Frank Feighan (Roscommon-South Leitrim, Fine Gael) | Oireachtas source

I thank the Minister. On behalf of the joint committee, I will ask the Minister a series of questions based on our meetings with health service representative organisations last Tuesday and on other briefings provided to the committee. I thank all the health service representatives for the work they did and for taking time out of their busy schedules for a very informative session last Tuesday.

A number of the representative organisations identified a need for an overarching strategic framework and implementation plan to develop sustainable cross-Border co-operation, as distinct from the existing focus on individual projects. I consider the lack of a framework to be a major stumbling block impeding progress in the implementation of real change on an all-Ireland basis. Is the Minister in favour of liaising with other Cabinet Ministers and his Northern Ireland counterparts with a view to introducing a framework that should lead to a more systematic, co-ordinated approach? As a follow-on point, do the Minister and his officials have regular meetings with their Northern Ireland counterparts in the Department of Health, Social Security and Public Safety with the common goal of enhancing health service provision through North-South co-operation? Is the Minister supportive of the idea of establishing a working group of civil servants from the Department of Health and the Department of Health, Social Security and Public Safety in Northern Ireland to progress the issue in parallel with the North-South Ministerial Council?

The issue of training and accreditation of health professionals in both jurisdictions is very important in the context of the development of services on a cross-Border basis. In particular, there are still significant issues around the recognition of professional qualifications and medical mobility across borders, notwithstanding EU directives in the area. What are the Minister's views on the development of a common register of medical professionals, through liaison with the Irish Medical Council and the UK's General Medical Council, which would end the requirement to register in both jurisdictions? This would significantly reduce costs, including indemnity insurance and professional registration fees, and encourage doctors to operate on both sides of the Border. There appears to be significant scope to extend the GP out-of-hours service in Border areas on a cross-Border basis. I understand that North East Doc has provided cover for south Armagh for some years now and that a similar arrangement is active in east Donegal, where patients can avail of the out-of-hours service in Derry. One significant problem is that GPs here are not entitled to travel to Northern Ireland to see patients and vice versa. Have the Minister or his officials or counterparts in Northern Ireland explored the issue with a view to identifying possible solutions and, if not, will the Minister undertake to do so?

The Minister is aware that alcohol abuse is a serious issue throughout the island. I welcome the comments in the Minister's statement but note that we need an all-island alcohol strategy. Obesity and childhood obesity in particular were referred to by the Minister. Would he consider liaising with his Northern Ireland counterparts on the introduction of all-island measures to combat obesity? Specifically, is the Minister in favour of developing a shared set of public health indicators, as it is difficult to make accurate comparisons in the absence of these indicators? For information, I note that yesterday Colin Regan of the GAA attended the joint committee. The GAA has a Healthy Clubs project. We talk about safefood and getting messages across, and this is absolutely the right vehicle to use, as the GAA encompasses many clubs in rural areas and can address everything from drug awareness to alcohol abuse to community fitness. This could be rolled out not only through the GAA but on a cross-Border basis, and the Minister could also work closely with the IRFU, the FAI and the IFA. We are looking at various bodies, but we are not getting the message across in the way we should. I encourage the Minister to look at the presentation Colin Regan made. He was invited in by Deputy Gerry Adams yesterday and he made a very worthwhile presentation.

On co-operation and cross-Border partnership between the health and social care services in both jurisdictions, there have been a number of successful initiatives in the field of quality and safety training. Are there plans to mainstream successful initiatives to other hospitals as models of best practice? The Minister referred to rare diseases. Deputy Joe McHugh has been instrumental in raising this issue also. Ireland has the lowest ratio of consultant rheumatologists per capitain Europe, with one per 135,000 people. Many patients must travel long distances, particularly from Border areas, to access appropriate treatment. Rheumatology patients in Donegal must travel to Leitrim for treatment since the cessation of rheumatology services at Letterkenny General Hospital. In addition, there is serious concern that expertise is not available nationally for more complex, life-threatening mixed connective tissue diseases including systemic lupus erythematosus and sceleroderma, which are treated primarily by consultant rheumatologists. Does the Minister consider that an all-Ireland centre of excellence based in one hospital would be a viable solution whereby both jurisdictions could piggyback on NHS expertise?

A further issue that has come up is the cost of pharmaceutical drugs in the Republic, which continues to be exorbitant according to international comparisons. While a great deal of work has been done in this area in the last six or seven years, a significant proportion of the overall health budget, at approximately €2 billion, continues to be spent in this area. These drugs can be bought significantly more cheaply in Northern Ireland. While I accept that there are complexities involved, have the Minister or his officials given any thought to an all-island arrangement for purchasing pharmaceutical drugs? Are there at least any lessons that can be learned from Northern Ireland as to how to cut margins? How can the huge disparity North and South of the Border be explained?

Another question that arose with the representative organisations related to the proposal that the planned children's hospital be constructed on an all-island basis. What are the Minister's views? Has the Minister had any discussions with his former or current Northern Ireland counterpart in this regard?

Finally, are his officials looking at organ transplant and retrieval services? How can these be provided on an all-island basis?

There seem to be discussions among medical professionals suggesting it would enhance the service and resolve a number of time factor issues that impact so greatly on organ donation and transplantation. The existing co-operation between both jurisdictions and the UK is testimony to the ability of services to overcome national borders to provide the best possible outcomes for patients.