių darbotvarkę; 17) suteikti jaunimui profesinio mokymo ir kvalifikacijos tobuli-nimo galimybių, kurios padėtų prisitaikyti prie pramonės poreikių ir kurios, taikant visuotinai pripazintas oficialias kvalifikacijas, yra viena iš svarbiausių sėkmės darbe prielaidų;97 Annex I18) stiprinti mokyklų, universitetų ir verslo ryšius, siekiant uzti-krinti, kad universitetinis ir profesinis švietimas bei mokymas būtų labiau ir konkrečiau orientuoti į darbo rinką, tam, kad būtų galima nustatyti darbo rinkos pasiūlos ir paklausos neatitiktį ir uzkirsti jai kelią;19) remtis BJVT programa „EuroFaculty“, kaip ilgalaikio projektopagrindu paremto bendradarbiavimo švietimo ir mokslo srityse Bal-tijos jūros regiono zmonių labui pavyzdziu, ir išsiaiškinti tolesnes šiai programai reikalingas priemones;20) skatinti įgytos kvalifikacijos (pagrindinės ir specializuotos)kėlimą ir galimybes įsidarbinti uztikrinant teisę į mokymąsi visą gyvenimą;21) pagerinti kvalifikacijų skaidrumą ir palyginamumą bei toliauplėtoti abipusį formalios kvalifikacijos pripazinimą;22) palengvinti įgūdzių, reikalingų darbo rinkai, nuspėjimą; 23) išsiaiškinti Šiaurės matmens darbo rinkos ir švietimo partnerys-tės poreikius toliau plėtoti švietimą ir darbo rinką Baltijos jūros regione;24) remti verslo ir švietimo bendradarbiavimą, siekiant tvarios eko-nominės teritorijos Baltijos jūros regione, ypač – sisteminį keitimąsi patirtimi darbo rinkos ir švietimo sektoriuose;25) stiprinti socialinių įstaigų, socialinių partnerių ir vyriausybiniųorganizacijų bendradarbiavimą plėtojant socialinį dialogą;26) remti mokslinius tyrimus ir standartizavimą kibernetinio sau-gumo srityje, ypatingą dėmesį skiriant jūrinei aplinkai ir taikomo-sioms programoms, ir skatinti duomenų valdymą siekiant teisingos ir palankios aplinkos naujais duomenimis grįstoms paslaugoms, kurios pagerins regiono technologijų kokybę ir paskatins aukštos kvalifikacijos darbo vietų kūrimą;27) Baltijos jūros regioną paversti mokymosi srityje pirmaujančiuregionu;28) paskatinti intensyvesnį „iš apačios į viršų“ principu paremtąbendradarbiavimą ir tinklų kūrimą, siekiant išplėtoti konkrečių mokslo, mokslinių tyrimų, inovacijų ir klasterystės sričių bendra-darbiavimą ir sukurti sinergiją;98 Annex I29) palengvinti tęstinį dialogą ir bendradarbiavimą mokslo, tyrimų,inovacijų ir aukštojo mokslo srityse pasitelkus politinius ir regioni-nius formatus ir iniciatyvas;dėl įsidarbinimo galimybių, darbo jėgos judumo ir jaunimo nedarbo:30) dirbti siekiant bendros ir bendradarbiavimu grindziamos darbo rinkos Baltijos jūros regione;31) remti bendrą darbo vietų platformą ir didinti jos zinomumą,kad Baltijos jūros regiono darbo jėga išnaudotų jos visą teikiamą potencialą;32) suburti nacionalines uzimtumo tarnybas ir privačias įdarbinimoagentūras, įskaitant socialinius partnerius, siekiant padidinti darbo ieškančių asmenų galimybes;33) taikyti ir plėtoti geruosius metodus, pavyzdziui, Europos Sąjun-gos Jaunimo garantijų iniciatyvą, siekiant kurti tvarias ir plataus masto koncepcijas jaunimo nedarbo problemai spręsti ir skatinti perėjimą iš mokyklos į darbinę veiklą;34) taikyti tikslingas priemones niekur nedirbantiems ir nesimo-kantiems jaunuoliams, siekiant juos sėkmingai įtraukti į mokymąsi ir darbą;35) skatinti ilgalaikių bedarbių integraciją į darbo rinką, taikantpatikrintus ir pasiteisinusius metodus, paremtus koordinuotu ir individualizuotu poziūriu, apimančiu ir darbdavius;36) šiam tikslui taip pat taikyti geruosius metodus, pavyzdziui,Europos Sąjungos Tarybos rekomendacijas dėl ilgalaikių bedarbių integracijos į darbo rinką;37) stengtis paskatinti pirmiausia zemos kvalifikacijos ir ilgalaikiusbedarbius bei vyresnio amziaus darbuotojus dalyvauti tęstiniame profesiniame mokyme;38) toliau populiarinti tęstinį mokymąsi ir gerinti tęstinio moky-mosi siekiant įgyti profesinio mokymosi kvalifikaciją sąlygas, įskai-tant jaunus suaugusius asmenis;99 Annex I39) palengvinti judumą, ypač pasienio regionuose, ir teikti informa-cijos paslaugas pasienio darbuotojams, kurie yra skirtingų naciona-linės praktikos ir teisinių sistemų subjektai;40) išnaudoti tarpvalstybinius pajėgumus asmenims, vazinėjan-tiems kiekvieną dieną mokytis ar studijuoti anapus sienos, taip ska-tinant sampratą, kad vazinėjimas anapus sienos dirbti gali būti nedarbo rizikos mazinimo priemonė;41) geriau išnaudoti senėjančios visuomenės išteklius;42) palengvinti švietimo institucijų ir verslo bendradarbiavimą, sie-kiant padėti jauniems zmonėms rasti darbą, o darbdaviams – pri-imti į laisvas darbo vietas;43) imtis grieztų ir ilgalaikių priemonių, siekiant sumazinti jau-nimo nedarbą ir atverti darbo perspektyvas ir gyvenimo galimybes visiems jauniems zmonėms, tam panaudojant ES finansines lėšas, ir stebėti rezultatus;44) kuo anksčiau informuoti jaunimą pereinamuoju iš mokyklos įdarbo rinką laikotarpiu apie mokymosi būdus ir galimybes, atsizvel-giant į karjeros planavimą, ir taip skatinti jų sėkmingą įsitraukimą į darbo rinką;45) siekti uztikrinti sąziningą darbo uzmokestį ir darbą, mazinantdarbus pagal subrangos sutartis, darbus per laikinojo įdarbinimo agentūras ir pagal laikinųjų paslaugų sutartis, ten, kur galimas nuo-latinis darbas;46) kaip įmanoma greičiau šviesti pabėgėlius ir integruoti juos įdarbo rinką, keistis gerosios patirties pavyzdziais Baltijos jūros regi-one. Kuo anksčiau ir visapusiškai į šią veiklą įtraukti ir socialinius partnerius;47) skatinti neįgaliųjų dalyvavimą darbo rinkoje, kur įmanoma –įsitraukiant į verslą, bendrojoje darbo rinkoje, atsizvelgiant į įtrauk-ties principus pagal Jungtinių Tautų neįgaliųjų teisių konvenciją;48) remti viešojo darbo administravimo institucijų pastangas ska-tinti piliečių mobilumą visame Baltijos jūros regione;100 Annex Idėl tvaraus turizmo:49) atsizvelgiant į unikalią Baltijos jūros gamtą ir daugelio jos arealųpazeidziamumą, parengti tarpvalstybines strategijas, siekiant mazinti turizmo ir jūros bei pakrančių apsaugos priešpriešą;50) stiprinti kaimo plėtrą ir zemės ūkio produktų gamybą, atsizvel-gus į aplinkosaugą taip, kad būtų saugomas ir atkuriamas gamtos kraštovaizdis ir natūrali aplinka – išankstinė tvaraus turizmo kaimo vietovėse sąlyga;51) remti tarptautines strategijas, skatinančias turizmo plėtrą Balti-jos jūros regione, ir kurti regiono turizmo politikos projektų ir komunikacijos strategijos sąveiką;52) uztikrinti geresnę visų Baltijos jūros šalių įtrauktį į bendrus pro-jektus ir strategijas, taip pat ir privataus sektoriaus, siekiant didesnio tiesioginio ekonominio poveikio;53) dirbti išvien, siekiant bendro poziūrio į tvarų turizmą regione; 54) sutelkti visas tvaraus turizmo galimybes, siekiant padaryti Balti-jos jūros regioną bendru ir vientisu turizmo centru;55) bendradarbiauti, siekiant bendros tvaraus turizmo sampratos irkurti bendrą rinkodarą ir zenklinimą;56) remti Baltijos jūros turizmo forumą ir jo naujai įgyvendinamąprojektą nuolatinę keitimosi informacija ir praktine patirtimi plat-formą – Baltijos jūros turizmo centrą – kaip tvaraus turizmo regione veiklos įgyvendinimo koordinatorių;57) ypač remti 2-ąjį kvietimą teikti paraišką dėl finansinės paramosBaltijos jūros turizmo centrui pagal ES Bendrijos iniciatyvos dėl pasienio regionų (INTERREG) programą „Baltijos jūros Pietų regi-onas 2014–2020“, siekiant įsteigti bendradarbiavimo tvaraus turizmo srityje paslaugų centrą ir nuolatinę keitimosi informacija ir praktine patirtimi tarptautiniu lygmeniu platformą, vadinamąjį Baltijos jūros turizmo centrą;58) remti ES Baltijos jūros regiono strategijos turizmo srityje politi-kos tikslus palengvinti ir sustiprinti Baltijos jūros turizmo forumo procesą, taip pat padaryti paprastesnį suinteresuotųjų šalių, ren-giančių bendrus seminarus, koordinavimą;101 Annex I59) padėti suinteresuotosiomis šalims jungtis į turizmo tinklus irkurti klasterius;60) atgaivinti ir atnaujinti turimas, bet neišnaudotas Baltijos jūrosregiono zinias apie tvarų turizmą, pavyzdziui, Agoros strategiją dėl tvaraus turizmo plėtros Baltijos jūros regione;61) siekti ilgalaikio poveikio ir naudos, kurie stiprintų visuomenėspritarimą;be to, Konferencija nusprendė:62) išreikšti padėką laisvajam Hanzos miestui Hamburgui ir pritarti jo pasiūlymui 26-ąją Baltijos jūros parlamentinę konferenciją surengti 2017 m. rugsėjo 3–5 dienomis Hamburge.102 Annex IIAnnex II – ProgrammeSaturday, 27 AugustArrival of participants and check-inRadisson Blu Hotel Latvia,Elizabetes iela 55, LV-1010, Riga18:00 – 20:00Participant registration and information deskavailable at the hotelSunday, 28 August8:00-20:00Participant registration and information deskavailable at the hotel9:30 Departure for the Saeima10:00-12:00 Meeting of the BSPC Drafting CommitteeJēkaba iela 10/12, Room 40912:00 Coffeebreak12:30-14:00 Meeting of the BSPC Standing CommitteeJēkaba iela 10/12, Room 40914:00Departure for the hotel16:00Departure for PilsrundāleRundāles pagasts, Rundāles novads, LV- 392117:30 Tour of Rundāle Castlehttp://rundale.net19:00-21:30Reception hosted by Dr Jānis Vucāns,President of the BSPC, in honour of the 25thanniversary (Silver Jubilee) of the Baltic SeaParliamentary ConferenceRundāle Castle21:30 Departure for Riga103 Annex IIMonday, 29 August9:00-18:30Participant registration and information deskavailable University of Latvia AcademicCentre of Natural Sciences Jelgavas iela 1,Riga, LV – 10048:40Departure for the University of Latvia AcademicCentre of Natural Sciences9:30 Cultural introduction – musical performanceOPENINGChair: Dr Jānis Vucāns, President of the BSPCVice-chair: MsCarola Veit, Vice-president of theBSPCIntroductory remarks: Dr Jānis Vucāns,President of the BSPCWelcome address:H.E. Mr RaimondsVējonis,President of the Republic of LatviaConfirmedH.E. Ms Ināra Mūrniece,Speaker of the Saeima of the Republic of LatviaConfirmed10:00-13:00 FIRST SESSIONCooperation in the Baltic Sea regionChair: Dr Jānis Vucāns, President of the BSPCVice-chair: Mr Franz Thönnes, MP , GermanyReport by Dr Jānis Vucāns, President of the BSPCMr ValdisDombrovskis,Vice-president of the European CommissionQuestions and AnswersReport from the Council of the Baltic States(CBSS)- Mr Michał Czyż, Outgoing CBSS Chair,Committee of Senior Officials, Ambassador ofPoland- Mr Guðmundur Árni Stefánsson,Committee of Senior Officials, Ambassador ofIceland11:00 Family Photo11:00-11:30 Coffee break104 Annex II11:30 CONTINU ATION OF THE FIRST SESSIONCooperation in the Baltic Sea regionMs Zanda Kalniņa-Lukaševica, ParliamentarySecretary of the Ministry of Foreign Affairs, LatviaImplementation of the BSPC Resolution- Ms Carola Veit, Vice-president of the BSPCReport from HELCOM- Ms Monika Stankiewicz, Executive Secretary ofHELCOMReport from the Baltic Sea NGO Forum- Ms Darja Akhutina,Coordinative Committeemember, BS NGO Forum and Network, RussianPlatform Chairperson- Ms Magda Leszczyna-Rzucidło, BS NGONetwork 2016 Forum CoordinatorAddresses by the representatives ofother Parliamentary Assemblies and international guestsH.E. Ms Maja Gojković, President of the Parliamentary Assembly of the Black Sea Economic Cooperation (PABSEC) and Speaker of the National Assembly of the Republic of SerbiaMr Vitaly Busko, Chairman of the Commissionon International Affairs of the House of Representatives of the National Assembly of the Republic of BelarusDiscussions13:00-14:00 Lunch14:00-15:30 SECOND SESSIONHow to develop competitiveness in the BalticSea Region by linking education and the labourmarketChair: Ms Dorota Arciszewska- Mielewczyk, MP ,PolandVice-chair: Mr Pyry Niemi, MP , Sweden-Defining labour market needs, tools forforecasting trends in the labour market; vocational education;- Cooperation in higher education;-Corporate social responsibility for systematic andsustainable introduction of work-based learning.105 Annex II- Ms Līga Lejiņa, S tate Secretary of the Ministryof Education and Science, Latvia- Ms Jadwiga Parada, Director of Vocationaland Continuing Education Department fromMinistry of National Education, Poland- Mr Poul Nielson, former EU Commissionerand Danish cabinet minister, Author of the announced strategic review of the Nordic labour market- Mr Jan Guz, OPZZ President and the Co-president of the Baltic Sea T rade Union Network- Dr Martin Sauer, Baltic Sea Labour Forum- Mr Vatanyar Yagiya, Professor of the SaintPetersburg State University and Counsellor to the Chairman of the Saint Petersburg Legislative AssemblyDiscussionsCEREMONIAL SESSION in honour of the 25thanniversary of the BSPCBaltic Sea parliamentary cooperation: yesterday,today, tomorrowModerator: Ms Carola Veit,Vice-president of the BSPC- Mr Trivimi Velliste, Former President of theBaltic Assembly, Former member of the Standing Committee of the BSPC, Estonia- Mr Franz Thönnes,Chairman of the delegationof the German Bundestag to the BSPC- Ms Anna Abrahamsson,President of the NordicYouth CouncilDiscussions17:00 Departure for the hotel17:00-18:30 Meeting of the Drafting Committee (if necessary)18:30 Departure for the hotel19:40 Departure for the Saeima20:00-21:30Reception at the Saeima hosted byH.E. Ms Ināra Mūrniece, Speaker of the Saeima21:30 Departure for the hotel106 Annex IITuesday, 30 August8:30-14:00Participant registration and information deskavailable University of Latvia Academic Centre ofNatural Sciences Jelgavas iela 1, Riga, LV – 10048:15Departure for the University of Latvia AcademicCentre of Natural Sciences9:00-11:00 THIRD SESSIONRealising employment opportunities – Improvinglabour mobility and combating youthunemploymentChair: Mr Jörgen Petterson, MP , ÅlandVice-chair: Ms Giedrė Purvaneckienė, MP ,Lithuania-Labour mobility, including emigration/immigration aspects,urbanization;-T rends, causes, solutions of youthunemployment;-Support mechanisms – the Youth Guarantee(support in the framework of active labour market policies, vocational education opportunities, measures to involve NEETs).- Mr Jānis Reirs, Minister of Welfare, Latvia- Ms Algimanta Pabedinskiene, Minister of SocialSecurity and Labour, Lithuania- Ms Anette Kramme,Parliamentary StateSecretary of the Labour and Social Affairs Ministry, Germany- Mr Thor Kleppen Sættem, State Secretary of theMinistry of Labour and Social Affairs, Norway- Ms Egle Käärats, Deputy State Secretary Generalon Labour and Employment Policy, EstoniaDiscussions11:00 Coffee break11:30 Contributions by the BSPCWorking Group andRapporteurs:- Interim report by BSPC Working Group onSustainable T ourism, Ms Sara Kemetter, WGVice-Chairman- Report by Ms Sonja Mandt, BSPC Rapporteuron Cultural Affairs107 Annex II12:00 CLOSING OF THE 25TH BSPCChair: Dr Jānis Vucāns, President of the BSPCVice-chair: Ms Carola Veit, Vice-president of theBSPC- Adoption of the Conference Resolution-Address by the incoming President of the BSPC2016-2017- Presentation by the incoming presidency12:30 LunchDeparture of delegations108 Annex IIIAnnex III – List of AttendeesPresident of the Republic of Latvia1.H.E. Mr RaimondsVējonisSpeaker of the Saeima2.H.E. Ms Ināra MūrnieceBaltic Assembly3.Ms Giedrė Purvaneckienė, Vice President of the BalticAssembly, Chair of the Lithuanian delegation to the BalticAssembly, Member of the Parliament4.Mr Romualds Razuks, Member of the Parliament of Latvia,Member of the Presidium of the Baltic Assembly5.Ms Marika Laizāne-Jurkāne, Secretary General6.Ms Anete Kalnāja,Senior ConsultantBremenBürgerschaft7.Ms Sülmez Dogan, Vice President of the Bremen StateParliament8.Ms Antje Grotheer, Member of the Bremen StateParliamentDenmarkFolketinget9.Ms Annette Lind, Member of the Danish Parliament10.Ms Kamilla Kjelgaard, Head of Section of the DanishParliamentEstonia11.Mr Trivimi Velliste, Former president of the BalticAssemblyRiigikogu12.Ms Ene Rõngelep, Senior Advisor of the Parliament ofEstoniaMinistry of Social Affairs13.Ms Egle Käärats, Deputy Secretary General on Labour andEmployment Policy109 Annex IIIEuropean Parliament14.Mr Jorn Dohrmann, Chair of the SINEEA-delegation,European Parliament15.Ms Amelia Padurariu,EU Foreign Policy Advisor,European ParliamentFinlandEduskunta16.Ms Saara-Sofia Sirén, Member of the Parliament of Finland17.Mr Mika Laaksonen, Secretary for International Affairs ofthe Parliament of FinlandMinistry of Foreign Affairs18.Ms Kristina Pingoud, Senior AdviserGermanyBundestag19.Mr Franz Thönnes, Member of the German Bundestag,Chairman of the German delegation to the BSPC20.Mr Herbert Behrens, Member of the German Bundestag21.Mr Frank Michael Junge, Member of the GermanBundestag22.Mr Peter Stein, Member of the German Bundestag23.Mr Thomas Stritzl,Member of the German Bundestag24.MsNicole T epasse, Secretary of the delegation of theGerman Bundestag25.MrT orsten Schneider, Secretary of the delegation of theGerman BundestagLabour and Social Affairs Ministry26.Ms Anette Kramme,Parliamentary State SecretaryHamburgBürgerschaft27.MsCarola Veit, President of the Parliament of Hamburg28.Dr Kurt Duwe, Member of the Parliament of Hamburg29.Mr Stephan Jersch, Member of the Parliament of Hamburg30.Mr Soeren Schumacher, Member of the Parliament ofHamburg31.Ms Ulrike Sparr, Member of the Parliament of Hamburg32.Dr Michael Westenberger, Member of the Parliament ofHamburg33.Dr Alexander Wolf, Member of the Parliament of Hamburg34.Mr Johannes Duewel, Director of the Parliament ofHamburg110 Annex IIIIcelandAlthingi35.MsVigdis Hauksdottir, Member of Parliament of Iceland36.Mr Róbert Marshall, Member of Parliament of Iceland37.Mr Helgi Thorsteinsson,Secretary to the IcelandicDelegation to the Nordic CouncilKaliningrad RegionKaliningrad Regional Duma38.MsGalina Yankovskaya, Member of the Parliament of theKaliningrad Regional Duma39.MrVladimir Belkov, Employee of the Kaliningrad RegionalDumaLatviaSaeima40.Dr Jānis Vucāns, President of the BSPC, Member of theParliament of Latvia41.Mr Ojārs Ēriks Kalniņš, Chairman of the Foreign AffairsCommittee, Member of the Parliament42.MrJuris Viļums, Chairman of the Education, Science andCulture Committee of the Baltic Assembly, Member of theParliament43.MrVeiko Spolītis, Member of the Latvian delegation to theBaltic Assembly, Member of the Parliament44.Ms Ingrīda Sticenko, Senior Adviser of theInterparliamentary Relations BureauMinistry of Foreign Affairs45.Ms Zanda Kalniņa-Lukaševica, Parliamentary Secretary46.Mr Māris Klišāns,Ambassador47.Ms Anda Catlaka,Director of Europe Department48.Ms Iveta Staņislavska, Deputy Director of EuropeDepartment49.Ms Egija Eglīte, Second Secretary50.MsVita Zivtiņa, Deputy Head of Baltic, Nordic Countriesand Regional Co-operationMinistry of Welfare51.Mr Jānis Reirs, Minister of Welfare52.Mr Imants Lipskis,Director of Labour Market PolicyDepartment53.MsIneta Tāre, Director of International Cooperation andEU Policy Department54.Ms Ina Elksne, Deputy Director of InternationalCooperation and EU Policy Department55.Ms Aija Bukova – Zideļuna, Adviser to the Minister ofCommunication56.Mr Nauris Kozuliņš, Senior Expert111 Annex III57. Mr Gundars Ignats, Senior ExpertMinistry of Education and Science58.Ms Līga Lejiņa, State SecretaryState Employment Agency59.Ms Inese Kalvāne, Director60.Ms Aiga Balode,Deputy Director of Finance andDevelopment DepartmentLithuaniaSeimas61.Ms Irena Šiaulienė, Member of the Lithuanian delegationto the Baltic Assembly, Member of the Parliament62.Mr Mindaugas Geibavičius, Driver of the Seimas of theRepublic of LithuaniaMinistry of Social Security and Labour63.Ms Algimanta Pabedinskiene,Minister64.Mr Kestutis Zaura, Deputy Director of Labour DepartmentMecklenburg-VorpommernLandtag65.Ms Silke Gajek, Vice President of the LandtagMecklenburg-Vorpommern66.Ms Regine Lück, Vice President of the LandtagMecklenburg-Vorpommern67.Mr André Brie, Member of Parliament of the LandtagMecklenburg-Vorpommern68.Mr Detlef Müller, Member of Parliament of the LandtagMecklenburg-Vorpommern69.Mr Georg Strätker, Senior advisor, Landtag Mecklenburg-Vorpommern70.Mr Florian Lipowski, Advisor, Landtag Mecklenburg-VorpommernNordic Council71.MrWille Rydman, Member of the Parliament of Finlandand Nordic Council72.MrT orkil Sørensen, International advisor of the NordicCouncil73.Mr Hrannar Arnarsson,General Secretary for the Socialdemocratic groupNorwayStortinget74.Mr Jorodd Asphjell, Member of the Norwegian Parliament75.Ms Heidi Nordby Lunde, Member of the NorwegianParliament112 Annex III76. Ms Sonja Mandt, Member of the Norwegian Parliament77.Ms Marianne Seip, Political Advisor, Norwegian Parliament78.Mr Bjørn Andreassen, Senior Advisor, NorwegianParliamentMinistry of Labour and Social Affairs79.Mr Thor Kleppen Saettem, State SecretaryPolandSejm80.Mr Grzegorz Matusiak, Member of the Delegation of theSejm and the Senate of the Republic of Poland to the BSPC, Sejm of the Republic of Poland81.Mr Jacek Protas, Member of the Delegation of the Sejmand the Senate of the Republic of Poland to the BSPC, Sejm of the Republic of Poland82.Mr Michał Stasiński, Member of the Delegation of theSejm and the Senate of the Republic of Poland to the BSPCSenate83.Ms Dorota Arciszewska-Mielewczyk, Chair of theDelegation of the Sejm and the Senate of the Republic of Poland to the BSPC, Senate of the Republic of Poland84.Mr Andrzej Mioduszewski, Member of the Delegation ofthe Sejm and the Senate of the Republic of Poland to the BSPC85.Mr Piotr Koperski, Secretary of the Delegation of the Sejmand the Senate of the Republic of Poland to the BSPC, Chancellery of the Senate of the Republic of PolandMinistry of National Education86.Ms Jadwiga Parada, Director of Vocational and ContinuingEducation DepartmentRussian FederationCouncil of the Federation87.Mr Igor Morozov, Member of the Committee for ForeignAffairs Council of the Federation88.Ms Anna Zhiltsova, Councillor of the Committee forForeign Affairs of the Council of the FederationState Duma89.Mr Iliya Kostunov, Member of the Parliament of the StateDuma90.MsYulia Guskova, Adviser of the State DumaMinistry of Foreign Affairs91.Mr Sergey Petrovich, Deputy Director of the SecondEuropean Department, Russian Senior Official at the CBSS Committee of Senior Officials113 Annex IIISchleswig-HolsteinLandtag92.Ms Angelika Beer, Member of the State Parliament ofSchleswig-Holstein93.Dr Ekkehard Klug, Member of the State Parliament ofSchleswig-Holstein94.Ms Regina Poersch, Member of the State Parliament ofSchleswig-Holstein95.MrBernd Voß, Member of the State Parliament ofSchleswig-Holstein96.MsJette Waldinger-Thiering, Member of the StateParliament of Schleswig- Holstein97.MrRainer Wiegard, Member of the State Parliament ofSchleswig-Holstein98.Ms Jutta Schmidt Holländer, Member of the staff of theState Parliament of Schleswig-HolsteinSt. PetersburgLegislative Assembly99.MsTatiana Zakharenkova, Plenipotentiary of the SaintPetersburg Legislative Assembly for International Relations100.Mr Vatanyar Yagiya, International Relations Adviser to theChairman of the Legislative Assembly of Saint PetersburgSwedenRiksdag101.Mr Fredrik Christensson, Member of the Parliament102.Mr Pyry Niemi, Member of the Parliament103.Mr Daniel Riazat, Member of the Parliament104.Ms Suzanne Svensson, Member of the Parliament105.MsCecilie T enfjord-T oftby, Member of the Parliament106.Ms Petra Sjoestroem, Senior Adviser of the ParliamentÅland IslandsLagting107.Ms Annette Holmberg-Jansson, Member of the ÅlandParliament108.Ms Ingrid Johansson, Member of the Åland Parliament109.Ms Sara Kemetter, Member of the Åland Parliament110.Mr Jörgen Pettersson, Member of the Åland Parliament111.MrStephan T oivonen, Member of the Åland Parliament112.Mr Niclas Slotte, Secretary of the delegation of the ÅlandParliament114 Annex IIIBSPC and OBSERVERSBSPC – Baltic Sea Parliamentary conference113.Mr Bodo Bahr, Head of the Secretariat of the Baltic SeaParliamentary Conference114.Ms Kim Kleine,Analyst115.Ms Claudia Peters,WriterBSLF- Baltic Sea Labour Forum116.Dr Martin Sauer, Manager of the Labour Market117.Mr Uwe Sassenberg, Science Link CoordinatorBASTUN - Baltic Sea Trade Union Network118.Mr Jan Guz, President of the All-Poland Alliance of T radeUnions119.Mr Piotr Ostrowski, Head of International Department ofthe All-Poland Alliance of T rade UnionsBSRUN - Baltic Sea Region University Network120.Mr Kari Hyppönen, President of the Baltic Sea RegionUniversity NetworkBSSSC - Baltic Sea States Sub-Regional Co-operation121.Mr Ossi Savolainen, Chairman of the Baltic Sea States Sub-Regional Co-operation122.MrJanne Tamminen, Secretary General of the Baltic SeaStates Subregional Cooperation123.Ms Małgorzata Ludwiczek, CoordinatorCBSS - Council of Baltic Sea States124.H.E. Mr Guðmundur Árni Stefánsson, Chair of theCommittee of Senior Officials of the Council of the Baltic States, Ambassador of Iceland125.Mr Michał Czyż, Outgoing CBSS Chair, Committee ofSenior Officials, Ambassador of Poland126.Ms Maira Mora, Director General of Secretariat of theCBSSCIS-IPA – Inter-Parliamentary Assembly of the Commonwealth of Independent States127.Mr Petr Riabukhin,Deputy Secretary General128.Mr Ivan Korotkiy, Advisor, International RelationsDepartmentCPMR - Baltic Sea Commission129.Mr Jari Sainio, President of the CPMR Baltic SeaCommission130.Ms Åsa Bjering, Executive Secretary of the CPMR-BalticSea Commission115 Annex IIIEuropean Commission131.MrValdis Dombrovskis, Vice-President of the EuropeanCommission132.Mr Gints Freimanis, Member of Cabinet Dombrovskis,European Commission133.Ms Inna Šteinbuka, Head of the European Commission’sRepresentation in LatviaHELCOM - Helsinki Commission134.Ms Monika Stankiewicz, Executive SecretaryNCM - Nordic Council of Ministers135.Mr Poul Nielson, Special Advisor of the Nordic Council ofMinisters136.MrJan Widberg, Director of the Nordic Council ofMinisters ́ Office in Latvia NDPHS - Northern DimensionPartnership in Public Health and Social Well- being137.Mr Marek Maciejowski, Director of the SecretariatNGO Forum138.Ms Magda Leszczyna-Rzucidło, Coordinating Committeemember of the Baltic Sea NGO Network / „BSR youth social entrepreneurship development“ project leader139.Ms Daria Akhutina,CC member, Chairperson of theRussian Platform, BS NGO Network and ForumNordic Youth Council140.Ms Anna Abrahamsson, PresidentPABSEC - Parliamentary Assembly of the Black Sea Economic Co-operation141.H.E. Ms Maja Gojkovic, President142.Mr Igor Becic,Vice-president143.Ms Natia Gaprindashvili, Secretary of PABSEC Legal andPolitical Affairs Committee144.Ms Milena Ljubinkovic, Secretary145.Mr Dragan Dejanovic, Security officerPolicy Area Coordinator for EUSBSR146.Ms Solveg Schmidt, Policy Area Coordinator147.Mr Anders Bergström,Policy Area Coordinator, PAEducation/EU Strategy for the Baltic Sea RegionUBC – Union of Baltic cities148.Mr Mikko Lohikoski,Strategy coordinator116 Annex IIISpeakers of the Conference• Mr Jānis Vucāns, President of the BSPC, Member of theParliament of Latvia• Mr Valdis Dombrovskis, Vice-President of the European Commission• Mr Michał Czyż, Outgoing CBSS Chair, Committee ofSenior Officials, Ambassador of Poland• H.E. Mr Guðmundur Árni Stefánsson, Chair of the Committee of Senior Officials of the Council of the Baltic States, Ambassador of Iceland• Ms Zanda Kalniņa-Lukaševica, Parliamentary Secretary, Ministry of Foreign Affairs of Latvia• Ms Carola Veit, President of the Parliament of Hamburg,Vice-president of the BSPC• Ms Monika Stankiewicz, Executive Secretary• Ms Daria Akhutina, CC member, Chairperson of the Russian Platform, BS NGO Network and Forum• Ms Magda Leszczyna-Rzucidło, Coordinating Committee member of the Baltic Sea NGO Network / „BSR youth social entrepreneurship development“ project leader• H.E. Ms Maja Gojkovic, President of PABSEC• Mr Vitaly Busko, Chairman of the Standing Commissionon International Affairs of House of Representatives of the National Assembly of the Republic of Belarus• Ms Līga Lejiņa, State Secretary of the Ministry ofEducation and Science of Latvia• Ms Jadwiga Parada, Director of Vocational and Continuing Education Department• Mr Poul Nielson, Special Advisor of the Nordic Council of Ministers• Mr Jan Guz, President of the All-Poland Alliance of T rade Unions• Dr Martin Sauer, Manager of the Labour Market• Mr Vatanyar Yagiya, International Relations Adviser to theChairman of the Legislative Assembly of Saint Petersburg• Mr Trivimi Velliste, Former president of the BalticAssembly• Mr Franz Thönnes, Member of the German Bundestag,Chairman of the German delegation to the BSPC• Ms Anna Abrahamsson, President of the Nordic YouthCouncil• Mr Jānis Reirs, Minister of Welfare of Latvia• Ms Algimanta Pabedinskiene, Minister• Ms Anette Kramme, Parliamentary State Secretary of theLabour and social Affairs Ministry of Germany• Mr Thor Kleppen Saettem, State Secretaryof the Ministry of Labour and social Affairs of Norway117 Annex III• Ms Egle Käärats, Deputy Secretary General on Labourand Employment Policy of the Ministry of Social Affairs of Estonia• Ms Sara Kemetter, Member of the Åland Parliament, BSPC Rapporteur on Cultural Affairs• Ms Sonja Mandt, Member of the Norwegian ParliamentOther participantsHouse of Representatives of the National Assembly of theRepublic of Belarus149.MrVitaly Busko, Chairman of the Standing Commissionon International AffairsDiplomatic corps150.H.E. Mr Hans Brask, Ambassador Extraordinary andPlenipotentiary of the Kingdom of Denmark to the Republic of Latvia151.H.E. Ms Ewa Dębska, Head of the Mission, Embassy of theRepublic of Poland to the Republic of Latvia152.H.E. Mr Steinar Egil Hagen, Ambassador Extraordinaryand Plenipotentiary of the Kingdom of Norway to the Republic of Latvia153.H.E. Mr Olli Kantanen, Ambassador Extraordinary andPlenipotentiary of the Republic of Finland to the Republic of Latvia154.H.E. Mr Henrik Landerholm,Ambassador Extraordinaryand Plenipotentiary of the Kingdom of Sweden to the Republic of Latvia155.H.E. Mr Alexander Veshnyakov, AmbassadorExtraordinary and Plenipotentiary of the Russian Federation to the Republic of Latvia156.H.E. Mr Artūras Zurauskas, Ambassador Extraordinaryand Plenipotentiary of the Republic of Lithuania to the Republic of Latvia157.Ms Liana Dulova, Second Secretary, Embassy of theRussian Federation to the Republic of Latvia158.Ms Ewelina Brudnicka, Deputy Head of Mission, Embassyof the Republic of Poland to the Republic of Latvia159.Ms Manja Kliese, Deputy Head of Mission, Embassy of theFederal Republic of Germany to the Republic of Latvia160.Mr Oleg Sloma, Counselor of the Embassy of Belarus inLatvia161.Mr Zoran Jovanović, Chargé d‘Affaires of Embassy of theSerbia in the Kingdom of Sweden162.MrHarald T ollan, Chargé d‘Affaires of Royal NorwegianEmbassy118 Annex IIIAdministration of the Parliament of Latvia163.Ms Gunta Pastore, Foreign Affairs Advisor of the Speaker164.Ms Sandra Paura, Head of the Interparliamentary RelationsBureau165.Mr Zigmārs Gratkovskis, Acting Head of the ProtocolDivision166.Ms Lelde Rāfelde,Head of the Public RelationsDepartment167.Mr Guntis Stungrevics, Head of Technic Department168.Mr Igors Aizstrauts,Deputy Head of theInterparliamentary Relations Bureau169.Mr Ainārs Stintmanis,Deputy Head of Protocol Division170.Ms Ieva Apine, Senior consultant171.Ms Signe Apsīte, Senior Consultant of the Press Service172.Mr Juris Ļipuncovs, Senior Consultant of the ProtocolDivision173.Mr Māris Krūmiņš, Senior Adviser of theInterparliamentary Relations Bureau174.Mr Martins Olekšs, Senior Adviser of theInterparliamentary Relations Bureau175.Ms Anete Penka,Senior Adviser of the InterparliamentaryRelations Bureau176.Ms Ieva Rubļevska, Senior Adviser of theInterparliamentary Relations Bureau177.MrKirils T eniševs, Senior consultant of the ProtocolDivision178.MsMadara Viļumsone, Senior Consultant of the PressService179.MsIneta Vītoliņa, Senior Adviser of the InterparliamentaryRelations Bureau180.Ms Skaidrīte Rudziša, Editor181.Mr Ernests Dinka, Photographer182.Mr Reinis Inkēns, Photographer/Video operator183.Mr Ilgonis Linde,Video director184.Mr Jānis Martinsons, IT staff185.Mr Alens Šlēziņš,IT staff186.Ms Gundega Zande, Secretary of the InterparliamentaryRelations Bureau187.Ms Judīte Petroviča, Intern of the InterparliamentaryRelations Bureau188.Mr Edmunds Budriķis, Technical support189.Mr Ivars Brauns, Technical support190.Mr Gatis Čirka, Technical support191.Mr Artūrs Kallings, Technical support192.Mr Aleksejs Kozlovs, Technical support193.Mr Andis Krekovskis, Technical support194.Mr Alvis Lazdiņš,Technical support195.Mr Andris Logins, Technical support119 Annex III196. Mr Armands Valdbergs, Technical suppor tGuests197.Ms Anitra Jankevica,Independent consultantWikipedia198.Mr Olaf Kosinsky, Photographer199.Mr Ralf Roletschek, PhotographerInterpreters200.Ms Raimonda Klancberga,Interpreter coordinator201.Ms Elena Almaas, Interpreter202.Mr Anna Hrapan – Gromņicka, Interpreter203.Ms Maria Hemph Moran, Interpreter204.Mr Aleksander Jakimowicz, Interpreter205.Mr Piotr Krasnowolski, Interpreter206.Mr Stein Larsen, Interpreter207.Ms Ana Milanovic, Interpreter208.Mr Aleksei Repin,Interpreter209.Ms Silvia Schreiber, Interpreter210.MrViesturs Sīlis, Interpreter211.Ms Anastasija Zaluņina,Interpreter212.Mr Ivo Puzo, Interpreter213.MsCarmen Tank, Interpreter214.MrAlexandre Tchekhov, Interpreter215.Ms Ieva Upmace, Interpreter216.MsMartina Würzburg, InterpreterThe Standing Committee of the Baltic SeaParliamentary Conference discusses continuously the implementation of the BSPC resolutions.It is customary that the national and regional delegations to the BSPC inform their governments aboutthe outcome of the respective annual conference, most importantly the respective resolution, with which the delegations call on the governments in the Baltic Sea Region, the CBSS, the EU and other pertinent actors to undertake a range of actions or measures.In order to receive a comprehensive and – most significantly – comparative overview of the actions takenby the governments in the Baltic Sea Region in response to the resolution of the 24th Baltic Sea Parlia -mentary Conference in Rostock, the Standing Committee has decided to convey a set of follow-up ques -tions to the recommendations contained in the resolution of particular common interest.The Standing Committee of the BSPC decided to publish the attached feedback of the governments asan Annex of this report.1. Åland2.Denmark3.Estonia4.Germany5.Hamburg6.Latvia7.Lithuania8.Mecklenburg-Vorpommern9.Norway10.Poland11.RussiaÅland P age 3Postadress Telefon Telefax E-postPB 1060 (018) 25000 (018) 19155 registrator@regerin gen.axAX-22111 MARIEHAMN, Åland URL www.regeringen.axTjänstebrev bör ställas till Ålands landskapsregering, inte till enskild tjänstemanDokumentnamn Nr SidnrBREV 32 Rk1c 1 (7)Datum Dnr25.4.2016 ÅLR 2015/9508Contact personPamela BaarmanUnofficial translation: The Government of Åland’s views onthe BSPC resolution as well as information on what the government has done alternatively plans on doing as a result of the resolution.BackgroundFollowing the resolution adopted in September 2015 in Rostock, Germany at theannual Baltic Sea Parliamentary Conference (BSPC), the BSPC-delegation from the Parliament of Åland has requested the Government of Åland’s views on the resolution as well as information about what the government has done, alternatively plans on doing as a result of the resolution. The initial request was complemented on the 8th of February 2016, after a meetingof the Standing Committee of the BSPC, where the Standing Committee decided to convey a set of follow-up questions to the recommendations contained in the resolution of particular common interest, with the aim to make the views from the various governments in the Baltic Sea region more comparable. This year, the main topics of the resolution focus on cooperation in the Baltic Sea region, cross-border cooperation in health care, health and economy as well as sustainable and available social and health care.Calls for action with regard to the preamble and Cooperation in the regionThe Baltic Sea Parliamentary Conference has chosen to emphasise a fewparagraphs under each main chapter of the resolution. With regard to the preambleof the resolution, as well as to the chapter entitl ed Cooperation in the region, theBSPC requests information from the governments on the following paragraphs:The participants, assembling in Rostock, call on the governments in the Baltic SeaRegion... ... to ensure the decent treatment of refugees especially concerning housing and healthcare (preamble of the resolution)The Government of Åland views the current refugee crisis as part of a global shared responsibility in which Åland also should play its part. The Government of Åland has examined possible ways of assisting the Finnish Migration Board relating to the reception of persons seeking integrational protection (asylum). Reception of asylum seekers falls under the legislative realm of the Finnish state (746/2011, Law governing the reception of persons seeking international protection and of identification of and assistance to victims of human trafficking).Åland P age 42 (7)The Finnish Migration Board is the national authority that decidesand enters into agreements relating to the opening and closing of reception centres. Formal parties to such agreements are the Finnish Migration Board and a service producer who operationally runs the reception centre. The Government of Åland concludes that there are no legal impediments for a reception centre to be established in Åland. The Finnish Red Cross has entered a declaration of intent with the Ministry of the Interior to assist in the reception of refugees. This is one of the organisation’s core areas of work. Following this, the Åland district of the Finnish Red Cross has since the beginning of 2016 started work to develop preparedness for a reception centre in Åland, with the Red Cross as service producer. The Government of Åland follows the matter closely in accordance with its government programme. It further notes that it is hard to predict how the situation of persons arriving in Finland to seek asylum will develop in the near future and that it is therefore appropriate to have preparedness for this also in Åland. Since autumn 2015 preparedness to temporarily house a larger group of persons arriving in Åland en route to Finland to seek asylum (offer emergencyhousing), has increased. The Åland district of the Finnish Red Cross acts uponrequest of the local police should such a situation arise. The Government of Åland is assisting by putting a building and some equipment at the disposal of the Red Cross for this purpose. The participants, assembling in Rostock, call on the governments in the Baltic Sea Region... ... to co-operate in order to strengthen the Baltic Sea Region as an important competitive knowledge region with an excellent higher education and research infrastructure (paragraph 4 of the resolution) The Agreement on Education between the Government of Åland and the Åland University of Applied Sciences stipulates that the University shall develop its educational programmes in cooperation with other relevant universities and colleges, and that the university shall develop cooperation models with other universities and colleges in the surrounding area when it comes to applied research. In accordance with the Bologna process, mobility is to be a distinctive feature of European higher education, and before 2020 at least 20 % of those graduating shall have completed a study period or internship abroad during their studies. International activities are important for the students' attractiveness on the labour market, which is why the university sets the goal that at least 70 % of the students shall have completed study periods or internships outside Åland during their studies. In 2015, 60 % of those graduating had completed study periods or internships abroad. In order to achieve the above-mentioned international goals, the Åland University of Applied Sciences participates in a number of cooperation programs. Nordplus, funded by the Nordic Council of Ministers, is an exchange program for higher education in the Nordic and Baltic countries. Within the Nordplus framework, the Åland University of Applied Sciences participates in seven different Nordplus Higher Education networks – the networks include around 80 universities and colleges altogether. The networks aim to provide student and teacher exchanges and organise intensive courses and development projects. The networks also enable the exchange of experiences, good practices and innovative results. The Åland University of Applied Sciences also participates in the Erasmus+ programme, the European Union's exchange and cooperation programme for universities and colleges during 2014-2020. The programme promotes internationalisation and quality in higher education, and through theÅland P age 53 (7)programme, participants can study or teach their own subject abroad, developtheir language skills, create networks as well as expand other international skills. Through the programme, the Åland University of Appl ied Sciences cooperateswith many universities and colleges within the Baltic Sea region. The Åland University of Applied Sciences participates in several research projects together with partners from the B altic Sea region: For example,the university participated in an Interreg Central Baltic project called ARCHOIL -Management of onshore cleanup operations of oil spills in archipelagos , in orderto establish cooperation between neighbouring regions to improve oil spill readiness in the archipelago and to create common strategies for oil protection and cross-border operational cooperation. The Åland University of Applied Sciences also runs a project called The Marine Research Platform, a project co-financed bythe European Regional Development Fund, with the purpose of developing an autonomous mobile marine research platform using wind and solar energy. The platform will be evaluated for marine sensor measurements and harbour porpoise monitoring in the Baltic Sea.The participants, assembling in Rostock, call on the governments in the Baltic SeaRegion... ... to continue work to upgrade reception facilities for sewage in passenger ports to ensure a timely activation of the special area status of the Baltic Sea under Marpol Annex IV of the International Maritime Organization, with the aim to hinder the release of untreated sewage from passenger ships in the future and to reaffirm the commitment for the continued improvement and modernization of the waste water treatment capacity throughout the entire Baltic Sea Region, in compliance with the stricter threshold values agreed by HELCOM (para. 8) The Government of Åland has actively pursued banning emissions from wastewater (sewage) from passenger ships throughout the Baltic Sea by theyear 2018. HELCOM has coordinated the Baltic Sea countries’ work to create such a ban, for which the timetable for implementation has been postponed. In March 2016, the Government of Åland adopted a new Action Programme for the Åland marine environment. In the Action Programme, the Government concludes that a ban on the discharge of sewage from passenger ships in the Baltic Sea is one step closer to implementation, due to a decision by the International Maritime Organization’s Environmental Committee in May 2015. A ban requires an amendment to the convention that regulates discharges from ships – an amendment is expected in April 2016. The directives are supposed to apply from 2019 for new ships, and from 2021 for existing ships in the Baltic Sea, with the exception of Russian waters. The Government of Åland intends to continue to pur sue the matterand to support the work striving towards implementing the ban as quickly as possible, by actively expressing their opinion when needed in different contexts. The Government of Åland has previously written to the Nordic ministers with an appeal to work for a ban on the discharge of sewage from ships, and has also sent an appeal to the Baltic Sea Parliamentary Conference (BSPC) and the Baltic Sea States (CBSS) to work towards maintaining the original schedule for theimplementation of the ban.Calls for action with regard to cross-border cooperation in healthcareIn regard to the chapter entitled Cross-border cooperation in healthcare , theBSPC requests information from the governments on the following threeparagraphs, which the Government of Åland will answ er collectively:Åland P age 64 (7)The participants, assembling in Rostock, call on the governments in the Baltic SeaRegion... ... to improve transnational cooperation and medical specialization in the treatment of rare diseases, bearing in mind the cost-effective usage of medical equipment (para. 20) ... to regulate transnational emergency care in a way that the fastest possiblehealthcare provision can be guaranteed regardless of the healthcare providers ́ country of origin (para. 21) ... to reduce the usage of antibiotics – general – and for agriculture (livestock farming) to an absolute minimum in order to prevent further increase of antimicrobial resistance (para. 22) The Government of Åland places great value in cros s-border Balticcooperation, and has long cooperated with neighbouring countries in various fields. Within the framework of cooperation between the Baltic countries and in the context of the Northern Dimension in the EU, the development of transnational cooperation and innovative approaches in health care and socialwelfare, and the economic aspects of these basic ideas form the basis for theBSPC-resolution. In the resolution, the BSPC puts forward the idea that through cooperation in the health sector, the Baltic Sea region can develop as a pioneer in terms of sustainable development, also with regard to environmental and economic conditions. The Government of Åland notes that these objectives are consistent with those of the Government’s which are formulated in the government programme for a sustainable Åland. The chapter on cross-border cooperation in health care focuses onobjectives which in some respects have already been materialised within the Nordic cooperation, where Åland is an active participant. The resolution mentions the Könberg report identifying areas for development of Nordic cooperation onhealth as an example for similar cooperation in the whole Baltic Sea region. The Government of Åland currently participates in a number of joint Nordic working groups which aims at exchanging information, establishing common guidelines and coordinating the use of resources. Examples of such cooperation are highly specialised care, rare diseases, drug cooperation, financing of health care, education, legitimacy and supervision in the health care professions, as well as mental health and psychiatric care. Another Nordic area of cooperation is the prevention and management of antimicrobial resistance. The Government of Åland states in the budget for 2016 that one objective for the current year is to identify antibiotic use in animal husbandry. The Government of Åland notes that the experience gained from the development of Nordic cooperation on health could be applied within the BSPC.Calls for action with regard to Health & EconomyIn regard to the chapter entitled Health & Economy , the BSPC requestsinformation from the governments on the following paragraphs:The participants, assembling in Rostock, call on the governments in the Baltic Sea Region... ... to improve conditions to support the development of innovations in health care, including in the fields of eHealth and telemedicine, whilst ensuring that investments in eHealth support the adoption of standards and drive interoperability across the health sector to leverage the “eHealth European Interoperability Framework” (eEIF) and observe the joint European initiatives,Åland P age 75 (7)such as the “Guidelines under eHealth Network” of the responsible member stateauthorities (para. 31) The Government of Åland has participated in a number of innovation projects in the health sector, including the projects Äldreomsorg på distans (~Elderly careremotely) and Virtual Elderly Care Service on the Baltic Islands (VIRTU) . Moreinformation on these projects can be found under the chapter Sustainable andAccessible Social- and Healthcare later in this report. The Government of Ålandstates in the budget for 2016 that one objective for the current year is to prepare for the introduction of e-prescriptions and to intensify the work to introduce a new health information system. The intention is that the Åland Healthcare services will introduce e-prescriptions from January 1st 2017.Generally, the Åland Healthcare services support the development of innovations in health care: The Vitalis exhibition, the leading Nordic eHealth exhibition in Gothenburg, is covered annually. With regard to dentistry, SMS-reminders have been introduced to avoid missed appointments, and the web service klamydia.ax, which allows anonymous testing for chlamydia infection, was introduced in 2014. Currently, the Åland Healthcare services are workingtowards introducing the possibility of online bookings for the hospital’s laboratorypatients. The intention is also to be able to offer patients’ health records online in the future. The participants, assembling in Rostock, call on the governments in the Baltic Sea Region... ... to improve early intervention to strengthen good public health through social investment such as vaccine programs, and take strong measures to reduce consumption of alcohol, tobacco and illicit drugs, and work towards stronger prevention of diabetes II and other lifestyle illnesses (para. 34) The Government of Åland has, with the aim to prevent, limit and manage hazardous use and abuse of alcohol, tobacco and drugs, adopted an action programme for 2013-2016. The programme is currently being implemented and has so far resulted in an increased collaboration between operators working toward limiting hazardous use and abuse, as well as a clarification of the distribution of labour in the action plan for people with hazardous use and abuse problems. The need for new legislation in this area has been raised by the three groups that drive the implementation of the action plan, and a project to promote responsible alcohol serving was initiated in 2013. In 2016, a survey was conducted with the aim to identify habits and attitudes of the people living on Åland toward alcohol, tobacco and drug use as well as gambling habits. The survey is a follow-up to similar studies conducted in 2001, 2005 and 2011. The Government of Åland, in cooperation with the Å land Healthcareservices, launched a project in 2014 called Tobakskampen (~the Tobacco Fight), a five-year project to strengthen the preventive and cessation efforts in the Åland Islands. By offering professional help for tobacco users, the aim of the project is to make as many as possible to permanently stop using tobacco. The target groups of the project are tobacco users without severe tobacco-related morbidity, youths in primary and secondary school, health professionals mainly in the public but also in the private sector, as well as other individuals/groups with an interest in tobacco prevention and cessation. The aim of the project is: • that Tobakskampen shall be a well-known and well-used resource for tobacco cessation and tobacco prevention work • that the proportion of tobacco users in Åland decreases in surveys during the project periodÅland P age 86 (7)• that a total of at least 50 frequent tobacco smokers who were the subject of themeasures under the first four years of the Tobakskampen-project should remain permanently free from tobacco smoking (> 12 months after the project) • that the free telephone helpline for tobacco cessation is used at least 150 times during the project period Other prevention programmes that the Government of Åland participates in include a web-based programme for anonymous testing for chlamydia infections, and a general society-funded TBE-vaccination programme for the prevention of tick-borne encephalitis.Calls for action with regard to Sustainable and Accessible Social- andHealthcareWith regard to the chapter entitled Sustainable and Accessible Social- and Healthcare , the BSPC requests information from the governments on thefollowing paragraphs:The participants, assembling in Rostock, call on the governments in the Baltic Sea Region... ... to develop and strengthen strategies addressing demographic change, such as the European Innovation Partnership on Active and Healthy Ageing and especially considering public services with regard to rural peripheral areas (para. 43) In 2016, the Government of Åland launches a three-year project called Äldres psykiska ohälsa (~Mental health problems of the elderly). The aimof the project is to develop preventive, restorative and health-promoting work regarding older people's mental health, and to develop the structures for multi-professional cooperation regarding individuals who need extra support. The aim of the project is to create the most optimal structure and content of care and treatment based on a holistic view of the client/patient aged 65 and older with temporary or chronic mental illness, beginning with making sure that the appropriate care is given at the right time and at the right place. In 2010-2013, the Government of Åland participated in the development project Virtual Elderly Care Service on the Baltic Islands (VIRTU) ,in which – with the help of modern IT-technology – new services within the elderly care were developed. Regarding Åland, the project was funded jointly by the Central Baltic IVA Programme and the Government of Åland. In the years 2013-2015, the Government of Åland funded the proje ct Äldreomsorg på distans(~Elderly care remotely). During 2016, the Government supports through funding the transition of the project to be part of the municipal ordinary activities. The aim is for municipalities to start using welfare technology on a permanent basis as one of several methods to support a safe living at home, prevention of health and social care needs, and as support in the development of economically sustainable solutions in a situation where the demographic trend points towards an increased number of elderly people. The possibilities to use technology for services in telemedicine are also being explored. The Government of Åland has participated in a Nordic project called Kvalitet inom äldreomsorgen (~Quality in elderly care). The project focuses on the experiences and knowledge gathered about the structure and quality of elderly care in the Nordic countries and autonomous territories, as well as to form a picture of what the main challenges are in elderly care in the future in the light of demographic trends.Åland P age 97 (7)The participants, assembling in Rostock, call on the governments in the Baltic Sea Region... ... to create incentives to improve the conditions of the nursing and care professions and to work towards intensified professional and vocational training for people employed in the health sector to signifi cantly facilitate a cost-effectivehealth system in the region and foster understanding of the health sector as a cross-cutting issue (para. 52) The Government of Åland aims to create better working conditions for health and social care professions by currently implementing a work evaluation, as well as digitalizing the health and social care operation. In parallel with this work, the Government of Åland strives to improve cost efficiency and has initiated a public debate about what mission the public health care should fill, and what could be managed in cooperation with the third sector/private sector. The Government of Åland notes that the same question is relevant in the entire Baltic Sea region, which means there should be good opportunities to learn fromeach other.Minister Wille ValveSenior Adviser Pamela BaarmanDenmarkDenmark P age 21ANNEXDanish responses to the 24th Baltic Sea Parliamentary Conference (BSPC) resolution,2015Recommendations with regard to the preamble and cooperation in the regionDenmark ensures all asylum seekers decent accommodation and sufficient access to healthcarein Denmark.- Accommodation of asylum seekersAs a main rule, asylum seekers are required to live at an asylum center while the application isbeing processed. Special centers are provided for unaccompanied minors seeking asylum and for asylum seekers with special needs for care such as in the case of severe illness. Furthermore,asylum seekers may under certain conditions be permitted to live outside the asylum centers.- Asylum seekers’ access to healthcare and social servicesThe Danish Immigration Service provides for the healthcare treatment of as ylum- seekers ,including rejected asylum seekers. Asylum seekers under the age of 18 are entitled to the samehealthcare as children who are residents in Denmark. As for adult asylum seekers, the DanishImmigration Service covers the expenses for healthcare , provided that the treatment isnecessary in the meaning urgent or alleviating/soothing. Furthermore, all persons staying in Denmark – including asylum seekers and illegal immigrants – are entitled to free emergencyhospital treatment, for example in cases of an accident, under the same conditions as persons residing in the country.- Refugees’ access to healthcare and social servicesWhen granted asylum, the applicant will be referred to a municipality by the DanishImmigration Service. The local authori ties are responsible for the integration of recognisedrefugees. As soon as possible after the responsibility for a refugee has passed to the localmunicipalities, the municipality must assign housing to the refugee. The local authorities cannot assign hou sing in deprived neighbourhoods. It is up to the local authorities to decide how theywill provide housing. With regard to health services, all residents in Denmark, including refugees who have receivedresidence permit, are entitled to public health car e. This includes hospital treatment andtreatment by a general or specialist practitioner free of charge. If rehabilitation is needed afterdischarge from a hospital this must be provided free of charge by the municipality. With regard to newly arrived refuges the municipality will decide whether a medical screening is needed. The purpose of the medical screening is to detect severe health problems at an earlystage to ensure adequate health treatment or social measures thus preventing health problemsfrom becoming a barrier to successful integration. The medical screenings are carried out bygeneral practitioners.Denmark P age 32- The Baltic Sea Region as an important competitive knowledge regionThere is a constant Danish focus on actively using the Nordic Council of Ministers’ Nordplusmobility program to foster increased co -operation across all fields of education between theparticipating Nordic and Baltic countries. This focus will once again be honored with thecurrent process of preparing the 2017-2021 program period.Denmark participates in the Baltic Science Network (BSN), which was established under the auspices of the Council of Baltic Sea States on 1 March 2016. The network consists of universities, relevant research organisations and public authorities. The aim of the BSN is to establish a coordination framework in the field of higher education, science and research policy in the Baltic Sea region in order to exploit the region’s untapped potential in these areas – andultimately to contribute to the realization of a European Research Area. The startup meeting of the BSN took place on 7 -8 April in Hamburg. The project, which is financed via INTER -REG(3 million €), will run for three years. Expected output include s an action plan for overcomingbarriers to transregional research, identification and development of areas of research excellence, optimizing use of existing/planned research and innovation infrastructures and Baltic Sea input to the EU’s research and inn ovation agendas.The European Spallation Source (EES) , which is currently under construction, will be theworld’s most advanced neutron science facility. The facility itself is located in Lund, while the corresponding data center (ESS DMSC) is established on the Danish side of Øresund inCopenhagen. ESS, together with XFEL and PETRA III in Hamburg and MAX IV in Lundform a cluster of research facilities in the Baltic Sea Region that will increase our knowledge of materials, down to molecular and atomic level, which is crucial for the progress of both the life sciences a nd materials technology as a whole. Most of the countries around the Baltic Sea aremembers or observers in the ESS-project and additional countries are considering future membership.Over the past few years, Denmark has worked intensively to facilitate the broadest possibleparticipation in the ESS -project among the Baltic Sea countries. Constituting the host region, itis imperative for Denmark to be in a position to take maximal advantage of the emergingscientific possibilities in relation to ESS and other new research facilities. As one meanstowards this goal, NordForsk together with the Norwegian research council, the Swedish Research Council and the Danish Agency for Science, Technology and Innovation have provided approximately 60 million NOK to fund a joint Nordic Neutron Research Program(NNRP) 2015 -2019.The aim of NNRP is to strengthen and increase the neutron scattering community in theregion. Particular focus will be pla ced on attracting young scientists to use the neutronscattering techniques. This will both broaden the use of neutron scattering to new scientificfields and areas and strengthen/consolidate existing neutron user groups. The program is openfor broader international collaborations and partners from the Baltic Sea States are welcome as collaborative partners. The Danish Agency for Science, Technology and Innovation is part of the management teamcurrently outlining the 2016 -2020 EUSBSR Strategic Action Plan for Policy Area Innovation Denmark P age 43(PA INNO) at the policy level. At the operational level of PA INNO, Denmark is – for thethird consecutive year - coordinating partner of the Innovation Express concept, atransnational cluster -to-cluster collaboration framework with its point of departure in the BalticSea Region.PA-INNO covers all activities related to strengthening the ability of the region to succeed ininnovation- based competition. Innovation is one of the region’s hallmarks, with seve ralcountries from the region regularly topping European and global rankings in innovativecapacity. Enhancing these strengths, increasing their effectiveness in creating broadly -sharedeconomic value, and spreading it to parts of the region that are not yet innovation -driven arekey overarching guidelines for PA -INNO and the spirit behind the 2016 -2020 Strategic ActionPlan.Innovation Express supports the internationalisation of SMEs through cluster initiatives, andencompasses a joint call for proposals and an annual cluster -to-cluster matchmakingconference. The call activities are supported by the Nordic Council of Ministers and approvedprojects are funded by national/regional funding agencies to initiate, develop or enhance transnational cooperation activities across all sectors. A particular focus in the upcoming 2016 -call is supporting linkages between clusters with a comprehensive attention towardssustainability (environmental or social).- ShippingIn the Sulphur Emissions Control Areas (SECA), th e Danish Maritime Authority and theDanish Environment Protection Agency have established a task force on the basis of an actionplan for Sulphur enforcement established a task force on compliance and enforcement of the Sulphur regulations. The enforcement of the Sulphur rules involves fuel sampling and close cooperation between re levant Danish authorities, such as the Danish Maritime Authority, theDanish Environmental Protection Agency, the Danish police and the District Attorney’s Office, to ensure effective legal action. So far, one infraction has been reported to the police forinvestigation and possible prosecution. Other cases are pending further investigation.The enforcement effort is supported by awareness raising measures, which in practice have ship- inspectors from the Danish Maritime Authority distribute info -hand-outs on the SECArules when conducting surveys on ships in Danish ports. In addition to the control in ports, the Danish EPA monitors Sulphur emissions from ships in Danish waters using Sulphur detection equipment (“sniffers”). One sniffer is installed on the Great Belt Bridge and one in a smallaircraft, which periodically inspects ships in major shipping lanes. The project started mid -2015and runs till the end of 2016. Furthermore, the Danish Maritime Authority is responsible for coordinating the Policy Are a onClean Shipping in the EU Strategy for the Baltic Sea Region (PA Ship). Actions and Flagship projects within PA Ship focus in particular on the support of efficient enforcement of the SECA regulations and on upgrading sewage reception facilities in the region. The Danish Maritime Authority is also responsible for coordinating the Policy Area onMaritime Safety and Security in the EU Strategy for the Baltic Sea Region (PA Safe) jointly with Denmark P age 54the Finland. Actions and Flagship projects within PA Safe focus in particular on enhancing themacro-regional capacity to respond to major maritime emergencies.Recommendations with regard to cross-border cooperation in healthcareIn July 2014 , the Danish Health Authority released a national strategy for rare diseases. Thestrategy aims to provide a comprehensive overview of rare diseases in Denmark and consists of 94 recommendations for a strengthened and more coherent effort for people with rare diseases. The Danish Health Authority in cooperation with The National Board of Social Services willevaluate the strategy and the implementation of the recommendations in 2016.With regard to the question o f regulating transnational emergency care i n a way that the fastestpossible healthcare provision can be guaranteed regardless of the healthcare providers’ country of origin , the Ministry of Health points to the following:The Danish emergency standby system across the whole country ensures safe and fasttreatment for people who are injured or suddenly have become seriously ill. Alert assistance isgiven in ambulances, by doctors on the scene or in specially equipped helicopters, where thetreatment continues at one of the 21 emergency standby clinics established at hospitals andstaffed with specialist doctors on a 24 hour basis in order to ensure that everybody receives thecorrect and appropriate treatment in case of sudden injury or illness. Additionally, a number ofsmaller emergency clinics have been established for patients who are not in need of hospitaltreatment.As regards the BSPC recommendation about ensuring guaranteed transnational emergency careregardless of the healthcare provider’s country of origin, Denmark continues to have well -functioning transnational agreements in place in regard to emergency care.With regard to reducing the usage of antibiotics – in general – and for agriculture to an absoluteminimum in order to prevent further increase on antimicrobial resistance, the Da nish Ministryof Health wishes to highlight the following initiatives as regards the human side of antibioticsuse: The National Antibiotic Committee consists of both representatives from the human andveterinarian sector and has the purpose to ensure a joint and coordinated effort to reduce AMR and the consumption of antibiotics among both humans and animals. Within the National Antibiotic Committee Denmark marks the annual European antibiotic awareness day with a national campaign. In 2014 and 2015 the focus has been on reducingthe consumption of antibiotics. DANMAP ( Danish Antimicrobial Resistance Monitoring and Research Program) has since1995 surveyed the annual consumption of antibiotics and the prevalence of antimicrobialresistance among humans, food and animals in Denmark. The Danish government has allocated funds for projects regarding prevention of infections in the primary and secondary sector, consumption of antibiotics and resistance. The Danish Health Authority has published guidelines on prescribing antibiotics withgeneral rules for prescribing antibiotics in the primary sector and at hospitals as well as special rules for prescribing three specific groups of antibiotics to ensure that they arereserved for seriously ill people and are only used when there are no alternatives. Denmark P age 65Based on the WHO’s action plan and the future EU council conclusions currently underdiscussion further initiatives are expected to be initiated.Recommendations with regard to health and economyIn order to improve conditions to support the development of innovations in health care ,eHealth and new technologies is a key answer to the challenges that health services in manycountrie s are facing. For this reason, innovation and the use of e -Health is an integra ted part ofmodern health services in the Danish Healthcare System. In recent years, a number of innovative projects and new e-Health solutions have been implemented or planned: A shared Medication Record c ontains updated information on a patient’s prescr iptionmedicine have been implemented at all hospitals, general practitioners and municipalities. The national health website “sundhed.dk” (health.dk) gives patients access to their ownmedical records from hospitals is used by more than 1/5 of Danish population each month. Telemedical assessment of diabetic foot ulcers have been implemented in all municipalitiesleading to better and more efficient ulcer treatment. Towards 2019, telemedicine for patients with COPD is being implemented nationally The use of patient reported outcome measures (PROMs) for planning and differentiation oftreatment is being implemented in three different types of diseases across all hospitals as first step in a widespread implementation of the use of PROMs in the Danish hea lth caresectorWith regard to the recommended early intervention to strengthen good public health throughsocial investment such as vaccine programs, and strong measures to reduce consumption ofalcohol, tobacco and illicit drugs, and work towards stronger prevention of diabetes II andother lifestyle illnesses, the Government refers to the following initiatives:- AlcoholThe Danish Health Authority has since September 2015 implemented the following initiatives to reduce alcohol consumption and to promote early intervention: A TV campaign supported by information activities in the municipalities with the message to drink below the low-risk drinking limit. Establishing a telephone hotline providing counseling to people with alcohol problems andtheir relatives. Initiation o f a project with 66 out of 98 municipalities aiming to develop the alcoholtreatment services to include a strong family focus in the alcohol treatment. Initiation of a program aiming at supporting pregnant women with alcohol and drug problems by establishing an in -patient treatment center. This is done in order to preventfetal damages on the baby. Courses for health professionals in brief intervention.Denmark P age 76 Focusing on implementing the prevention package on alcohol issued (2012) by the DanishHealth Autho rity including professional recommendations for the local alcohol preventionintervention.- DrugsThe Danish Health Authority is doing the following to reduce the consumption of illicit drugs: Supporting the implementation of the prevention package on drugs issued (2013) by theDanish Health Authority including professional recommendations for the local drugprevention intervention. Carrying out the anti -drug campaign “Music Against Drugs” in a variety of music festivalsand music halls in Denmark. The social reserve agreement for 2015 -2018 sets aside 3 million DKK to develop anevidence- based teaching course focusing on preventing cannabis smoking in commercialcolleges and production school s.- TobaccoThe Danish Health Authority is doing the following to reduce the consumption of tobacco: Supporting the implementation of the prevention package on tobacco issued (2012) by the Danish Health Authority including professional recommendations for the local tobaccoprevention intervention. In 2013 the Government ensured funds for 2014 -2017 (42 million DKK) to help heavysmokers quit smoking. This program includes services which comprise covering parts of the cost of pharmaceutical products to smokers (when relevant) and municipal smoking cessation services. A national campaign targeted at heavy smokers which focuses on enhancing the awareness of smoking cessation services available. In 2011 the Parliament earmarked funds for 2012 -2015 (16 million DKK) allocated toprevention measures aimed at preventing youth smoking. In May 2016 the Danish Parliament passed an act regulating electronic cigarettes.o According to the act it is illegal to sell electronic cigarettes (with or without nicotine)to people younger than 18 years and to advertise electronic cigarettes (with orwithout nicotine). Furthermore, in 2016 the Government has presented an act on tobacco products whichbans adding flavours to cigarettes and demands that warnings constitute a larger percentageof tobacco packaging.Both acts from 2016 are implementing the EU tobacco products directive.- Type-2 diabetes and other lifestyle illnessesPhysical activity, healthy diet and prevention of overweight are key elements in the preventionof type -2 diabetes and other lifestyle related diseases. The Danish Health Authority is doing thefollowing to prevent lifestyle related diseases: Denmark P age 87 Supporting the implementation of the prevention packages on physical activity (2012),health food and meals (2012) and overweight (2013) issued by the Danish Health Authorityincluding professional recommendations for the local prevention intervention. The Danish H ealth Authority has a continuous focus on preventing physical inactivity andhas since 2005 conducted a yearly nationwide campaign on physical activity for children and adolescents, entitled “Get moving”. It is important to focus on physical activity in ch ildren,as physically active children have a healthier level of risk factors for type -2 diabetes andcoronary heart disease and a reduced risk of developing life style related diseases in adulthood. Moreover, physically active children are more physically active as adults thaninactive children.- Vaccination programsThe Danish Health Authority is continuously considering how to increase the uptake of thevaccines in the Danish childhood vaccination programme . At the moment, an initiative tostrengthen the uptake of the HPV vaccine is being planned as the coverage of this particularvaccine has been decreasing significantly the past couple of years.Two research projects at Statens Serum Institut aim to illuminate some of the aspects that seems to be a barrier for the uptake of the HPV vaccine.Recommendations with regard to s ustainable and accessible social- and healthcareThe Danish Ministry of Health points to the following with regard to strategies addressingdemographic change, such as the European Innovation Partnership on Active and HealthAgeing and especially considering public services in rural peripheral areas:The older generation today lives longer and is healthier than previous generations. Preventive measures, promotion of healthy living and encouraging elderly to be more self -sufficient areessential elements in the Social Service Act. This is supported by specific legislation and specificpolitical initiatives which will be laid out in the following.- Rethinking elder careIncreasing awareness of the differentiated ways of life and needs of older citizens has made itessential for the Government to ensure the provision of tailor made support to help people continue to live independent and self-reliant lives.In recent year s there has been a shift away from performing the specific domestic tasks thecitizen can no longer manage, for instance cleaning, towards focusing on the underlyingproblem, i.e. the functional impairment.This change represents a new way of re -thinking elder care by ensuring the promotion of theindividual person’s capacity for self -reliance. The aim is to empower the citizen as much aspossible in cooperation with the citizen.- Re-enablement (rehabilitation)Re-enablement is the promotion of independence in elderly people following deterioration inhealth or increase in the need for support.Since January 2015, local authorities have been obligated to evaluate if a person in need of home care services could benefit from a re -enablement/rehabi litation scheme in the form of a Denmark P age 98training program focusing on regaining independence, physical or social functionality andthereby a better quality of life.The rehabilitation scheme is offered to all elderly citizens that are considered to be able to profit from this initiative. Every rehabilitation scheme must be adjusted to the individual needsand capabilities of the elderly citizens to improve functionality and quality of life. Elderly individuals who are not capable of going through a rehabilitation scheme still receivehome care service when needed.- Preventive home visitsLocal authorities are responsible for initiating preventive measures that can help each individual to manage his or her own life for as long as possible. This includes locally ba sed socialactivities, physical training facilities, organisation of volunteer services and other efforts withpreventive purposes.A specific effort is the preventive work made through the so -called home visits. Every citizenin Denmark who has reached the age of 80 has the right to receive a preventive home visit atleast once a year and preventive house visits must also offered to vulnerable and socially exposed people between 65 and 80.The aim of the home visit is to identify the need for individua l assistance and discuss the well -being and current life situation, as well as give advice and provide guidance about activities andsupport services that will help elderly citizens to maintain their personal resources andfunctional capacity.- Welfare technologyThere is an increased focus on how welfare technology can support and solve future challenges in elder care. These years the municipalities are working on implementing welfare technologiesin response to future challenges.Welfare tech nology can in many cases support citizens to become more self -reliant andindependent and help create a better working environment for care staff. The strategy "Digital welfare - an easier everyday” has been established to support and increasethe use of technology and digitalization within the major welfare areas , including elderly care.As a part of the strategy, the dissemination of four welfare technology solutions has beenlaunched: lifting, washing toilets, better use of assistive technology and dining robots.- New action plan for the elderly patientBy the Financial Act for 2016 the Government has prioritized an annual allocation of 300 million DKK to a new action plan for the elderly patient, including a plan for immediate actionagainst hospital overcrowding.The parties behind the Financial Act for 2016 agreed on the content of the plan for immediateaction against hospital overcrowding in February 2016. The plan concentrates on methods andtools to secure better use of hospital capacity across d epartments. One element is betterplanning of the patient pathway in order to make sure that patients are admitted to departments with available wards during the entire hospital stay.The content of the plan for the elderly patients will be decided in the spring 2016. The plan isexpected to focus primarily on efforts before and after hospitalisation and increased coherence Denmark P age 109across sectors, e.g. initiatives to strengthen the ability of the municipalities to preventhospitalisation of elderly people due to a preventable condition.- Targeted effort for the weaker elderlyBy the special pool for the social areas for 2016 -2019 266 million DKK were allocated toconcrete initiatives in order to strengthen the effort for weaker elderly people. The initiativesinclude: projects with the aim to gain more knowledge on how to increase coherence in patientpathways across sectors development of national clinical guidelines follow-up home visits after hospitalisationIt is o ne of the main priorities of the Danish government that all Danes have access to highquality health care in all parts of the country, including access to medical specialists.In November 2015 the Danish Minister for Health formed a committee to analyze andrecommend initiatives that can support a more proper geographical distribution of doctors in Denmark. The committee is expected to release the analysis and recommendations by the endof 2016.Copenhagen, May 2016Denmark P age 11EstoniaEstonia P age 2Answers from ministries of the Republic of Estoniaabout the implementation the Resolution of the 24th Baltic Sea Parliamentary ConferenceMinistry of Social Affairs(Sotsiaalministeerium)Recommendation Comment-to ensure the decent treatment of refugeesespecially concerning housing and healthcare (preamble of the resolution)The Ministry of Social shall organise the settlement of a person enjoying international protection in the territory of a local government in an agreement with the local government, taking into account the state of health of a person enjoying international protection, the place of the residence of the relatives by blood or marriage and other significant circumstances, and considering the housing and employment opportunities, including the proportional allocation of beneficiaries of international protection among the local governments. The Ministry of Social Affairs shall conclude a contract under public law with the local government or a legal person governed by private law for the admission of the person enjoying international protection and the provision of services. The local government a legal person governed by private law shall arrange for the admission of a person enjoying international protection and, if necessary, assist him or her in:finding housing and renting thereof.During his or her stay in Estonia, a person enjoying internationalprotection has the right to receive state pensions, family support, employment services and employment subsidies, social benefits, health care and other assistance on the same grounds provided by legislation as permanent residents of Estonia.-to improve transnational cooperation and medical specialization in the treatment of rare diseases, bearing in mind the cost-effective usage of medical equipment (paragraph 20)The European Commission set up an expert group on rare diseases on 30 July 2013, among the expert group’s tasks is advising the Commission on international cooperation as well as exchange of experience, policies and best practices. Estonia has been an active member of this expert group.Also, under Directive 2011/24/EU the European Commissionwill support the development of European Reference Networks between healthcare providers in member states, in particular in the area of rare diseases. The aim of these networks is to improve cooperation regarding highly specialised healthcare, contribute to the pooling of knowledge and facilitate improvements in diagnosis and the delivery of high-quality, accessible and cost-effective healthcare for all patients with a medical condition requiring a particular concentration of expertise in medical domains where expertise is rare. The first call for networks and members opened on 16 March and will close on 21 June. Estonia is looking to actively participate in the European Reference Networks as well.Estonia P age 3-to regulate transnational emergency care in a waythat the fastest possible healthcare provision can be guaranteed regardless of the healthcare providers’ country of origin (paragraph 21)In 2010 Estonia and Latvia signed a Trilateral agreement between the Ministry of Social Affairs, Ministry of the Interior and the Ministry of Health of the Republic of Latvia on mutual aid on providing the ambulance service in close to border area. The agreement has been fully implemented and works very well.-to reduce the usage of antibiotics – general – and for agriculture (livestock farming) to an absolute minimum in order to prevent further increase of antimicrobial resistance (paragraph 22)Estonia is participating in various EU initiatives related to AMR, for example the ESAC-Net (European Surveillance of Antimicrobial Consumption Network) which collects and analyses data on antimicrobial consumption from EU and EEA/EFTA countries. During the last European Antibiotic Awareness Day, we organized a briefing for the press on AMR and antibiotic use that also involved members of the academia and experts. In the near future we are also planning to integrate AMR into the National Health Plan and conduct further studies on antibiotic prescription at the primary healthcare level as well as organize awareness campaigns.On the agriculture side, the Ministry of Rural Affairs hasdeveloped guidelines for the rational use of antibiotics in livestock for veterinaries and farmers. The Ministry also established a working group for coming up with an action plan for reducing AMR in the field of veterinary medicine in early 2015. The action plan is currently in an early stage of development, but the main focuses would be on the use veterinary drugs and medicated feed; awareness raising among veterinaries, farmers and food producers through training, advice and information; AMR monitoring and research.-to improve conditions to support the development of innovations in health care, including in the fields of eHealth and telemedicine, whilst ensuring that investments in eHealth support the adoption of standards and drive interoperability across the health sector to leverage the „eHealth European Interoperability Framework“ (eEIF) and observe the joint European initiatives, such as the „Guidelines under eHealth Network“ of the responsible member state authorities (paragraph 31)The Estonian eHealth Strategic Development Plan 2020 was approved in December 2015. Its implementation plan is currently under development and should be approved in April 2016. The main areas of focus in the plan are data quality, people-centeredness and personal medicine, integration of services and cooperation between organisations, improving capacity for analysis and development of remote services.Estonia is looking to apply for financing under the ConnectingEurope Facility to fund a national contact point for cross-border e-prescriptions as well as cross-border sharing of patient data. The goal is to get cross-border e-prescriptions to work in practice starting with Estonia-Finland. We are also preparing a study on factors affecting cross-border sharing of patient data across, it should be done by autumn 2016. The study would include people from all over Europe and focus on their expectations for access and use of their health data as well as the problems that member states have with regard to sharing patient information across borders.Estonia P age 4-to improve early intervention to strengthen goodpublic health through social investment such as vaccine programs, and take strong measures to reduce consumption of alcohol, tobacco and illicit drugs, and work towards stronger prevention of diabetes II and other lifestyle illnesses (paragraph 34)Estonia continues to implement measures from the Green Papers on Alcohol and Tobacco Policy (both adopted in 2014) as well as measures from the white paper on drug abuse prevention. A Green Paper on Nutrition and Physical Activity is currently under development. Estonia also continues to follow its national immunization plan with regard to vaccination.With regard to tobacco policy, we are currently implementingthe EU Directive 2014/40/EU on Tabacco Products as well as conducting routine activities from the Green Paper on Tobacco Policy, such as providing counselling for quitting smoking, awareness campaigns, fighting against the smuggling and trade of illegal tobacco products. A ban against indoor smoking areas (not separate smoking rooms) will go into effect on June 1 2017.With regard to alcohol policy, a bill for implementing restrictionson alcohol sale and advertising based on the Green Paper on Alcohol Policy is currently under discussion by the government. Various routine activities such as awareness campaigns are also being conducted. In the near future we will also expand treatment for alcohol addiction.With regard to drug policy, we are currently updating the Act onNarcotic Drugs and Psychotropic Substances and precursors thereof to allow for adding substances by category. We are also conducting routine awareness campaigns.-to check the possibility to establish a „Baltic Health Forum“, to ensure and improve a sustainable exchange and networking in this policy field around the Baltic Sea.Baltic Policy Dialog involving all three Baltic countries has been organized annually since 2004 with support from WHO Regional Office for Europe and European Observatory on Health Systems and Policies. It offers a focused platform for discussing health policy and networking. The Northern Dimension Partnership in Public Health and Social Well-being is a regional organization currently involving the 3 Baltic countries as well as 6 others in the Baltic Sea Region. It was created in 2003 and provides a platform for more regional discussions on health policy, it currently has 7 expert groups and is chaired by Estonia and co-chaired by Latvia until 2017.-to develop and strengthen strategies addressing demographic change, such as the European innovation partnership on Active and Healthy Ageing and especially considering public services with regard to rural peripheral areas (paragraph 43)Estonia is currently working to reducing the burden on informal carers through local municipalities by providing them different services through the 2014-2020 European Social Fund. The services are day care, temporary care service and home care. An interministerial task force for reducing the burden of care was also created in November 2015 with the aim to provide policy measures on this topic. The Parliament also adopted the new Social Welfare Act in 2015 which, among other things, sets minimum standards for social services provided by local municipalities. The National Institute for Health Development is also supporting local municipalities with developing their health profiles to address specific local problems better. Currently 69% of local municipalities have health profiles.Estonia P age 5-to carry out studies with the aim of developingprevention strategies in health care, such as the North Trondelag Health Study (HUNT) (paragraph 49)Estonia has joined the World Health Organization’s European Childhood Obesity Surveillance Initiative, the first study will be carried out in 2016 and the data will be used for developing potential interventions in the future. We are also involved in multiple other international studies such as the Identification and Prevention of Dietary- and Lifestyle- induced Health Effects in Children and Infants; Survey of Health, Ageing and Retirement in Europe. Estonia also carries out its own studies on Nutrition, Population Health and other topics. The data from all these studies will be used in the development of any strategies or other policy documents relevant to the research topics.In 2012 the Centre for Health Technology Assessmentwas established at the Department of Public Health in the University of Tartu. The Centre assesses new services and pharmaceuticals by health economy evaluation and considers the perspectives of society and patients in addition to cost-effectiveness criteria. To date the centre has published 19 assessments and continues its work.This year we are also planning to evaluate the National HealthPlan and consider any recommendations from the evaluation when making the next implementation plan. We are also planning to evaluate the National HIV and AIDS Strategy 2006–2015 and the National Cancer Strategy 2007–2015 and also integrate any recommendations into the new National Health Plan implementation plan.-to create incentives to improve the conditions of the nursing and care professions and to work towards intensified professional and vocational training for people employed in the health sector to significantly facilitate a cost-effective health system in the region and foster understanding of the health sector as a cross-cutting issue (paragraph 52)A bill was passed in 2015 to grand nurses the ability to write prescriptions, this went into effect 1 March 2016, we are currently working on creating the legal framework to allow nurses to also have independent patient visits.With regard to improving the conditions, we are looking toimplement a tool that allows family doctors to easily assess whether a person needs medical care or social care and find the best solution for that person specifically. Nurses and care workers are also always included in the collective salary negotiations and the agreement that establishes their minimum salaries.With regard to training, we started a new programme in2015 in order to bring nurses working in other sectors back to the health sector, 22 nurses completed it and returned to the health sector in 2015 and we will repeat the programme this year. Also the number of nurses trained each year has steadily increased over the last years.Estonia P age 6Ministry of Education and Science(Haridus- ja Teadusministeerium)The Baltic States support the continuous cooperation in the field of education and research in order to strengthen thewhole region as a competitive knowledge region.Baltic research infrastructureWe continue to implement the Memorandum of Understanding between the Ministry of Education and Science of Latvia, the Ministry of Education and Science of Lithuania and the Ministry of Education and Research of Estonia on Closer Cooperation in Higher Education, Research and Innovation signed in November 2012. The aim of the Memorandum is to develop coordinated research and development policy and foster innovation in the Baltic republics. In 2014 Baltic research infrastructure expert group completed its tasks and published the results of Baltic research infrastructure mapping exercise on their respective internet pages by providing links to the lists of core research infrastructure objects of two other parties. The creation of these lists was a pilot project, which provides necessary background for the future collaboration of Latvian, Estonian and Lithuanian researchers and policy makers. The list is open for the public, and the content is being regularly updated (see at http://www.etag.ee/en/funding/infrastructure-funding/core-infrastructures/).Baltic Summer AcademyThe Baltic States will continue the ongoing international cooperation related to school sector. The project of the Regional Baltic Summer Academy was initiated in 2015 by the Ministry of Education and Research of Estonia in close cooperation with the Council of Europe and the Wergeland Centre, and later joined by the Ministry of Education and Science of Lithuania and the Ministry of Education and Science of Latvia (see at http://www.theewc.org/Content/What-we-do/Summer-Academies/Regional-Baltic-Summer-Academy).Regional Baltic Summer Academy focuses inparticular onhow human rights can be promoted in history teaching. Participants join the training as ateam of four members. Eachteamconsist of a representative of schooladministration, ateacher, a student representative(recommended age 16)and a representativefrom the community (NGO or local authority). It has been agreed that the piloting of project is goingto rotate to the other Baltic States - this year to Lithuania and next year to Latvia.Continuous cooperation between the MoER22th Meeting of the Baltic Ministers of Education and Research/Science will take place in Estonia on 16-17 June 2016. Usually, the Ministers are accompanied by the delegation of max 9 people. This format offers a great opportunity to share the ideas and best practices in the field of common interest as well as enhance the longstanding trilateral cooperation between the Baltic countries. During the forthcoming meeting the key-topics are going to be “Automatic recognition of qualifications between the Baltic States (status of the joint project AURBELL conducted by the Baltic Centres of ENIC/NARIC)”, “OECD cooperation on education”, and “STEM education as a tool for integration”.Estonia P age 7Ministry of Environment(Keskkonnaministeerium)On the implementation of the 23rd Baltic Sea Parliamentary Conference ResolutionRecommendations in regard to Environmental Legacy- What measures have been taken and will be taken by the governments of the Baltic States in regard to the implementation of theHELCOM Baltic Sea Action Plan and decisions of the HELCOM 2013 Copenhagen ministerial meeting?Pursuant to the 2013 declaration we continue with environmental pollution reduction activities. For our priorities, please see the link toEstonian Chairmanship in HELCOM 2014-2016: http://helcom.fi/Documents/About%20us/Chairmanship/HELCOM%20priorities%20during%20the%20Estonian%20Chairmanship.pdf- How do the governments of the Baltic States support the joint HELCOM - VASAB Regional Baltic Maritime Spatial PlanningRoadmap 2013 - 2020?In the context of Maritime Spatial Planning (MSP) governments work on EU and regional levels (HELCOM-VASAB). Spatial dataproduced during MSP needs to be comparable to and usable with already existing systems. The INSPIRE directive provides framework for preparation, compilation and submission of data. Consequently, governments cooperate on both national and international levels in order to make the information gathered during MSP comprehensive, and accessible via already existing information systems. Estonia support continuation of relevant cooperation on MSP issues between HELCOM and VASAB.- What measures have been taken and will be taken by the governments of the Baltic States in regard to the development of thereception facilities for sewage in passenger ports in line with the Special Area Status of the Baltic Sea under MARPOL Annex IV of the IMO?In compliance with the MARPOL Annex IV requirements, big passenger ports of Estonia together with other Baltic Sea coastal statesare ready for the Baltic Sea marine area to be declared as special area in the context of the Annex.According to this Annex passenger ships sailing on the Baltic Sea are required to discharge their sewage in correspondent portsand these specific ports1 receiving passenger ships shall have necessary adequate capacity to service incoming passenger ships.Thus, these ships must avoid discharging their sewage into the Baltic Sea.1 Situation in the Baltic in regard of MARPOL IV and port reception facilities readiness: http://helcom.fi/Lists/Publications/Baltic%20Sea%20Sewage%20Port%20Reception%20Facilities.%20HELCOM%20overview%202014.pdfGermanyGermany P age 2Federal Foreign OfficeToMember of the German BundestagMr Franz ThönnesRet. Parliamentary State SecretaryPlatz der Republik 111011 BerlinBerlin, 27 April 2016Dear colleague, dear FranzMany thanks for your letter dated 18 February and the enclosed resolution of the 24th Baltic Sea Parliamentary Con-ference 2015 in Rostock.I enclose the opinion of the Federal Government on this resolution you requested as an annex to this letter, which theFederal Foreign Office drafted in tandem with the relevant Federal Ministries. It also addresses the questions raised in your letter for each of the different points.The resolutions of the Baltic Sea Parliamentary Conferences have provided a great deal of important impetus overthe past years. I would like to thank you very much for your work for the region and your unfailing commitment in the scope of the Baltic Sea Parliamentary Conference. I wish you every success in the future.Yours sincerely,[signed by hand “Your Frank”]Dr Frank-Walter SteinmeierFederal Minister for Foreign AffairsMember of the German BundestagGermany P age 3Opinion on the resolution of the 24th Baltic Sea Parliamentary Conference 2015The Federal Government welcomes the work by the Baltic Sea Parliamentary Conference to strengthen the Baltic SeaRegion’s shared identity and to foster the cooperation between government and non-governmental institutions – in particular through the Council of the Baltic Sea States and the Northern Dimension. By championing better cooperation between the parliaments, governments and civil societies in the Baltic Sea Region and initiating political activities, the Baltic Sea Parliamentary Conference acts as an important catalyst to the cohesion of the Baltic Sea Region.The Federal Government adopts the following opinion on the resolution of the 24th Baltic Sea Parliamentary Confer-ence 2015 in Rostock:On the preamble and cooperation in the region:The Federal Government’s Baltic Sea cooperation consists of three pillars: the Council of the Baltic Sea States, theEU Strategy for the Baltic Sea Region and the Northern Dimension. Germany’s interests in the Baltic Sea Regionare boosting competitiveness, dealing with environmental challenges, closing gaps in the infrastructure and fostering economic solidarity in the region, which was politically and economically divided for a long time, to forge a common re-gional identity. The Federal Foreign Office assumes an active role as moderator between the different ministerial remits. Fundamentally, the Federal Government also sees one of the benefits of the cooperation in the Baltic Sea Region in the opportunity to engage in a confidence-building dialogue which promotes transparency in the Baltic Sea Region, and in particular with Russia, Member State on the Council of the Baltic Sea States. In spite of the strain on political relations as a result of the Ukraine crisis, international consultation and coordination with Russia also remains indispensible when it comes to dealing with shared challenges. The Council of the Baltic Sea States is an important forum for keeping com-munication channels with Russia open on such questions of common interest at an appropriate level.Ensure decent treatment of refugees, especially in terms of housing and medical care:The housing and medical treatment of refugees is a core task in the context of dealing with the current refugee move-ments. In Germany this comes under the remit of the federal states (Länder) and the municipalities. The Federal Gov-ernment provides support in the scope of its remit.On the basis of the decision by the Federal Government and the Länder on 24 September 2015, in the Act IntroducingExpedited Asylum Procedures (Asylverfahrensbeschleunigungsgesetz ) and the associated Ordinance, by changing theFederal Building Code (Baugesetzbuch ), the Act on the Promotion of Renewable Energies in the Heat Sector (EE-WärmeG) and the Energy Saving Ordinance (Energieeinsparverordnung ), the Federal Government launched the frame-work for accelerating the procedure and for the requisite flexibility in terms of using or establishing refugee housing tosupport the responsible Länder and municipalities in providing initial accommodation for refugees. In addition to this,the compensation funds for social housing for the period 2016 to 2019 have been doubled. The legislative package has provided the Länder and municipalities with very extensive scope for action to plan, approve and carry out conversionand building measures to house refugees.As a second step, the aim is to respond to the growing demand on the housing market – not just as a result of the influx ofrefugees. The challenges in building new housing can only be met by major efforts on the part of all government actors, private investors and civil society. The aim is to provide enough affordable housing in Germany.On the matter of health care, please also refer to the publically available documents of the Federal Ministry of Health.Germany P age 4Point 4Cooperate to bolster the Baltic Sea Region as an important competitive region of knowledge with an excellenthigher education and research infrastructure.As an institution funded by the Federal Foreign Office, the DAAD (German Academic Exchange Service) has promotedthe cooperation between higher education and research institutions in the Baltic Sea Region through a whole host of initiatives, programmes and projects since 01.09.2015. These include for examplea)The Eastern Partnershipsb) The Baltic-German University Liaison Officec) The EuroFaculty PskovOn a) Eastern PartnershipsThe DAAD uses funds provided by the Federal Foreign Office to promote partnerships between German universitiesand universities in eastern Central Europe, South East Europe and Eastern Europe and in the Caucasus and Central Asia, including many universities in the Baltic Sea Region.This is with the aim of contributing:-to cementing existing and initiating new lasting partnerships with universities in the target region,-to cooperation in teaching and research covering a broad range of disciplines,-to scholar, graduate and student exchanges in the scope of the partnerships,-to lasting structural improvements in the teaching and research conditions in the partner countries,-to internationalising the German and foreign universities.The German universitieshave the prospect of receiving funding for a period of three years. The autonomy and planningcertainty the universities are thus afforded aims to encourage them to set priorities in their partnership activities and develop a partnership concept. The funding measures include inter alia German and foreign university lecturer ex-changes, exchanges of scholars, students and graduates, the funding of German participants’ travel costs and funding the costs of board and accommodation for foreign participants.On b): Activities of the Baltic-German University Liaison Office (BDHK) since 1.9.2015 to promote cooperation in theBaltic Sea Region (as on: 09.3.2016)The Baltic-German University Liaison Office supports the academic cooperation and academic exchange between Ger-many and the Baltic States. At the fore are scholar exchanges and networks. Over its ten-year history, the University Liaison Office has made a decisive contribution to the cooperation between German and Baltic academic institutions through events and by funding academic projects. The BDHK issues a call for projects twice a year and is open to all disciplines.Since September 2015, the BDHK has organised 13 events in the Baltic countries on subjects linked to Germany andEurope. Generally, German and Baltic scholars are invited as speakers.Germany P age 5Furthermore, between September and December 2015, the BDHK funded eleven projects between Baltic and Germanhigher education institutions. The projects contribute to the academic exchange, inter alia in the field of mathematics,engineering and natural sciences, languages and cultural studies as well as law, economics and social sciences.Another seven projects have already been selected for funding in 2016 by an academic advisory council comprisingGerman, Latvian, Estonian and Lithuanian university lecturers.On c): Activities in the scope of the EuroFaculty Pskov since September 2015 The EuroFaculty Pskov (EF-P) is a higher education initiative by the Council of the Baltic Sea States. The aim in estab-lishing a “EuroFaculty” is to support the universities benefiting from the project in their wide-ranging reform efforts, for instance in modernising their curricula, establishing quality assurance systems, setting up modern specialist libraries and providing modern foreign language lessons. In the scope of the EuroFaculty Pskov, during an initial project phase (2009-2011) first of all a model BA degree course and then in a second project phase (2012-2015) a model MA degree course were established at the Pskov State University in line with the Bologna model. The DAAD contributed Federal Foreign Office funds to the EuroFaculty Pskov through the European University V iadrina.In October 2015, the final conference of the initiative, which ended in late 2015, took place. Some 200 international guests from the field of politics and higher education attended the event entitled “EuroFaculty — Towards A Modern Uni-versity”. During the two-day conference, presentations and discussions were used to elucidate inter alia prospects for amodern university and to present the most important outcomes of the EuroFaculty Pskov project.There are currently deliberations in the Council of the Baltic Sea States as to whether to continue the Council of theBaltic Sea States’ flagship program.Measures funded by the Federal Ministry of Education and Research (BMBF): Summary of the cooperation to dateand future outlookFrom Germany’s perspective, the Baltic Sea Region is a model region for cross-border multilateral cooperation. It isa pilot region for EU Macro-Regional Strategies (since 2009). Furthermore, the Baltic Sea Region harbours great po-tential for measures in the context of the target fields one and two of the Internationalisation Strategy and exceptional competencies in the fields of action of the High-Tech Strategy 2020. The BMBF has taken action in and for the region in many different ways in recent years (for instance through the three Baltic Sea Announcements to date):In 2010, 2011 and 2013, the BMBF published funding announcements to promote an ideas competition to establish anddevelop innovative R&D networks with partners in Baltic Sea States.The aim of these funding measures is to use international cooperation to harness innovation potential in the context ofthe HTS and the EU Framework Programme for Research and Innovation Horizon 2020, to increase the competitive edge of German companies and research institutes in the Baltic Sea Region and enhance the research excellence in the Baltic Sea Region. The Baltic Sea Region boasts an excellent university and research infrastructure, but this needs to be networked further.At least three partners have to be involved in the establishment or development of the R&D network: one Germanpartner and additionally at least one partner from Denmark, Finland, Norway or Sweden and at least one partner from Estonia, Latvia, Lithuania or Poland.Germany P age 6There are currently a total of 15 projects from the third announcement round underway up until 2016. Since 2010, 195partners have received funding for 55 projects.The partners of the newly formed networks, universities, research institutions, scholars, students and SMEs worktogether very closely, network and apply successfully for the European Union’s calls for proposals for funding. The BMBF’s Baltic Sea Announcements mean there is high potential for raising EU funds jointly and there are prospects for direct follow-up funding.Other projectsAnother project worthy of note is G-Risc (German-Russian Interdisciplinary Science Center) at St. Petersburg Univer -sity. G-Risc is funded by a collaborative project between the FU Berlin and St. Petersburg State University. It does notconcentrate on the Baltic Sea Region, however, but instead promotes research cooperation in the natural sciences between Russia and Germany ( http://www.g-risc.org).Point 8Continue the measures to improve sewage reception facilities in passenger ports to ensure the timely activa-tion of the Baltic Sea’s status as a special area in the meaning of Annex IV of the Convention of the Internation-al Maritime Organisation, whose aim is to prevent the release of untreated sewage from passenger ships in the future and to reaffirm the commitment to further improving and modernising the sewage processing capacities of the entire Baltic Sea Region in compliance with the stricter threshold values set by HELCOM.The subject has been under examination since 2007 at relevant Baltic Sea bodies and is to be implemented under theHELCOM Baltic Sea Action Plan (BSAP, 2007) by 2021. For background information please refer to the past comments of the Federal Government on the last resolutions adopted by the Baltic Sea Parliamentary Conference.The 68th IMO Marine Environment Protection Committee (MEPC 68, May 2015) established that the notification ofavailability of the port reception facilities for ship sewage in the Baltic Sea States (without Russia) is sufficient and that the implementation dates proposed by the Baltic States (2019 for new, 2021 for existing ships) should apply.At the same time, MEPC identified the need for Annex IV of the MARPOL Convention to be amended to legally reflectthe changed effective dates and the changed area of application (Baltic Sea without Russia). As the coordinating coun-try (“Lead Country”) in the scope of the Helsinki Convention (HELCOM), Sweden drafted the required MARPOL amend -ments in close consultation with the IMO Secretariat, which were also coordinated in several meetings of the relevant Council Working Party on Shipping within the group of the EU28 and submitted as a joint submission (notification) by all 28 EU Members States and the European Commission in time for the MEPC 69 meeting with the IMO resolution change.The aim is to secure an amendment of MARPOL Annex IV during MEPC 69. The IMO Secretariat has submitted theproposed amendments and the draft resolution in line with due procedure in the form of a submission to agenda item 3 (Consideration and adoption of amendments to mandatory instruments) and as such laid the formal foundation for the adoption of the amendments at MEPC 69 from 18 to 22 April 2016 in London (Document MEPC 69/3/3).In response to the submission by the EU MS, Russia submitted comments to MEPC (Document MEPC 69/10/4). In thisdocument, Russia notes that while the proposed amendments to Annex IV of the MARPOL Convention circulated did contain the effective dates for the special area regulations, they did not contain any direct reference to the special areaGermany P age 7of the Baltic Sea or parts thereof. Russia also criticises the fact that the proposed amendments were submitted with thesupport of 20 countries which were not even countries bordering on the Baltic Sea special area. This then led Russia to make the criticism that here a regional approach was being used to establish a global regulation. Russia accordingly called on MEPC to reject the proposed amendments.In an additional submission (MEPC 69/10/5) Russia emphasises its concerns regarding the procedure to implement theMARPOL amendments and in particular on the later subdivision of the special area. Alongside this, the Cruise Lines International Association (CLIA) (MEPC 69/10/6) also made a submission, which again casts doubts on the availability of sufficient port reception facilities for ship sewage inside the special area and calls for the creation of an exceptional discharge provision.Sweden is currently engaged in intensive bilateral endeavours with Russia to find a solution Russia also accepts in thescope of the Brussels EU mandate as well, which could mean that Russia is accorded additional temporary exemptions. In spite of all of this, it would be a major success globally (IMO) and regionally (HELCOM) if after years of negotiations at many decision–making levels the aim of the entry into force of stricter requirements for the Baltic Sea special sewage area as of 2019/2021 were to be achieved.Recommendations regarding cross-border cooperation in the field of health carePoint 20Improve cross-border cooperation and medical specialisation in the treatment of rare diseases with due regardfor the cost-efficient use of medical equipment.The Federal Government supports the wide-ranging initiatives in the Baltic Sea Region to promote cross-border healthcare geared towards the efficient shared used of medical equipment. The EU Member States have a network in place for the treatment of rare diseases. The possibility of expanding this to countries outside of the EU and including this issue in the Health Action Programme or the Horizon 2020 Programme of the European Union, for instance, should be examined.Point 21Regulate cross-border emergency care in a way that guarantees the fastest possible provision of medical ser-vices irrespective of the country of origin of the health provider.Germany has concluded agreements and arrangements for the provision of cross-border emergency services withmost of its neighbouring countries. There has been a framework agreement in place with Poland since 2012, which is currently being supplemented by execution agreements in negotiations conducted by the Länder . With Denmark, too,regular cooperation takes place between the emergency services. The main problems arising here relate to liability and the requisite insurance policies and can be resolved well in what in some cases are very involved bilateral negotiations.Point 22Reduce the use of antibiotics – in general – and in agriculture (livestock farming) to the bare minimum to pre-vent a further increase in antimicrobial resistance.Germany P age 8Lowering the use of antibioticsMeasures to reduce antimicrobial resistance and the use of antibiotics are outlined in the German Antibiotics ResistanceStrategy (DART 2020). They were developed jointly by the Federal Ministry of Health (BMG), the Federal Ministry of Food and Agriculture (BMEL) and the Federal Ministry of Education and Research (BMBF) and adopted by the Federal Cabinet in May 2015.DART 2020 supports a systematic approach to prevent the emergence and spread of cases of antimicrobial resistancein Germany and pursues the following specific aims:1.Strengthening the One HealthApproach nationally and internationally2.Early detection of the development of resistance3.Preserving and improving treatment options4.Early interruption of chains of infection and prevention of infections5.Raising awareness and boosting competences6.Supporting research and developmentCross-sector cooperationto combat resistance to antibiotics in human and veterinary medicine is at the heart of DART2020. All of DART 2020’s aims target human and veterinary medicine alike. Both the improvement of rational therapywith antibiotics and reducing the use of antibiotics are important objectives for DART2020, for which the strategy sets forth specific measures for implementation. One joint activity by the relevant departments is the renewal of the research agreement on zoonoses in January 2016. The guiding principle of the new research agreement is the “One Health Ap-proach”, as zoonoses are a stark reminder that the health of humans and animals is closely intertwined. To implement the “One Health Approach” in research, cooperation is required between human and veterinary medicine and other disciplines such as biology, environmental research, agricultural sciences and food technology.Human medicineTo improve rational antibiotic therapy, increased awareness-raising among the public and medical staff is required onthe proper use of antibiotics and on resistance to antibiotics. The Federal Centre for Health Education (BZgA) has there-fore developed a fact sheet on antimicrobial resistance and the proper use of antibiotics for the public and distributed it widely to doctor’s surgeries, pharmacies and nursing homes. Additional information is available on the website of the Federal Centre for Health Education (BZgA) at http://www.bmg.bund.de/fileadmin/dateien/Publikationen/ Ministerium/Flyer/ Anbtibiotikaresistenz_Merkblatt.pdf.A key component in strengthening the proper use of antibiotics and lowering antimicrobial resistance is ensuring hospi-tals are sufficiently staffed with qualified hygiene specialists and that nursing and medical staff receive continued and ad-vanced training in this area. To support the hospitals in implementing the stipulations of the Protection Against InfectionsGermany P age 9Act (Infektionsschutzgesetz ), in 2013 the Hospitals Hygiene Promotion Programme was set up. This provides funding tosupport the recruitment and continued training of hygiene specialists. It also promotes professional continued training inthe field of antibiotic stewardship. This programme was recently extended to 2019 and expanded. Continued training in infectiology and advisory services by infectiologists are now also eligible for funding.The existing systems to monitor antibiotic resistance and antibiotics use at the Robert Koch Institute are being expandedfurther. This will allow new pathogens and cases of resistance to be detected early on and important data to be gathered to develop and adapt treatment and hygiene recommendations. The extension of the reporting obligation to include Car-bapenem-resistant Gram-negative pathogens and Clostridium difficile contributes to this. This enables the health author-ities to take action as soon as they have evidence of individual cases rather than only once there has been an outbreak.The increase in cases of antibiotic resistance means that fewer and fewer effective antibiotics are available to treatbacterial infections. The need for new active ingredients is therefore great. In the dialogue with the pharmaceuticals in-dustry solutions are being developed to better cover the need for new APIs in the future. These will be incorporated into agreements reached within this dialogue.Combatting resistance to antibiotics and lowering the use of antibiotics require a global approach, as resistance spreadsglobally inter alia due to commerce and travel. The Global Action Plan adopted by the WHO in 2015 provides the frame-work for this. Not all countries already have the requisite capacities to successfully fight resistance to antibiotics over the long term. Germany has been working since 2014 as a co-lead country for the “Action Package AMR” of the Global Health Security Agenda (GHSA) in concert with other countries (Great Britain, Netherlands, Sweden, Canada and Ja-pan) to support partner countries in building these capacities.Given the global significance of the issue and the need for a globally coordinated approach, Federal Chancellor andMember of the German Bundestag Dr Angela Merkel made the issue of antimicrobial resistance a priority for the German G7 presidency in 2015. In this context, the G7 partners committed inter alia to developing national AMR strategies orto further develop existing ones. Germany has already delivered on this pledge with DART 2020. A brochure with best practice examples from the G7 countries is designed to assist other countries in developing national action plans. In addition to this, incentive systems for developing new antibiotics, alternative treatments and diagnostics were discussed. Germany will organise an international expert meeting as the first concrete measure in the autumn of 2016.Veterinarian medicine/agriculturea)planned:Please refer to the respective chapters of DART 2020 on which aims and measures are to be met or taken on whichsubject from the sector of agriculture and animals. We draw your attention to the following by way of example:- Bolstering preventive measures to maintain the health of animal stocks without antibiotics as the key task for agricul-ture and veterinary medicine because infections need to be avoided and infection chains interrupted early.- Continuation and expansion of resistance monitoring for zoonosis pathogens and animal pathogens to systematicallymonitor trends in the development of antimicrobial resistance. This will allow the success of measures to be evaluated. The law sets forth evaluation of the efficacy of the measures of the 16th amendment of the Medicinal Products Act in 2019.Germany P age 10b) Initiated:To attain the aims and objectives stated in DART 2020 the following has already been initiated:- Implementation of the authorisations to regulate the use of antibiotics on animals created with the 16th Amend-ment of the Medicinal Products Act, in particular by amending the Veterinary House Dispensary Ordinance (TÄHAV) with the aim of introducing restrictive provisions on the use of critical antibiotics on animals. In Novem-ber the Federal Ministry of Food and Agriculture (BMEL) asked for opinions on the core principles put forward for further provisions governing the use of antibiotics on animals. The opinions received are currently being evaluated at the BMEL.- BMEL funding of several research projects, inter alia on the issues of improving animal health, interruptingchains of infection, improved diagnosis and the development of vaccines.c) implemented:- introduction in 2011 of records of the quantities of antibiotics dispensed to veterinarians. The Federal Officeof Consumer Protection and Food Safety publishes these annually. Between 2011 and 2014, the quantity of antibiotics dispensed dropped by 27%; the figures for 2015 are not available yet.- The antibiotics minimisation concept established by the 16th Amendment of the Medicinal Products Act andlaunched in 2014 is a benchmarking system where those holding animals intended for slaughter have to report the number of animals kept and their treatment with antibiotics on a semi-annual basis. This information is used to calculate treatment frequencies for each farm semi-annually and to calculate nationwide benchmarks. Live-stock farmers whose individual treatment frequencies are higher than the benchmarks have to try to identify the causes of the frequent use of antibiotics and take countermeasures. If the treatment frequency is particularly high a written measures plan has to be presented to the relevant authority. If necessary, the authority in charge may order additional measures.- The new Animal Health Act (Tiergesundheitsgesetz ) enacted in 2014 focuses more on prevention and containsa host of new provisions to provide preventive protection against animal diseases and illnesses, on combattingthese and improving monitoring. In this context, the conditions for the use of vaccines were adapted to reflect the current situation. The vaccination of animal stocks including against viral infections is of huge importance in reducing the use of antibiotics in animal husbandry to fight secondary bacterial infections.In the field of studies on antimicrobial resistance, one project in the Baltic Sea Region can be referred to in particular. NoDARS (Northern Dimension Antibiotic Resistance Study) by the Northern Dimension’s health partnership (NDPHS) is a research project Germany is involved in alongside the Baltic Sea States Finland, Latvia, Norway, Poland, Russia and Sweden. The aim of the study is to measure the extent of the specific cases of resistance in E.coli isolates in simple urinary tract infections. In addition to this, in a second study, the prevalence of ESBLThere are laws governing the conduct of vaccinations in Germany. Preventive measures and encouraging individual responsibility through information and awareness-raising activities are at the heart of the Protection Against Infections Act (Infektionsschutzgesetz - IfSG). For this reason, there is no statutory vaccination obligation in Germany. Under Sec-tion 20 (2) IfSG the Standing Committee on Vaccination (STIKO) based at the Robert Koch Institute issues vaccination recommendations. These are updated regularly and adjusted in line with the latest findings from vaccination research and the development of specific infectious diseases. The recommendations of the Standing Committee on Vaccination (STIKO) form the basis of the public vaccination recommendations of the Länder .Germany P age 11(Extended-Spectrum-Betalactamases) among the normal population is being investigated.The project is of extremely high importance for this region as it aims to provide health specialists, authorities and policy -makers in the Member States with comparable data which shows the exact prevalence of antimicrobial resistance andits degree of penetration among the healthy population, as well as to assess existing strategies against antimicrobial resistance inside the partner countries involved and to encourage according improvements.The data compiled as a result will enable the participating countries to develop evidence-based guidelines for screeningfor multi-resistant enterobacteriaceae and for fighting infections (urinary tract infections). In the future the project can directly [reduce] the burden on health and the economy posed by antimicrobial resistance (around EUR 1.5 billion per year).Recommendations regarding health and the economyPoint 31Improve the conditions for supporting the development of innovations in the health service, including in theareas of “eHealth” and telemedicine, whilst at the same time ensuring that investments in the area of “eHealth” support the adoption of standards and the interoperability across the whole health sector to foster the creation of the “eHealth European Interoperability Framework” (eEIF) and to monitor the joint European initiatives, for instance the “Guidelines under eHealth Network” of the relevant authorities of the Member States,The Act for Secure Digital Communication and Applications in the Healthcare System and amending other Acts (re-ferred to as the “eHealth” Act), which largely entered into force on 29 December 2015 created incentives for the swift introduction and use of the national telematics infrastructure and the medical and administrative applications based on this. The “eHealth” Act also includes provisions inter alia to promote telemedical services. Furthermore, with the estab-lishment of a national directory at the Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH (gematik) or Company for Telematic Health-card Applications, which also has to include the European decisions, progress has been made regarding the interoperability of the IT systems used in healthcare systems. The Federal Ministry of Health (BMG) actively supports the work of the EU “eHealth” network. The “eHealth” Act means that the European dimension of gematik has been bolstered, which has been acting since early 2015 as the national competence centre in the Joint Action to support the eHealth Network (JAseHN) and has already contributed to EU predecessor projects on interop -erability. Currently the European Commission is promoting the establishment of the EU eHealth infrastructure through the financing instrument “Connecting Europe Facility” (CEF). With the support of the BMG, gematik will bid in the CEF tender to pilot and establish a cross-border exchange of abridged patient medical records. Germany’s high security standards will be incorporated into this project, allowing Germany to contribute to promoting Europe-wide interopera -bility in the field of “eHealth”.Point 34Improve early intervention to boost public health through social investments such as vaccination programmes,implementing decisive measures to lower consumption of alcohol, tobacco and illegal drugs and championing greater prevention in the area of diabetes II and other illnesses related to our way of life.Vaccination programmesGermany P age 12STIKO’s vaccination recommendations also form the basis for the assumption of the costs in the catalogue of benefitsand services covered by the statutory health insurance funds (GKV). Under the Act to Strengthen Competition in the Statutory Health Insurance System (GKV-WSG) of 2007, general mandatory services have to be paid by the health in-surance funds. This also applies to the recommended booster vaccinations for adolescents and adults and for catch-up vaccinations for missed standard vaccinations for children and adolescents. Some of the health insurance funds pay for vaccinations for travel abroad on a voluntary basis. Vaccinations for people with a higher occupational risk of infection have to be paid by the employer (Section 3, (3) Occupational Health and Safety Act - Arbeitsschutzgesetz ).In the area of child vaccination, in spite of major progress in recent years many children are still vaccinated too late and not by their second birthday as recommended by STIKO. In the age group of one to six year olds, the risk of falling ill – in particular for children attending communal facilities – therefore remains higher in the period up until full immunisation. Gaps in immunisation against measles, especially amongst adolescents and young adults, are problematic. The major outbreak of measles in Berlin and other parts of Germany last year highlight this fact.Preventive Health Care Act (Präventionsgesetz)The Preventive Health Care Act, which entered into force in 2015, sets forth numerous improvements in immunisa-tion:-Explicitinclusion of vaccination advice as part of the health check-ups for adults (Section 25 (1) German Social CodeBook 5 (SGB V)) and the early diagnosis check-ups for children and adolescents (Section 26 (1) German SocialCode Book 5 (SGB V)). Now it also has to be examined whether for check-ups under the Act on the Protection of Young People at Work (Jugendarbeitsschutzgesetz ) measures to improve the level of immunisation are necessary(Section 37 (2) no. 2 and (3) no. 3 and Section 39 (1) no. 3 of the Act on the Protection of Young People at Work). Health Insurance Funds should provide bonuses for vaccinations (Section 65a (1) no. 2 German Social Code Book 5 (SGB V)).-Whenchildren start attending care facilities there is a special public interest in them having been appropriately im-munised for their age. That is why in the future when a child is first enrolled at a nursery proof must be provided that a doctor has advised the child’s parents or guardians on the issue of vaccinations (Section 34 (10a) IfSG).-Ifmeasles occur at a communal facility (e.g. nursery, school, afterschool care) then the authority in charge can tem-porarily ban susceptible persons (without immunisation or natural immunity) from attending the facility (Section 34 (10a) IfSG).- Specifically with regard to staff coming under the scope of application of Section 23 (3) IfSG, there are provisionsgoverning the collection, processing and use of employee data on their vaccination status and serostatus in relation to illnesses which can be prevented by vaccinations (Section 28 (2) IfSG).-The provision of the vaccination record booklets will be part of the services covered by the health insurance funds asof 2016 (Section 20i (3) sentence 4 German Social Code Book Five - SGB V [previously Section 20d]); the provision enters into force on 1 January 2016.-Allthe new vaccination record booklets will have to provide a field in which the doctor performing the vaccinationscan enter a proposed date for the next booster vaccination (Section 22 (3) IfSG).- The framework agreements between the health insurance funds and the public health service under Section 20i (3)SGB V (formerly Section 20d (3) SGB V), on the basis of which the Länder are reimbursed for the material expensesGermany P age 13for the vaccinations performed on the insured persons, should set forth simplified invoicing possibilities. This mayconcern, for instance, issues relating to individual invoicing, documentation, the availability of card-readers or elec-tronic invoicing. This should facilitate the sometimes difficult negotiations between the Länder and health insurancefunds on the conclusion of framework agreements.-Company doctors can make an important contributionto increasing the rates of vaccination thanks to their proximityto employees at their place of work. A supplement to Section 132 e SGB V (Provision of vaccinations) therefore has ensured that company doctors are also authorised to perform general vaccinations on insured persons at the expense of the health insurance funds .To improve immunisation for refugees the following statutory measures were adopted:Asylum seekers eligible to receive benefits must be offered the opportunity to complete their immunisation at an earlystage (Modification to Section 4 of the Asylum Seekers Benefits Act – Asylbewerberleistungsgesetz ). To create legalclarity regarding the scope of benefits and to facilitate implementation, the scope of the entitlement to vaccinations – without extending the entitlement – was made subject to uniform provisions for the entire duration of the benefits claimed under AsylbLG in line with the benchmarks of the statutory health insurance system (modification to Section 4 of the Asylum Seekers Benefits Act). A provision now sets forth the use of the Central Register of Foreigners (Ausländerzen-tralregister ) for storing and exchanging data on the vaccinations given (modification of the Act on the Central Registerof Foreigners - AZR-Gesetz).The Robert Koch Institute (RKI) has developed a concept in consultation with the Standing Committee on Vaccination(STIKO) and the Länder on how vaccinations can be done as efficiently as possible in the special of situation of theprovision of initial medical care to refugees.In 2015, the National Action Plan 2015-2020 to eradicate measles and rubella in Germany was adopted. It aims to makean important contribution to achieving this health goal.The Preventive Health Care Act of July 2015 considerably boosted prevention and the promotion of health in Germany.In future, the health insurance funds will spend around EUR 500 million every year on prevention benefits and services, at least EUR 280 million of which will be in settings such as nurseries, schools, municipalities or businesses. In addition to prevention in everyday settings, promoting immunisation is one of the Act’s priorities.The basis for all the preventive measures by the health insurance funds is the “Prevention Guidelines” of the National Association of Statutory Health Insurance Funds ( Spitzenverband der GKV ):-Exercise habits-Food-Stress management-Use of addictive substancesAlack of physical activity, unhealthy diet, tobacco use and alcohol consumption are considered to be lifestyle-relatedhealth risks. They can expedite the development of many illnesses such as diabetes, cardiovascular diseases or cancer. An approach geared towards these risk factors enables health risks to be prevented across multiple illnesses at once.Germany P age 14Furthermore, the Preventive Health Care Act has led to the incorporation of a total of eight health goals in Book Five ofthe German Social Code (SGB V). The Central Federal Association of Health Insurance Funds (Spitzenverband Bund der Krankenkassen ) is obligated to cater for these health goals in its preventive healthcare activities. The health goalswere developed by the cooperation network gesundheitziele.de. and incorporate risk factors (e.g. tobacco or alcohol) and illnesses (such as diabetes or depression) of major importance.National Health GoalsDiabetes mellitus type 2: lower the risk of con-tracting the disease, ensure early diagnosis and treatment of sufferers Increase health expertise, boost sovereignty ofthe patientsBreast cancer:lower mortality, raise quality oflifeDepression-related illnesses:prevent,ensure early diagnosis, lasting treatmentLower tobacco consumption Healthy ageingGrowing up healthy: life skills, exercise, diet Lower alcohol consumptionEven if there is no formal resolution by the Bundestag for a national diabetes strategy currently, stepping up preventionand the fight against diabetes mellitus has high priority for the Federal Ministry of Health (BMG) in its health policies. This is also reflected in the creation of a separate budget item entitled “diabetes” from the budget year 2016 onwards (chapter 1503, item 684 01), which is to be used from 2016 to 2019 in relation to the area of diabetes mellitus preven -tion primarily to allow the Federal Centre for Health Education (BZgA) to develop, implement and evaluate a National Awareness and Communication Strategy on Diabetes Mellitus. The National Diabetes Awareness and Communication Strategy is to address all three phases of the illness (primary prevention, early diagnosis (secondary prevention), prevention of secondary illnesses (tertiary prevention)) for those effected, vulnerable groups, but also the general public. The aim is to boost knowledge regarding the illness of diabetes and on prevention and treatment possibilities, to increase the social acceptance of the sufferers and to support the attainment of the national health goal for diabetes mellitus type 2.Furthermore, this budget item will also fund other smaller projects serving to improve the prevention of diabetesmellitus. This includes, for instance, the project “Diabetesberatung auf Rädern ” (“Diabetes advice on wheels”), whichspecifically targets migrants and the older population in rural areas lacking structures to raise awareness of the illness and possible prevention measures, and promotes early diagnosis of previously undetected cases of diabetes.The Preventive Health Care Act adopted in 2015 has meant that the national health goal for type 2 diabetes – “lowerthe risk of contracting the disease, ensure early diagnosis and treatment of sufferers” – has been enshrined in law. This addresses all three dimensions of diabetes prevention (primary, secondary and tertiary prevention).Improving early intervention to promote public health by social investments, here: health check-upCurrently, insured persons from the age of 35 onwards can take advantage of the “Check-up 35”, in particular for earlydiagnosis of cardio-vascular diseases, kidney disorders and diabetes mellitus. On the basis of the Preventive Health Care Act of July 2015, the check-up will be gradually further developed over the next three years by the Joint Federal Committee (G-BA) (Section 25 SGB V). Here, the G-BA is to make the previously rigid age limit, the frequency of theGermany P age 15entitlement and the prescribed examination methods more flexible in the future and based more on the needs of thetarget groups in question. Furthermore, the check-up will also cover possible future impairments to health and risk factors, for instance lack of exercise and excess weight more and verify the patient’s vaccination status. Based on the results of the check-up, doctors should be able to recommend individual measures for primary prevention in the future, for instance exercise classes, diet, stress management or dealing with addiction, and issue a doctor’s certificate on this. The certificate will provide the health insurance funds with an important basis for the decision on the provision of prevention courses.The Preventive Health Care Act (Section 26 German Social Code, Book 5 - SGB V) raised the maximum age for thetraditional check-up programme for children so that health check-ups for children and adolescents can now be intro-duced from birth up to the age of 18 as a service paid for by the statutory health insurance funds. At the same time, prevention-oriented advice to parents will be a binding part of the check-ups. This means the doctor conducting the check-up will also record individual problems and health risks of the child and, based on this, inform the parents as to how they can promote the development and health of their child and avoid risks. In addition to this, the doctor will also to be able to issue a prevention recommendation as needed and inform parents about regional parent-child pro-grammes. Part of the check-up should also entail checking the child’s immunisation status. In the future, when a child is first enrolled at a nursery parents or guardians will have to provide evidence of having being advised by a doctor on vaccinations. The Preventive Health Care Act gives the Joint Federal Committee (G-BA) the possibility and the task of further developing the health check-ups for children and adolescents in this vein.National Action Plan “IN FORM —Germany’s Initiative for healthy eating and more exercise” The aim of the action plan is to improve people’s exercise and eating habits and to foster healthy lifestyles throughinformation and structures which promote health. This has led, for instance, to the creation of practice-related online programmes for quality assurance, evaluation and communication. Prevention projects and quality-assured health programmes are being recognised and made visible with the logo “supports the aims of IN FORM”. A progress report which documents the work to date and identifies future priorities is in the process of being compiled.The funding priority of preventing children or adolescents from becoming overweight or obeseBuilding on existing structures, existing knowledge and tried-and-tested models are being used, implemented sus-tainably and made accessible to the different players in a practicable way. This puts the transfer and dissemination of general, quality-assured knowledge in the field of practice at the fore. 12 projects are currently receiving support, others are in the pipeline.Lowering the consumption of alcohol and tobaccoSince 2015 mainly the following measures have been implemented:-Health goal of “lowering tobacco consumption”-On the basis of the experience gained in the scope of implementing the national health goal of “lowering to-bacco consumption” adopted in 2003 and current scientific findings, in 2015 a revised health goal of “loweringtobacco consumption” was adopted in a consensus-oriented process with all those involved.The new goal agreed on, whose attainment will be supported by the implementation of a wide range of mea-sures for circumstance and behaviour-based prevention is:Germany P age 16- Adolescents and young adults stay non-smokers.- The numbers of people stopping smoking increases in all age groups.- Comprehensive protection against passive smoking is in placeFor each goal, sub-goals are defined whose implementation also serves as an indicator of the degree of success inattaining the targets.Transposition of the EU Tobacco Products Directive into German lawThe EU Tobacco Products Directive has to be transposed into German law by May 2016. To this end, the FederalForeign Ministry of Food and Agriculture (BMEL) has presented a draft Tobacco Products Act, which was adopted by the Bundestag on 25 February 2016 in the third reading. Currently, the Bundesrat is deliberating the bill. The Federal Government assumes that the measures contained in the Act will lower the prevalence of smokers in Germany further. The key content is:There will be a ban on the selling of cigarettes and tobacco for hand-rolling which-have a characteristic aroma,-whose components containaromas or technical features enabling the odour, taste or smoke intensity to bechanged-contain tobacco or nicotine in filter paper or capsules.Tobacco products may only be sold in packages and external packaging which display health warnings.To ensure the tobacco products are traceable and authentic, their packaging must include an individual identificationfeature and a falsification-proof security feature.An approvals procedure will be introduced for novel tobacco products.For the first time, in addition to tobacco products and herbal smoking products, electronic cigarettes and refill con -tainers will also be regulated.Inclusion of the ban on the selling and use of electronic cigarettes and electronic water pipes in the Youth ProtectionAct (Jugendschutzgesetz )Electronic cigarettes and electronic water pipes are popular among many children and adolescents. According to a re-cent study by the Federal Centre for Health Education one in five of 12 to 17 year-olds have already tried an electronic water pipe once and one in seven of the same age group an electronic cigarette. 11.3 % of this age group has already used an electronic water pipe or an electronic cigarette without ever having smoked a tobacco cigarette. Given the fla-vours like chocolate and various fruit varieties, the products seem harmless and appeal to children and adolescents.Electronic cigarettes and electronic water pipes are not harmless for children and adolescents though. The healthrisks of the drug and neurotoxin nicotine, such as physical addiction and cardiovascular disorders have been known for a long time, but now studies by the Federal Institute for Risk Assessment and the German Cancer Research Centre have also shown the health risks associated with using nicotine-free electronic water pipes and electronic cigarettes for children and adolescents.Germany P age 17On 1 April 2016, an amendment of the Youth Protection Act therefore came into force expanding the ban on selling andconsuming tobacco products to electronic cigarettes and electronic water pipes. This should also ensure that the ban on selling tobacco products, electronic cigarettes and electronic water pipes to children and adolescents applies to the mail order sector as well.Health goal “Lowering alcohol consumption”In April 2015 the new health goal of “lowering alcohol consumption” was adopted by the committee of the cooperationnetwork gesundheitsziele.de and published on 19 May 2015 in the Federal Gazette (www.bundesanzeiger.de) and onthe cooperation network’s website. The working group for the health goal comprises decision-makers from politics, professional associations, patient and self-help organisations and the science community.The reason for developing a national health goal on the subject of “lowering alcohol consumption“ was that the neg-ative effects of consuming too much alcohol are among the avoidable health risks in Germany. Whilst it is true that alcohol consumption has been in decline in recent years, many parameters still point to the fact that too high a con-sumption of alcohol is cause for concern in Germany and that further action is required. The working group is currently discussing a set of issues relating to the advertising, pricing and availability of alcoholic beverages. Once finalised, the set of issues is to be added to the existing version of the health goal of lowering alcohol consumption.Prevention of alcohol consumption during pregnancyIn addition to the awareness-raising measures already underway on the dangers of alcohol consumption during preg-nancy, the Federal Ministry of Health (BMG) is funding a three-year model project on school-age prevention of alcohol -ic consumption during pregnancy. The results are expected to be available in early 2018. The BMG also funded a mo-bile exhibition illustrating the potential consequences of alcohol consumption during pregnancy using a walk-in womb.From July 2013 to December 2015 the BMG funded the IRIS II project at the Tubingen university teaching hospitalfor psychiatry and psychotherapy. The online-based and interactive advice platform “IRIS” is designed to support pregnant women who consume alcohol or tobacco to abstain. Of great interest here is which pregnant women such a programme reaches and how they find access to advice. In addition to this, IRIS II tackles the question of whether an advice platform which is also moderated by an expert (“e-coaching”) results in a higher degree of compliance and rate of abstinence among the pregnant women benefiting from the advice. The contents of the programme aim to raise awareness and provide information, to make people aware of the problem and to motivate them to change their behaviour, support them and achieve alcohol and tobacco abstinence.Diagnosis of Foetal Alcohol Spectrum Disorders (FASD)The development and dissemination of the S3 guideline criteria for the diagnosis of full foetal alcohol syndrome (FAS)was a first step towards early and uniform diagnosis among children and adolescents in Germany. Both the sufferers and their caregivers and the professionals helping them are calling urgently for uniform diagnosis of FASD among children and young people in Germany. Since the middle of 2015, a body of experts has therefore been developing the S3 Guideline for the Diagnosis of FASD to supplement the aforementioned guideline. The aim of the BMG-funded project is to develop an evidence-based, formal expert consensus on the requisite diagnostic criteria and relevant rec-ommendations for Foetal Alcohol Spectrum Disorders amongst children and adolescents. The project is scheduled to be completed in the early summer of 2016 and should contribute to improving FASD diagnosis.Germany P age 18Prevention of alcohol abuse at discos and nightclubsTo enable club and disco operators and their staff to deal well with their guests, who sometimes consume riskyamounts of alcohol, in 2015 the specialist outpatient clinic for addiction disorders of the charity Diakonisches Werk Rosenheim e. V. drafted the training concept entitled “safe - sauber feiern” (“partying safely”) and put it into practice in cooperation with the Federal Association of Discotheques and Nightclubs at well-known venues. Safe’s target au-dience is clubs and discos of all kinds and sizes nationwide. The training concept is designed to be closely related to the field of practice and is based on the concrete everyday working lives of all staff. The project uses a key training unit to create awareness of “safer clubbing”, offering people the opportunity to reflect on their own view of alcohol con-sumption, deepening their knowledge of relevant laws, common substances and the issue of first aid, expanding basic skills, proving specific recommendations for action for conflict situations in the area of alcohol and substance use, encouraging the optimisation of working processes and creating low-threshold access to the addiction support system.Prevention of alcohol consumption amongst studentsThere have been comparatively few activities promoting health and prevention in the setting of universities to date.A study funded by the BMG on “Forms of stress compensation and performance enhancement amongst students” in 2010 examined the need for prevention more precisely. The findings of the study show that the stress perceived as a result of pressure to perform is closely liked to the consumption of substances (alcohol, cannabis, tobacco). Building on this, since summer 2013 the BMG has funded three projects (Dein Masterplan or “Your Masterplan”, INSIST and eCHECKUP TO GO) in which new approaches for prevention targeted at students were developed. The effectiveness of the measures developed in the scope of the projects was documented by a scientific evaluation. To successfully and durably embed the measures developed in the three model projects in the university setting, the BMG has been funding a dissemination project since February 2016. The aim of the project is to develop dissemination strategies and qualify universities to deal with the instruments that have been developed.Point 39Examine the possibility of creating a Baltic Health Forum for the purpose of providing and improving a lastingexchange of information and cultivating contacts in this policy area in the entire Baltic Sea Region.The Federal Government is fundamentally in favour of an increased exchange of information, knowledge and data in the scope of partnership-based cooperation. This also holds true for the Baltic Sea Region. But here, specifically, we already have a suitable body in the form of the Northern Dimension Partnership in Public Health and Social Well-be -ing/NDPHS. In recent years this partnership has led to in-depth and trust-based cooperation in the health sector, both professionally and politically, although Denmark is not a member of this partnership and as such cannot benefit from the advantages of this cooperation. Denmark, however, for its part also rejects new structures.Another, new institution — like the aforementioned Baltic Health Forum – in this area would possibly lead to duplicatework and duplicate structures and also tie up scarce resources. This is not something the BMG would wish to see.Germany P age 19Recommendations in relation to sustainable and easily accessible social and health servicesPoint 43Develop and bolster strategies to manage demographic change, for instance the European Innovation Part-nership in the area of “Remaining active and healthy in old-age”, and special consideration of basic public services in rural peripheral areas.SHI Supply Enhancement Act (GKV-Versorgungsstärkungsgesetz )Ensuring nationwide, high-level medical care within easy reach and tailored to people’s needs is one of the FederalGovernment’s key health policy aims. This aim is of particular importance, especially also on account of demographic change and the ensuing changes in the needs of those insured and the varying supply situations in conurbations and rural regions.Wide-ranging reforms of the healthcare system ensure that in the future, too, easily accessible, high-quality medicalcare will be provided. The wide-ranging legislative initiatives of the Federal Government boost supply structures, im-prove services for patients and increase the quality of the medical care provided.A focal point is guaranteeing care by SHI-accredited doctors. The SHI Supply Structure Act (GKV-Versorgungsstruk-turgesetz - GKV-VStG) of 1 January 2012 already created a package of measures at different planning and responsi -bility levels to ensure the continued provision of enough doctors in the future in all regions of Germany for high-quality, needs-oriented care for patients. Those concerned were afforded flexible opportunities to manage health care in line with regional circumstances and requirements.The SHI Supply Enhancement Act (GKV-Versorgungsstärkungsgesetz - GKV-VSG), which entered into force on 23July 2015, develops the measures introduced by the 2012 SHI Supply Structure Act, which bolster the provision ofmedical care in rural areas in particular, for instance through targeted incentives for establishing a practice in under -supplied or structurally weak areas, further. For instance, to promote the establishment of doctor’s surgeries, the es-tablishment of a structural fund is being simplified and funding opportunities expanded. The possibilities for setting up medical care centres (medizinische Versorgungszentren - MVZ) are being developed further. Municipalities can now actively contribute to shaping care by founding an MVZ, in particular in rural areas.The SHI-accredited doctors associations (Kassenärztlichen Vereinigungen - KVen) have been obliged to set up ap-pointment service centres to arrange appointments at a specialist doctor for patients with a referral (an exemption fromthe referral obligation applies for appointments at gynaecologists or ophthalmologists) within the space of four weeks as a general rule. To improve psychotherapy services the Joint Federal Committee has been tasked with revising the Psychotherapy Directive. Furthermore, hospital discharge management has been improved and structured treatment programmes are being expanded.The law also sets forth a whole host of additional measures to improve the care of patients in Germany. This includes, for instance, the right to seek a structured second doctor’s opinion for certain foreseeable operations which are performed particularly frequently. The care of disabled persons is being improved by medical treatment centres being able to be authorised to provide outpatient treatment for adults with mental disabilities or severe multiple disabilities. To improve preventive dental care for those requiring long-term nursing care, people with disabilities and people with permanently impaired everyday skills, a right to preventive dental care is being established for these groups of people.In addition to this, an innovation fund has been set up which can fund innovative, cross-sectoral care forms and care research from 2016 to 2019 with an annual sum of EUR 300 million each year. Following evaluation, a decision will beGermany P age 20taken on the continuation of the fund. To supplement this, red tape has been cut in the provisions governing selectivecontracts and their scope for action has been expanded to bolster competition in innovative and efficient forms of care provision. All of this improves medical care and ensures a swift and uninterrupted treatment process.Ensuring care by SHI-accredited doctors is generally the task of the SHI-accredited doctors associations (KVen)in the Länder and the Federal Association of SHI-Accredited Physicians (Kassenärztliche Bundesvereinigung ). Inagreement with the regional associations of the health insurance funds and the supplementary health insurance funds, the KVen have to put in place a requirements plan at Länder level to ensure the provision of care by SHI-accrediteddoctors and adapt it to developments as required in line with the directives issued by Joint Federal Committee (G-BA). The KVen are obligated to take all financial and other measures in accordance with the requirements plans to ensure, improve or promote the provision of care by SHI-accredited physicians.The KVen’s task of ensuring the provision of care by SHI-accredited doctors also encompasses medical care outsideof usual surgery hours (for urgent cases). This does not include care by an emergency doctor accompanying the emergency services unless otherwise stipulated under the law of the Land in question.During this legislative period, the Federal Government has already implemented or initiated the following relevant initiatives.The Hospital Structure Act (Krankenhausstrukturgesetz ) has further developed the general conditions for hospital careso that in the future, too, it is possible to ensure easily accessible, high-quality hospital care in Germany on a solidfinancial basis. To enhance the focus on quality in hospital care, quality is being firmly embedded in hospital planning as an additional criterion and quality-related pay components are being introduced. To improve hospital funding further, volume management will be structured more efficiently with the result that volume increases will no longer be a factor that is considered for all hospitals but only for those that do actually expand their services accordingly. To promote the conversion of existing hospital capacities in line with needs, a hospital structure fund is being put in place which can be used to fund the reduction, concentration and conversion of care capacities. The Act also aims to improve the staffing situation in the area of nursing care for patients. To this end, in the scope of a nursing position funding programme, up until 2018 funds of up to EUR 660 million will be provided for nursing care. In addition to this, an expert commission will examine to what extent the nursing needs occurring in the hospitals are properly reflected in the remuneration system. The special care needs of those requiring long-term care, and those suffering from dementia and requiring long-term care have to be taken into account here. The introduction of a care supplement and better collective wage funding are boosting staffing funding further.The following measures of the Hospitals Structure Act in particular will have a positive impact on developments inrural areas:- Service guarantee incentives for hospitals (Sicherstellungszuschläge ) can be agreed on if hospitals cannotcover their costs with flat rate payments because of too low a demand but their services are necessary to ensure the in-patient treatment of the population. This is a measure designed to ensure nationwide hospital care through higher remuneration in rural areas in particular. The option of a service guarantee incentive was already introduced into the hospitals funding legislation in 2002. The prerequisite is that these services cannot be provided by another suitable hospital without payment of the supplement.- Hospitals with a large amount of emergency structures at the ready will be better off in the future than hospitalswhich do not have or do not have much in the way of emergency care services. This will reflect the differences in the maintenance of in-patient emergency structures better than the current EUR 50 deduction for non-par -ticipation in in-patient emergency care. Hospitals in rural areas which maintain comprehensive emergency structures and in doing so contribute to full-coverage emergency care in rural areas will therefore be better off.Germany P age 21The Act to improve Hospice and Palliative Care (Hospiz- und Palliativgesetz ) means that nationwide hospice and pal-liative care in Germany is being bolstered thanks to targeted measures in statutory health insurance and social long-term care insurance. Incentives are being created for the establishment and expansion of hospice and palliative care, and cooperation and networking in the relevant areas of care are being promoted.First, this is taking place by improving outpatient palliative care and promoting cooperation between the different ac-tors. SHI-accredited physicians receive additional remuneration, which is designed to increase the quality of palliative care and to foster networking. Palliative care has been boosted and is now an explicit part of home-based nursing. In addition to this, the expansion of the specialised outpatient palliative care system (SAPV) has been accelerated by the introduction of an arbitration procedure for corresponding care agreements. Furthermore, funding from the health insurance funds has been increased in order to be able to factor in the material costs in the supplements for out-patient hospice services in the future in addition to personnel costs.Second, in-patient hospice care is also being strengthened. The funding of in-patient hospices is being improved by the daily minimum premium paid by the health insurance funds being raised from EUR 198 to around EUR 261 per insured person. Furthermore, the health insurance funds have to cover 95% instead of the previous 90% of the costs eligible for the premium, in adult hospices, too.The expansion of palliative care in the area of in-patient hospital care is being promoted. Hospitals with their own pal-liative ward can now agree individual remuneration with the institution covering the costs. And hospitals without their own palliative ward can form multi-professional palliative services for which they are paid extra money by the health insurance funds. Furthermore, the hospice culture is being fostered inside in-patient care institutions. Hospice care is now an explicit part of the care mandate of the social long-term care insurance system. Nursing homes are required to work with the hospice services and conclude cooperation agreements with GPs and specialist doctors. Doctors who participate will receive additional remuneration. The SHI Supply Enhancement Act (GKV-VSG), which already entered into force in July 2015, has already created the conditions for guaranteeing nationwide, easily accessible medical care in line with needs in the future, too. The provisions of the GKV-VSG further develop the measures of the SHI Supply Structure Act (GKVVersorgungsstrukturgesetzes - GKV-VStG), which already entered into force on 1 January 2012. The GKV-VSG sets forth inter alia the following measures:-The Joint Federal Committee has been tasked with further developingthe Requirements Planning Di-rective by 31 December 2016. To this end the ratios (number of inhabitants per doctor) are also to be reviewed in terms of the social and morbidity structure. Furthermore, the possibility of micro-spatial planning is to be catered for.- The provisions governing the structure fund have been extended to improve the incentives to set up doctor’s practices in undersupplied or structurally weak areas.-To further reduce the waiting times to see specialists, provisions have been made for the establishment ofappointment service centres by the SHI-accredited physicians associations.- The statutory stipulations to promote continued training in general medicine have been improved and extendedto include continued training for specialist doctors providing basic care. This is designed to counter the short-age of doctors.-As anotherstep to ensure nationwide outpatient care in the future, in the scope of delegation the increase in anduse of non-doctor health professionals with pay adequately reflecting their work will relieve doctors and allow them to focus on what are strictly doctor’s activities.-Hospitals’authorisation to provide outpatient treatment in cases of supply shortages will be made more bind -ing.Germany P age 22- Removal of unjustified differences in pay in the scope of fees negotiations through a one-off base-effectiveincrease in the benchmark value in 2017.In tandem with the Federal Ministry for Education and Research (BMBF), the Federal Ministry of Health (BMG) is cur-rently engaged in discussions with representatives of the Standing Conference of the Ministers of Health and of the Ministers of Education and Cultural Affairs of the Länder in the Federal Republic of Germany and representatives ofthe coalition parliamentary groups of the German Bundestag on the “Masterplan Medizinstudium 2020” (“Masterplan for studying medicine 2020”). This also entails measures to attract the next generation of doctors to rural areas. Ex-perience shows that if students of human medicine can gain on-going experience in veterinary work in rural areas at an early stage of their degree, they tend to decide to work there as doctor’s later on. For students originally from rural areas themselves, this willingness is often even higher.One topic of discussion in the scope of the masterplan is also the option of awarding places to study medicine on thecondition of later working as a country doctor. To clarify the legal requirements of this very controversial measure, the BMG has commissioned a legal expertise, which is now available. The expertise comes to the conclusion that it is constitutionally possible to design a quota to ensure primary medical care by doctors when admitting people to study medicine. The admissions procedure could thus – in addition to its main purpose of selecting candidates – also make a contribution to more doctors working in primary medical care in undersupplied, especially rural regions.In the wake of demographic change, the number of older people with restricted mobility who are reliant on support isgrowing. Here, people requiring long-term care are particularly vulnerable. The Federal Government is increasing the benefits and services provided by the long-term care insurance system (Pflegeversicherung ) during this electoral termby the First and Second Act to Strengthen Long-term Care (Erstes und Zweites Pflegestärkungsgesetz ) considerably,by 20 %. Long-term care policies are thus initiating and supporting processes to develop socio-spatial structures. The long-term care insurance system is thus also and especially ensuring a nationwide infrastructure for long-term care services. This benefits the rural areas in particular. This should enable older people requiring long-term care to live as autonomous a life as possible in the environment of their choice even if they require long-term care. Long-term care homes are an important economic factor especially in rural areas. The expansion of the benefits and services provided by the long-term care insurance system is also driving new communal forms of housing and the development of new local support schemes for everyday life. The Second Act to Strengthen Long-term Care also gives the long-term care insurance funds the possibility of providing long-term financing to regional care networks.Furthermore, the Federal Government has also developed recommendations with the Länder and the municipalitiesto strengthen the role of the municipalities in long-term care and will pass federal legislation to create the frameworkfor the cooperation between the key players on the ground to boost socio-spatial care structures. The Third Act to Strengthen Long-term Care is scheduled to enter into force on 1 January 2017.The aim of the Preventive Health Care Act of July 2015 is to prevent and reduce health risks, encourage insured per-sons to take responsibility for their health and act in a health-conscious way, and to reduce the social and gender-based inequality in health opportunities. At the heart of all of this is strengthening prevention and promoting health in settings such as nurseries, schools, municipalities or workplaces. The target groups who are to benefit more in the future from health promotion and prevention activities also include those living in nursing homes. The Preventive Health Care Act therefore contains a specific prevention mandate for the social long-term care insurance system for semi-in-patient and in-patient care facilities. The National Preventive Health Care Strategy also improves the cooperation between the different actors and the coordination of their preventive health benefits and services. Other focal points of the law also include bolstering workplace health promotion, the prevention-oriented further development of health check-ups for children, adolescents and adults and the promotion of the vaccination system.As part of a model programme, Local Alliances have been set up and promoted which aim to permanently improve the lives of people with dementia and their families by pooling and dovetailing potential. By 2016 a total of up to 500 Local Alliances are to be funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.Germany P age 23The “Allianz für Menschen mit Demenz” (Alliance for People with Dementia) is a network comprising various differentorganisational partners at federal level and supports the formation of these help networks in the immediate surround -ings of those affected. The Local Alliances are one of the key measures among the numerous contributions the Agen-da “Gemeinsam für Menschen mit Demenz” (“Joining Forces for People with Dementia”) is making. The Alliance for People with Dementia shows how the Federal Government is incorporating its long-term care policies into alliances between the government and civil society, for instance in the context of the Demographic Strategy.The aim of the Alliance is to continue to develop help and support for those affected and to foster understanding andsensitivity for people with dementia. The hope is to help ensure a good life in spite of dementia and in familiar social re-lationships. In a joint declaration, the Alliance has pledged to adopt specific measures in different fields of action. The Agenda was signed by all the Alliance organisational partners in September 2014 after two years of work. This marks the launch of the implementation process of the contributions. It lays the foundation for a national dementia strategy.The Agenda is divided into four fields of action with a total of 27 thematic priorities:- Science and research - Social responsibility - Supporting people with dementia and their families - The design of the support and care systemThe Agenda contains 155 measures the organisational partners have undertaken to implement. The implementationof the measures will be surveyed in the scope of a monitoring procedure. 133 of the 155 measures have now been backed up by contributions by the organisational partners. The last meeting of the working group was held on 12 November 2015 at the BMG in Berlin. The contributions of the organisational partners formed the foundation for the presentation of the first results at the Federal Government’s Demography Summit on 22 September 2015.For 2016, the next meeting is scheduled at the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) on 3 May. At this meeting the measures in the Field of Action III (Supporting people with dementia and their families) will be examined separately and their degree of implementation discussed and possibly supplemented selec-tively with additional sub-measures. The results will be incorporated into the Alliance’s first progress report, which is expected to be presented during “Dementia Week” (calendar week 38, 19.9.- 25.9.2016). 2018 has been agreed on for the completion of the implementation process.People with dementia requiring assistance and long-term care are catered for largely in their own home or family or in a nursing home in Germany. The outpatient care system is not sufficiently geared towards the widely varying needs of those affected and their relatives though. Against the backdrop of demographic change, new care models are therefore becoming increasingly interesting, such as regional networks in which various professions and institutions work togeth-er to help people with dementia and their relatives (dementia networks). Given the significance of dementia and with the new cases of illness to be expected in light of the demographic trend, the Federal Ministry of Health also continues to be active in this field in the scope of its research activities.In 2008-2009 in the scope of the “Lighthouse Project on Dementia” 29 projects were funded whose outcomes werepresented at a public event in September 2010 and explored in terms of their significance for the care situation of people with dementia. The BMG’s funding programme “Zukunftswerkstatt Demenz ” (Laboratory for the future on de-mentia) is geared towards supplementing the findings gained so far from the Lighthouse Project on Dementia – where necessary - and to put the existing knowledge into practice in routine care appropriately. To support the implementation of successful model projects and initiatives, the BMG saw a special need for action in the following areas:Germany P age 24- regional dementia networks- supporting family members caring for people with dementia.A total of seven model projects were funded as part of the Zukunftswerkstatt Demenz . Six model projects in the areaof “supporting family members caring for people with dementia” and one project in the area of “regional networks”. Inmany regions of Germany, networks for people with dementia or care networks already exist. They make an important contribution in many places to improving care by trying to align regional supply and actual demand better. In the scope of the evaluation study DemNet-D success factors and conditions were researched more closely. This evaluation study is a measure that the BMG has initiated and implemented in the Field of Action III of the agenda.From the very outset, the aim of the evaluation study funded by the BMG between 2012-2015 was to develop a guidefor the field of practice. For this purpose, the knowledge relating to the founding and upkeep of 13 regional networks for people with dementia was collected and organised systematically. The scientific evaluation shows that improved coop-eration in fields of medicine and care can significantly stabilise the domestic situation of those suffering from dementia and of their relatives. The Federal Government has implemented the findings.From the broad base of data from different networks and their experiences in the field of practice, the researchers were able to establish overarching findings. The website www.demenznetzwerke.de now makes the findings and documentsuseable — with a tool kit for people’s own daily working lives in the field. There are numerous materials available here which have been tried and tested in practice in the evaluated networks.The Act for Secure Digital Communication and Applications in the Healthcare System and amending other Acts (Ge-setz für sichere digitale Kommunikation und Anwendungen im Gesundheitswesen sowie zur Änderung weiterer Ge-setze) which largely entered into force on 29 December 2015 (known as the “eHealth” Act) provides incentives for the swift introduction and use of the telematics infrastructure and the medical and administrative applications building on this. The “eHealth” Act means that provisions inter alia to fund specific telemedicine services such as telediagnostics/teleconsultation for x-rays and online video consultation hours have become part of care provided by SHI-accrediteddoctors. The expansion of telemedicine applications in particular can make a key contribution to enabling high qualityaccess to medical expertise in the future, too, especially for people in rural areas.In the scope of the Federal Government’s Demographic Strategy, in addition to this a wide range of further measures of demographic relevance were taken, for instance such as the Federal Programme on “Rural Development” or the KfW programme for home conversions to meet the needs of older people.Demographic changeAmong the many challenges demographic change confronts us with, the increasing number of people requiring assis-tance and care is one of the most demanding – due to the fact alone that the number of cases of dementia in an aging society will continue to rise even if not to the degree calculated in the past, as more recent studies on prevalence give cause to hope.In addition to good medical and long-term care, it is above all society’s attitude towards sufferers and their relatives thatplays a key role in terms of quality of life.With the Alliance for People with Dementia, a remarkable alliance between the Federal Government and civil societyhas therefore been created under the joint leadership of the Ministry of Health and the Ministry for Family Affairs aim-Germany P age 25ing to ensure the requisite underlying conditions for participation and quality of life for people with dementia.A central measure by the BMFSFJ in the Agenda of the Alliance “Joining Forces for People with Dementia” signed on15 September 2014 is the model programme of the Local Alliances for People with Dementia. The aim of these local help networks is to promote support in the immediate surroundings of those affected and to have a lasting impact on ensuring that dementia sufferers and their relatives caring for them are not socially excluded but are accepted with understanding and empathy in their needs and feel helped and supported individually as needed.To date, in four waves, a total of 369 locations have received funding; the selection procedure for the fifth wave hasbegun. By the end of 2016 the plan is for up to 500 Local Alliances to be created. Some of these are active in rural regions and are characterised unusual partnerships and ideas, for instance mobile advice and assistance to avoid people having to travel long distances, support schemes at farms by trained and instructed farmers reminiscent of the use of village farm helpers used to fill in for sick farmers or their wives (Dorfhelfer), the use of farm machinery coop-eratives (Landmaschinenringen ) and local women’s associations (Landfrauenschaft ).In consultation with the Länder , the programme was organised as a long-term scheme and will undergo a final im -pact assessment in 2018.Point 49Conduct studies with the aim of developing prevention strategies in the healthcare system, for instance theNord-Trøndelag Health Study (HUNT study).Since 2008, there has been a health monitoring programme at the Robert Koch Institute (RKl), which encompasses in-terview and examination surveys for all age groups. Nationwide studies enable both population-related, cross-section analyses as well as longitudinal analyses. The collation of health data (including measuring parameters) in combina -tion with social and demographic information, risk and protection factors give rise to broad possibilities for evaluating health over the course of people’s lives. This also allows aims to be defined for prevention strategies on the basis of the studies. The data collected also provides important information which health reporting, health policy and health sciences can draw from.Data is currently available from the following studies:-KiGGS (“German Health Interview and Examination Survey for Children and Adolescents”, baseline studyand wave 1);-DEGS1 (“German Health Interview and Examination Survey forAdults”);-GEDA(“German Health Update” 2009, 2010, 2012).With KiGGS Wave 2, the data collation for the German Health Interview and Examination Survey for Children andAdolescents has been continued since September 2014. In this wave of data collection, in addition to the interviews of those participating in the study, physical examinations and tests will also take place again. KiGGS Wave 2 will once again – again on the basis of a new random sample - provide an update on the health situation of under 18s in Germa-ny and – in comparison with the two predecessor studies – provide indicators for developments over time (trends). The participants in the baseline study who are now in some cases already 18 and over will also be invited back to KiGGS. This will mean that KiGGS Wave 2 will provide data on the development of individuals’ health which can deliver import-ant insight into the significance of living conditions and risk factors for the occurrence of illnesses.Germany P age 26Thanks to GEDA Wave 2014/2015-EHIS, which the instruments of the European Health Interview Survey (EHIS)were integrated into, from 2017 there will also be representative interview data on health across the whole popula -tion enabling comparison with the data of the European Member States. The EHIS was conducted under Regulation 141/2013 of the European Commission of 19 February 2013. Conducting the survey is binding for all EU Member States. In addition to this, the EFTA countries Iceland, Norway and Switzerland have joined the survey. This means that from 2017/2018 onwards there will be comparable and up-to-date health data for the Member States of the Baltic Sea Parliamentary Conference with the exception of the Russian Federation.The National Cohort - a joint, interdisciplinary project by German research institutes from the Helmholtz Associa-tion, the universities, the Leibnitz Association and departmental research - adopts a similar approach to that of the Nord-Trøndelag Health Study (HUNT Study). The National Cohort’s objective is to study the occurrence of the most important chronic diseases such as cardiovascular diseases, diabetes, cancer, dementia-related disorders and infec-tious diseases as well as their subclinical preliminary stages. The findings of this study will enable new prevention, prediction and early diagnosis possibilities for the major diseases. Interview data is being collected, bio-samples taken and numerous medical examinations carried out for a total of 200,000 women and men aged 20 to 69 in 18 study cen-tres. The main phase was launched in October 2014 following intensive preparation. The plan is to invite all participants back after 4 years for re-examination.The HBSC study (Health Behaviour in School-aged Children), which is being conducted by 44 countries in cooper -ation with the WHO, is designed to collect and analyse data on health and health-related perceptions, attitudes andbehaviour patterns of school children in years 5, 7 and 9. The aim of the HBSC Study is to investigate the underlying personal and social conditions which influence health and healthy development positively or negatively in addition to health-relevant modes of behaviour in order to identify levers for prevention and health promotion. Out of the Baltic Sea countries, in addition to Germany, Denmark, Estonia, Finland, Iceland, Lithuania, Norway, Poland, Sweden and the Russian Federation are taking part. The most recent wave of data collection took place in 2013/2014.Point 52Create incentives to improve the conditions in nursing and healthcare professions and to strengthen initialand continued training measures for health specialists to resolutely support the development of a cost-effi-cient healthcare system in the region and to promote the realisation that the healthcare system is a cross-cut-ting issue.There is no information we can provide on this recommendation of the resolution in terms of planned, initiated or im-plemented measures and actions. In terms of relevant measures not directly related to the resolution but of general overarching significance to sub-sections of this recommendation, the following contributions are to be noted:Training and skills offensive in geriatric careEnsuring qualified staff in the field of care for the elderly: the Federal Government, Länder and associations signed thejoint agreement in December 2012. The comprehensive measures agreed on to promote initial, continued and furthervocational training and to increase the appeal of this professional area and employment setting are to be implemented by the end of 2015 during the term of the agreement. One key target agreed on in this joint initiative with its three-year term lasting until the end of 2015 is the gradual increase in entries into vocational training to qualify as a geriatric nurse of 10 % each year. In addition to this, retraining courses to become a geriatric nurse started between 01.04.2013 and 31.03.2016 can receive three years of funding by the employment agencies or job centres and as such be fully funded.Germany P age 27These three years of full funding for professional retraining in the field of geriatric care started in the period from 1 April2013 to 31 March 2016 is now to be extended to 31 December 2017 up until the expected start of the new vocational nursing degree (Section 131b sentence 1 German Social Code, Book 3 - SGB III). Since entering into force in March 2013, this provision has made an important contribution to securing skilled staff in the field of geriatric care. This is reflected in particular in the considerable increase in the number of geriatric care retraining courses funded by the Federal Employment Agency on the basis of the special provision since its entry into force. This means that up until the planned entry into force of the Care Professions Act (Pflegeberufsgesetz) further entries into geriatric care retraining programmes are ensured with a high level of funding, making an important contribution to securing qualified staff in the field of care of the elderly. Regarding the planned increase in the number of people completing training, in the school year of 2013/2014 there was already an increase of 14.2 %. This meant that in the school year 2013/2014, at 26,740 entries nationwide more people than ever before chose to complete a vocational degree in geriatric care. No reliable figures are available for the school year 2014/2015 yet.Act Reforming the Care Professions ( Gesetz zur Reform der Pflegeberufe )The Act aims to further develop the care professions to prepare them for the future, to make them more attractive andto improve the quality of their content. Demographic and epidemiological developments and changes to the supply structures also change the requirements that care services and care professionals have to meet. This means that in the future it must be ensured that the training of care professionals imparts the skills required to care for people of all ages in all care settings reflecting the progress made in the field of care science and research. The three different voca-tional qualifications in “geriatric nursing” (Altenpflege ), “health nursing and nursing” (Gesundheits- und Krankenpflege )and “paediatric health nursing and nursing” (Gesundheits- und Kinderkrankenpflege ) are being reformed and mergedinto one uniform occupation. In the Vocational Training and Examinations Ordinance to be developed in parallel to the parliamentary procedure, it will have to be ensured that the high quality of the training is preserved and at the same time is developed into a generalist vocational degree.In addition to the specialist professional training in nursing care, for which broad access will be ensured (intermediateschool leaving certificate - mittlerer Schulabschluss – or a lower secondary school leaving certificate Hauptschulab-schluss with further skills or qualifications or ten years of general school education), a foundation will be created in fed-eral law for an initial university degree in nursing care qualifying the holder to enter the profession. The new degree will prepare the trainees for universal deployment in all the general fields of work in the care profession, facilitate moves between the different care areas and open up additional working and promotion opportunities. This will enhance the appeal of the nursing profession for all school leavers.This is particularly important in light of the shortage of skilled staff which already exists today. Ensuring there is apermanent and reliable pool of specialist staff is an important task, also in the context of reforming the training of care professionals. Providing cost-free training for the trainee nurses and an appropriate training bursary in the scope of the new funding provision boosts the attractiveness of the new nursing qualification further. This is an important signal in terms of enhancing the status of the nursing profession. The bill is currently undergoing parliamentary examination.HamburgHamburg P age 2Answers to the q uestions of the BSPC by the responsible ministries ofHamburgImplementation of the resolutions of the 24thBaltic Sea ParliamentaryConference1.)Recommendations with regards to the preamble and Cooperation in the Region•To ensure the decent treatment of the refugees especially concerning housing andhealthcare (preamble of the resolution)The housing and healthcare of refugees in Hamburg complies with the legal requirements ofthe EU to the full extent ,in particular with directive 2013/33/EU (laying down standards for thereception of applicants for international protection), and the requirements of the FederalRepublic of Germany. In this respect it must be taken into account that the Federal Republic ofGermany in general and Hamburg in particular faced massive challenge due to the very high number of refugees entering in 2015. This applies to a special degree to Hamburg as an attractive metropolis insofar as more than 61,000 protection seekers asking for initial receptionhad to be accommodated here, whereas “only” about 22,000 asylum seekers were allocated to Hamburg due to the nationwide distribution key based on the asylum law. Occasionallymore than 600 newly -arriving protection seekers had to be accommodated per diem.Nevertheless homelessness could be averted.Also healthcare is exemplary compared to European or national standard, which means localmedical care at the different initial reception facilities as well as access to thegeneral medicalcare system provided by means of the health insurance card.Currently in Hamburg there are two different forms of refugee housing. In the first step refugees are accommodated in one of the 39 C entral Initial Reception Facilities ( ZentraleErstaufnahme–ZEA) (as at March 2016). These institutions are provided for people affected by mandatory residence according to the asylum law. Housing preferentially takes place incontainers or wooden houses, in individual cases in tents or industrial buildings. Besides accommodation in these institutions, in which each person has about 6m2 at one’s deposal ,refugees are entitled to benefits in kind, medical care, food and clothing. Furthermore basic care in the Central Initial Reception Facilities includes imparting language skills as well as virtues and rules of our society. Families are offered childcare.On arrival at the Central Initial Reception Facilities a routine health check is held according§62 Asylum Law ( Asylgesetz –AsylG ) to detect contagious diseases. During this health checkexisting vaccination gaps are detected and blood samples are taken to diagnose contagiousdiseases. Vaccination is offered to close eventually existing vaccination gaps. Additionallyallergies, pregnancies and (chronic) diseases amongst others are recorded.Moreover the refugees have access to the regular ly held consultation hours of the generalpractitioners and the paediatricians in the institution. If necessary they can also consult aspecialist or go to a hospital. This comprehensive care is organised and provided by means ofan agreement with a health insurance. The refugees get a status similar to that of a regularmember of the health insurance and basically can make use of the same services the regular member receives. The insurance bills the appropriate social insurance carrier for all medicalcosts. This system has been well accepted and has proved itself to be very efficient concerning the comprehensive health care for the increasing number of refugees over therecent years.Hamburg P age 3The residents’ mandatory residence duty generally e nds after six months. Housing withoutmandatory residence duty is available in 104 public accommodation facilities all over Hamburg(as at March 2016). These accommodation facilities feature increased quality. The objective isto give people with the prospect of permanent residence the possibility to orientate in the city of arrival, until they find a flat and an employment. The residents receive mainly cash benefitsand prepare their own food, for example in shared kitchens. They have a right to receiveeducation and schooling in regular schools and day -care centres as well as integration andlanguage courses. Moreover they have a right to receive social benefits.Both forms of housing permit physical integrity according to article 2(2) GG (German BasicLaw), as homelessness is avoided and basic needs are covered. By basic health -care andsupply with the electronic health insurance card access to the health system is assured.Opening an Arrival Centre for refugees as an only Central Initial Reception Facility is planned(expected in May 2016). It will become the central place in Hamburg for registration,accommodation and distribution of the refugees. Centralisation in the Arrival Centre isintended to accelerate decisions on applications and distribut ion. People who remain inHamburg subsequently undergo basic health-c are, receive an appointment with the FederalAgency of Migration and Refugees (Bundesamt für Arbeit, Migration und Flüchtlinge) to file anapplication for asylum, and registration and processing for social benefits (see parliamentarypaper 21/2148).•To co -operate in order to strengthen the Baltic Sea Region as an important competitiveknowledge region with an excellent higher education and research infrastructure (paragraph 4 of the reso lution)With regard to science and university co- operation the Baltic Sea Region forms not only animportant economic area but also one of the most competitive and innovative economic areas in the world with a premium university and research structure. This is why the Baltic Sea Reason is of utmost importance for Hamburg as a centre for science and research. The Senate already took account to this fact and enacted a “Baltic Sea Strategy for Hamburg as aCentre for Science and Research” (parliamentary paper 20/10410) on 7thJanuary 2014, thatalready focuses geographically on the Baltic Sea Region.The Senate explicitly appreciates an intensive cooperation in science and scientific policy within the Baltic Sea Region and therefore has initiated and performed various measures on alocal and international level: To promote the network between the Hamburg universities and scientific institutions and their counterparts in the Baltic Sea Region, the Hamburg Senate hasestablished a “seed money facility” within the framework of the Hamburg Research Funding(Landesforschungsförderung), with which the initiation of that kind of partnerships is financially supported. In three funding rounds in 2014 and 2015, 28 projects with a total subsidy amountof 353,193 € have been granted.Whereas there is a high quantity of networks on many other policy fields, such a structure isstill missing in the field of scientific policy. Currently scientific policy in the Baltic Sea Region ispurposed separately on local, national or European level. A macro- regional dimension is stillmissing. To close this gap, the Hamburg Senate has started an initiative to create a newnetwork structure for scientific policy / research management in the Baltic Sea Region, underthe working tit le“Baltic Science Network”. This is because it sees great potential in a closercooperation within the field of university, research and scientific policy in the Baltic Sea Region. The first international partner meeting of the “Baltic Sea Network” took place on 7th/8thApril 2016 in Hamburg. To finance the network, Hamburg has managed to raise funds ofHamburg P age 4about 3 million € from the EU support programme INTERREG Vb Baltic Sea Region. The hereestablished consortium consists of partners from twenty organisations relevant on the field ofscientific policy from all nine Baltic Sea countries, primarily from the appropriate national orregional Ministries of Science, Research Councils, University Networks, as well as the Council of the Baltic Sea States.•To con tinue work to upgrade reception facilities for sewage in passenger ports toensure a timely activation of the special area status of the Baltic Sea under MarpolAnnex IV of the International Maritime Organization, with the aim to hinder the releaseof untr eated sewage from passenger ships in the future and to reaffirm the commitmentfor the throughout improvement and modernization of the waste water treatment capacity throughout the entire Baltic Sea Region, in compliance with the stricter threshold values agreed by HELCOM (para. 8)Hamburg appreciates the continuation of the work to upgrade reception facilities for sewagefrom passenger ships. Though the Hamburg Port is not directly affected by the commitment for the special area of the Baltic Sea, Hamburg observes the development with great interest.Feasible solutions for suitable reception facilities in the Hamburg Port could make importantcontributions to protect the Elbe River and the North Sea –in view of an increasing number ofpassengers and cruise ships entering the port.2.)Recommendations with regard to cross -border cooperation in healthcare•To improve transnational cooperation and medical specialization in the treatment of rare diseases, bearing in mind the cost -effective usage of medical equipment (para. 20)Hamburg supports the National Action League for People with Rare Diseases (NationalesAktionsbündnis für Menschen mit Seltenen Erkrankungen– NAMSE) by supporting singularorganisations of the ACHSE e.V. (Allianz Chronischer Seltener Er krankungen–Alliance forChronic Rare Diseases), an umbrella association of self -help organisations in the field of RareDiseases. Meanwhile the action league consists of 28 partners (head organisations andumbrella associations of the fundamental players in the public health sector). The National Action League for People with Rare Diseases has developed a total of 52 suggested common measures to improve the health situation of people with rare diseases and compiled a National Plan of Action for People with Rare Diseases in 2013.In 2013 the Martin Zeitz Centre for Rare Diseases (Martin Zeitz Centrum für SelteneErkrankungen– MZCSE) was established in Hamburg. In this centre specialist sfrom severalhospitals and institutes of the University Medical Centre Hamburg Eppendorf (UKE) work together on an interdisciplinary level. Hereditary metabolic diseases as well as hepatic and renal diseases are counted among the main emphases of the treatment. The centre’s aimsare manifold: cause and treatment options of rare diseases are to be found, diagnostics,therapy and care for affected patients to be improved. Also medical training and qualification concerning rare diseases play an important role.•To regulate transnational emergency care in a way that the fastest possible healthcare provision can be guaranteed regardless of the healthcare providers’ country of origin (para. 21)The emergency care structures of the state of Hamburg already correlate with theserecommendations. Due to recurring national and international emergency evacuations (e.g.MED -EVAC) to the national Bernhard Nocht Institute for Tropical Medicine as well as theHamburg P age 5Military Hospital the appropriate authorities in Hamburg have enough routine in handling thiskind of cases. On the part of Hamburg there are corresponding agreements and arrangementswith the neighbouring German Federal States. In this context also the preventive structures in maritime emergency prevention, danger defence, salvage and lifesaving, the FederalGovernment and the five North German Federal States, including Hamburg, established intheir agreement about the formation of a command for maritime emergencies to improve thecommon emergency management in the North and the Baltic Sea on 14thMay 2002 come intoeffect. Currently there is no need for further measures for transnational emergency care.•To reduce the usage of antibiotics – general –and for agriculture (livestock farming) toan absolute minimum in order to prevent fur ther increase of antimicrobial resistance(para. 22)Hamburg supports the realisation of the “German Antimicrobial Resistance Strategy 2020”(Deutsche Antibiotika- Resistenz -Strategie 2020– DART 2020)In its Hamburg Decree on Hygiene and Infection Prevention in Medical Institutions(Hamburgische Verordnung über die Hygiene und Infektionsprävention in medizinischenEinrichtungen–HmbMEdHygVO) Hamburg obliged the hospitals to produce an annual reporton the realisation of these measures. These reports are produced by close cooperation with the Hamburg Hospital Society (Hamburgische Krankenhausgesellschaft –HKG). The reportsare published and generally accessible. Besides the parameters “surveillance of nosocomial infections” and “special resistant and multi resistant agents” as well as “information aboutresources of expert staff for hygiene and hygiene training” , also nature and extent ofantimicrobial consumption are presented. To improve the present situation, the consolidationof the existing regional networks is indispensable.The trans -sectoral network with a consequent and coordinated MRSA/MRE management ofall players in the supply chain is also a key aspect in Hamburg health policy, in the overallcontext of development of antimicrobial resistance de velopment. The Public Health Service(Öffentlicher Gesundheitsdienst –ÖGD) coordinates and chairs the network. Hamburghospitals, nursing facilities, ambulance services and practitioners in cooperation with the Hamburg Association of Statutory Health Insurance Physicians are incorporated in thisnetwork.3.)Recommendations with regard to Health & Economy•To improve conditions to support the development of innovations in health care,including in the fields of eHealth and telemedicine, whilst ensuring that investments ineHealth support the adoption of standards and drive interoperability across the health sector to leverage the “eHealth European Interoperability Framework” (eEIF) and observe the joint European Initiatives, such as the “Guidelines under eHea lth Network”of the responsible member state authorities (para. 31)We share the general aim expressed in resolution para. 31. The objective suits the intentionsof the Hamburg Authority for Health and Consumer Protection (Hamburger Behörde für Gesundheit und Verbraucherschutz) and those of eHealth, which has been enacted at federallevel.•To improve early interventions to strengthen good public health through social investment such as vaccine programs, and take strong measures to reduceconsumption of alcohol, tobacco and illicit drugs, and work towards strongerprevention of diabetes II and other lifestyle illnesses (para.34)Hamburg P age 6Infection protection is one of the urgent tasks of the Hamburg Public Health Service(Öffentlicher Gesundheitsdienst –ÖGD). The ÖGD implements the Infection Protection Act(Infektionsschutzgesetz –IfSG) in Hamburg and manages disease onsets to avoid the spreadof contagious diseases. With respect to the prevention of contagious diseases the ÖGD in Hamburg has a high- performance package of measures available, including for examplevaccination consultation, vaccination offers and information campaigns. In 2015 the city of Hamburg accomplished a campaign against measles. During this campaign especially young adults but also health care employees were advised of the importance of the vaccinationagainst measles .Hamburg explicitly supports the objective to reduce alcohol and tobacco intake. For example Hamburg makes plans to participate in an EU project on prevention and treatment of alc oholintake and alcohol caused diseases. Also the city of Warsaw plans its participation. We support an active exchange of experience with all the Baltic Sea Nations on this subject.4.)Recommendations with regard to Sustainable and Accessible Social -andHealthcare•To develop and strengthen strategies addressing demographic change, such as theEuropean Innovation Partnership on Active and Healthy Aging and especially considering public services with regard to rural peripheral areas (para. 43)In 2014 the Senate of the Free and Hanseatic City of Hamburg adopted a comprehensivestrategy on the demographic change, called “Hamburg 2030: More. Older. More diverse.” All departments are involved in the advancement and implementation of the strategy. It is targete d on accomplishing good long- term living conditions for all generations in Hamburg.Because as the number of elderly and very old people in Hamburg steadily increases, the city has to deal with the future effects of the demographic change –no matter Hamburg is agenerally growing city or not. The demographic change strategy focuses on the opportunities for a longer and– in most cases –healthier life, without ignoring the challenges associated withit. It is mainly about families with children, students, seniors, education, the job market, urbandevelopment, housing, health and long- term care, integration and inclusion, public transportand mobility. In 2016 this strategy continues to be discussed and developed. The main focuswill be on the question how different quarters can become prepared for the demographic change. As a result the common population is intended to be involved in the discussion,mainly in an internet based dialogue. Furthermore Hamburg is a member of the actioncommittee D4 “Innovation for Age- friendly Buildings, Cities & Environments” of the EuropeanInnovation Partnership Active and Healthy Ageing.•To carry out studies with the aim of developing prevention strategies in health care,such as the North -Trøndelag Health Study (HUNT) (para.49)In May 2015 the University Medical Centre Eppendorf (UKE) started a similar study called “Hamburg City Health Study”. This long- term study examines the health of 45,000 people inHamburg.•To create incentives to improve the conditions of the nursing and care professions andto work towards intensified professional and vocational training for people employed inthe health sector to significantly facilitate a cost -effective health system in the regionand foster understanding of the health sector as a cross- cutting issue (para. 52)Over the past years Hamburg has already accomplished several measures to improve theeducation and training of specialised medical staff and to provide incentives for thisHamburg P age 7professional field. So for example a dual course in medical and healthcare was created, whichprovides the graduates with a training qualification as well as a university degree. Additionallya generalised professional training for nursing staff is tested in a pilot project. Hereby Hamburg prepares the ground for the consolidation of the different training courses for nursing staff currently planned at federal level, which intends an integrated understanding of the healthsector. The modular further education in intensive care eventually provides the opportunity tofreely combine andchose and to flexibly modify the modules according to the interests anddemands of the participants and the employers.LatviaLatvia P age 21No. 21/215 Riga, April 6 , 2016Mr Jānis VucānsPresident of the Baltic AssemblyMr Helir -Valdor SeederVice -President of the Baltic AssemblyMs Giedrė PurvaneckienėVice -President of the Baltic AssemblySecretariat of the Baltic AssemblyCitadeles Street 2- 616Riga, LV- 1010Dear Colleagues,It is my honour to reply to your letter No. 1/0216 -52 of February 9, 2016 concerning yourquestions on the implementation of the 24th Baltic Sea Parliamentary Conference Resolution.Please find attached the answers to your questions, submitted by the respective line ministriesof the Republic of Latvia.Enclosed: Annex on 13 pages.Yours sincerely,Minister of Foreign Affairs Edgars RinkēvičsLatvia P age 32Answers to the Question s of the Baltic Assemblyby the responsible ministries of the Republic of Latvia- Recommendation with regard to the preamble and Cooperation in the Region : toensure the decent treatment of the refugees especially concerning housing andhealthcare(Answer prepared by the Ministry of Interior)To address the issues related to migration crisis in Eu rope, o n 2 December 2015 theCabinet of Ministers of the Republic of Latvia adopted The Action P lan on Relocation,Resettlement and Reception in Latvia of Persons Who Are in Need of I nternationalProtection (hereinafter – Action P lan). The Action Plan contains 48 measures, whichare div ided into the following Action L ines: 1. Selection and relo cation/resettlement ofpersons; 2. Reception and accommodation; 3. Socioeconomic inclusion . There areministries, municipalities, Latvian Association of Local Regional Governments andNGOs involved in the implementation of the Action P lan. Regarding decisions andconclusions of the Council of t he European Union and Member States of the EU1 Latviahas made a political decision to relocate and resettle 776 asylum seekers in total fromthird countries and EU Member States. Curre ntly, the adopted decisions provide for areception of 531 asylum seeker s from whom 50 persons will be received from the thi rdcountries ( more likely Turkey), 295 from Greece, but 186 from Italy within the next twoyears.Part of activities of the Action P lan (No. 2.2., 2.3., 2.4.) foresees adapting the premisesat the Asylum Seekers Reception Centre in Mucenieki (hereinafter – Centre ) for theaccommodat ion of larger number of asylum seekers and detained foreigners. Atpresent, the preparatory work has been undertaken for renovation of premises of theCentre and repair of three buildings and the boiler house. In one of the buildings thereis a plan to provide a space for recreation and social events for local inhabitants , as wellas for so cioeconomic inclusion of asylum seekers.Two other activities of the Action P lan (No. 2.6., 2.7 .) provide for personal health checkof asylum seekers and, if necessary, the establishment of quarantine zones , as well theprovision of emergency me dical assistance and primary, secondary and outpatient healthcare.The asylum seeker may stay in the Centre until the final decision of internationalprotection sta tus. During thi s time period the person is provided with the followingservices: initial mandatory health inspection and necessary health care in case of illness; livelihood - 2.15 euros per day; Latvian language courses (120 hours), where person c an learn the basics of thelanguage and basic phrases used in everyday communication; integration courses (40 hours), where person c an learn the most importantinformation about Latvia, including practical knowledge for living in Latvia; introductory course of labour market "Job Opportunities in Latvia.”Shortly after arrival of the asylum seeker a support plan is drawn up for person’sadaptation and social inclusion. According to the Action P lan, the person is providedwith the contact person (mentor) for various issues (up to 15 months). Responsibility ofthe contact person is to help the asylum seeker to communicate with different1 Conclusions of 20 July 2015 of the Representatives of the Governments of the Member States meeting within theCouncil on resettling through multilateral and national schemes 20 000 persons in clear need of internationalprotection; Council Decision (EU) 2015/1523 of 14 September 2015 establishing provisional measures in the areaof international protection for the benefit of Italy and of Greece ( OJ L 239, 15.9.2015, p. 146 ); Council Decision(EU) 2015/1601 of 22 September 2015 establishing provisional measures in the area of international protection forthe benefit of Italy and Greece (OJ L 248, 24.9.2015, p. 80 –94).Latvia P age 43institutions for solving social and other iss ues. If necessary, the service of interpreter isprovided to help communicate in a language, whi ch asylum seeker understand s.After obtaining the status of international protection, the person should go to themunicipality where he or she has found a suitable housing. The p erson will be paid anallowance of 139 euros per month, which has to be used for food, housing and otherneeds. This amount of allowance (139 euros) is paid only to one member of the family;other family members will receive 97 euros each. The allowance shall be paid up to 12months for a person with refugee status (but only 9 month s for a person with alternativeprotection status).At the same time on 17 March 2016 the Parli ament of the Republic of Latvia passed thelaw "Amendments to the State Material Reserves Law" (entered into force on 5 April2016), providing the set ting of material reserves in case of mass arrival of asylumseekers. The draft law was submitted for consideration to the Parliament o n 28 Janua ry2016 by the Cabinet of Ministers.- Recommendation with regard to the preamble and Cooperation in the Region : toco-operate in order to strengthen the Baltic Sea Region as an important competitiveknowledge region with an excellent higher education and research infrastructure(Answer prepared by the Ministry of Education and Science)I. The INTERREG project application for the project „Baltic Science Network(BSN)” has been approved on 22 /02/2016; the implementation of the project willstart 01/03/2016 and will end 28/02/2019.Main objectives of the project are:- to provide science and research ministries of the BSR states with an overall coordination framework to develop and implement science policy in a macroregional dimension and to ensure a better representation of macroregionalinterests at the EU level;- to develop and implement transnational strategies, incentives and programmesto support Higher Education, research and innovation infrastructures to becomebetter transnationally interconnected and to develop R&I excellence.Leading partner: Free and Hanseatic City of Hamburg, Ministry of Science, Researchand Equalities. The partnership consists of relevant national ministries/ governmentalagencies responsible for defining and implementing science policy from all 8 EUmember states in the BSR (DE, DK, SW, FI, EE, LV, LT, PL).UNIVERSITIES as full partners: University of Turku (UTU) and Baltic UniversityProgramme network of ca. 250 univ, represented by Abo Akademi (AAU).Associate organisations: BSRUN (Baltic Sea Region University Network of 27 univ.)and St. Petersburg State University of Economics, appoi nted by the RU ministry as theBSR centre for innovation issues.The COUNCIL OF THE BALTIC SEA STATES (CBSS) is a forum for regionalintergovernmental cooperation of 11 states of BSR (incl. IC, NO, RU) and the EU.Information about the all approved projects within programme “Interreg Baltic SeaRegion” could be find at: http://www.interreg -baltic.eu/about- projects.htmlII. Project: “Seed Money project No S 58, Platform of Baltic infrastructure forResearch, Technology and Innovation”Purpose of the project is to make a feasibility study for a platform of communicationinvolving universities and scientific institutions in the Baltic Sea Region that will beLatvia P age 54specialized in certain areas of material sciences, providing effective use ofinfrastructure in cooperation with industry, improving global competitiveness of theBaltic Sea Region by fostering innovation.Leading partner: Baltic Institute for R esearch, Technology and Innovation(www.birti.eu )Project partners: Tallinn University of Technology, Kaunas University of TechnologyFraunhofer Institute for Material and Beam Technology DresdenDuration of the project: 14/12/2014- 13/12/2015Project closure phase: 14/12/2015- 13/01/2016 More information: http://www.birti.eu/en/- Recommendation with regard to Su stainable and Accessible Social andHealthcare : to develop and strengthen strategies addressing demographic change,such as the European Innovation Partnership on Active and Healthy Ageing andespecially considering public services with regard to rural peripheral areas(Answer prepared by the Ministry of Welfare)1. Active ageingCurrent demographic situation in Latvia indicates ageing and depopulation trends,especially among the working -age population. This emphasises the need to fully usethe existing labour force potential. In order to respond to ageing challenges the Ministryof Welfare of Latvia with the support of the European Uni on implemented an activeageing project with the objective to develop an ev idence -based and comprehensiveActive Ageing S trategy in Latvia that would facilitate longer and better working livetaking into account the consid erable demographic challenges t he country is currentlyfacing.Within this project the World Bank carried out a study “The Active Aging Challengefor Long er Working Lives in Latvia”2 and gave recommendations for the improvementsin active ageing situation. Taking into consideration results of the study and projectactivities, the main priorities of the Active Ageing Strategy are: employment,education, health and social protection. The target group of the strategy is older peopleaged 50+ (hereinafter – older people), especially before retirement age, who facesignificant barriers to enter the labour market.The increase of labour force participation of older adults has a significant potential toreduce the projected increase of age dependency. Therefore, given that better educated and healthy people want to stay longer in the labour market as they become older andare capable of working longer, the prim ary focus is on increasing of human capital inLatvia. However, a proper work environment, employability and social security also play an important role.Taking into consideration that older people have a relatively higher risk ofunemployment and this age group faces greater difficulties in returning to the labourmarket after losing a job, a significant focus within the Active Ageing Strategy is onpreventive measures, which would promote the competitiveness of this age group in thelabour market. To prevent premature withdrawal from the labour market and preserve capability for labour, it is planned to assess ability, skills and health of older adults and give recommendations that would help to prolong working live. This would help identify skill shortage, health problems or other obstacles that can lead to an increasedrisk of unemployment and eliminate them.As for improvement of the situation in the field of education, in order to achieve betterindicators of education and skills in the coming years, i t is essential to involve older2 World Bank Study “The Active Aging Challenge for Longer Working Lives in Latvia”http://www.lm.gov.lv/upload/aktualitates2/wb_lv_active_aging_report_0110151.pdfLatvia P age 65individuals in training activities, as well as provide with adequate opportunities foradult education, including Latvian language courses, defining them as a target groupwith a specific focus on the most vulnerable, low -educated individuals.Concerning health aspects, the objective of the Active A geing Strategy is to strengthenemployers’ and older workers’ understanding of the link between the work environmentand employees’ health and productivity. Despite the fact that Latvia’s legislationestablishes requirements for risk assessment as well as definition and implementationof adequate labour protection measures, there is much room for increasing the number of employers who comply with these requirements and do not fulfi l them only as aformal requirement without the objective to actually improve the work environment. Consequently, it is planned to provide support for improvement of the workenvironment, thus increasing employee s’ health and productivity.With regard to e xtending the working life, it is also taken into account that there arechallenges in terms of unemployment and especially long -term unemployment amongolder population groups. Thus, considerable attention is drawn not only towardsextending the working life, but also towards adequate support to participate in thelabour force. It is planned to activate the long -term unemployed by providingindividualized support. Widespread problems of long -term unemployment are due tolack of motivation to look for work, lack of knowledge and skills, inadequate state ofhealth f or the offered jobs, consequent need for a different kind of job, addictionproblems that need to be addressed, thus promoting the inclusion of the long -termunemployed into society and helping them to find regular work.Taking into account that negative perceptions and stereotypes exist with regard to olderpeople being less productive, it is necessary to combat such perceptions. Studies haveshown that decrease in productivity is linked to job qua lity and monotonous tasks, ratherthan age. Therefore, it is important to promote job quality and proper organization of work, including flexible work organization solutions, thus contributing to the capabilityfor labour and employability of older people, as well as promoting the overallproductivity of businesses. A v ital contribution might be both informative materials andeducational activities, as well as practical support for employers to assess the suitabilityof their labour organization to tap the potential of older workers, and providingrecommendations.Described activities within the Active Ageing S trategy are planned to be implementedwith the support of the ESF , including funding o f the ESF operational programme’s“Growth and Employment” specific obj ective 7.3.2. “To Prolong P reservation ofCapacity for Labour and E mployment of Elderly Employees”.2. Social servicesSocial care and social rehabilitation services are organized to reduce, eliminate orcompensate the consequences of functional limitation of a person. Person’s eligibilityfor social care or social rehabilitation services depends on presence and level of s pecificfunctional limitation rather than belonging to a specific social group.The Ministry of Welfare plans to continue a gradual transition of the provision of socialcare from institutions to community based social care services. It is intended that s ocialcare services for a person should be organized in accordance with the individual needs and necessary level of care.In the field of social care and social rehabilitation services, a municipal social serviceoffice within multidisciplinary team evalu ates the needs of a person and provides thenecessary services. Service providers in most cases are established by municipalities, but they can also be, for example, NGOs.Latvia P age 76- Recommendation with regard to the preamble and Cooperation in the Region: tocontinue work to upgrade reception facilities for sewage in passenger ports toensure a timely activation of the special area status of the Baltic Sea under MarpolAnnex IV of the International Maritime Organization, with the aim to hinder therelease o f untreated sewage from passenger ships in the future and to reaffirm thecommitment for the continued improvement and modernization of the waste watertreatment capacity throughout the entire Baltic Sea Region, in compliance with thestricter threshold values agreed by HELCOM(Answer prepared by the Ministry of Environmental Protection and RegionalDevelopment)The Baltic Sea Area was designated as Special Area under MARPOL Annex IV withmore stringent criteria for the discharge of sewa ge by passenger ships in 2011(Resolution MEPC.200(62)). At the IMO MEPC 68 all the Baltic Sea coastal countries, including Latv ia (but exceptRussia), submitted the joint notification as prepared and discussed within the HelsinkiCommission (HELCOM) confirming that adequ ate facilities for the reception ofsewage are provided in ports and terminals used by passenger ships in their res pectivecountries. Major Latvia’ s ports used by passenger ships have adequate facilities, andfurther improvements are planned (e.g., in Riga port).IMO MEPC 69 (18 -22 April 2016) will consider, with a view to adoption, the documen tsubmitted by all EU countries ( including Latvia) – proposed amendments to MARPOLAnnex IV to set effective dates for part of the Baltic Sea Special Area under MARPOLAnnex IV.Latvia supports the adoption of the amendments to MARPOL Annex IV, Regulations1 and 11 concerning the establishment of the effective dates to make most of the Baltic Sea area a Special Area regarding discharge of sewage from passenger ships as follows:- for new passenger ships - on 1 June 2019;- for existing passenger ships - on 1 June 2021.Ministry of Environmental Protection and Regional Development has regularlyinformed the Latvian Board of Ports, Tra nsit and Logistics on the ongoing work withinHELCOM towards implementation of more stringent requirements for the discharge ofsewage by passenger ships in the Baltic Sea Special Area as required by MARPOL andagreed by HELCOM Baltic Sea action Plan (2007).- Recommendations with regard to cross -border cooperation in healthcare : toimprove transnational cooperation and medical specialization in the treatment ofrare diseases, bearing in mind the cost -effective usage of medical equipment(Answer prepared by the Ministry of Health)There are currently no official designated centres of experti se for rare diseases in Latvia.A legal framework for centres of expertise, including those for rare diseases, is expectedto be established in the future. Currently the Latvian State University Children’sHospital provides genetic services: hospital specialists deal with children with haematological, oncological and endocronological diseases. The Riga East University Hospital has a specialised clinic (Chemotherapy and Haematology C linic) wherepatients with haemophilia A, haemophilia B, Factor XII deficiency and von Willebranddisease receive diagnostics and treatment (in this hospital rare oncological diseases canalso be treated, e.g. Burkitt’s lymphoma, Langerhans c ell histiocystosis, Mantle -cellNHL, multiple endocrinology neoplasia, Erwing’s sarcoma, Wilm’s tumour,Waldenström macroglobulinemia and othe rs). Pauls Stradins University H ospitalprovides services in areas of different rare diseases: cardiology, nephrology, vascularLatvia P age 87diseases (Arteriovenous vascular malformations, lymphatic disorders, aortic pathology,endarteritis, caroti d tumours, etc.), ophthalmology, oncology, gastroenterolo gy,endocrinology, pulmonology.The Centre for Disease Prevention and Control is the supervising authority and keeper of the Register of patients with particular diseases, including cancers, congenitalanomalies (some of these are rare diseases). The Centre started to use the Orpha codefor rare diseases in the Register of patients with congenital anomalies and cancers inSeptember 2014.Accor ding to Directive (2011/24) of P atients’ Rights in C ross-border H ealthcare, Latviahas a focal point for providing information on the Latvian health care services, as wellas health care services provided in other countries, including treatment of rare di seases.Latvian National Health Service performs functions of the contact point.- Recommendations with regard to cross -border cooperation in healthcare : toregulate transnational emergency care in a way that the fastest possible healthcareprovision can be guaranteed regardless of the healthcare providers ́ country oforigin(Answer prepared by the Ministry of Health)On 24 September 2010, th e Agreement between the Ministry of Health of the Republicof Latvia, the Ministry of Social Affairs of the Republic of Estonia and the Ministry ofInterior of the Republic of Estonia on Mutual Aid for providing Ambulance Services inBorder Area was signed.From 2011 to 2014 the State Emergency Medical Service of the Republic of Latvia hasrequested aid from Estonia 33 times, but Estonia has requested aid from Latvia 30 times. In 2015, the State Emergency Medical Service of the Republic of Latvia dispatched an ambulance crew to Estonia 10 times.There is ongoing work to sign a similar agreement with Lithuania.- Recommendations with regard to cross -border cooperation in healthcare: to reducethe usage of antibiotics – general – and for agriculture (livestock farming) to anabsolute minimum in order to prevent further increase of antimicrobial resistanceAnswer prepared by the Ministry of HealthThe use of antimicrobials in human medicine is relatively low in Latvia, especially in the sector of primary care and in comparison with other European countries. Theconsumption was 12,6 DID (DDD per 1000 inhabitants and per day in 2014) in thecommunity (primary care sector) and 2,3 DID i n the hospital sector. In 2015 ClinicalGuidelines for A ntimicrobi al Use for Children were devel oped by the National HealthService together with experts and opinion leaders. There are changes within thereimbursement system for some antimicrobials, as well. In 2013 the Committee onContainment of Antimicrobial Resistance was created and a national action plan isunder development.There is a new regulation in place with request for hospitals to develop antimicrobial stewardship programmes in order to promote prudent use of antimicrobials and strengthen infection control practices (Republic of Latvia Cabinet Regulation No 104Adopted 16.02.2016). This regulation also includes specific standards for infectioncontrol and surveillance with main emphasis on control of multidrug resistantpathogens.Standing population of livestock animals is relatively small in Latvia. Therefore total consumption of antimicrobials in veterinary sector is relatively low (167 PCU (Population correction unit) per 1000). Nevertheless the Ministry of Agriculture isLatvia P age 98workin g on a strategy to promote prudent use of antimicrobials and to controlantimicrobial resistance in livestock farming.Answer prepared by the Ministry of AgricultureThe Ministry of Agriculture supports the recommendation of the Members of the BalticSea Parliamentary Conference stipulated in the paragraph 23 of the ConferenceResolution. Antimicrobial resistance is a very topical issue in the scale of the EU andgloba lly, and currently there are numerous documents being prepared on the EU level(both legislation and recommendations, as well as guidelines) to reduce the use ofantimicrobial agents, thus limiting the development of antimicrobial resistance.1. Herein the Ministry of Agriculture proposes:1.1. to avoid of using the word “absolute” in the paragraph 23 “to reduce the usage ofantibiotics – general – and for agriculture (livestock farming) to an absolute minimumin order to prevent further increa se of antimicrobial resistance’’ as it cou ld be verybroadly interpreted.All EU and international documents include specific recommendations andrequirements to reduce the use of antimicrobial agents for livestock to a minimum ofnecessary quantity (and t herefore - to a minimum). The use of antimicrobials foranimals in the justified cases is a necessity, because it helps to save the lives of animals and is needed for the treatment of the disease and prevention of its further spreading.In the 15th November 2012 European Parliament ’s Report o n the Rising Threat fromAntimicrobial Resistance , Article 11, the term “minimal use” is used, while Article 13of the Conclusions sets that “the use of antimicrobials to the minimum necessary”.(REPORT 15 November 201 2 on the Microbial Challenge – Rising threats fromAntimicrobial Resistance (2012/2041(INI)) http://www.europarl.europa.eu/sides/getDoc.d o?pubRef=- //EP//TEXT+REPORT+A7 -2012-0373+0+DOC+XML+V0//EN- Recommendations with regard to Health & Economy: to improve conditions tosupport the development of innovations in health care, including in the fields ofeHealth and telemedicine, whilst ensuring that investments in eHealth support theadoption of standards and drive interoperability across the health sector to leveragethe “eHealth European Interoperability Framework” (eEIF) and observe the jointEuropean initiatives, such as the “Guidelines under eHealth Network” of therespo nsible member state authorities(Answer prepared by the Ministry of Health )To strengthen the network capacities through science and development of innovationsand research in the area of health care, the Ministry of Health collaborates with theMinistry of Education and Science to provide representation and joining of Latvian scientific institutions in European Strategy Forum on Research Infrastructures (ESFRI)and participation in European Research Infrastru cture Consortium (ERIC) in 2016 and2017:• BBMRI ERIC (Biobanking and Biomolecular Resources Research Infrastructure)(participating research institutions subordi nated to the Ministry of Health : PaulsStradins Clinical University Hospital and Riga Eastern Clinical University Hospital);• INSTRUCT ( Integrated Structural Biology Infrastructure for Europe)(participating research institutions subordinated to the Ministry of Health: Riga Stradins University);Latvia P age 109• EATRIS ERIC (European Advanced Transnational Research Infra structure inMedicine): (participating research institutions subordinated to the Ministry ofHealth: Riga Stradins University and Pauls Stradins Clinical University Hospital).In the future a possibility of joining the ECRIN ERIC (European Clinical Researc hInfrastructure Network) will be examin ed.To facilitate the efficiency and quality of the treatment process, as well as rationalmanagement and supervision of the health sector, the National Health Service continues the implementation of a unified elect ronic health information system ( e-HealthInformation S ystem). The patient data process ed in the e-Health System is regulated bythe Cabinet of Ministers Regulations No. 134 "Regulations on the Single ElectronicHealth I nforma tion System" (11.03.2014). The e-Health S ystem will contain thefollowing patient health data: patient summary, e -health prescription, e -sick-leave, e -referral, e -epicrisis, etc. In accordance with the Regulations No. 134 , medicalinstitutions and pharmaci es have to conclude a contract with the National HealthService for the use of e-Health System by 1 November 2016. No later than 1 December2016 medical instit utions will be required to use two e-Health S ystem functionalities –e-sick leave and e -prescript ion, however pharmacies will be obliged to process the e -prescription data. The m edical institutions will be obliged to use the rest of thefunctionalities of e-He alth S ystem no later than 1 July 2017.Both patients summary, as well as e-prescription is established in accordance with theguidelines adopted by the eHealth Network . The implementation of cross -border patientdata exchange among other Member States depends on the available funding.- Recommendations with regard to Health & Economy: to improve early interventionto strengthen good public health through social investment such as vaccineprograms, and take strong measures to reduce consumption of alcohol, tobacco andillicit drugs, and work towards stronger prevention of diabetes II and ot her lifestyleillnesses(Answer prepared by the Ministry of Health )Non-communicable diseases (NCDs) are the main cause of mortality in Europe and inthe Baltic region, as well. Sedentary lifestyle, unbalanced diet, smoking and other lifestyle risk fact ors have led to rising levels of overweight, obesity, diabetes,cardiovascular diseases etc. The main health policy planning document in Latvia is the Public Health Strategy for 2014 -20203 and it aims to prolong healthy life years of theLatvian population and to prevent untimely deaths, while maintaining, improving andrestoring health. One of the objectives is to prevent premature death from NCDs. The Strategy includes a number of activities focusing on health promotion and disease prevention, such as healthy nutrition, physical activity, reducing usage of addictive substances in the community, mental health, sexual and reproductive health issues.Special attention is paid to high risk population groups (socioeconomic and geographical exclusion) in order t o ensure equal access to healthcare services for allcitizens of Latvia. One of the basic principles of public health policy included in thestrategy is “health in all policies ”.In addition, the Minister for Health Dr. G. Belēvičs has set healthy nutrit ion, sufficientphysical activity, addiction free lifestyle and prophylactic health check -up promotionas four priority areas for long term program “Be Healthy!” for improvement of publichealth in Latvia.3 Other documents: Public Health Strategy 2011 -2017.; Cabinet of Ministers Regulation No. 504 of 5October 2011.Latvia P age 1110Under the Public Health Strategy for 2014 -2020 an d long term program “Be Healthy!”the Ministry of Health has planned a range of activities for promoting healthy andactive lifestyle , including public campaigns, educational lectures for various specifictarget groups, activities at kindergartens and schools, workplaces, for low incomefamilies, for people living in care homes and special institutions and for other targetgroups. For implementation of these activities substantial financial resources areallocated, including from EU funds.In order to reduc e the spread of NCDs in Latvia, educational health promotion activitiesaimed at various age groups have been implemented over a period of several yearsfocusing on the health benefits of physical activity and nutrition, the importance of hygiene and the h ealth consequences of substance abuse, child safety and reducing childtraumatism (aimed at new parents), as well as the importance of breast -feeding etc.Each year since 2012, the Ministry of Health chooses a public health issue to focus on throughout tha t year by implementing various comprehensive measures, includingactivities aimed at improving public health and raising awareness (e.g. Family health, Maternal and child health, Oncologic diseases).Some examples of the legislative initiatives and promoti on activities in the area ofNCDs reduction in Latvia:• Since 2006 Latvia has banned drinks, sweets and salty snacks in schools andkindergartens in order to restrict selling and marketing of food products that aretoo salty, sweet and contain certain food additives. This regulation applies also to vending machines and school cafeterias. This regulation coupled with excise taxled to significant reduction (double reduction) of soft drink consumption among11, 13 and 15 year old children (HBSC survey).• Since 2012 in order to promote availability of healthy and nutritious food tochildren in school environment dietary standards for kindergarten and schoolmeals have been set. In the end of 2015 the Latvian government approvedamendments to the dietary standards for improving the quality of schools meals by defining that meals must be freshly prepared from natural food productswithout flavourings (except natural flavourings) and vanil lin and without certainfood additives. Quality requirements have been set for some food products that could be included in school lunch meals (e.g., meat products, confectionery,mayonnaise and ketchup). At the same time these amendments change theapproa ch by defining the list of food products that are allowed to bedistributed in schools (including school cafes, snack and beverage vendingmachines) in addition to school lunch, to make healthy choice an easy choice.Such products are, for example, fresh and dried fruits, berries and vegetables,water and natural juices, bread, butter, jam, fruit and berry sauce and puree etc.and quality requirements are set also for these products.• In Latvia state funded meals are provided for the 1 -4th graders and it is plannedto provide state funded meals for 5th and 6th grade pupils, as well. There are anumber of municipalities that provide meals as well for other grade students freeof charge.• Support programs are available in Latvia - from 2004 the EuropeanCommission (EC) support program “ School Milk ” for supplying certain milkproducts to children in kindergartens and for pupils from 1st – 9th grades has beenintroduced and from 2010/2011 EC support program “School Fruit Scheme ” forsupplying fruit and vegetables to 1st – 9th grade pupils has been implemented.According to the latest data (about 2014/2015 school year) 71,1% schools andkindergartens in Latvia are participating in the program “School Milk” and 96,2%schools in Latvia are participating in the program “School Fruit Scheme”.Latvia P age 1211• Latvia made legislative efforts in 2012 to limit the access to food products withhigh amounts of trans -fatty acids in schools, kindergartens, healthcare andsocial care insti tutions .• Currently Latvia is moving forward and has drafted the regulation on maximumamount of trans -fatty acids in food (should not exceed 2% of total fat in foodproduct). This draft has been conceptually supported by the Cabinet of Ministersof Latvia on 25 August, 2015 and has been sent to the EC for notification. It isplanned that this normative act will be adopted by the government in 2016.• The law for energy drinks was approved by the Parliament in January 2016 andit shall enter into force on Ju ne 1, 2016. It includes not only the definition andselling restriction for energy drinks to children, but also restriction of advertisingand marketing of energy drinks to persons under 18 years of age.• As regards the measures aimed to reduce alcohol consumption, currently theMinistry of Health is working on additional marketing restrictions for sales outlets, to limit the advertising of alcoholic beverages stock. The Ministry alsoworks on the draft legal act to introduce additional restrictions on alcoholbeverages advertising on TV and radio during the daylight hours. Currently a newaction plan is under preparation - Action Plan for Reduction of Consumption ofAlcoholic Beverages and Limitation of Alcoholism , since the previous action planexpired in 2014 and has been evaluated in 2015. In 2015 a social campaign wasorganized to raise awareness on negative consequences from harmful use ofalcohol. During the campaign control purchases were done and traders were asked to join the social movement aga inst alcohol sales for underage persons.Discussions for parents on how to talk with their children about alcohol use were also organized. Since 2013 in the legislation a prohibition to sell alcoholicbeverages on distance sales has been introduced and per sons aged 18 to 25 areobligated to show a personal identification document when purchasing alcoholic beverages. Since 2014 a prohibition of outdoor advertising of alcoholic beveragesis in force.• Tobacco products. In order to ensure person’s rights to he alth in terms of beingprotected from second -hand smoking, in 2014 a new principle in Latvianlegislation was introduced - non-smoker’s rights to a smoke -free area are abovesmoker's rights to smoke. In addition to existing measures, in 2014 a newlegislat ion was introduced that smoking is prohibited in the presence of a childand according to the Protection of the Rights of the Child Law smoking nearby achild is now defined as physical violence. Since 2014 the law also states that smoking in any public pl aces in the presence of people who oppose smoking, isprohibited. Since 2014 the use of electronic smoking devices are subject to thesame smoking restrictions as tobacco products. In 2014 a social campaign wasorganized to raise awareness among youth on the harm of smoking and in 2014/2015 another social campaign was organized to raise awareness on negativeconsequences from second -hand tobacco smoke. Currently the Ministry of Healthis intensively working on the EU legislation – The Tobacco Products Direc tive2014/40/EU and its related legal acts – transposition into national legislation.• Narcotic and psychotropic substances, new psychoactive substances. Since2013 new psychoactive substances are put under control by generic approach,which means that clusters of psychotropic drugs which evolve from the samebasic chemical formula are banned in advance. The term "new psychoactivesubstance" and the system for putting these substances under so -called temporaryban also were introduced in the law in 2013. Since 2014 t he offences of temporaryban are also a subject of criminal sanctions. All together these actions havecurrently reduced the trade of new substances in the country. In 2014 the socialLatvia P age 1312campaign was launched with the main aim to engage youth in physical activity inorder to promote meaningful spare time activities as an alternative to the risingrate of abuse/consumption of new psychoactive substances. In 2014 a project in schools (6th and 7th grade) was organized to raise awareness among youth o n newpsychoactive substances and harm from using them, as well.• In order to strengthen good public health through a vaccine programme, Latviahas indicated infectious diseases, against which mandatory vaccination shall beperformed and financed fro m the State basic budget (however, a person mayrefuse the vaccination). Latvia's vaccination calendar is one of the widest in theEU. Vaccination is mandatory for:1. children – against tuberculosis, diphtheria, tetanus, pertussis,poliomyelitis, measles, rubella, epidemic parotitis, haemophilusinfluenzae type B infection, hepatitis B, chickenpox (v accination againstchickenpox for children aged 7 years (2nd dose) starts from 1 January2017), pneumococcal disease, rotavirus infections;2. adults – against diphtheria, tetanus;3. children and adults – against rabies after contact with animals or humanswho are ill or are suspected of being ill with rabies;4. 12-year-old girls – against human papillomavirus infection;5. patients treated with haemodialysis – against hepatitis B.Against tick-borne encephalitis vaccination is provided for children aged 1 to 18 intick-borne encephalitis endemic areas, if a child's declared place of living is in the tick -borne encephalitis endemic area, and for orphans and ch ildren left without parental care.For preventing occupational infections , vaccination of employees shall be mandatoryagainst the following infectious diseases: hepatitis B, rabies, tick -borne encephalitisand yellow fever. Employers and heads of educati onal institutions have a duty toprovide employees with vaccine free of charge in conformity with the risk of infection and, if necessary, to repeat vaccination.According to the Cabinet Regulation No. 899 “Procedures for the Reimbursement ofExpenditures for the Acquisition of Medicinal Products and Medicinal DevicesIntended for Out-patient Medical Treatment”, the need to immunize against influenzais reimbursed (from the State basic budget):50% of the cost covered for: persons over the age 65; adult p ersons who belong to the following health risk groups (persons withchronic pulmonary diseases; persons with chronic cardiovascular diseasesregardless of the cause; persons with chronic metabolic diseases; persons with chronic renal diseases; persons with immune deficiency; persons receivingimmunosuppressive therapy); pregnant women (in prescription s pecifying diagnosis code "Z33")100% of the cost covered for: children aged from 6 to 24 months; children aged from 24 months to 18 years who belong to the following healthrisk groups (children with chronic lung diseases; with chronic cardiovasculardiseases regardless of the cause; with chronic metabolic diseases; with chronicrenal diseases; with immune deficiency; who receive immunosuppressive therapy; who for a long time receive therapy with ac.acetylsalicylicum).- Recommendations with regard to Health & Economy: to check the possibility toestablish a “Baltic Health Forum”, to ensure and improve a sustainable exchangeand networking in this policy field around the Baltic Sea(Answer prepared by the Ministry of Health )Latvia P age 1413There is ongoing cooperation in the field of health across the Baltic Sea Region withinmultiple other formats. In order to evaluate the necessity to establish a new cooperationplatform, more detailed information about who will coordinate the exchange andnetworking is needed.- Recommendations with regard to Su stainable and Accessible Social andHealthcare: to carry out studies with the aim of developing prevention strategies i nhealth care, such as the North -Trøndelag Health Study (HUNT)(Answer prepared by the Ministry of Health )To create world -class knowledge and technology in the areas of life threatening diseaseswhich have a major impact to the survival and quality of life of the Latvian population- cardiovascular and metabolic diseases, oncological diseases, child and infectiousdiseases, as well as mental illness, the state funded research program "Bio -Medicine forPublic H ealth" is being implemented from 2014 to 201 7. The program is financed bythe Ministry of Education and Science.To obtain information about the health related behaviours of the Latvian population, to detect public health problems and to show their geographical and socio -demographicdistribution, as well as to provide the understanding of health promotion and educational challenges in the future, different population studies are conducted inLatvia, for example:1. Since 1990/1991 Latvia is participating in the cross -national survey of schoolstudents "Health Behaviour in School -aged Children" (HBSC) which isorganised in collaboration with the WHO Regional Office for Europe. The latestsurvey was conducted in 2014.2. Since 1998 every second year the survey „Health Behaviour among LatvianAdult Populatio n” is conducted in Latvia. The latest survey was conducted in2014.3. In the framework of Global Tobacco Surveillance System (GTSS) Latvia hasparticipated in four international youth smoking research surveys (2002, 2007, 2011 and 2014).4. Latvia is participating in the WHO European Child Obesity Surveillance Initiative (COSI) and has conducted three studies on Children's anthropometricparamet ers and school environment (2007/2008, 2009/2010 and 2012/2013).- Recommendations with regard to Su stainable and Accessible Social andHealthcare: to create incentives to improve the conditions of the nursing and careprofessions and to work towards intensified professional and vocational training forpeople employed in the health sector to significantly facilitate a cost -effective healthsystem in the region and foster understanding of the health sector as a cross -cuttingissue(Answer prepared by the Ministry of Health )In the framework of European Social Fund financing for period 2014 -2020, it is plannedto support two specific objectives aimed to improve accessibility of medical personnelin regions and training of health care professionals:Latvia P age 15141) to improve accessibility of health care and health care support fo r persons whoprovide services in priority health sectors (circulatory, oncology, perinatal and neonatalperiod and mental health) to inhabitants outside Riga. Indicative actions to be supported: s upport for attraction of medical and medical support person s (generalpractitioners, professionals, nurses, etc.) to work outside Riga: regional business tripsystem, m oving allowances, training etc.;2) to improve accessibility of qualified health care and health care support personnel.Indicative actions to be s upported: e laboration and implementation of qualificationimprovement training programmes, including improvement of specific skills related to necessary knowledge and skills for implementation of four priority networks including, for example, medical and m edical support personnel.LithuaniaLithuania P age 2LIETUVOS RESPUBLIKOS UZSIENIO REIKALŲ MI NISTERIJAMINISTRY OF FOREIGN AFFAIRS OF THE REPUBLIC OF LITHUANIABudget institution, J.Tumo -Vaizganto str. 2, LT -01511 Vilnius, Lithuania, tel.: + 370 5 236 2444, + 370 5 236 2400,fax + 370 5 231 3090, e -mail urm@urm.lt , http://www.urm.ltData are accumulated and stored in the Register of Legal Entities, code 188613242Secretariat of the Baltic AssemblyCitadeles iela 2 -616Riga, LV -1010, Latvia -03-2016 No.RE: No. 1/0216 -52 from 9 February 2016Dear Ms Anete Kalnāja,Herewith I am sending to You the information regarding the implementation of therecommendations of the Resolution of the 24th Baltic Sea Parliamentary Conference in Rostock,30 August – 1 September 2015.Enclosed: The information submitted by the Lithuanian state institutions, 11 pages.Vice -Minister Neris GermanasLithuania P age 32Informationabout the implementation of the recommendations of the Resolution of the 24thBaltic Sea Parliamentary Conference in Rostock,30 August – 1 September 2015Recommendations with regard to the preamble and Cooperation in the regionTo ensure the decent treatment of the refugees especially concerning housing and healthcare(preamble of the resolution)Information submitted by the Ministry of Health of the Republic of LithuaniaPursuant to Article 6 (1)(2) of the Law on Health Insurance of the Republic of Lithuania (hereinafter referred to as „the LHI“) foreign nationals temporarily residing in the Republic of Lithuania who are legally employed or have been legally employed in the Republic of Lithuania for at least 6 months and are registered wi th locallabour exchange offices as unemployed persons, as well as minor members of their families shall be coveredby the compulsory health insurance. Article 6 (5) of the LHI lays down that foreign nationals who havesubmitted an application for asylum in the Republic of Lithuania, also foreign nationals who are granted temporary protection in the Republic of Lithuania shall be covered from the state budget in accordance withthe procedure laid down by the Government of the Republic of Lithuania or an ins titution authorized thereby.Therefore they will be provided with the same healthcare services as other individuals covered by the healthinsurance in Lithuania which means that they will get treatment in the same health institutions of our country, as for example, clinics, general practice centers and, if necessary, municipality’s, where they will besheltered, hospitals. No special procedures for their treatment are planned. As Lithuanian citizens they will be subject to the same legislations and procedur es to access health institutions. Refugee healthcare servicescosts will be paid to health institutions by the National Health Insurance Fund under the Ministry of Health.All patients are entitled to receive necessary (primary and emergency) medical care from personal healthcareinstitutions. In order to receive an emergency medical care, patient can apply directly, without doctor‘s noteto the personal healthcare institution. The Law on the Legal Status of Aliens of the Republic of Lithuaniastipulates th at unaccompanied minor aliens, regardless of the lawfulness of their stay in the territory of theRepublic of Lithuania, have a right to receive emergency medical care free of charge in the manner prescribedby the Minister of Health. In order to ensure ap propriate refugee healthcare and coordinate actions withother government departments, the working group has been established by Order No V -1094 of the Ministerof Health of the Republic of Lithuania of 1 October 2015 on the Establishment of Permanent Work ing GroupResponsible for Ensuring Refugee Healthcare. An action plan setting out the measures to ensure refugeehealthcare and institutions responsible for them was drafted by the working group.Information submitted by the Ministry of Social Security and Labour of the Republic of LithuaniaIntegration of aliens who have received asylum is a process when aliens are provided with the same opportunities to support themselves and participate in public life as other members of society.Taking into account the fact that aliens who have received asylum in Lithuania in society are widely referredto as refugees, we shall hereinafter be referring to them as ‘refugees’. However, society should be awarethat asylum in the Republic of Lithuania is defined as a status of asylum or additional protection granted toSaulius Butkus, +370 70652480, saulius.butkus@urm.ltLithuania P age 43an alien in the Republic of Lithuania on the basis of the Law on the Legal Status of Aliens of the Republic ofLithuania.Lithuania creates the following conditions for refugees: provides temporary accommod ation, organizeseducation and employment; ensures social security and health care, informs the public about aliens who have received asylum in order to prevent their isolation, public xenophobia and promote tolerance.First assistance is provided to refugees at the Refugee Registration Centre up to 3 months.During this period, social workers from the Refugee Registration Centre, in collaboration with the LithuanianLabour Exchange, assess refugees’ skills and qualifications, check their health, perform a n assessment of anyhealth problems, disabilities and others. Refugees are intensively taught Lithuanian language and theLithuanian culture so that they are properly prepared to integrate into the Lithuanian society and labour market. Refugees living in the Refugee Reception Centre receive a monthly allowance (according to a set procedure)enabling them to pay for food and pocket expenses.Once first stage of integration is complete at the Refugee Registration Centre, further integration support is provided at local municipality territory and lasts for up to 12 months. This stage of support is coordinated bythe Refugee Registration Centre.Currently there are two non -governmental organizations that won the public tender to support refugeesduring their integration on a municipal territory level. They are Caritas of Vilnius Archdiocese and LithuanianRed Cross Society. Other non -governmental organizations, municipal social support centers and otherorganizations are also invited to participate in tenders. Non-governmental organizations provide curator services. Curators help refugees buy necessities, rent anapartment; pay out cash benefits, organize Lithuanian language training for refugees, organize kindergartenattendance and school education for children, advise foreigners on all issues, ensure that refugees attendLabour Exchange Office, help them complete and prepare all necessary documents and other. Institutionsimplementing the integration process report monthly to the Refugee Registration Centre about the services provided to refugees and their integration progress (through an administrative information system).During the period of integration support on a municipal territory level, refugees receive a monthly allowancefor their essential needs (apartment rent, utilities, food, transport and others).To cooperate in order to strengthen the Baltic Sea Region (BSR ) as an important competitiveknowledge region with an excellent higher education and research infrastructure (paragraph 4)Information submitted by the Ministry of Education and Science of the Republic of LithuaniaThe Baltic States already cooperate in the field of research infrastructures. There are publicly available listsof open access centres (research infrastructure, which can be used both for scientific and business purposesby anyone) in Latvia, Lithuania and Estonia. This information should encourage scientists from the BalticStates to use each other‘s infrastructure and reduce the need to have the exact same facilities at the homecountry. At the same time, it should help policy makers to make more informed decisions on futureinvestments in research infrastructure.Baltic science network project under INTERREG program will start soon. Network seeks to exploit untappedpotential of the BSR higher education, science and research landscape. The main expected results are:- sustainable transnational BSR science policy coordination framework, leading to increasedtransnational cooperation in science policy between BSR states and contr ibuting to the reali zation of aEuropean Research Area;- Developed structured mobility tools and joint BSR funding instruments to foster students’ andresearchers’ mobility in the BSR;- Identified strategic transnational development of areas of research excellence in BSR;- Increased transnational utili zation of research, higher education and innovationinfrastructures, which will increase the innovation capacity of the region;- Enhanced strategic communication of BSR science policy interests at the EU level.Lithuania P age 54To continue work to upgrade reception facilities for sewage in passenger ports to ensure timelyactivation of the special area status of the Baltic Sea under Marpol Annex IV of the InternationalMaritime Organization, with the aim to hinder the release of untreated sewage from passengerships in the future and to reaffirm the commitment for the continued improvement and modernization of the waste water treatment capacity throughout the entire Baltic Sea Region, incompliance with the stricter threshold valu es agreed by HELCOM (paragraph 8)Information submitted by the Ministry of Transport and Communications of the Republic of LithuaniaKlaipėda State Seaport Authority is responsible for the collection and utilization of the sewage from the shipscalling at Klaipėda State Seaport. In order to improve and ensure proper collection of the sewage from theships , the designing activities of waste reception facilities have been started in 2015 . Furthermore, theproject with the aim to install reception facilities for waste from tanker (ship -sewage collector) has beenlaunched.To enhance macro regional capacity to respond to major emergencies based on all -hazardsapproach and joint, cross -border preparations to protect lives, health wellbeing of citizens(paragraph 9)Information submitted by the Ministry of Interior of the Republic of LithuaniaIn order to enhance macro -regional capacity to respond to major emergencies based on all -hazards approachand joint, cross -border preparations to protect lives, health and wellbeing of citizens, Lithuania takes part inseveral macro- regional projects.• In January 2015, FRD together with the Secretariat of the Council of Baltic Sea States, Latvia, Estonia,Finland, Sweden, Norway, Denmark, Germany, Poland and Iceland have launched a 2 year project“Risk Management Capability Based on Gaps Identification in the Baltic Sea Region (BSR) ( From Gapsto Caps )” co-financed by the EU.The objective of the project is to facilitate future national assessments of risk managemen t capability inaccordance with the EU Decision on the Union Civil Protection Mechanism (UCPM) among the participatingcountries. The expected results of the project are to enhance capabilities for preparing and reviewing national capability assessments an d risk assessments, increase comparability between future nationalcapability assessments, enhance awareness of cross -border hazards, elevate awareness and understandingfor the cross -border needs and to enhance preparedness. The outcomes will be achieved by involving expertsand key actors, publication of ideas, creation of Methodology for future assessments of capability and dissemination of findings on actual disaster risk management capability and ways forward.The above mentioned project started as a follow -up of the “14.3 macro -regional risk scenarios and gapsidentification” project, the aim of which was to develop scenarios and identify gaps for all main hazards andthe potential of such hazards in the BSR, in order to anticipate disasters, thus ena bling a rapid and effectiveEU response through the UCPM.• Another inter -regional project funded by Interreg BSR Monitoring Committee “Mitigating the effectsof emergencies in Baltic Sea Region Ports ( HAZARD )” started in February 2016. The project involvespartners from Finland, Lithuania, Germany, Estonia, Poland, Sweden as well as internationalorganizations. Duration of the project is 3 years.The HAZARD project aims at mitigating major accidents and emergencies in major seaports in the BSR, allhandling large volumes of cargo and passengers. Harbours, terminals and storage facilities, including thosefor dangerous goods are often located close to residential areas, thus potentially exposing a large number of people to the consequences of accidents. The project deals with these concerns by bringing together logisticsoperators, rescue services and other relevant regional and local authorities.This project enables better preparedness, coordination and communication to reduce damages and loss oflife in emergencies, and handling of post -emergency situations by making a number of improvements. Theseimprovements include harmonization and implementation of safety and security codes, standards and regulations, communication between key actors, the use of risk analysis methods and adoption of new technologies.Lithuania P age 65Recommendations with regard to cross -border cooperation in healthcareTo improve transnational cooperation and medical specialization in the treatment of rarediseases, bearing in mind the cost -effective u sage of medical equipment (paragraph 20)Information submitted by the Ministry of Health of the Republic of LithuaniaCurrently two academic hospitals (Vilnius University Hospital Santariškių Klinikos and The Hospital ofLithuanian University of Health Sciences Kauno klinikos ) act as centers of expertise including Rare diseasesmanagement coordination centers providing services for Lithuanian residents. Centers of expertise wereestablished by the resp ective orders of academic hospital directors (Vilnius University Hospital ( SantariškiųKlinikos and The Hospital of Lithuanian University of Health Sciences Kauno klinikos ). Diagnosis, treatment,research, education and healthcare services performed by the abovementioned institutions are based on amultidisciplinary approach (not on the basis of a single disease) and are provided by teams of healthprofessionals. In theory Lithuanian centers of expertise conform to the quality criteria set out in theRecomm endations on Quality Criteria for Centers of Expertise for Rare Diseases in Member States (e.g.capacity to produce and adhere to good practice guidelines for diagnosis and care; quality management toassure the quality of care; to have an appropriate capa city to manage rare diseases patients and provideexpert advice; to be capable to participate in clinical trials) by the European Union Committee of Experts onRare Diseases (EUCERD).A new reimbursement model for medicines used to treat ultra -rare disease s was implemented in 2016.According to the new rules the incidence, therapeutic benefit, budget impact have to be evaluated, even ifan application is submitted on individual patient level. Those new rules will enhance cost -effective use ofmedicines for the treatment of ultra- rare diseases.To regulate transnational emergency care in a way that the fastest possible healthcare provisioncan be guaranteed regardless of the healthcare providers’ country of origin (paragraph 21)Information submitted by the Ministry of Health of the Republic of LithuaniaIn 2014, representatives of the Ministry of Health of the Republic of Lithuania, National Health InsuranceFund under the Ministry of Health and the Lithuanian Association of Emergency Medical Care Institutio nsprepared draft agreement for cross -border cooperation concerning the provision of emergency medical careservices in the border area between Lithuania and Latvia and submitted to the Ministry of Foreign Affairs of the Republic of Lithuania and to the Ministry of Health of the Republic of Latvia. The draft agreement wasdiscussed in the meeting held by the Ministry of Health of the Republic of Latvia on 27 August 2015 in Riga.Representatives of the Ministry of Health of Latvia added new provisions to the draft agreement. The expertsof the Ministry of Health of the Republic of Lithuania, National Health Insurance Fund under the Ministry of Health and the Lithuanian Association of Emergency Medical Care Institutions assessed the supplementeddraft agreement, improved and submitted to the Ministry of Health of Latvia on 14 December 2015. TheMinistry of Health of Lithuania submitted questions concerning the extent of the agreement, financing andthe competences of the emergency medical care institutions in Lithuania. The submitted questions arediscussed at the Ministry of Health in collaboration with the National Health Insurance Fund under theMinistry of Health. Lithuanian and Latvian competent authorities are currently preparing a n agreement on cooperation in theprovision of emergency services in the border area .It is also important that in accordance to the provisions of R egulations on coordination of social securitysystems of European Parliament and of the Council the person insured by the compulsory (public) healthinsurance in one Member State can get necessary treatment in other EU Member State. In order to exercisethis right the person has to get the prior authorisation of his competent institution ( form E112 or portabledocument S2). The authorisation shall be granted where the treatment in question is among the benefitsprovided for by the legislation in the Member State where the person concerned resides and where he cannotLithuania P age 76be given such treatment within a time -limit which is medically justifiable, taking into account his state ofhealth and the probable course of his illness.Implementing this provision Lithuania has issued 81 prior authorizations in 2014. 43 authorizations wereissued to receive healthcare services in the Member States belonging to the Baltic see region (Germany,Estonia, Poland and Sweden) in 2014. At the same time 103 Latvian patients having prior authorization issuedby their competent authorities in Latvia were treated in Lithuania during 2014.To reduce the usage of antibiotics – general – and for agriculture (livestock farming) to an absoluteminimum in order to prevent further increase of antimicrobial resistance (paragraph 22)Information submitted by the Ministry of Health of the Republic of LithuaniaLithuania is preparing a national antimicrobial resistant microorganisms program (2016 – 2020), which willtackle AMR problem by means of a One Health approach and ensure the co -operation between health andveterinary sectors, will contribute to a comprehensive solution of antimicrobial resistance problem byimproving the prevention of the spread of antimicrobial resistant organisms, expanding and improving the surveillance of antimicrobial resistance, nosocomial infections and consumption of antimicrobial agents,promoting prudent use of antimicrobial agents. Recently national surveillance of consumption of antimicrobial agents in healthcare sector was approved, which regulates data collection and feedback procedures including collection of hospital -based data. Since2006 the Institute of Hygiene provides the data of antimicrobial agents consumption in ambulatory and hospital sector to the European Centre for Disease Prevention and Control Antimicrobials consumption Care Network ( ESAC - Net). Total consumption of antimicrobial agents in Lithuania is close to th e Europeanaverage, low consumption rates in outpatient sector but high rates in hospital sector are observedNational Health Insurance Fund has introduced a new indicator for measurement of prescribing quality in2016. This indicator is the number of children treated with antibiotics per 1000 children. This quality indicatorwill help to benchmark the performance of prescribers and primary health care institutions.Information submitted by the State Food and Veterinary Service (SFVS) of the Republic of L ithuaniaIn 2016 Action Plan against antimicrobial resistance (AMR) was approved by the order No B1 -11 of thedirector of the State Food and Veterinary Service. The tasks and enforcement actions of this plan are below:No. Tasks Actions1 2 31. Needs and priorities of AMR studies in 2016. Analysis of data of AMR studies received understate control carried out in the periods of 2004 –2008 and 2008 –2014.Analysis of data from submitted EU reports andpriority axesComparison of AMR data on humans, animals andfood productsAnalysis of AMR data on milk available at the StateEnterprise “Pieno tyrimai“Recommendations for drawing up the Action planagainst AMR for 2016, its drafting andimplementation2. Identification of tendencies in the registration ofveterinary medicines and biocidesAnalysis of registration data for veterinarymedicines and biocides3. Improvement of prevention and controlpractices for animal infectious diseasesDrawing up a report on the sales of veterinaryantimicrobial medicinal products in veterinaryand agricultural sectors4. Training, presentations and articles for:Lithuania P age 87Professional training to improve clinicalpractices and increasing awareness of the use ofantimicrobial agents - employees of SFVS and National Food andVeterinary Risk Assessment Institute (NFVRAI); - private veterinarians;- pharmacists;- farmers;- the public.To prepare national guidelines for best practicesfor the use of antimicrobial agents in veterinaryactivitiesTo prepare handout materials about the use andresistance of antimicrobial substances for ownersof farm animals and the publicTo prepare a general brief overview of AMR inLithuania5. The implementation of CommissionImplementing Decision 2013/652/EU o f 12November 2013 on the monitoring andreporting of antimicrobial resistance in zoonotic and commensal bacteria To develop a procedure for the implementation ofthis Commission Implementing Decision, tocontrol its implementation and to deliversummary technical and financial reports to theEuropean CommissionTo select samples in accordance with the adoptedprocedure, to transport them to NFVRAI and to deliver monthly reports to the Veterinary SanitaryDepartment of the SFVS.To conduct tests in accordance with theProcedure and the Commission ImplementingDecision 2013/652/EU, to provide monthlyreports and to perform annual data analysis6. Organise AMR publicity campaign To organise events during the World AntibioticAwareness Week7. Cooperation with other institutionsTo coperate with Veterinary Academy ofLithuanian University of Health Sciences toexchange information about the spread ofresistant strains of bacteria in veterinary medicineParticipation at joint meetings of the humanmedicine expert working group on the preventionof occurrence and spread of antimicrobialresistant microorganisms organised by theMinistry of Health8. Control, effectiveness and efficiency of the 2016Action Plan against antimicrobial resistance Meetings of the working group for theimplementation of the 2016 Action Plan AgainstAntimicrobial ResistanceFurthermore, from 2010 SFVS is a participant of the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project, which is managed by European Medicine Agency. According to data of ESVACan apparent 22% decrease in sales (in mg/PCU) from 2010 to 2014 was seen in veterinary and agriculturesectors in Lithuania, and this is accounted for by all antimicrobial classes.To strive to introduce the same standards on a high level in the treatment of contagious infectiousdiseases throughout the Baltic Sea Region (paragraph 24)Information submitted by the Ministry of Health of the Republic of LithuaniaLithuania P age 98The list of reimbursable pharmaceuticals approved by Order No 49 of the Minister of Health of the Republicof Lithuania of the Republic of Lithuania of 28 January 2000 was complemented with pharmaceuticals forhepatitis C virus treatment Ombitasvir et Paritoprevir et Ritanovir (prescribed together with Dasabuvir forpeople with advanced HCV with genotype 1 -HCV (not treated before, treated ineffectively or uncompleteddue to relapse) when the rate of liver fibrosis is more than 3 using the METAVIR system) and Dasabuvir (OrderNo V -1087 of the Minister of Health of the Republic of Lithuania of 28 September 2015 on the amendmentof Order No 49 of the Minister of Health of the Republic of Lithuania of 28 January 2000 on Approval of theReimbursable Pharmaceutical List”).With a view to improve treatment and medical care for people with tuberculosis the following measureswere adopted: The purchase of pharmaceuticals for tuberculosis treatment for residential personal careinstitutions is centralized; out -patient treatment will be continued with antituberculosis pharmaceuticals freeof charge, in accordance with Order No V -1582 of the Minister of Health of the Republic of Lithuania of 31December 2015 on Approval of the Provision of Tuberculosis Pharmaceuticals for Personal Healthcare Institutions. It further provides that it is necessary to supply healthcare institutions with new pharmaceuticalsfor tuberculosis treatment (pharmaceuticals should be purchased in May 2016). Ministry of Health prepared and approved the procedures of Directly Observed TreatmentShort course (DOTS) services (Order No V -237 of the Minister of Health of the Republic of Lithuania of theRepublic of Lithuania of 12 February 2016) which sets out treatment procedures of out -patient treatment forpatients with tuberculosis (both adults and children) in their residential area. Directly observed treatment isthe main subject of the DOTS strategy and ensures that the right antituberculosis drugs are taken by patient in direct observation of medical personnel. The planned incentive service (it is planned that from 1 January 2017 doctors providing generalmedical services will be supported for the achieved results, i.e. that patient with tuberculosis has been cured)and will be financed from the Compulsory Health Insurance Fund if the bacteriological examination results(microscopy and culturing) after the completion of tuberculosis course treatment of the last two month ofthe treatment course taken and in case of tuberculosis drug resistance the last three months of treatm entcourse are negative, i.e. patient does not release tuberculosis mycobacteria.Recommendations with regard to Health & Economy of the Republic of LithuaniaTo improve conditions to support the development of innovations in health care, including in the fields of eHealth and telemedicine, whilst ensuring that investments in eHealth support the adoption of standardsand drive interoperability across the health sector to leverage the “eHealth European InteroperabilityFramework ” (eEIF) and observe the j oint European initiatives, such as the “Guidelines under eHealthNetwork” of the responsible member state authorities (paragraph 31)Information submitted by the Ministry of Health of the Republic of LithuaniaThree large public investment eHealth projects are completed: the central part of the eHealth system (“The development of E. health services and co -operation infrastructure“(ESPBI IS)), ePrescription (“Thedevelopment of the electronic service „E. prescription“) and medical image exchange (“National medicalpicture archiving and information exchange system“). Several large regional projects, which were dedicatedfor the development of information systems for health care institutions, by combining them to re gionalHospital information systems (HIS), are completed, about 170 health care institutions have alreadyimplemented projects of eH ealth development information systems and currently they start the electroniccompletion of patient health records within th e scope of the project : 12 clinical forms : referrals, epicrysis ,description of visits, ePrescription , descriptions of research, etc., as well as 8 medical certificates : healthcertificates for students, drivers , holders of weapons , birth o r death certific ates, and others. These projectsensure data exchange among healthcare institutions and enable successful functioning of the ESPBI IS and create preconditions to avoid duplication of healthcare services such as diagnostic test, digital image.Lithuania P age 109Establishment and development of the national eHealth systems infrastructure and Electronic Health Recordservices (ESPBI IS) was one of the most important development directions foreseen in the National ElectronicHealth System Development Program for the period of 2009 –2015 and remains in period of 2015 - 2025.Lithuanian central part of the eHealth system enables faster exchange of the data about the patients’treatment services, procedures and lab tests results among healthcare institutions and enables secondaryusage of patient health records. Patient -needs- oriented EHR aims to assure lifelong and effective provisionof healthcare services in Lithuania. EHR is being developed gradually, i.e. during the first years it will carry only the critical patient health information and certain certificates. Later it will be expanded andsupplemented with more detailed medical data.Lithuania strives to involve all healthcare institutions in participation and secure data exchange, to enablesuccessful functioning of the ESPBI IS and to create, store and transfer data about patient health even between European countries according to the principle “one resident – one EHR”.ESPBI IS and HIS is just starting in Lithuania. We are sure, that eHealth aims to improve the ac cessibility andquality of healthcare services and to ensure the necessary information exchange. In order to ensure a coherent policy of development of the e Health system in Lithuania , smooth operationof health care institutions, to save the time of doct ors and patients, to receive health care services of a betterquality, the E. health System Development Program for period of 2015 -2025 was approved by the Order NoV-1006 of the Minister of Health of the Republic of Lithuania of the Republic of Lithuania of 27 August 2015,i.e. it is aimed that all health care institutions should participate in the eHealth system in order to createconditions for all health care institutions in Lithuania to provide patient’s electronic health records from thehealth care institution s information systems or through the portal www.esveikata.lt .After implementing the eHealth projects, Lithuania will be ready to provide of patient’s data andePrescription data to other participants of eHealth in Europe.Ministry of Health of the Republic of Lithuania is planning to integrate the central part of the ehealth system(ESPBI IS) to European Union health information resources. We would like to note that Lithuania is an active member of the eHealth Network, which was enforced dueto the provisions of the Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011on the application of patients’ rights in cross -border healthcare.Ministry of Health of the Republic of Lithuania is preparing and will submit application for CEF funds.Lithuania is planning to implement data exchange on ePrescription and Patient Summary.To improve early intervention to strengthen good public health through social investment such as vaccine programs, and take strong measures to reduce consumption of alcohol, tobacco and il licit drugs,and work towards stronger prevention of diabetes II and other lifestyle illnesses (paragraph 34)Information submitted by the Ministry of Health of the Republic of LithuaniaThe working group, which has been established by the Ministry of Health, prepared a draft project of Diabetes(hereinafter referred to as the „D“) control program 2016 -2024 (hereinafter referred to as the „D program“).The D program aims to reduce D care burden for patients and country by strengthening, improving andmanaging efficient D prevention on primary, secondary and tertiary level and ensure continuous monitoringand analysis of D situation in Lithuania.We further inform that non-specific measures for the prevention of chronic non-communicable diseases areprovided in the following strategic planning documents:1. National Public Healthcare 2016 -2023 Development Program approved by Resolution No 1291 of theGovernment of the Republic of Lithuania of 9 December 2015;2. Action Plan 2014 -2023 to Reduce Health Inequalities in Lithuania approved by Order No V -815 of theMinister of Health of the Republic of Lithuania of the Republic of Lithuania of 16 July 2014 on the Approvalof the Action Plan 2014-2023 to Reduce Health Inequalities in Lithuania set out in:2.1. The procedure plan reducing morbidity and premature mortality from circulatory system diseases,2.2. The procedure plan reducing morbidity and premature mortality from cerebrovascular circulatorydiseases,Lithuania P age 11102.3. The procedure plan on str engthening children health, preventing diseases and ensuring efficienttreatment;3. National Program 2014 -2025 on Prevention and Control of Cancer approved by Order No V -814 (withamendment No V -1209 of 24 November 2014) of the Minister of Health of the Repu blic of Lithuania ofthe Republic of Lithuania of 16 July 2014 on the Approval of National Prevention and Control of CancerProgram 2014 -2023;4. Action Plan 2014 -2023 Ensuring Healthy Ageing in Lithuania approved by Order No V -825 of the Ministerof Health o f the Republic of Lithuania of the Republic of Lithuania of 16 July 2014 on the Approval ofAction Plan 2014 -2023 Ensuring Healthy Ageing in Lithuania;5. National Progress Program approved by Resolution No 1482 of the Government of the Republic ofLithuania of 28 November 2012 on the Approval of National Progress Program 2014- 2020;6. Interinstitutional Action Plan of the National Progress Program 2014 -2020 with the Priority “Health forAll” approved by Resolution No 293 of the Government of the Republic of Lith uania of 26 March 2014 onthe Approval of Interinstitutional Action Plan of the National Progress Program 2014 -2020 with thehorizontal priority “Health for All”.Other draft measures financed from ES structural assistance also proposed to include the pre vention ofchronic non-communicable diseases, diagnosis and prepare procedures for treatment in the action plan. In 2015 Ministry of Health of the Republic of Lithuania started the permanent Program of Heath Promotion for Patients with Coronary Heart Disease Risk. The aim of this Program - education and training of smallgroups of risk group persons in field of nutrition, physical activity, stress management and giving up addictions. Simultaneously were monitored body and blood indicators of these patients during one year. TheProgram has been carried out in whole country. Outpatient centers and public health bureaus ofmunicipalities were involved in activities. There were more than 1400 patients graduated this Program duringthe first year. Good results of health improvement among the patients graduated the Program wereobserved. The Program is going to be continued and developed further. Ministry of Health took a decision to extend the Program from 2017 by inclusion of additional patients having the risk of diabetes mellitus.The permanent Programme of Heath Promotion for Patients with Coronary Heart Disease Risk is in line withthe policy of strong measures to reduce alcohol and tobacco consumption. One of the major obstacles to theimplementation of such a policy is that alcohol consumption is still socially acceptable phenomenon.Alcoholic drinks are available in both time and space. In 2016 the Ministry of Health has initiated efforts ofdifferent institutions at national and local level , to reduce the alcohol consumption harm and has preparedan action plan for 2016 year - a document that includes evidence-based policy priorities (effective measures)to combat alcohol -related harm: to control the availability of alcohol ; leadership, awareness andcommi tment ; health services response ; community action ; drunk driving policies; control of alcoholicbeverages and marketing etc.In order to manage communicable diseases and protect all children the National Immunization Program2014 -2018 is being implemented. In accordance with Childhood Vaccination Schedule of the Republic ofLithuania, the major achievements in the field of vaccination in 2014- 2015 are: pneumococcal disease vaccination which is one of the main reasons causing sepsis, meningitis andpneumonia has been included in the Childhood Vaccination Schedule of the Republic of Lithuania since 2014; include human papillomavirus vaccination for girls in 2016 in the Childhood Immunization Scheduleof the Republic of Lithuania in order to prevent 70 per cent of cases of cervical cancer in the future; from the end of 2015 teenagers started to be vaccinated against pertussis (whooping cough) inorder to reduce morbidity of children and adults as well as protect infants from pertussis (whooping cough)infection acquired from adults; in order to protect high -risk groups against pneumococcal disease which is especially life -threatening for persons suffering from certain diseases, pneumococcal disease vaccination for high -riskgroups has become available since December 2015.To check the possibility to establish a “Baltic Health Forum”, to ensure and improve a sustainableexchange and networking in this policy field around the Baltic Sea (paragraph 39)Lithuania P age 1211Information submitted by the Ministry of Health of the Republic of LithuaniaThis possibility could be discussed in the meeting of the Prime Ministers Council of the Baltic Council ofMinisters.Recommendations with regard to Sustainable and Accesssible Social - and HealthcareTo ensure affordable health care for everyone and emphasize the focus on the needs of patientswith due regard to age and gender and to warrant equal and affordable access to high -qualityhealth services throughout the whole Baltic Sea Region (paragraph 40)Information submitted by the Ministry of Health of the Republic of LithuaniaLithuanian Healthcare System ensures the universal healt h coverage for all residents. The Law on HealthInsurance provides that all permanent residents of the Republic of Lithuania are eligible for the compulsoryhealth insurance scheme. Vulnerable groups (children, elderly, disabled, unemployed, on maternity l eave),which account for about 60% of the population, are also covered by the compulsory health insurance. Allpeople covered by the compulsory health insurance scheme in Lithuania have a right to receive thehealthcare services guaranteed by the State fre e of charge. The necessary medical care in the territory ofLithuania is available free of charge to all permanent residents irrespective of whether or not they are covered by the compulsory health insurance. Only the high -quality healthcare services whic h meet the criteria defined by the Government shall be coveredfrom the budget of the Compulsory Health Insurance Fund (CHIF). Healthcare services covered from thebudget of the CHIF are: preventive medical services, curative healthcare services provided o n the primary,secondary and tertiary level, medical rehabilitation services, long term and palliative treatment (the detailedlist of healthcare services is foreseen in the contracts between the Territorial Health Insurance Funds andhealthcare providers) .To develop and strengthen strategies addressing demographic change, such as the EuropeanInnovation Partnership on Active and Healthy Ageing and especially considering public serviceswith regard to rural peripheral areas (paragraph s 43 and 44 )Information submitted by the Ministry of Social Security and Labour of the Republic of LithuaniaAction Plan for the 2016 on the Family Wellbeing and Reduction of the Consequences of Population Ageing was adopted by the Minister of Social Security and Labour on the 10th of March 2016. Adoption of the Plancontributes to the implementation of the recommendation No.43 of the Conference Resolution Adopted bythe 24th Baltic Sea Parliamentary Conference (BSPC).Information submitted by the Ministry of Health of the Republic of LithuaniaAction Plan 2014 -2023 Ensuring Healthy Ageing in Lithuania has been approved by Order No V - 825 of theMinister of Health of the Republic of Lithuania of the Republic of Lithuania of 16 July 2014. One of the majoraims is to i mprove quality and availability of the complex healthcare services for elderly and older people,and develop these services.The procedure plan on complex healthcare and geriatric services network in the optimization area for the Implementation of the Lit huanian Health Program 2014 -2025, the National Progress Program and ensuringappropriate organization of geriatric services was confirmed by Order No V -825 of the Health Minister of theRepublic of Lithuania of 16 July 2014 on the Approval of Action Plan 2 014-2023 Ensuring Healthy Ageing inLithuania; and provides the following: establish two geriatric centers closely collaborating with two universities which have a study programfor doctors geriatrics; establish stationary geriatric departments in hospitals at district -level since healthcare services in themunicipalities are less available compared to major cities. Taking into account the existing and intendedresources, departments at first would be established/renewed in 11 district- level hospita ls where stationaryLithuania P age 1312surgical services are no longer provided, the premises of the hospitals would be modernized and adaptedand the equipment necessary for geriatric services would be purchased; instruct medical personnel on newly established geriatric departments and ensure the continuousprofessional development; provide opportunities to gain practical knowledge of geriatric patient care forpeople who do not work at medical institutions, volunteers from non-governmental organizations, familymembers, relatives and comforters of geriatric patients (polypathology and polypragmasia).Currently stationery geriatric services are provided in 7 Lithuanian institutions: Mykolas MarcinkevičiusHospital (public establishment), Kaunas Clinical Hospital (public establishment), Zarasai Hospital (publicestablishment), Alytus district S. Kudirka Hospital (public establishment), Klaipėda Seamen’s Hospital (publicestablishment), Gargzdai Hospital (public establishment), Jonava Hospital (public establishment). Out -patien tgeriatric services are provided by 3 institutions: Kaunas Clinical Hospital (public establishment), Hospital ofNaujoji Akmenė (public establishment) and Republican Hospital of Kaunas (publish establishment).Ministry of Health is going to implement the Action plan on Promotion of healthy ageing in 2014 -2023,which will contribute to implementing of Operational programme for the European Union funds’ investments in 2014 -2020.To ensure support services for families, pregnant women and prospective parent s in support offamilies and parenthood, provide an integrated package of services to families with children inorder to encourage childbirth, childcare and child rearing with a view to counteracting thecurrent demographic trends and investing in families and fostering child -friendly communitiesand societies (paragraph 46)Information submitted by the Ministry of Social Security and Labour of the Republic of LithuaniaAction Plan on the Provision of Complex Services to Families was adopted by the Minister of Social Securityand Labour on the 10th of March 2016. The plan envisages delivery of various types of services to families(courses on positive parenting, assistance to the families to overcome various types of crises, mediation, childcare ser vices etc.). Delivery of services is envisaged through Community Family Houses. Creation ofCommunity Family House is planned in each municipality. Adoption of the Plan contributes to theimplementation of the recommendation No.46 of the Conference Resolution Adopted by the 24th Baltic SeaParliamentary Conference (BSPC);To carry out studies with the aim of developing prevention strategies in health care, such as theNorth -Trøndelag Health Study (HUNT) (paragraph 49)Information submitted by the Ministry of Health of the Republic of LithuaniaThe monitoring of wellness of the Lithuanian citizens (morbidity and number of deaths) since 2016 has beensupplemented with periodical lifestyle surveys, i.e., from 2016 every four years a survey of children lifesty leand from 2018 – a survey of adult lifestyle - will be carried out. It is planned that these surveys will beimplemented by the Institute of Hygiene.To create incentives to improve the conditions of the nursing and care professions and to worktowards intensified professional and vocational training for people employed in the health caresector to significantly facilitate a cost -effective health system in the region and fosterunderstanding of the health sector as a cross -cutting issue (paragraph 52)Information submitted by the Ministry of Health of the Republic of LithuaniaIt is planned to prepare and implement one of the measure's No. 08- 1.3-CPVA -V-601 "Improving the qualityof services for healthy ageing" activities - "Infrastructure for geriatrics and diabetes care, training of nursesand other specialists working with geriatric patients, training of patients' family members.Mecklenburg-VorpommernMecklenburg-Vorpommern P age 21Answers to the Question s of the BSPC by the responsible ministries ofMecklenburg -Vorpommern1- Recommendation with regard to the preamble and Cooperation in theRegion : to ensure the decent treatment of the refugees especiallyconcerning housing and healthcare- Recommendation with regard to the preamble and Cooperation in theRegion : to co -operate in order to strengthen the Baltic Sea Region asan important competitive knowledge region with an excellent highereducation and research infrastructureThe universities of Mecklenburg -Vorpommern are working on furtherstrengthening their partnerships in the Baltic Sea region in accordance withtheir research focuses. The Ministry of Education, Science and Cultureparticipates as an associated partner in the "Baltic Science network" project,which is implemented under the leadership of the scientific authority of Hamburg and sponsored within the framework of the "Baltic Sea region" EU INTERREG programme.2 The core of the project is the creation of a supra -regional network, which is an effective "administrative network" in addition to the existing "scientific networks", in order to be able to control the scientificand research co -operation in the Baltic Sea region in a meaningful andtargeted manner. At the same time, the project is a flagship project in the"Education" policy area in the EU's Baltic Sea strategy.3- Recommendation with regard to the preamble and Cooperation in theRegion: to continue work to upgrade reception facilities for sewage inpassenger ports to ensure a timely activation of the special area statusof the Baltic Sea under Marpol Annex IV of the International MaritimeOrganization, with the aim to hinder the release of untreated sewagefrom passenger ships in the future and to reaffirm the commitment forthe continued improvement and modernization of the waste watertreatment capacity throughout the entire Baltic Sea Region, incompliance with the stricter threshold values agreed by HELCOMAt the 68th session of the Marine Environment Protection Committee of theIMO (MEPC 68) in May 2015, the entry into force of the regulations on theBaltic Sea special area was decided within the context of MARPOL AppendixIV, they shall now apply from 01.06.2019 for new vessels and from01.06.2021 for existing ships. The regulations currently in place regarding thedischarge of waste water by passenger ships will be significantly tightened bythese. Obligations thus arise for the ports to provide adequate collecting1 Disclaimer: This opinion covers the areas where a responsibility is given at state level, whereby it isbased on the structure of the above resolution. Thus, only the paragraphs of the resolution whichfrom the point of view of the State Government constitute a professional political competence orhave an overriding importance for Mecklenburg-Vorpommern are recorded in the statement.2 For information about the "Baltic Science Network" project, see https://www.interreg-baltic.eu/fileadmin/user_upload/about_programme/Cooperation_priorities/P1_Innovation/R003_Baltic_science_network.pdf .3 For information abou t the "Education" policy area in the EU's Baltic Sea strategy, seehttp://groupspaces.com/eusbsr-education .Mecklenburg-Vorpommern P age 32facilities for the disposal of ship waste water. Since - as is expected to bedecided this year at MEPC 69 - Russian wate rs will be excluded from theregulations, it would be welcomed within the context of marine protection if thecorresponding regulations would achieve validity in the future for the entire Baltic Sea.- Recommendations with regard to cross -border cooperati on inhealthcare: to improve transnational cooperation and medicalspecialization in the treatment of rare diseases, bearing in mind thecost-effective usage of medical equipment- Recommendations with regard to cross -border cooperation inhealthcare: to regulate transnational emergency care in a way that thefastest possible healthcare provision can be guaranteed regardless ofthe healthcare providers ́ country of originThe German -Polish framework agreement on the cross -border co -operation ofemergency services, although it was signed in 2011, could not yet beimplemented. The co -operation agreements between the States ofMecklenburg -Vorpommern , Brandenburg and Saxony, the districts along theborder and the adjacent voivodeships, which are necessary for this purpose inaccordance with article 4 of the framework agreement, were not able to befinalised. The obstacle is the still missing assurance for the Polish emergencyservices against liability claims after assignments in Germany.- Recommendations wit h regard to cross -border cooperation inhealthcare: to reduce the usage of antibiotics – general – and foragriculture (livestock farming) to an absolute minimum in order toprevent further increase of antimicrobial resistancePlease refer to the statements on paragraphs 15 and 16 below regarding theHICARE project. In addition, the problem of antibiotic resistance and the need both to combat the spread of resistance and to explore and develop new agents are on the Pharma dialogue agenda for the German Fed eralGovernment.- Recommendations with regard to Health & Economy: to improveconditions to support the development of innovations in health care,including in the fields of eHealth and telemedicine, whilst ensuring thatinvestments in eHealth support the adoption of standards and driveinteroperability across the health sector to leverage the “eHealthEuropean Interoperability Framework” (eEIF) and observe the jointEuropean initiatives, such as the “Guidelines under eHealth Network”of the responsible member state authoritiesElectronic healthcare services (eHealth) can provide considerable innovationsand employment opportunities in the healthcare sector and in the health careindustry. With the potential of productivity gains among health sector ser vicesand the development of markets in the ICT sector, they can thus, in addition togood medical care, contribute significantly to more economic and employment growth. The legal framework conditions in Germany, inter alia with regard toMecklenburg-Vorpommern P age 43the interoperability of telemedicine applications, are regulated at federal levelin the "eHealth Act", which entered into force on 21 December 2015.4Regardless of the necessary creation of the legal framework conditions, theStrategic Council for Economics and Science of Mecklenburg -Vorpommern , inits "Regional Innovation Strategy 2020 for the State of Mecklenburg -Vorpommern “ (RIS) adopted in 2014, sees tele -medicine as one of the fivestructure-determining areas in which the State has developable strengths and exploitabl e potentials from an economic perspective. In order quickly tostimulate innovation, the most specific, economically effective and sustainable projects possible should be developed and implemented in the short term.- Recommendations with regard to Health & Economy: to improve earlyintervention to strengthen good public health through socialinvestment such as vaccine programs, and take strong measures toreduce consumption of alcohol, tobacco and illicit drugs, and worktowards stronger prevention of diabetes II and other lifestyle illnessesThe Ministry of Agriculture, Environment and Consumer Protection ofMecklenburg -Vorpommern has for years been promoting relevant projectsand activities in the Consumer Association of Mecklenburg -Vorpommern e.V.,the Mecklenburg -Vorpommern section of the German Society for Nutritione.V. and the networking office for child day care facility and school catering at the German Society for Nutrition. The state food programme for pupils ofprimary and special schools of the State is also aligned with this point.5Ultimately, all the measures are embedded in the State action plan for healthpromotion and prevention. The action plan is updated regularly.Furthermore, please refer to the prevention work in the area of sexuallytransmitted infections in the District of Vorpommern-Greifswald, which takesplace within the framework of the cross -border project "Sexual HealthPromotion in the region of Mecklenburg -Vorpommern-Greifswald". The projectis carried out by the Christian Association of Youth Villages in Germany (CJD) on behalf of the Health Department of Vorpommern-Greifswald. Sexual healthpromotion functions and cross -border public relations and networking tasksare thereby undertaken. The area of application also includes a part of the Polish voivodeship of West Pomerania, particularly Wollin and Swinemünde, in addition to the District of Vorpommern-Greifswald.- Recommendations with regard to Health & Economy: to check thepossibility to establish a “Baltic Health Forum”, to ensure and improvea sustainable exchange and networking in this policy field around theBaltic SeaThe possibility of creating a "Baltic health forum" is currently being assessedfor Mecklenburg -Vorpommern by BioCon Valley® GmbH together with theState Parliament of Mecklenburg -Vorpommern.- Recommendation with regard to Sustainable and Accessible Socialand Healthcare: to develop and strengthen strategies addressingdemographic change, such as the European Innovation Partnership on4 Act for secure digital communications and applications in the health care sector and amendment of otherlaws ("E-health Act"), see http://dipbt.bundestag.de/extrakt/ba/WP18/671/67134.html .5 For information on the state nutrition programme for school pupils, see www.schulobst-mv.de .Mecklenburg-Vorpommern P age 54Active and Healthy Ageing and especially considering public serviceswith regard to rural peripheral areasThe State Government of Mecklenburg -Vorpommern adopted a demographystrategy in January 2011, which deals with the consequences and the needfor action for all policy areas.6 For rural areas, the Ministry of Agriculture,Environment and Consumer Protection is implementing the strategy within theframework of the development programme for rural areas (EPLR 2014 -2020M-V). Please refer to the corresponding statements in paragraph 42. The establishment of a "Forum for rural areas in MV" at the Landgesellschaft Mecklenburg -Vorpommern mbH is planned as a communication andnetworking project within this framework, which will serve as a common platform for the dire ct co -operation of the various actors in regionaldevelopment and demography consulting.Also, please refer to the representation in paragraph 28 on activities in health care, which in particular aims at new strategies for the future medical care ofthe population in rural areas.The draft plans for the integrated State transport plan for Mecklenburg -Vorpommern (ILVP M -V) are currently being developed by the Ministry ofEnergy, Infrastructure and Regional Development, setting out the guidelinesfor future development in the transport sector. One of the major challengesfacing the plan is demographic change in a sparsely populated territorial state.In the preparation of the draft plans, the discussions and findings of theCommission of Inquiry "Ageing in Mecklenburg -Vorpommern " are involved inparticular in the issue of public mobility.- Recommendations with regard to Sustainable and Accessible Socialand Healthcare: to carry out studies with the aim of developingprevention strategies in health care, such as the North -TrøndelagHealth Study (HUNT)The international and national study location for many areas of prevention isgood. There is often an implementation problem rather than a recognition problem. Nevertheless, the State Government of Meckle nburg -Vorpommernsupports research in the area of prevention, currently inter alia through thefinancing of a study on the topic "Consumption of gambling, media, alcoholand cannabis among adolescents and young adults in Mecklenburg -Vorpommern ".- Recomme ndations with regard to Sustainable and Accessible Socialand Healthcare: to create incentives to improve the conditions of thenursing and care professions and to work towards intensifiedprofessional and vocational training for people employed in the hea lthsector to significantly facilitate a cost -effective health system in theregion and foster understanding of the health sector as a cross -cuttingissue6 For more on the demography strategy of the State Government of Mecklenburg-Vorpommern, seehttp://www.demografie-mv.de/cms2/Demografie_prod/Demografie/de/start/Demografiestrategie/index.jsp .Mecklenburg-Vorpommern P age 65Training in the field of health professions is ensured by the vocational schools.Currently training for 15 occupations in this area are being maintained in thisregard at nine public vocational schools and 16 professional alternativeschools in Mecklenburg -Vorpommern . In particular, this training area includesthe following types of school: Higher vocational school for health and nursing,health and paediatric nursing, midwives (maternity care), physiotherapy,medical assistance (laboratory assistance, diagnostic and radiologyassistance), diet assistance, ergotherapy, orthoptics, speech therapy, pharmac eutical assistance, geriatric care, medical documentation andemergency paramedics as well as the vocational school for nursing and elderly care. With regard to the training of health professionals, significantimprovements were made in 2014 due to the great demand for trainedprofessionals with the amendment of the Education Act. In the area of professional alternative schools, the grant rate for programmes of elderly care, health and nursing, child care as well as medical and nursing care for the elderly has been raised to 80 percent.Furthermore, the draft of the Federal Government on the "Care ProfessionsReform Act" envisages in the future fee -free training for all trainees training inthe nursing profession, in order to further increase the attractiveness of thisprofession.7The responsible ministries of Mecklenburg -Vorpommern havefurthermore responded to the following paragraphs of the resolution:Co-operation in the regionParagraph 1.The State Government of Mecklenburg -Vorpommern is involved in many waysin co -operation in the Baltic Sea region. These include in particular thebilateral partnerships and co -operations with the regions of SouthwestFinland, the Voivodeships of West Pomerania and Pomerania and the Leningrad region, as well as Skåne. In addition, the State is a member of theBaltic Sea Commission of the Conference of Peripheral Maritime Regions (CPMR), is co -ordinated within the context of North German co -operation withthe Foreign Office with regard to the Council of Baltic Sea States and theimplementation of EU Baltic Sea strategy. The Ministry of Economy,Construction and Tourism holds the coordinating role for the policy area oftourism in the EU Baltic Sea strategy, characterised by a very diverse multi -level dialogue with regional tourism associations, regional authorities, nationaltourism organisations, national ministries, the tourism industry, universities,other research institutions and other actors in the Baltic Sea strategy. BioConValley® GmbH is involved in the management of the flagship project"ScanBalt Health Region" in the policy area of "Innovation". Furthermore,more actors from Mecklenburg -Vorpommern are active in other flagshipprojects and thus contribute to the success of the EU Baltic Sea strat egy.The Ministry of Agriculture, Environment and Consumer Protection ofMecklenburg -Vorpommern has taken an active role in the framework of the7 The law to reform of the care professions ("Care Professions Reform Act" - PflBRefG) is currently in thelegislative process. For the current state of the proceedings, seehttp://dipbt.bundestag.de/dip21.web/searchProcedures/simple_search_list.do?selId=71711&method=select&offset=0&anzahl=100&sort=3&direction=descMecklenburg-Vorpommern P age 76German delegation and through participation in working group meetings in thework of the Helsinki Commission for the protection of the Baltic Sea(HELCOM). Thereby, contacts to all other Baltic States are constantly maintained and expanded.From a State perspective, the programmes of European territorial co -operation, that allow organisations networks and other co -operation to pursuetheir common priorities within the framework of projects, make an important contribution to the Baltic Sea cooperation. Hereby, the EU -INTERREGprogrammes "Baltic Sea" and "Southern Baltic Sea" are at the forefront. In the current prog ramming period (2014 to 2020), a corresponding 278 millioneuros and 83 million euros respectively are available in funding for projects oftransnational and cross -border co -operation within this context. Theseprogrammes have been used intensively in the last programming period from2007 to 2013. Overall, actors from Mecklenburg -Vorpommern participated inapproximately 120 projects financed by these two programmes. The thematic priorities were in particular in the areas of innovation, education andemploym ent, promotion of entrepreneurship and the sustainable use of thenatural and cultural heritage. The funding for the programme period up to2020 is now underway. In the "Baltic Sea region" programme, the first application round was completed in November 2015. Of the total of 35 funded projects, 14 involve participation from Mecklenburg -Vorpommern.8 The focushere is on the areas of transport, renewable energy, blue growth and protection of the Baltic Sea. For example, the Ministry of Energy,Infrastructure and Rural Development co -ordinates on the one hand theproject "Baltic Energy Areas - A Planning Perspective" ("BEA APP")9 as aleading partner. The project aims to support the development of renewableenergies through further development of regional planning instruments,increase in acceptance and development of pilot projects. In addition theMinistry participates as a partner in the project "Coherent Linear Infrastructures in Baltic Maritime Spatial Plans" ("Baltic LINes")10, whichserves the better harmonisation of spatial plans, especially for shipping routes and energy routes,.In the "South Baltic" programme, the projects to be funded in the first round are expected to be decided at the end of April. According to the EU growth strategies, the potential for growth in the "blue" and "green" sectors of the economy will be increased by the programme through cross -border co -operation in the southern Baltic region. Hereby, "green" describes thesustainable use of natural resources. This pertains to, for example, the areasof renewable energy, environmental management, food production andprocessing, sustainable tourism. "Blue" refers to the maritime and marineareas - for example, to coastal and cruise tourism, to marine biotechnology,aquaculture, coastal protection, maritime security and offshore wind energy.Paragraph 2.8 For information on the projects in the EU programme "Baltic Sea region" corresponding to the programmepriorities, see http://www.interreg-baltic.eu/about-the-programme/cooperation-priorities.html .9 For information about the project "BEA -APP", see http://www.interreg-baltic.eu/fileadmin/user_upload/about_programme/Cooperation_priorities/P2_Natural_resources/R017_Baltic_energy_areas_a_planning_perspective.pdf .10 For information about the project "Baltic LINes", see http://www.interreg-baltic.eu/fileadmin/user_upload/about_programme/Cooperation_priorities/P2_Natural_resources/R020_Coherent_linear_infrastructures_in_Baltic_maritime_spatial_plans.pdf .Mecklenburg-Vorpommern P age 87In the areas of Justice and Home Affairs, different styles of cross -border co -operation have developed between public prosecutors and police. Thus,regular meetings of representatives of the public prosecutor's offices of the State of Mecklenburg -Vorpommern with the appeal prosecutor in Szczecintake place, most recently on 24 and 25 June 2015 in Szczecin and GorzówWielkopolski (Landsberg) and on 17 and 18 September 2015 in Rostock.These meetings serve the mutual exchange of experiences and information,for example in the area of information and communication crime or regardingselected offences with a cross -border character.Police co -operation in the Baltic Sea States is primarily co -ordinated within theframework of the "Visby co -operation" and of Interpol. The Baltic States andIceland are represented in the "Operational Committee" of the "Task -Force onOrganised Crime in the Baltic Sea Region". On the German side, the States of Schlesw ig-Holstein and Mecklenburg -Vorpommern are involved in addition tothe Federal Government.The Polish -German joint project "Security in the neighbouring country",established by the State Office of Criminal Investigation (LKA) ofMecklenburg -Vorpommern , the Voivodeship headquarters of the police inSzczecin, the Federal Police Office in Rostock and the former PoliceDirectorate in Anklam will also be continued in 2016. In addition, regular co -operation takes place between German and Polish police officers duringinspections in the area of transport and in the tourist season.The cross -border co -operation, existing since 2001, within the framework ofthe German -Danish co -ordinating group is also continuing, in which the LKAfrom Mecklenburg -Vorpommern , the State Water Police Office and the policeheadquarters in Rostock and Neubrandenburg participate. Since October 2014, representatives of the headquarters of the West -Pomeranian police inSzczecin as well as the Polish border guards MOSG / sea unit from Gdan skhave also been taking part in the meetings as observers. The co -operationfocuses inter alia on the areas of danger prevention, crime fighting, includingcustoms offences, traffic safety activities and crime prevention.The annual International Security Conference "Gdansk meetings", held for thefirst time in 2000, will be held from 27 to 28.04.2016 in Stralsund. The focus ofthe Conference, organised by the LKA of Mecklenburg -Vorpommern in co -operation with the Polish Pomeranian Voivodeship office, is the topic of "Technology and Internal Security".Paragraph 3.The State Government of Mecklenburg -Vorpommern supports the Baltic SeaParliamentary Conference's goal of developing the economy in the Baltic Searegion in a sustainable manner and hereby attributes an important role to theuse of renewable energy.Paragraph 6.Measured in terms of transport capacity, shipping is a comparatively more climate -friendly and efficient mode of transport. However, increasing shiptraffic leads to additional pollution from contaminants, dust, exhaust andnoise. For the protection of public health and the protection of the marineenvironment and climate change, shipping must reduce its emissions in theparticularly sensitive coastal area of the Baltic Sea. The State therefore in principle supports the activities for improving the protection of the marine environment. This topic is also the subject of the "Green Cruise Port" project,Mecklenburg-Vorpommern P age 98in which, among other things, concepts for reducing the environmental impactof cruise t ourism on port cities are being investigated, with the participation ofthe port of Rostock.11 The project is supported by the "Baltic Sea region" EUINTERREG programme.The regulations on the monitoring area for sulphur emissions (SulphurEmission Control Areas - SECA) in the Baltic Sea have been implemented inthe State, without so far any negative impacts on shipping and ports becomingknown. However, an evaluation of the regulations at EU level is required to assess the long -term consequences. In principle, any reinforcement ofenvironmental requirements on sustainability should be applied; this includes the avoidance of undue economic consequences. Due to the internationalnature of maritime transport the State Government is committed toestablishing as globally uniform environmental standards as possible at a highlevel. Thus a designation of other monitoring areas for sulphur emissions is sought. This happens against the background that different environmental standards can affect the competition between competing navigated areas.Paragraph 7.In the EU strategy for growth and jobs in coastal and maritime tourism,12 theEuropean Commission announced in "measure 3" the promotion of a pan -European dialogue between cruise organisers, ports, and other stake holdersin the coastal tourism sector. The opening event took place on 05 March 2015in Brussels. More events with regional relevance, including the Baltic Searegion, are being planned. The basis is the EU initiative for blue growth13,which attests to the special potential for sustainable blue growth for sea,coastal and cruise tourism. On the other hand, it is important for small coastaltourism to participate more in the structured growth of cruise ship tourism, inorder to better exploit the existing potential, particularly in coastal tourism. Thecruise dialogue should likewise contribute to this. In the area of policy relating to tourism in the EU Baltic Sea strategy, which is co -ordinated by the Ministryof Economy, Construction and Tourism of Mecklen burg-Vorpommern , thisdialogue on cruise tourism is actively pursued by the European Union in closecontact with the European Commission and the Information Office of the Stateof Mecklenburg -Vorpommern.Paragraph 9.The State of Mecklenburg -Vorpommern and the Republic of Poland signed anagreement of mutual assistance in the case of disasters and serious accidentsin 2002. The agreement contains provisions that mainly serve the form andthe procedure of practical co -operation, as well as the legal clarity and thusrepresents an action document for civil protection authorities. It shall then apply in the territory of the State of Mecklenburg -Vorpommern and theRepublic of Poland, if the authorities responsible for combating disasters or serious accidents consider forces and resources from the neighbouringcountry necessary to support their own measures.11 For information about the project "Green Cruise Port", see http://www.interreg-baltic.eu/fileadmin/user_upload/about_programme/Cooperation_priorities/P3_Transport/R026_GREEN_CRUISE_PORT_Sustainable_Development_of_Cruise_Port_Locations.pdf.12 European Commission, COM(2014) 86 final.13 European Commission, COM(2012) 494 final.Mecklenburg-Vorpommern P age 109The relevant civil protection authorities shall work closely together and informeach other of potential and actual threats as well as their impact and re sponsemeasures in the 25 kilometre zone on both sides of the border.Furthermore, there shall be information about the forces and resourcesappropriate for assistance with the specific incidents as well as aboutprocedures for requesting and providing assistance, including about themanner of transmission of information.Conceptually, in future joint training and participation in competitions /benchmarking and exercises should deepen the co -operations. A constantexchange of information is to be ensured for special events.Currently, a German -Polish working group is working to update the agreementfor the development of guidelines of good practice to ensure civil protection in the border region. The Committee for border co -operation of the German -Polish Government Commission proved satisfied with this development at its34th session on 15 and 16 April 2015 in Breslau.Paragraph 10.The Ministry of Agriculture, Environment and Consumer Protection ofMecklenburg -Vorpommern , in co -operation with the Federal Government andSchleswig -Holstein, supports a broad implementation of the HELCOM Balticaction plan ("Baltic Sea Action Plan") and thereby ensures a coherence withthe work and measures for implementation of the European marine strategyframework directiv e in the "Baltic Sea" marine region.Paragraph 11.The Ministry of Labour, Gender Equality and Social Affairs is committed to deepening the political exchange among young people in the Baltic Searegion and supporting the establishment of a permanent foru m for Baltic Seayouth. Therefore, a closer co -operation is aimed at in the future. A financialparticipation of the Ministry of Labour, Gender Equality and Social Affairs ishowever not possible. The former Baltic Sea Youth Secretariat was financedfrom f unds from nation states - for Germany from funds of the Federal Ministryfor Family, Senior Citizens, Women and Youth - and not with funding from theindividual Baltic Sea coastal regions.Paragraph 12.The "2020 regional innovation strategy for the State of Mecklenburg -Vorpommern " (RIS, 2014) identifies the bio -economy as one of the fivestructure-defining areas in which the State from an economic perspective has promising strengths and exploitable potential. Within the framework of theregional innovation strategy of the State, the aim is by 2020 to bundle theexisting core competences in the area of the bioeconomy, to further developthem, to accelerate the transfer of results from research and development intoeconomic products, as well as to promote the development, survival, and settlement of manufacturing companies in this area. The measures for achieving the goals are undertaken in the fields of action relevant to the bioeconomy: Projects in research and development, image -building,networking, technology transfer and technology -oriented start -ups.The Ministry of Agriculture, Environment and Consumer Protection actively participates in the events organised within the framework of the Nordic bio -economy initiative for strengthening the development of rural areas in the Baltic Sea region. In 2016 a series of events will take place in this context withMecklenburg-Vorpommern P age 1110the participation of representatives of the State, organised by the SwedishInstitute for Rural Development.Cross -border co -operation in the health sec torParagraph 13.The State Government of Mecklenburg -Vorpommern still attributes a highpriority to the international orientation of the health economy, both against thebackground of increasing the export quota required for the continued economic succes s of the State, and against the background of the offered useof the potential of cross -border co -operation in the health care of the States.The Baltic Sea region hereby offers a special opportunity. Within the framework of the EU strategy adopted in 2009 for the Baltic Sea region, thehealth care industry with the flagship project "Baltic Sea Health Region" ("ScanBalt Health Region") in the "Innovation" policy area is an important partof the action plan of the EU Baltic Sea strategy. From the State side,assistance for this flagship project is provided by BioCon Valley® GmbH andthe ScanBalt Liaison Office MV Germany established in Rostock in 2014 as a focal point for actors in the life science and healthcare sector in the Baltic Sea region. Within the context of the ScanBalt activities, BioCon Valley® alsocarries out among other things workshops and expert meetings andparticipates in the coordination of project initiatives and collaborations ontopics such as cross -border infection protection, eHealth, biomaterials,medical devices, as well as international clinical trials.However, the public health system in the Baltic States is very heterogeneouslyorganised. In Germany, the legal framework conditions for health care are setlargely at the federal level. Their guarantee is here primarily incumbent on theactors of health care provision: the outpatient care of the Doctors' Association and ensuring the inpatient care of the hospitals designated in the Statehospital plan. Comprehensive strategies and programmes for the promotion ofcross-border co -operation in the field of health care are therefore not primarytasks of the Federal States in Germany.With regard to the Baltic Sea region, there is a very different initial position depending on the State in terms of the economic, social, demographic and spatial conditions and the financing of the health system. Enhanced Baltic -wide co -operation in this area requires a comprehensive knowledge of therespective initial situation in the Baltic States. Transnational networks cancombine regional expertise and thus promote co -operatio n in selected areas.Paragraphs 15 and 16. (summary opinion)In the cross -border co -operation of the State of Mecklenburg -Vorpommern ,there are a variety of projects and structures in the fields of health care andprevention, which should be pointed out a t this point.In the area of tackling multi -drug resistant pathogens (MRE), the regionalAction Alliance HICARE brings together the development of innovativeintervention measures and strategies from over 40 research, clinical andeconomic and institutio nal partners in Mecklenburg -Vorpommern . The results- studies, developments, concepts, materials of the project - will sustainablyinfluence the handling and combating of MRE in the region and open up newnational and international methods of prevention or targeted interventions.Mecklenburg-Vorpommern P age 1211Against the background of growing international patient flows, a closer cross -border co -operation in the fight against dangerous hospital pathogens issought after. This was taken into account in HICARE from the outset, forexample , in the sister project "Baltic Alliance against Multi -Resistant Bacteria"(Baltic Amber), which was finished in October 2014 with submission of an EUproject funding application for the Horizon 2020 research programme.Participating, in addition to HICARE partners and other German institutions,were research institutions and companies from Denmark, Greece, UnitedKingdom, Italy, Lithuania and Sweden.14HICARE project partners are also active in the development of international co-operations. For example, the HICARE Partner Techniker Krankenkasseand the University Clinic in Greifswald agreed a cross -border co -operationwith the Polish hospital operator EMC Medical Institute for a joint MREmanagement, on the fringes of the 10th National Industry Conference f or theHealth Sector in May 2014 in Rostock. In the implementation of the co -operation project, the partners closely follow the action catalogues developedwithin HICARE. This includes the very restrictive and responsible use ofantibiotics in addition to risk-based screening.15 In addition, outpatient andinpatient care facilities should be better networked.All supported fields of work were completed by the end of the project fundingat the end of 2015. HICARE however remains a central point of contact forhygiene and infection control for the whole of Mecklenburg -Vorpommern . Itsupports the work of the regional sanitation networks as well as the StateOffice for Health and Social Affairs (LAGuS) which takes care of publicrelations and skills training. These activities are supported by a grant from the Damp Foundation.In Mecklenburg -Vorpommern , BioCon Valley® GmbH supports the exchangeof experience in the field of research and the fight against multi -drug resistantpathogens (MRE). BioCon Valley® acts not only as HICARE Project Office,but also organises international expert meetings and workshops under theumbrella of the life science and health sector "ScanBalt" network. Theobjectives are the formation of working groups and the development andapplic ation of common project proposals with partners from the Baltic Searegion.New technologies in bone healing are increasingly being used in the form ofimaging procedures, implants, medications, wound care or disposableinstruments. In order to exploit the potential for innovation in this area, 15project partners have agreed to co -operate within the framework of the "BFCC- Baltic Fracture Competence Centre" project.16 This project is financed by the"Baltic Sea region" EU INTERREG programme. The BFCC already now hasan excellent basis, with their leading partner Life Science Nord ManagementGmbH and 14 other project partners from the Baltic Sea region - including theUniversity Hospital of Schleswig -Holstein (UKSH), the Lübeck campus andStryker Trauma Gmb H from the Life Science Nord cluster - as well as with the14 The project proposal was rejected as a result, the co-operation in the field of combating the MRE willhowever be continued with partners from the Baltic region.15 In this context, please also note the opinion on paragraph 22.16 For information about the BFCC project, see http://www.interreg-baltic.eu/fileadmin/user_upload/about_programme/Cooperation_priorities/P1_Innovation/R001_Baltic_fracture_competence_centre.pdf .Mecklenburg-Vorpommern P age 1312Institute of Community Medicine at the University of Greifswald and 25 otherassociated organisations, to build a Baltic -wide platform for future co -operation and to advance innovation in the area of fracture management.In the field of health prevention, a collaboration has evolved in the German -Polish border region, which is funded by the "Mecklenburg -Vorpommern /Brandenburg / Poland" EU INTERREG programme. At this point, two projects in particular are worthy of note:The University clinic in Greifswald of the Ernst -Moritz -Arndt University ofGreifswald has been working since 2011 as a leading partner in a project ofthe German -Polish cross -border co -operation in the area of newbornscreening together with the Pomorska Akademia Medyczna in Szczecin, aswell as the Instytut Matki i Dziecka in Warsaw. The aim of this EU project was the establishment of a common cross -border newborn screening between theregional screening centres in Greifswald and Szczecin. Through the jointplanning, financing, organisation and implementation of the screening, itsquality could be improved, the range of recorded illnesses expanded and thecare of affected children improved. In this way, a Europe -wide visible modelregion was created for future collaborations in newborn screening. The co -operation was subsequently extended to include Cystic Fibrosis screening.Another network, which was developed within the framework of a cross -borderproject, refers to the subject of addiction prevention in the Euroregion of Pomerania. The prevention work of the Regional Office for Addiction Prevention and the conflict management of the University and Hanseatic town of Greifswald in collaboration with the universities of Greifswald and Szczecinwas established between 2009 and 2012 in child day -care centres, schools,high schools in the region of Greifswald, Szczecin and Kołobrzeg, as well as in underprivileged neighbourhoods.Furthermore, please refer to the activities of BioCon V alley® GmbH in co -operation with ScanBalt, presented in paragraph 13.Paragraph 18.The State Research Institute of Mecklenburg -Vorpommern Institute is workingwith partners in the Baltic Sea region specialising in various topics. A co -operation has existed since 2002 with Estonia on the cultivation of seabuckthorn, on the basis of which in autumn 2004 / spring 2005 a jointGerman-Estonian sea buckthorn varieties and cultivation trial was set up. Thisbrought many new insights to the cultivation and harvesting of sea buckthorn, however also raises new questions.In the field of fisheries, there is a co -operation with Sweden and Denmark in aresearch project on eels; a co -operation with partners from Poland and theBaltic States is being carried out in a project concerning sturgeon. On the topic of grassland management, there is a co -operation with the grasslandteaching chair at the Universi ty of Szczecin.Strengthening the ecological agriculture and food industry in the Baltic Searegion is the subject of the co -operation of the State with Estonia, Latvia andLithuania. In 2014 a collaborative project was implemented on this with thetitle " BalticEco" ("Strengthening Organic Agrifood Production in the Baltic SeaMecklenburg-Vorpommern P age 1413Region"), which was funded as an initiative project within the framework of theEU Baltic Sea strategy.Topics of the subsequent discussions on an operational level were:- Framework c onditions and promotion of organic farming;- Exchange of information on national regulations in organic farming;- Structure and functioning of the eco control system;- Implementation of legal provisions, including organic certification in thecatering indust ry;- Use of organic seeds and planting material.Due to the positive response, a co -operation agreement was concluded at theGreen Week in Berlin in 2015 between Mecklenburg -Vorpommern and Latvia.The essential content of this agreement is the closer co -operation in the areaof organic farming through:- Creation of a platform for exchanging further information on the framework conditions for organic farming;- Strengthening of the ecological control system through the exchange ofinformation and experiences of the respective competent regulatorybodies;- Co-operation in the field of research and innovation;- Provision of information for the ecological agriculture and food sector,including about research results and developed technologies;- Exchange of students in the field of organic farming;- Promotion of exchanges between environmental companies in theagriculture and food sector.Co-operation in the field of organic farming also extends to the countries ofEstonia and Lithuania. The Ministry of Agriculture, Environment and Consumer Protection has the ability to take over costs incurred under thisagreement in the budget title 'International co -operation'. Between the 23rdand 25th November 2015, a delegation of nine people from the three Balticcountries undertook a work visit to Mecklenburg -Vorpommern . A continuationof the project is planned and is mutually thematically organised at the operational level.Paragraph 19.The implementation of occupational health and safety in Germany is the responsibility of accident insurance institutions and the governmentaloccupational health and safety authorities of the States. The focus of the workof the accident insurance institutions is on prevention, the governmentaloccupational health and safety authorities operate mainly in a managerialcontext. In order to guarantee a uniform execution co -ordinated among theoccupational health and safety institutions, the National Occupational Health and Safety Conference is developing work programmes geared to therespective needs. Uniform enforcement aids are being developed for the workprogrammes and nationwide are being based on the work of the peopleresponsible for execution. The State Office for Health and Social Affairs of Mecklenburg -Vorpommern , as the enforcement agency, puts theserequirements into practice. A requirement -oriented exchange of informationtakes place with customs authorities responsible for the fight againstundeclared work. The work currently focuses on the areas of operationalhealth and safety organisation, muscle and musculoskeletal disorders and psychological stress in the workplace.Mecklenburg-Vorpommern P age 1514The Polish -German occupational health and safety dialogue has establisheditself in the field of cross -border co -operation. Since 2014 Mecklenburg -Vorpommern has also parti cipated in this exchange of information. Thedialogue is organised with the co -operation of the umbrella organisation of theDGUV (German Statutory Accident Insurance), the BASi (National Associationfor Health and Safety e.V.), CIOP -PIB (Centralny Instytut ochrony pracy -Państwowy instytut Badawczy), the BAUA (Federal Institute for OccupationalHealth and Safety), the State of Brandenburg and the Państwowa Inspekcja Pracy. It takes place every two years alternately in Germany or Poland. Within the context of this dialogue, cross -border issues of occupational health andsafety are discussed. For example, a working group of the dialogue with theparticipation of Mecklenburg -Vorpommern is currently working on acomparison between of the legal and technical requirements of both States indealing with asbestos. Core topics in this are the conditions for the approval of establishments in the two countries, the acquisition of the necessary materials and expertise, as well as the requirements for areas where asbest os ishandled. This is important in this respect, because German companies inPoland and Polish ones in Mecklenburg -Vorpommern are operating in thisfield. This year, Poland is the host country, in 2018, Mecklenburg -Vorpommern will organise the dialogue.Paragraph 23.The call for a reduction in the use of antibiotics in livestock is supported by theMinistry of Agriculture, Environment and Consumer Protection ofMecklenburg -Vorpommern . Appropriate measures have already been taken inGermany. Thus with the entry into force of the 16th amendment to theMedicines Act on 01 April 2014, a politically desired and legally standardisedantibiotic minimisation concept was implemented, in which the primarilyresponsible livestock owners must take the required measures in their operations, in order to keep their use of antibiotics to the necessary minimum.For this reason, as of 01 July 2014, affected livestock owners must reportconsumption data of antibiotics to the competent authority.If consequently an above -average frequency of therapy is determined, thecorresponding livestock owners must submit a treatment plan. Repeated exceedance of given thresholds could entail tough restrictions by the competent authority up to a ban on animal husbandry. The competentauthority in Mecklenburg -Vorpommern , the State Office of Agriculture, FoodSafety and Fisheries (LALLF M -V), is continuously concerned with theexamination of these treatment plans from the previous bi -annual inspection.Thus, an effective instrument has been created to achieve a long -termreduction in the use of antibiotics.Already before entry into force of the Act, monitoring of livestock (chickens,turkeys, pigs) had been conducted in Mecklenburg -Vorpommern since 2012with the aim of lowering antibiotic us e.Paragraph 26.The state of health of the population is the subject of research at the Instituteof Community Medicine (CM) at the University of Greifswald.17 It focuses onanalysis, intervention and evaluation at the local population level. TheCommunit y Medicine basic sciences are human and dental medicine,17 Institute of Community Medicine, University of Greifswald: http://www2.medizin.uni-greifswald.de/icm/index.php?id=19 .Mecklenburg-Vorpommern P age 1615epidemiology and biometrics, social medicine, demography, healthpsychology and medical informatics. The Community Medicine researchfocuses on analytical epidemiology and risk factor research, healt hcareresearch, health systems research and transfer research.As a result of population -related research and education in the region, newmodels should be developed and put into practice in the area of rationalhealth promotion, outpatient and inpatient care as well as rehabilitation andcare. The objectives of Community Medicine are the improvement of the quality of life of the population and the long -term security of medical care inthe region of Mecklenburg -Vorpommern.Health and economyParagraph 2 8.Against the background described in paragraph 13, comprehensive strategiesand programmes for the promotion of innovation in the field of health care arenot the primary mission of a Federal State. Therefore the initiatives of theState are primarily for bringing together the relevant actors in healthcare and thus contributing to solving healthcare issues.The "Concerted Action" initiated by the Ministry of Labour, Gender Equalityand Social Affairs of Mecklenburg -Vorpommern combines the expertise of thedifferent partners. Health insurance companies, the Association of StatutoryHealth Insurance Physicians of Mecklenburg -Vorpommern , the MedicalAssociation of the State, hospitals and regional politics are meanwhiledevelopin g new strategies for the future medical care of the population.The focus is on the medicine of the future being interdisciplinary and cross -sector, high quality, affordable and accessible for all citizens. At the end of 2014, within the framework of the concerted action, all participants agreed that the District of Vorpommern-Greifswald can serve as a model region for futuremedical care.An intensive exchange of information about possible co -operations andalternative approaches to healthcare took place on 10 July 2015 at a regional conference in Ueckermünde. Around 120 participants discussed among other things existing offers, better co -operation between inpatient and outpatientdoctors and health professionals as well as necessary skills acquisition.Paragraph 29.The ScanBalt strategy is supported by BioCon Valley® GmbH within thecontext of various activities. Please refer to the activities of BioCon Valley®GmbH in co -operation with ScanBalt, presented in paragraph 13.Paragraph 32.BioCon Valley® is in meetings with partners from the Baltic Sea region withregard to the establishment of a joint co -operation platform for eHealth.Horizon2020 offers, for example, funding opportunities for internationalresearch excellence in the area of eHealth / Healthy Ageing. Possible fundinginstruments and opportunities for co -operation were discussed on theoccasion of various workshops in Tallinn in November 2015, in Helsinki inJanuary 2016, as well as during the ScanBalt eHealth Accelerator days on 29.02.2016 in Copenhagen. BioCon Valley® regularly participates in such relevant specialist events.Mecklenburg-Vorpommern P age 1716Paragraph 33.See also the opinion on this from paragraphs 30 and 31.Paragraph 36.The Ministry of Agriculture, Environment and Consumer Protection advocatesa better labelling of food and in this context supports a project of theConsumer Association in Mecklenburg -Vorpommern e.V. The objective of themeasure is to exemplify the target group -oriented labelling of foodstuffs.Paragraph 37.Linking health services with tourism has been promoted strategically in Mecklenburg -Vorpommern for many years. Health tourism is a key area of the"2020 Master Plan for the Health Economy of Mecklenburg -Vorpommern ".18With the project "Interactive marketplace for health tourism resources in M -WP - product and market development as well as central information andexchange platform 2015 - 2018", a combined and tangible acquisition,presentation, support and mediation of health tourism services including consulting and booking possibilities, the promotion of development and expansion of health tourism offerings and corresponding state structures should be set up for the first time in the State of Mecklenburg -Vorpommern.Paragraph 38.The objective of a comparability of data from the health economy between the Baltic States is in principle to be welcomed. However, from the point of view of the Ministry of Economy, Construction and Tourism of Mecklenburg -Vorpommern this requires a common understanding regarding the conceptsand the boundaries of the industry.At the end of 2015, Mecklenburg -Vorpommern was the first German State toobtain an initial picture of the health economy in the categories of nationalaccounts (VGR) on the basis of national health accounts (GGR) and thus wasthe first State to submit comprehensive nationally comparable figures. Thecalculation made by the Economic Research Institute WifOR for Mecklenburg -Vorpommern is based on the research projects carried out for the Ministry ofEconomy and Energy and thereby also takes into account the recentmodification of the European system of national accounts. Within theframework of the project, which was carried out on behalf of the BioConValley® GmbH, the Inst itute examined and presented the importance of thehealth economy sector for economic growth, employment and foreign trade aswell as the integration of heterogeneous industry with the overall economy inMecklenburg -Vorpommern . Further emphasis was placed on the differentiatedview of the mid tier within the health care industry. The published resultsrelate to the year 2014.The expertise of the Economic Research Institute WifOR, from the point ofview of the Ministry of Economy, Construction and Tourism, also appears to be appropriate for making calculations for the Baltic States on the basis of the research projects carried out.Sustainable and accessible social and healthcare services18 The master plan for the health economy 2020 in Mecklenburg-Western Pomerania is available online at:http://www.regierung-mv.de/Landesregierung/wm/Service/Publikationen?id=3762&processor=veroeff .Mecklenburg-Vorpommern P age 1817Paragraph 42.Measures for ensuring an equitable use of public welfare and health services,better health care in rural areas, as well as measures to improve the conditions for nursing and health professions are welcome. They can help to compensate for existing structural differences in the border regions.The State Government of Mecklenburg -Vorpommern is eager to take intoaccount for future measures the fair distribution, fair access and fair use of public welfare benefits. A first approach of the State Government of Mecklenburg -Vorpommern is for the Ministry of Labour, Gender Equality andSocial Affairs to receive the assignment to check to what extent, given the ongoing demographic changes, existing counselling services for various targetgroups can and must be linked or matched and optimised. The objective is toreshape the heterogeneous and partially small -scale consulting landscape insuch a way that public welfare facilities are equally available to all citizens of the State. This means a community -based accessibility with good transportlinks or the creation of conditions that allow for mobile or outreach support.Rural areas require special attention in this respect. The Ministry ofAgriculture, Environment and Consumer Protection of Mecklenburg -Vorpommern has determined the assurance of the quality of life in rural areasas a strategic focus in the development programme for rural areas (EPLR M -V2014 -2020).19 The focus on demographic processes of change was explicitlycalled for by the districts which are responsible for integrated ruraldevelopment in implementation of the EPLR M -V. The same applies to theLEADER strategies. The regional actors are particularly well suited to developing customised strategies for their respective territories.Hereby, both the guarantee of public services and the economic structur aldevelopment of the region are recognised. In especially peripheral rural areas,alternative forms of use are additionally supported and funded throughLEADER, for example, the linking of different public services in so -called"multiple houses".Paragraph 44.An Advisory Committee was formed under the auspices of the Ministry of Labour, Gender Equality and Social Affairs to achieve the objectives set in 2011 in the Geriatrics plan of Mecklenburg -Vorpommern.20 It has the task ofadvising the Ministr y of Labour, Gender Equality and Social Affairs andsubmitting recommendations for the further development of Geriatrics. Arequirement of the Geriatrics Advisory Council is the establishment of aprofessorial chair for Geriatrics in Mecklenburg -Vorpommern . At theGreifswald university clinic, lectures are now offered in Geriatrics.The lack of Geriatrics experts in outpatient rehabilitation is considered to bemajor problem. One solution better adapted to the State was already able tobe found for outpatient geriatric complex treatment, which the StateGovernment has put a lot of energy into, such as for example through the healthcare centre for outpatient geriatric complex treatment "Pro mobil" in19 The development programme for rural areas (EPLR M-V 2014 -2020) is available online at:http://www.europa-mv.de/cms2/Europamv_prod/Europamv/de/_Dokumente/EU_Foerderinstrumente_2014_2020/ELER/2015-02-13_EPLR_MV_genehmigt_13.02.2015.pdf .20 The Geriatri cs plan of the Mecklenburg-Western Pomerania is available online at: http://www.regierung-mv.de/Landesregierung/sm/Service/Publikationen?id=4543&processor=veroeff .Mecklenburg-Vorpommern P age 1918Waren/Müritz. The AOK is currently evaluating the three exi sting contracts forthis form of service.Emphasis must continue to be first placed on prevention and health promotion, in order to maintain the quality of life in one's own home as long as possible. An important goal of the "State action plan for health promotion andprevention" is to discover and to use appropriate community -based potentialsand above all provide information about the offerings. The "Action group forhealth" has created a suitable platform together with the working group "Healthy ageing i n Mecklenburg -Vorpommern ".21A "Geriatric outpatient clinic" (GIA) pursuant to § 118a of the SGB V has not yet been established in Mecklenburg -Vorpommern , since the allocationprocess is not sufficiently ensured from the perspective of the potential operato r.In Mecklenburg -Vorpommern , there are 32 places available for semi -inpatientcare in three day -clinics.Paragraph 45.Paediatric healthcare is basically secured in Mecklenburg -Vorpommern . Bothoutpatient and inpatient paediatricians, as well as the yout h-medical servicesof the health authorities also provide a child -friendly range of health careservices. Through a system of screening from infancy up to adolescence, certain risks can be detected in good time. An early treatment and earlyintervention for identified or potential health problems is possible inspecialised facilities with specially trained medical and therapeuticprofessionals. The early intervention includes medical and non -medical socialpaediatric, psychological, curative educational and psychosocial assistance.The rehabilitation funding bodies are responsible. For education of childrenwith disabilities or threatened by disability, in Mecklenburg -Vorpommern , thereare special curative education early intervention centres / interdiscipli naryearly intervention centres (IFF) and social -paediatric centres (SPC).In Mecklenburg -Vorpommern , there is also a well -developed network ofchildren's daycare, including some bilingual child daycare centres in the border region.Paragraph 46.In Meckl enburg -Vorpommern , there is a developed and professionallyoperating network of consulting, support and meeting facilities and offeringsfor families. These are multifunctional family centres, parent -child centres,multi-generation houses, recognised State institutions of further education(family educational centres), family midwives as well as pregnancy (conflict)counselling centres and marriage, family and life counselling. Also within thecontext of federal initiative networks for early intervention and familymidwives , offerings for families were developed in a targeted and demand -orientated manner in the districts and cities. The portalswww.familienbotschaft -mv.de and www.familienhebammen -in-mv.de informfamilies and assist them in finding appropriate information so that they can make use of their support and educational missions accordingly. Furthermore,the State supports couples with infertility issues.The specified offers aim in particular to provide needs -based support forfamilies in their different life stages. A focal point in the past two years was21 For more on the "Action group for health", see http://www.aktionsbuendnis-gesundheit-mv.de .Mecklenburg-Vorpommern P age 2019family education. The country has supported and accompanied the localpublic youth organisations in the performance of their planning and controlfunctions with regard to the promotion of education in family, so that the focus will be placed more firmly on social space -oriented offerings.The specified offers are open to all families in Mecklenburg -Vorpommern . Inthe border region, in part some families from the Baltic States can participate.Paragraph 48.Many schools in Mecklenburg -Vorpommern have developed successfully fromthe point of view of individual resource strengthening for a healthy way of life. The State programme "Good healthy school" was established to make schoolhealth promotion holistic and sustainable. About 100 schools haveimplemented health promotion and disease prevention models in their school programmes. Children and young people in the school should be enabled to develop a positive self -image, in order to live and act healthily with socialresponsibility and increasing self -determination. The educational andpedagogical development of school -based health promotion has for yearsbeen developed and stimulated significantly by external actors in the healthcare sector, such as health insurance companies, associations, foundations and other partners in the health sector.The administrative regulations of the Ministry of Education, Science andCulture of Mecklenburg -Vorpommern on health education, addiction andviolence prevention in State schools is the essential working base for theschool management, in addition to the recommendations of the Conference ofMinisters of Education on health promotion and prevention in the school. Support teachers for health promotion and prevention provide active support in State Education Authorities. They instruct the schools locally to link thehealth issues with the school development and quality management, as wellas the initiation of self -evaluation, advise and support the teachers in thecreation and implementation of projects and create networks with externalpartners for the relevant school jurisdiction.About ten percent of all schools in Mecklenburg -Vorpommern alreadyreceived the certificate "Good healthy school". More schools are striving forthe certificate and are in the auditing process. Conditions for the receipt of the certificate are participation in the State programme "Good healthy school" and fulfilment of quality criteria for holistic and sustainable health promotion andprevention in the school.The following measures have been initiated and carried out in the field ofhealth promotion and prevention:- Boosting nutritional expertise and improving quality in school catering- Prevention of dependency behaviour (smoking, project offerings foraddiction, alcohol and drug prevention, as well as offerings on thetopics of cyber-bullying and media addiction).- Prevention of psychological stress, especially in the field of stressmanagement.The schools of the State exhibit a variety of examples of best practice, whichcan be provided if necessary for a database. They can possibly contribute tothe projects becoming better known and complement the functioning local networking, which is the basis for successful health promotion.Mecklenburg-Vorpommern P age 2120Paragraph 50.Acute psychiatric emergencies are taken care of by the rescue services,emergency services of the Association of Statutory Health Insurance Physicians and the emergency ambulances of the psychiatric hospitals. In addition, there are the social -psychiatric services of the health authorities thatperform home visits during normal working hours.For victims of violent crimes, trauma clinics are available at six locations in Mecklenburg -Vorpommern for adults and at five locations for children andadolescents in spatial and organisational proximity to the Psychiatric Institute Clinics that also treat emergencies.Paragraph 51.The full -day working schools (full half day schools and day schools) havedeveloped into learning and living places for the children and adolescents,where a versatile and colourful extra -curricular school life has establisheditself. Additional educational, leisure and care services complement theteaching. Full -day learning offers more time for individual promotion andsupport, for exploration and discovery, gives everyone the chance of equalityof education and opportunity.The opening of the school in this context is indispensable for its urban environment. The use of the full -day budget since the beginning of the schoolyear 2014/2015 enables binding long -term co -operation with non -schoolpartners, in particular in the areas of youth work, sports, culture, education orthe environment. The range of full -day offerings and their attractiveness toeach school will be significantly extended thereby and the educational missionof schools supported.Starting with the academic year 2015/2016, the State is stepping up thequantitative expansion and the qualitative further development of full -daylearning through the provision of additional financial resources.Paragraph 53.Social partners and trade unions are substantially negotiating wage andworking conditions in Germany. Their involvement in regulatory andimplementation processes in the healthcare sector is thematic.Paragraph 54.The wo rk of the health and safety bodies currently focuses on the areas ofoperational health and safety organisation, muscle and musculoskeletaldisorders and psychological stress in the workplace. Here concerted actionswith regard to inventory management, prevention, advice and enforcement ofoccupational safety and health regulations preferably in small and medium -sized enterprises (see also the opinion in paragraph 19.) currently take placebetween the institutions.Paragraph 55.The second section of the M ecklenburg -Vorpommern State Hospital Actregulates the patient rights in §§ 4 -8. For the care of patients insured abroad,the policy 2011/24/EU contains the rules on the reimbursement of costs foroverseas treatment. These can be found in § 13, paragraph 4 and 5 SGB V.Other important provisions of the policy were implemented by the PatientRights Act. The national contact point in Germany, located with the GermanMecklenburg-Vorpommern P age 2221Liaison Office for Health Insurance Abroad (DVKA), became operational on 25October 2013.22Paragraph 56.In its capacity as co -ordinator of the policy area for tourism in the EU BalticSea strategy, the Ministry of Economy, Construction and Tourism inMecklenburg -Vorpommern is available as a dialogue partner for the 24thBaltic Sea Parliamentary Conference working group for sustainable tourism.The first meeting of the Working Group on 13 November 2015 was supportedby a presentation, with an emphasis on the implications of sustainability in the implementation of the EU Baltic Sea strategy. It thereby referenced the varietyof existing knowledge for sustainable tourism development in the Baltic Searegion, which should be used as a basis for work. The focus of the work should be on a results -oriented approach aiming to promote sustainabletourism development in the Baltic Sea regions.With a view to the EU initiative for blue growth23, the EU strategy for growthand jobs in coastal and maritime tourism24 and the agenda for sustainableblue growth in the Baltic Sea region25, economic growth and sustain abledevelopment are inextricably linked, in particular in the Baltic Sea region. Potential is seen for sustainable blue growth in the tourism sector, especially in coastal and maritime tourism. With the updated version of the action plan ofthe EU Baltic Sea strategy,26 the tourism sector is also increasingly focusedon coastal and maritime tourism in the Baltic Sea region.22 German Liaison Office for Health Insurance Abroad (DVKA): https://www.dvka.de .23 European Commission, COM(2012) 494 final.24 European Commission, COM(2014) 86 final.25 European Commission, SWD(2014) 167 final.26 European Commission, action plan on the EU strategy for the Baltic Sea region, SWD(2015 ) 177 final, 10September 2015.NorwayNorway P age 21Norwegian comments to the Resolution of the 24th Baltic Sea ParliamentaryConference (BSPC) in Rostock 30 August – 1 September 2015With reference to the set of follow -up questions to the recommendations contained in theresolution of particular common interest as highlighted by the BSPC Standing Committee ,information of measures and actions that have been implemented or in some casesplanned is the following:Preambl e:• to ensure the decent treatment of the refugees especially concerning housing and healthcareIn the first stage, accommodation is offered to all asylum seekers in Norway, usually a placein a reception cent er. Asylum seekers who stay in a reception cente r receive financialassistance during their stay if they do not have money.If the asylum seekers staying at reception cent ers have expenses for medicine or medicaltreatment that is necessary for their life and health, they can apply to have these expensescovered. Those choosing to stay outside a reception cente r will not receive any cashallowances, but will receive necessary medical care.Asylum seekers in Norway have the same rights to health care services as Norwegian citizens.In the second stage, a foreigner, who has been granted a residence permit as a refugee or withhumanitarian status, enjoys full freedom of movement. In principle, s/he may choose to settle wherever s/he wants. However, initially most of them will depend on public assistance to find suitab le housing and to ensure their subsistence needs. Those who depend on assistance, haveto settle in the municipality that accepts them.The Norwegian municipalities are sovereign when deciding on the number of refugees to accept if the person will require assistance. The municipalities are responsible for findingsuitable accommodation for refugees who cannot find housing on their own. Themunicipalities receive a government grant of a fixed sum per refugee over a five -year period.There are additional gra nts for some unaccompanied minors, and for elderly and handicappedpersons.Paragraph 4• co-operate in order to strengthen the Baltic Sea Region as an importantcompetitive knowledge region with an excellent higher education andresearch infrastructureNorway participates in the European cooperation on equipment, laboratorie s and databases,described in the Roadmap of the European Strategy Forum on Research Infrastructures(ESFRI ), where Baltic Sea countries are members.Norway is hosting three infrastr uctures covered by this Roadmap: ECCSEL (Carbon captureand storage, CESSDA (cooperation on scientific databases) and SIOS (Observation system atNorway P age 32Svalbard of atmosphere, land, ocean and ice). Norway is member of several other Europeanresearch infrastructu res.Many ESFRI -projects are organised as European Research Infrastructure Consortium (ERIC),which was included in the EEA Agreement in 2015. The ERIC - regulation was adopted asNorwegian law in autumn 2015.The Norwegian Research Council has prepared a Norwegian Roadmap for infrastructure,describing projects that are ready for investment, being quality checked and of nationalstrategic importance . The Roadmap does not provide any guarantee for financing. Eachproject has to apply for financing through available sources, mainly provided by theNorwegian Research Council, the most important financial source for research infrastructurein Norway.The European Spallation Source (ESS) in Lund, Sweden , is probably the largest researchinfra structure projec t in the Baltic Sea Region , with Sweden and Denmark most heavilyinvolved. Norway together with Pol and and the Baltic States are also activ ely involved.Norway participates in cooperation on higher education, including the project Euro FacultyPskov, which is now subject to final evaluation. In order to develop the Baltic Sea Region intoa competitive knowledge region , Norway is also engaged in ongoing discussions withinCBSS to explore the potential to build networks and partnerships on higher education,research and innovation.Paragraph 8• to continue work to upgrade reception facilities for sewage in passenger ports to ensure a timely activation of the special area status of the Baltic Sea under Marpol Annex IV of the Internationa l Maritime OrganizationNorway is a driving force in developing a good international framework for climate and environmentally friendly shipping. Norwegian ports can offer adequate reception facilities,and we will have the needed focus on this topic in o rder to assure that needed capacity andavailability is in place to accommodate the need of ships to deliver sewage to shore.Norway , having long experience with climate and environmental friendly shipping anddeveloping green ports , will continue cooperating to develop green ports in the Baltic Searegion.Recommendations with regard to cross-border cooperation in healthcareParagraph 20•to improve transnational cooperation and medical specialization in thetreatment of rare diseases, bearing in mind the cost -effective usage ofmedical equipment;Norway P age 43Treatment of rare diseases profits from international cooperation because of small patientpopulations in each country. Knowledge base strengthens, giving better treatment andpatien t safety. Similarly cost - effectiveness regarding implementing new drugs andmedical equipment benefits from international cooperation, according to principles forHealth Technology Assessments (HTA).In EU countries, any disease affecting fewer than 5 people in 10 000 is considered rare. Norway's definition 1 in 10 000.Norway is a member of The Commision Expert Group on Rare Diseases and The Nordic Council of Ministers' "Nordic Network on Rare Diseases," supporting international cooperation, coordination and reference networks, more research into rare diseases and rare d iseases registries.Paragraph 21• to regulate transnational emergency care in a way that the fastestpossible healthcare provision can be guaranteed regardless of thehealthcare providers ́ country of originAll persons staying in Norway are entitled to r eceive emergency care. If a member of theNorwegian Social security insurance (Folketrygden) receives healthcare in another EEA country, the patient can use the European Health Insurance card. If the patient has not used the mentioned card, the costs can b e reimbursed up to the costs of the equivalenthealth care services in Norway, cf. Regulation on reimbursement of health care services received in another EEA State. The main condition is that the health care is the same orsimilar to the treatment the patient would receive by the public in Norway.The Russian Federation is a CBSS country which is not member of the EEA. An agreement "regarding emergency and planned medical transportation in the b orderadjoining countries – Finnmark and Murmansk oblast" was concluded between theNorthern Norway Regional Health Authority and the health authorities in Murmanskregion in 2010. The agreement has since been successfully exercised with Russian andNorwegian ambulances crossing the border. The latest exercise was a rranged inNovember 2015.Paragraph 22• to reduce the usage of antibiotics – general – and for agriculture(livestock farming to a minimum in order to prevent further increase of antimicrobial resistanceWHO's Global action plan on antimicrobial resistance was approved by the World Health Assembly in May 2015. Member States have agreed to implement the plan. A new EUaction plan is now under way. The Nordic countries and Estonia are members of the EUJoint Programming Initiative on Antimicrobial Resistance . It would strengthen theresearch cooperation in this area if also other countries in the region would join. TheNorway P age 54Norwegian cross -sectoral strategy against antibiotic resistance (2015- 2020) was releasedin June 2015 , and action plans for the health sector as well as for the agricultural sectorhave been published. Norway is willing to further strengthen the cooperation in this field,but due consideration has to be made in order to avoid overlap with other existinginitiat ives as mentioned above.Recommendations with regard to Health & EconomyParagraph 31• improve conditions to support the development of innovations in health care, including in the fields of eHealth and telemedicine, whilst ensuring that investments in eHealth support the adoption of standards and driveinteroperability across the health sector to leverage the “eHealth European Interoperability Framework” (eEIF) and observe the jointEuropean initiatives, such as the “Guidelines under eHealth Network” ofthe responsible member stat e authoritiesWe strongly support the continued work to support and strengthen the medical and care professionals through use of eHealth technologies. Norway has been a forerunner indigitizing the health and care information, and are now taking on the more difficult taskof transforming the health and care delivery model through use of ICTs and eHealth.Norway closely follows up Europea n initiatives in eHealth, and is a member of theeHealth Network and the supporting Joint Action, promoting Europe- wide guidelines andinternational standards for eHealth. We recognize the challenge of aligning health and care service processes in a cross border setting, and we are targeting services providingpatient centered value, supporting the vision of the empowered patient.Paragraph 34• to improve early intervention to strengthen good public health throughsocial investment such as vaccine programs, and take strong measures to reduce consumption of alcohol, tobacco and illicit drugs, and work towards stronger prevention of diabetes II and other lifestyle illnessesThe Northern dimension partnership in public Health and Social wellbeing (NDPHS)adopted in December 2015 a new strategy s 2020 - with the aim to Promote sustainabledevelopment in the Northern Dimension area through improving human health and social well-being. NDPHS is covering all the states participating in the Baltic Sea parliamentaryconference. Seven expert groups covering different specific issues are set up. One of the objectives of the strategy is - "Reduced social and health harm from alcohol, tobacco andillicit drug use through strengthening and promotion of multi sectoral approaches"The alcohol and Substance abuse expert group are working along four main tracks.i) Exchange of experience and new knowledge on population level approaches toprevent alcohol, tobacco and drug related harmii) Encourage the improvem ent of local level prevention work on youthNorway P age 65iii) Preparation of the 12th Partnership Annual Conference Side event that will takeplace in Tallinn, Estoniaiv) Develop cross -disciplinary meetings of expertsEarly intervention is a priority area in several ministries and sectors, from early childhoodto elderly , often more universal and less symptom oriented.One of the main goals of the Substance Use A ction Plan is to ensure that persons indanger of developing a substance use problem must be identifi ed and helped at an earlystage.Paragraph 39• check the possibility to establish a “Baltic Health Forum”, to ensure and improve a sustainable exchange and networking in this policy field around the Baltic SeaNorway collaborates with the Baltic Sea countries w ithin the Northern DimensionPartnership in Public Health and Social Well -being (NDPHS). The NDPHS , established in2003, has since 2009 had a formal role as the priority area coordinator for health underEU's Balti c Sea Region Strategy (EUSBSR). The NDPHS provides a suitable arena forsustainable exchange of knowledge in the field of health care and innovation, andfacilitates networking among professionals and decision makers around the Baltic Sea.Recommendations with regard to Sustainable and Accessible Social - andHealthcareParagraph 39• to develop and strengthen strategies addressing demographic change, such as the European Innovation Partnership on Active and Healthy Ageing and especially considering public services with regard to rural peripheral areasThe Norwegian Government has launched a strategy for active ageing, called "More Years– More Opportunities". The strategy is basing on a multi sectorial platform for developingan age -friendly society. The demographic changes and increasing longev ity is changingour society and the local communities. An active ageing policy implies that we must domore than making a sustainable pension system and a health system for providing long -term- care. The present and coming older generations will have better resources thanprevious generations to have an active ageing. By giving senior citizens the opportunitiesto participate in work and society longer, their life quality and autonomy can be maintained longer. The strategy shows how we must change our mind-s et about ageing,and how we can use the potential in social and technological innovations for promoting active ageing. (An English translation of the strategy will be published end of May).Paragraph 49• to carry out studies with the aim of developing prevention strategies inhealth care, such as the North -Trøndelag Health Study (HUNT)Norway P age 76The Norwegian Ministry of Health and Care Services gives financial support to twopopulation based health studies. The 4th North -Trøndelag Health Study (HUNT) which iscarrying through from 2017, and the 7th Tromsø Health Study which is carrying throughduring 2016.Through the Research Council of Norway, the Ministry is financing a new Public HealthProgram running for the period 2016-2025, replacing a few former programs.Paragraph 52• to create incentives to improve the conditions of the nursing and careprofessions and to work towards intensified professional and vocational training for people employed in the health sector to significantly facilitate a cost -effective health system in the region and foster understanding ofthe health sector as a cross -cutting issueThe government has established an action plan for recruitment, competence and professional development in the municipal health and care, Competence Plan 20 20. Thepurpose of the plan is to contribute to professional services, and to help ensure that the municipal health and care services have sufficient and competent personnel. The planconsists of a series of measures.PolandPoland P age 2INFORMATION ABOUT THE IMPLEMENTATION IN POLAND OF THEPROVISIONS OF THE 24TH BALTIC SEA PARLIAMENTARY CONFERENCERESOLUTIONPreamble:(to ensure the decent treatment of the refugees especially c oncerning housing andhealthcar e)Individual Integration Programmes (IIP):A foreigner who has a refugee status or who is covered by subsidiary protection is provided with, for aperiod not exceeding 12 months, assistance to support his/her integration with the society, according tothe procedure and in line with the rules laid down in the Act of 12 March 2004 on social assistance. Theintegration assistance is granted at the request of the foreigner, submitted via a poviat family assistance centre to the staroste competent for the place of residence of the foreigner.The integration programme has a form of an agreement between a foreigner and a poviat familyassistance centre. The programme comprises financial support for maintenance and covering ofexpenses related to learning Polish, in the amount from PLN 600.75 to PLN 1335 per person, payment ofhealth insurance premiums, social work, specialist counselling (including legal advice, family and psychological counselling), provision of information and support in contacts with institutions, inpartic ular labour market institutions, local community and non -governmental organisations, and allother activities that may prove necessary.Assistance for the foreigner is provided under an individual integration programme agreed between thepoviat family assistance centre and the foreigner. The programme specifies the amount, scope andforms of assistance, depending on the individual life situation of the foreigner and his/her family. It also includes commitments on the part of both the foreigner and the poviat family assistance centre.The poviat family assistance centre undertakes to provide the foreigner with information on assistancelaid down in the programme and the conditions of its suspension or refusal, cooperate with a foreignerand support him/her in contacts with the local community, including in establishing the contact with thesocial assistance centre competent for the foreigner’s place of residence, provide assistance in obtainingaccommodation, if possible, in a protected apartment, conduct social work with the foreigner and other agreed activities resulting from the individual life situation of the foreigner, to appoint an employee,hereinafter referred to as the “programme executor”, who will arrange the programme with theforeigner and will support the foreigner during the programme implementation.Poland P age 3The foreigner undertakes to register at the place of residence, register at the poviat labour office withinthe period specified in the programme and actively search for a job, participate in obli gatory Polishlanguage courses, if necessary, cooperate and contact the programme executor at agreed dates, at leasttwice a month, perform other activities agreed with the programme executor and resulting from theforeigner’s individual situation and comp ly with the commitments under the programme.Paragraph 8The work to upgrade reception facilities for sewage in passenger ports continues to ensure a timelyactivation of the special area status of the Baltic Sea under MARPOL Annex IV of the InternationalMaritime Organization, with the aim to hinder the release of untreated sewage from passenger ships inthe future and to reaffirm the commitment for the continued improvement and modernization of thewaste water treatment capacity throughout the entire Baltic Sea Region, in compliance with the stricterthreshold values agreed by HELCOM.In order to achieve these goals several initiatives were undertaken on the regional (under the auspicesof HELCOM) and national level:- On the national level measures in order to upgrade port reception are envisaged underNational Programme of measures under the Marine Strategy Framework Directive. The aim isto constantly monitor the needs of ships calling at the first priority Polish ports and terminalsand to provide adequate facilities for ship generated waste and guarantee that their operation do not cause undue delay to ships. PRF capacity will be adjusted to meet any future needs asappropriate.- Polish representatives also participate in works of subgroup on Port Reception Facilitiesestablished in 2015 under the European Commission’s European Sustainable Shipping Forum(ESSF). The subg roup role is to facilitate Commission’s works of improving implementation andoperation of the Directive 2000/59 on Port Reception Facilities for ship generated waste andcargo residues.- National correspondence and working group on port reception facilities was also establishedin 2015. The participants to the group are representatives of Ministry of Maritime Economy,maritime offices, port authorities, ports waste operators and representatives of scientificinstitutions. The aim of the group is discussion on technical and legal issues related to collectionand management of ship generated waste at ports.Paragraph 9enhance macro -regional capacity to respond to major emergencies based on all -hazards approach andjoint, cross -border preparations to protect lives, health and wellbeing of citizens.HELCOM countries organize yearly international oil spill response exercises BALEX DELTA. The generalobjective of the exercises is to test the procedures documented in the HELCOM Response manual andrespo nse capability of the Contracting Parties in case of a major accident and an international responsePoland P age 4operation. In 2015 the exercise was organized in Poland by Maritime Search and Rescue Service (SAR)and State Fire Service.The capacity to response to oil pollution in the Baltic Sea region will be additionally enhanced with anew European Maritime Safety Agency (EMSA) system of Equipment Assistance Service (EAS) for vesselsof opportunity established and a deposit in the Baltic Sea, close to Gdansk with mob ilization of 12 h.There will be a familiarization of the contents during autumn 2016 and training offered later on.Paragraph 10. to strengthen and further develop HELCOM as the main coordinating body in the effort toprotect the Baltic marine environment, and to strongly support the implementation of the Baltic SeaAction Plan (BSAP), and to stress the importance of BSAP as the environmental pillar of the EU Strategyfor the Baltic Sea Region.HELCOM countries actively participate in the Second Holistic Assessment of THE Ecosystem Health Ofthe Baltic. The HOLAS II project will give an update on the overall state of ecosystem health in the BalticSea. The assessment will follow up on the goals of the Baltic Sea Action Plan. It will be developed so thatthe results will also support reporting under the EU Marine Strategy Framework Directive (MSFD) bythose Contracting Parties to the Helsinki Convention that are also EU member states. The project willdevelops common concepts and methods for status assessment and performs assessments at regionalscale. The first assessment results will be released by mid-2017. The report will be finalized by mid- 2018.Poland implements the National Programme for municipal wastewater treatment (Krajowy programoczyszczania ś cieków komunalnych – KPOŚK). 376 new wastewater treatment plants were built between2003 and 2014. However, most investments concerned expansion and modernization of already existingwastewater treatment plants. 1206 of such investments were completed unti l 2014, 110 of which in2014. 76 169 km of sewage network were built under the National Programme. From 2003 to 2014 theimplementation cost for tasks included in the National Programme amounted to about 55.9 billion PLN(ca. 14 billion EUR), of which abou t 39.2 billion PLN (ca. 10 billion EUR) was allocated to the collectivesewage systems.The tables below present the length of constructed sewage network and a list of capital expenditures indifferent years.Table 1. The length of the sewage system built in the years 2003- 2014The length of the sewage system built between 2003- 2014 (in km)2003 -2011 2012 2013 2014 Total56 215 7 239 6 409 6 306 76 169Table 2. Capital expenditures from 2003 to 2014Capital expenditures from 2003 to 2014 (in million PLN)Year Municipal sewage treatment Collective sewage systemsPoland P age 5plants2003 -2005 2 352.80 5 223.902006 762.50 1 848.002007 985.10 2 226.102008 1 218.50 3 325.602009 2 478.50 4 800.002010 3 028.30 5 031.602011 1 774.00 5 414.102012 1 282.90 4 515.202013 1 160.80 3 149.602014 1 701.30 3 684.30Total 16 744.70 39 218.4055 963,1[Data for 2015 is not yet available]Poland implements the National Programme according to the requirements defined in the Regulation ofthe Minister of the Environment of 18 November 2014 on the conditions to be met for discharge ofwastewater into waters or ground and on substances particularly harmful to the aquatic environment(Official Journal of 2014, position 1800). They reflect the requirements of the Wastewater TreatmentDirective 91/271/EEC, which is less stringent than similar recommendations made by HELCOM.---------------Response from the Ministry of Health(Paragraph 14.)The Ministry of Health undertakes its activities Regarding Cross- border Co -operation inHealth Care from the Conference Resolution adopted by the 24th Baltic Sea ParliamentaryConference by participating in NDPHS.The Ministry of Health carried out the procedure for the signature of Agreement between theGovernment of the Republic of Estonia, the Government of the Republic of Estonia, theGovernment of the Republic of Finland, the Government of the Federal Republic of Germany, the Government of the Republic of Iceland, the Government of the Republic of Latvia, theGovernment of the Republic of Lithuania, the Government of the Kingdom of Norway, theGovernment of the Republic of Poland, the Government of the Russian Federation and thePoland P age 6Government of the Kingdom of Sweden on the Establishment of th e Secretariat of the NorthernDimension Partnership in Public Health and Social Well -being, NDPHS.The Agreement c ame into f orce for Poland on January 8th , 2016 .Poland was participating in the NDPHS from its establishment during ministerial meeting in Osloin 2003, without signing the Agreement on establishment of the Secretariat its role in thePartnership was limited. Some Polish experts and their alternates were changed to selectpeople really engaged, interested and fully operational in the active work of NDPHS expertgroups.Signing the Agreement obliges the Ministry of Health to pay annual country contributions.Moreover MoH provide s the necessary funding for the effective participation of Committee ofSenior Representatives and the Expert Groups Representatives.Polish expert are active in the following expert groups:• Expert Group on Antimicrobial Resistance (AMR EG) ;• Expert Group on Alcohol and Substance Abuse (ASA EG);• Expert Group on HIV, AIDS and Associated Infections (HIV, AIDS&AI EG);• Expert Group on Non -communicable Diseases (NCD EG);• Expert Group on Occupational Safety and Health (OSH EG);• Expert Group on Primary Healthcare (PHC EG)Poland has no representation in the newly created Expert Group on Prison Health .Polish expert is co-Chair the Expert Group on HIV, AIDS and Associated Infections .Polish Ministry of Health and public health institutions hosted several meetings of expertsgroups (ASA EG – 19-20.04.2016, HIV, AIDS&AI EG - 3-4.03.2016, PHC – 19-20.03.2015,OSH EG – 4.06.2014).Recently the groups were active preparing the input to the NDPHS Strategy 2020 adopted 5June 2015 and Action plan accompanying Strategy 2020 adopted 28 September 2015.The NDPHS Strategy 2020 is a guiding instrument assisting the partner countries andorganisations in their joint efforts to achieve improvements in the chosen priority areas. It aimsto strengthen the recognition of health and social well -being on the political agenda in theNorthern Dimension area and to ensure a broader stakeholder commitment to include theaspects of health and quality of life in policy -making.The expert groups prepare the projects to implement the goals of strategy and action plan whichunderline the importance of actions addressing regional challenges and producing tangiblePoland P age 7results with measurable impact. Effective implementation of the Action Plan requires allocationof funds. The NDPHS Secretariat informs the groups about funding opportunities for regionalhealth and social well -being projects.The NDPHS activiti es answer the following points of Resolution.Paragraph 22.Intensify exchanges of experience and cooperation with the aim of fighting antimicrobialresistance as one of the main global challenges in health care, to implement research in thisarea, and support and intensify all efforts to develop and implement a global action plan onantimicrobial resistance by WHO.Polish expert is the one of partners in a collaborative European research project NoDARS -Northern Dimension Antibiotic Resistance Study . NDPH S Secretariat is the lead partner of theproject. This 3 -year project, which is co -financed by the European Union, has been started inOctober 2014. The aim of the study is to determine the levels of specified antimicrobialresistance in Escherichia coli bacteria isolated from uncomplicated urinary tract infections (UTIs)in patients attending primary health care centers. Moreover, the penetration of antimicrobialresistance in the population (healthy individuals) will be examined by determining the carria gerate of ESBL - and carbapenemase -producing E. coli and Klebsiella pneumoniae in communitycarriers. The obtained results will be used to assess current national recommendations ofempirical antibiotic therapy and antimicrobial resistance strategies, as well as to suggest properchanges. The objective is that treatment recommendations for uncomplicated UTIs will be based on actual resistance levels to a larger extent. Such recommendations may make itpossible to avoid unnecessary use of broad -spectrum antibiotics in empirical therapy and slowthe development and dissemination of antibiotic resistance.- AMR EG has been preparing a new project on the implementation of the Global AMRSurveillance System (GLASS) (recommended by WHO) in EU countries .Paragraph 34.Expert Group on Alcohol and Substance Abuse (ASA EG) undertakes the activities to reviewthe nature and extent of the problems caused by alcohol in partner countries, prevalence andimpact, and the opportunities and possible constraints in establishing new policies andprogrammes .Poland P age 8The ASA EG participates in Joint action financed from the Second EU Health Programme(2014 -2020) on Reducing the Alcohol Related Harm (RARHA) and facilitating the disseminationof result (cross -country comparable data on levels and patterns of alcohol consumption andalcohol related harms experienced due to alcohol use) .The ASA in Norway and Russia implements pilot project on early detection and earlyintervention on alcohol and drug problems .The ASA plans and prepares th e project on “cannabis usage in the Northern Dimension area”with the aim of formulating policy recommendations for improving the cannabis policy includingtreatment and early intervention offers .The ASA plans few cross -border seminars on tobacco and alcohol cross -border flow .Expert Group on Non -Communicable Diseases (NCD EG) undertakes the activities to reducethe impact on non -communicable diseases through strengthened prevention and addressinglifestyle -related risk factors.The NCD implements the project “International Comparison of Differences in Premature Deathsand their Causes in NDPHS Partner Countries Measured by Potential Years of Life LostIndicator (PYLL)” .The last project includes the activities stated in p.49 (carry out studies with the aimof developing prevention strategies in health care).The Primary Health Care Expert Group (PPHS) implemented the proposed by Pol ish expertproject Imprim on integration of primary health care – the project was not implemented inPoland (lack of financial input).The PPHS contributed to the NDPHS project proposal to the DG REGIO with proposed activityon Development of Transnational Policy Conclusions on Best Model Solutions for LocalHospitals to support High Quality Primary Care in the Baltic Sea Region .The PPHS prepares the project for Integrated Care for senior citizens around the Baltic Sea.The expected outcome of the planned project will be sustainable, patient centered, integratedsystems of care. The integrated health care models will influence patient pathways. Patients will stay longer at home and will receive the appropriate care with fewer costs._______________Poland P age 9Paragraph 43. [To] develop and strengthen strategies addressing demographic change, such as theEuropean Innovation Partnership on Active and Healthy Ageing and especially considering publicservices with regard to rural peripheral areas;”At its meeting held on 18 May 2016, the Council for Senior Policy decided that it would give priority toupdating and revising the document entitled “Assumptions for the Long -Term Senior Policy in Poland forthe years 2014 -2020” to ensure that the redefined senior policy assumptions or strategy respond to thereal demographic changes and the needs of the seniors. Currently, two programmes aimed atsupporting senior citizens are being implemented, namely: the Government Programme for SeniorCitizens Social Activity 2014- 2020” (each year PLN 40 million is earmarked under this programme for thetasks aimed at social activation of senior citizens, carried out by non -governmental organisations andother authorised entities); and the Multiannual “Senior -WIGOR” Programme for 2015 -2020 (PLN 370million will be a llocated under this programme for the establishment, by local government units, of“Senior -WIGOR” Daily Residences all over Poland, where senior citizens may benefit from care,participation, educational, cultural and recreation offer, as well physical act ivity and kinesiotherapy, aswell as other services, tailored to the defined needs).In 2015, moreover, an Act has been adopted of 11 September 2015 on elderly persons. In result,by the end of October 2016, a report on the situation of older citizens in Poland will be prepared, whichwill be a diagnosis giving grounds for further actions benefiting that group.RussiaRussia P age 2May 26, 2016Update of theMinistry of Healthcare of the Russian Federationon the implementation of Resolution adopted by the 24th Baltic Sea Parliamentary Conference(BSPC)Par 14Participants in the 11th Partnership Annual Conference in Berlin, Germany, adopted a newNDPHS Strategy 2020 and an A ction Plan until 2017. In addition, the participating member sunanimously supported and adopted the proposal for Russia to assume the chairmanship in theExpert Group on Primary Healthcare ( Yulia Mikhaylova , Federal Research Institute forHealth care Organization and Information of the Ministry of Healthcare of the RussianFederation) , as well as the Expert Group on Non -Communicable Diseases Related to Lifestylesand Social and Work Environmen ts (Rafael Oganov , National Research Center for PreventiveMedicine at the Ministry of Healthcare of the Russian Federation ).Par. 20In February 2015, the Public Cou ncil for Protection of Patients’ Rights of Russia’s Ministry ofHealthcare held its first public meeting, bringing together regional healthcare authorities and patient protection NGOs to mark the Rare Disease Day. Focusing on the topic Rare Diseases inRussian: From Problems to Solutions, participants explored the issue of providing medical care and medicines to patients suffering from rare diseases in Russia, shared experience inimplementing regional programs and organizing schools for patients, and discussed internationalexperience in caring for people suffering from rare dise ases, and charity initiatives aimed athelping such patients.Par. 21Taking into account the social significance of emergency care in life -threatening and non- life-threatening situations and the need to ensure consistency in the provision of primary healthcareservices and emergency care, including specialized medical aid, as well as emergency care in life-threatening situations , the Ministry of Healthcare of the Russian Federation developed asubprogram Developing Emergency Health Services as part of a government program (the“subprogram”) with the following aims:- improve emergency care accessibility and quality, including specialized emergency care,primary emergency healthcare services in non- life-threatening situations and specialized medicalaid in life- threatening situations ;- improve the provision of emergency medical aid in life -threatening situations;- reduce waiting time s for receiving emergency medical care, including specialized careadministered outside medical facilities;- developing aeromedical evacuation services.Russia P age 3The subprogram envisages the following key initiatives:- developing the administration of emergency aid, including specialized emergency care , andmedical evacuation;- developing the system for providing emergency medical care in life -threatening and non- life-threatening situations;- implementing IT solutions within the system of emergency care in life-threatening and non- life-threatening situations ;- pro viding for the operations of Zashchita (Protection) Russian National Center for MedicalEmergencies with a view of developing the National Medical Emergencies Service.- In 2015, as per the instructions of the Ministry of Healthcare of the Russian Federation,aeromedical brigades from Zashchita (Protection) Russian National Center for MedicalEmergencies and the Federal Medical-Biological Agency provided for the evacuation of 1,020patients, including 399 patients transported by air, with a total of 37 Russians evacuated from abroad.Par. 22Efforts to prevent and contain antimicrobial resistance in Russia should be consistent with theinternational principles in this area. Many government agencies are working on the issue ofmicroorganisms and bacteria becoming resistant to antibiotics, which can be resolved only byadopting a comprehensive approach. The main stakeholders in tacklin g this issue and the mainareas of work in specific countries and within the global community have already been identifiedin international instruments to this effect .On April 20, 2016, the Institute of Antimicrobial Chemotherapy (IAC) of the Smolensk Sta teMedical University was designated as the WHO Collaborating Center for Capacity Building onAntimicrobial Resistance Surveillance and Research.The creation of this center is not only indicative of the research and organizational potential ofthe Russian academic community, but also paves the way to diversif ying research activities andintegrat ing them into international programs to fight antimicrobial resistance. In addition, thisinstitution will be able to provide guidance to countries within the post-Soviet space and beyond.The Collaborating Center will be in charge of facilitating WHO’s efforts in strengthening,expanding and integrating epidemiological surveillance over antimicrobial resistance in Russian-speaking member states.Russia Page 2May 26, 2016Update of theMinistry of Healthcare of the Russian Federationon the implementation of Resolution adopted by the 24th Baltic Sea Parliamentary Conference(BSPC)Par 14Participants in the 11th Partnership Annual Conference in Berlin, Germany, adopted a newNDPHS Strategy 2020 and an A ction Plan until 2017. In addition, the participating member sunanimously supported and adopted the proposal for Russia to assume the chairmanship in theExpert Group on Primary Healthcare ( Yulia Mikhaylova , Federal Research Institute forHealth care Organization and Information of the Ministry of Healthcare of the RussianFederation) , as well as the Expert Group on Non -Communicable Diseases Related to Lifestylesand Social and Work Environmen ts (Rafael Oganov , National Research Center for PreventiveMedicine at the Ministry of Healthcare of the Russian Federation ).Par. 20In February 2015, the Public Cou ncil for Protection of Patients’ Rights of Russia’s Ministry ofHealthcare held its first public meeting, bringing together regional healthcare authorities andpatient protection NGOs to mark the Rare Disease Day . Focusing on the topic Rare Diseases inRussian: From Problems to Solutions, participants explored the issue of provid ing medical careand medicines to patients suffering from rare diseases in Russia, shared experience inimplementing regional programs and organizing schools for patients , and discussed internationalexperience in caring f or people suffering from rare dise ases, and charity initiatives aimed athelping such patients.Par. 21Taking into account the social significance of emergency care in life -threatening and non -life-threatening situations and the need to ensure consistency in the provision of primary healthcareservices and emergency care, including specialized medical aid, as well as emergency care in life -threatening situations , the Ministry of Healthcare of the Russian Federation develop ed asubprogram Developing Emergency Health Services as part of a government program (the“subprogram”) with the following aims:- improve emergency care accessibility and quality, including specialized emergency care,primary emergency healthcare services in non -life-threatening situations and specialized medicalaid in life -threatening situations ;- improve the provision of emergency medical aid in life -threatening situations ;- reduc e waiting time s for receiving emergency medical care, including speciali zed careadministered outside medical facilities;- developing aeromedical evacuation services .Russia Page 3The subprogram envisages the following key initiatives:- developing the administration of emergency aid, including specialized emergency care , andmedical evacuation;- developing the system for providing emergency medical care in life -threatening and non -life-threatening situations ;- implementing IT solutions within the system of emergency care in life-threatening and non -life-threatening situations ;- providing for the operation s of Zashchita (Protection) Russian National Center for MedicalEmergencies with a view of developing the National Medical Emergencies Service.- In 2015, as per the instructions of the Ministry of Healthcare of the Russian Federati on,aeromedical brigades from Zashchita (Protection) Russian National Center for MedicalEmergencies and the Federal Medical -Biological Agency provided for the evacuation of 1,020patients, including 399 patients transported by air , with a total of 37 Russ ians evacuated fromabroad.Par. 22Efforts to prevent and contain antimicrobial resistance in Russia should be consistent with theinternational principles in this area. Many government agencies are working on the issue ofmicroorganisms and bacteria becoming resistant to antibiotics, which can be resolved only byadopting a comprehensive approach. The main stakeholders in tacklin g this issue and the mainareas of work in specific countries and within the global community have already been identifiedin international instruments to this effect .On April 20, 2016, the Institute of Antimicrobial Chemotherapy (IAC) of the Smolensk Sta teMedical University was designated as the WHO Collaborating Center for Capacity Building onAntimicrobial Resistance Surveillance and Research .The creation of this center is not only indicative of the research and organizational potential ofthe Russian academic community, but also paves the way to diversif ying research activities andintegrat ing them into international programs to fight antimicrobial resistance. In addition, thisinstitution will be able to provide guidance to countries within the post -Soviet space and beyond.The Collaborating Center will be in charge of facilitating WHO’s efforts in strengthening,expanding and integrating epidemiological surveillance over antimicrobial resistance in Russian -speaking member states.www.bspc.netBSPC Secretariatc/o Lennéstraße 119053 SchwerinGermanyPhone (+49) 385 525 2777