Ms Angela Fitzgerald:

The cross-border directive is not specifically about the Border within Ireland; it relates to all European borders. I am sure the Senator is well aware of that. A process is currently in place between the HSE and the Department of Health to look at the implications with specific reference to the North of Ireland. It is more likely that we will see migration in the other direction, because their access issues are just a bit better than ours, but I suppose there are other concerns around the wider European context. There is a process under way to look at how we manage that.

With specific reference to the matter in hand, it is probably less relevant because there is access in the North and we seek to access its service. What is probably of equal relevance, as Deputy Ó Caoláin is well aware, is the conduit by which we have achieved other all-Ireland solutions, such as Co-operation and Working Together, CAWT. If we were seeking to develop an all-Ireland service, we would try to do it under that construct, and we have done that quite successfully in other areas, particularly complex areas.

We do need to distinguish the current arrangements for delivering the service under the TAS - in which case we would expect the treating hospital to have a lot of the infrastructure in place, and that is what we are paying for - from a scenario in which we develop an all-Ireland service and put the infrastructure in place ourselves. The questions around cost savings are relevant in that context as well, because the cost savings referred to in the document show that we have now got a better price than we were getting when we were sending people overseas, so it would possibly allow us to treat more patients. The cost implications of setting it up here largely relate to the set-up costs.

To answer the question, there is a process under way, with particular reference to this, but it will not result in increased demands that might displace us; it might just enable patients to access it without reference to the treatment abroad scheme. Because Tim Lynch and his colleagues have worked very closely with the treatment abroad scheme, they have tried to make sure that this service almost behaves as if it is a cross-border one. Patients who meet the clinical criteria are getting relatively free access. That is evidenced by the increase in referrals in the past three years. The point is well made; we do need to consider the implications. It is less relevant for this than, perhaps, for other services, but in the context of an all-Ireland solution, we have good mechanisms already in place to enable some of that to be considered, and we are talking to the Department of Health about it.