Dr. Alasdair McDonnell:

I apologise for arriving late but I had to travel from the far flung corners of the island. I apologise as well because I could not possibly have the eloquence of my friends from Cavan or even worse my friend from Ballybay but I shall make an attempt.

I am a former GP and warmly welcome the potential for the cross-Border directive outlined by Mr. Barron. It is interesting and exciting and I want to see it in action. I shall be brief and have one or two simple questions. What, in the name of God, is stopping further practical patient-oriented co-operation and health? There is no issue more frustrating for people along the Border than the flexibility on that, in both directions but probably on balance slightly more going North than those coming South. I do not want to incriminate myself too far. I abused the British system for years because I was aware of dozens, if not hundreds, of people from Donegal fabricating an address in the North so that they could access health care. I have never mentioned this before and I do not wish to make a song and dance about it but it was a scandal for all sorts of reasons. That frustration exists. The British side or the British National Health Service has tightened up significantly and has managed to sift all of these people out of the system. Therefore, somebody living in Donegal today has great difficult accessing the North but 15 or 20 years ago - and I do not want to say any detail because probably some of it was slightly fraudulent - people were desperate to access health care. That is not justifiable, whether it is surgery or an item of health care.

The witness wisely mentioned pricing. We know what pricings are here in the VHI system. We know what pricings were in the North under fund holding 15 years ago. We gave up fund holding because the bureaucracy around it was more than the clinical care. It is easy enough to price things. A price can be put on a gall bladder or appendix removal. There is space and accommodation. At times there are queues for some issues in the North but there is always accommodation around the system as well. There is always vacant accommodation around the system.

My colleague here wisely mentioned the Enniskillen hospital. I am very worried about the Enniskillen hospital because it needs more customers, to be put at its simplest. Those customers could be people living in Blacklion or similar places along the Border. It could equally be people in the South and south of Donegal on the other side. It is not beyond the wit of man to get some of this together.

I have a lot of time for Co-operation and Working Together, CAWT, the various organisations, and Mr. Tom Daly and his efforts. From what I have seen, our bureaucracy on both sides of the Border seems incapable of defining the barriers and removing them. Everything is perfect in theory and practice but we do not seem capable of getting it to the final stage and over the line. Nothing would create more satisfaction in people's minds, on both sides of the Border, than opening up flexibility. I shall not go into a ream of detail on the matter but shall suggest one simple thing. There can be a trade-off. People on the southern side of the Border would warmly welcome, as Deputy Conlan has outlined, access to primary care, GPs and similar in the North and early, simple and straightforward secondary care. If it came to a complicated situation there might be a decision made that a person must be referred back to Dublin or whatever.

We have a problem in the North which is being highlighted at the moment by congenital cardiac surgery that you guys are tackling and I thank them for doing so. That could have been tackled a wee bit more sensitively and with a wee bit more political understanding. The initiative is almost over the line, if not over the line already. There is a need for high quality coronary care and there are facilities in the North. The Minister in the North would like to create a second set of facilities around Altnagelvin which would serve Donegal and other areas. That initiative must be got over the line because if one's father, mother, brother or sister is dying with a heart attack one is not terribly choosy as to who will save his life. That is essentially what we are talking about here - getting people in remote rural areas, within an hour or less than hour, to a catheter lab where the clot or whatever is threatening their life can be removed.

Other issues can be traded off in a southern direction. We desperately need a plastic surgical unit dealing with burns. We have a small but very significant number of people, on both sides of the Border, who have been very badly disfigured and scarred. However, we do not have a coherent unit to deal with burns on the island. There are some good people in the North who work at the discipline but they have at least one hand tied behind their backs and the same happens in the South.

There is another issue around obesity. There is a desperate need for an all-island obesity service where surgeons can take out bits of bowel or whatever in order to help those people who are unable to control their weight. I have outlined a number of niche markets and issues where there is no major coherent service, North or South. There can be a coherent service on both directions and must of it can be located in Dublin. It would lead to a win-win situation. As Deputy Conlan suggested, we could have a flow northwards at primary care level and there can equally be the same for highly specialist and niche markets or rare diseases.

I congratulate the delegation. I am not levelling any accusation against any of the people here because I know the work that they have done. We must find the driver, somebody or something that will make more happen quicker because health initiatives should not be so slow. I want to know if there have been issues in the North. I have regular conversations with Edwin Poots. Regardless of politics, he has made it very clear to me that he has signed up for as much cross-Border co-operation on health as he can and it is not a political issue with him but a humanitarian one. Therefore, we must find the ways and means. Are there medical obstacles? Is it the medical profession?

If people are guarding patches, and my guess is that the medical profession have a hand to play in it, we must find some system of moving around it. There are gains for everyone and there are gains for the Department of Health and the Department of Health in the North. I have gone on far longer than I intended but there is an array of issues.