Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I will do my best. There are many questions and to give comprehensive answers to all of them would take up the rest of the meeting, so I will not do that. The Chairman asked about an overarching strategic framework. The North-South Ministerial Council is designed to do that and has identified areas of specific co-operation, namely, accident and emergency services, planning for major emergencies, high-technology cancer research and health promotion. The bottom-up activity has been most successful - the identification of the need for radiation oncology services in west Ulster, which are now provided in Altnagelvin; the identification by clinicians of the need in respect of paediatric cardiothoracic surgery, which is now happening in Dublin; and deepbrain stimulation, which is now done for many patients from the Republic in Belfast. The area of transplants is also being examined, but is only at the initial stages. The question was whether it would be better to have a top-down approach, rather than a bottom-up approach. I am not sure. Some work was done in 2009 on a strategic framework. The nature of such frameworks is to take forever to be drawn up and then get reduced to the lowest common denominator. I would be interested to hear the views of members on this. If the objective is to deliver cross-Border services in the interests of patients, it could be argued that is best done on a bottom-up approach to respond to service needs as they arise, rather than a top-down approach, but the reverse could also be argued, so I do not have an answer for that one.

Regarding meetings, I meet with my counterpart two to three times a year at ministerial level. I am not sure exactly what happens at Civil Service level. Perhaps Ms Joyce or Ms Hagerty want to answer that.