Mr. Paul Barron:

I am conscious of time also. A number of questions were raised about the EU directive so I will try to deal with them as quickly as I can. There were also questions on cross-Border GP care, which also falls into my area.

Deputy Conlan suggested that the directive is discriminatory. The directive is European legislation not domestic legislation. If it is discriminatory it is not because the State wants to have discriminatory legislation. In my opening remarks I very briefly compared and contrasted the two routes, as I described them. It is fair to say that the new route under the directive might not suit everyone because it involves one having to pay upfront and seek recruitment. I take the point that it might not suit on every occasion but the other route still exists – where one does not have to pay upfront – albeit one is limited to availing of public facilities rather than private facilities. There is good and bad in respect of each route. One of the important roles the national contact point will play is to provide advice to people so that they can make decisions as to which route they wish to follow.

Deputy Smith inquired about my commitment to the end of the first quarter. The intention is that at the end of the first quarter we would have full implementation and that on or before the end of the first quarter the Minister would sign the commencement order and then we are in business. There would not be a further lead-in period. Hopefully, from the beginning of the next quarter we will be up and running legislatively.

Deputy Smith also inquired about the number of member states. To the best of our knowledge, as of the end of last year, only seven member states out of the total had transposed the directive. That is no excuse for us not having done so but the fact of the matter is that only seven member states have so far transposed the directive. Our understanding is that the UK transposed it at the very end of December. Deputy Smith then asked a supplementary question on the position whereby some countries have transposed the directive and others have not.

The position at present is that it is not open to residents here to avail of the directive and to go abroad because we do not have a system in place to enable them to be recouped. However, for those countries that have transposed, it is open to their citizens to come here because their home member state will recoup them. Consequently, until such time as we have transposed, it is not open to people here to avail of the provisions of the directive, unfortunately. There have been a small number of inquiries to the HSE and the position has been explained to them. Our understanding is that people are prepared to wait for the few weeks until the directive comes into operation.

Deputy Crowe kindly asked whether there was anything the joint committee could do and we are grateful for the offer. The position is that through no fault of our own, there was pressure of business following on from the Presidency and so on and we had a backlog of legislative work. Much of that backlog now has been cleared and while a number of issues are ongoing, this one is very much a priority. We have engaged a legal draftsman to help us and the matter is very much in train. As I stated, we hope to have the directive transposed by the end of the quarter. Consequently, while we are grateful for the offer, I do not think any further assistance is required at this stage.

The Deputy also asked about differences between countries and I suppose an important point to make is that what I described this morning are two routes for people to avail of elective treatment abroad, whereas the Deputy's example pertained to an emergency situation. Generally speaking, such emergency situations in the European Union are dealt with under what used to be known as the E111, and which now is known as the European Health Insurance Card, EHIC, which sits beside the two routes. It is getting complicated now, in that there are two routes to avail of elective treatment abroad and then in addition, the EHIC is there to assist if one is on holidays or whatever abroad. My colleague, Mr. Tom Monks, sits on a European grouping that oversees these various measures and it appears as though there can be difficulties in certain jurisdictions, Spain being one of them. If the Deputy has a specific case in mind, we might be able to provide him with some assistance.

Senator Moran raised a specific case and while we are not familiar with the case in question, we would be happy to talk to the Senator about it. One condition that applies at present is that a person going abroad under the current E112 arrangement must have sign-off by the Irish consultant. I do not know whether that arose in this case but we can talk to the Senator about that. Some questions in respect of GP out-of-hours services were raised by Deputy O'Reilly and Mr. McDonnell - I am unsure whether he has any other designation. Our estimate is that in the case of approximately 65,000 people, their nearest GP out of hours is across the other side of the Border. Consequently, a pilot project allowing patients in Inishowen to attend out-of-hours GP services in Derry came into operation as long ago as January 2007. A second pilot project, allowing people resident in south County Armagh to obtain the service in Castleblayney, commenced in November 2007. Since commencement and up to 31 December 2013, approximately 700 patients from Inishowen received services in Derry, which is an average of approximately eight per month, while 2,300 patients from south County Armagh received out-of-hours services in Castleblayney, which is an average of approximately 32 per month. Both jurisdictions are involved in monitoring this on an ongoing basis. There were proposals to extend the trial to cover Blacklion, County Cavan, and Pettigo, County Donegal, to assist people on the opposite sides of the Border. Initial discussions took place with local GPs but there did not appear to be a great deal of interest. However, if there is a particular interest in it, we would be happy to take this up again.