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

I have done that. I actually launched it. The healthy club project is very encouraging.

On the common register for medical professionals and other professionals, that would be extremely difficult. If we were to have common registration in Ireland and Northern Ireland, all the legislation would first have to be aligned just for doctors, then for nurses, dentists and 14 other professions. About 16 different Acts of Parliament would have to be passed in both jurisdictions. We would have to agree to align our legislation in both jurisdictions and things are different. The universities are set up differently, competence assurance is different, and requirements for continuing professional development are also different. There would also be the issue of extra-judicial decisions. The Medical Council in Dublin hears complaints against doctors and can make serious findings against doctors and then strike them off. If there were to be an all-island medical council that could strike off doctors in two different jurisdictions, I imagine an international treaty would be required. It would need to have the effect of a cross-Border court. That would then apply to the Nursing and Midwifery Board of Ireland, CORU and all the others as well. It is not impossible. Unification of the island might be simpler. That would be the way to start, rather than trying to align 14 different pieces of legislation and create 14 different quasi-judicial bodies with cross-Border powers. We might even need referendums on that. It would not be where I would start in unification. I am not sure how East and West Germany did that, but that would be the case study to look at.

On out-of-hours services, from its commencement to 30 April 2015, 739 patients in Inishowen received GP out-of-hours services in Derry. That is about seven per month. Some 2,839 patients from south Armagh have received GP out-of-hours services in Castleblayney in County Monaghan, that is about 32 per month. Patient uptake in the Inishowen-Derry pilot is quite low. That is partly due to the reduction in the pilot size. Initially, the pilot area was supposed to cover the Buncrana area, but I am told the HSE could not get agreement from the Buncrana GPs, so it did not happen. There is also the issue of accommodation address, which affects people living along the Donegal Border, who are in some cases entitled to NHS treatment because they are frontier workers and use the service in Northern Ireland anyway. The authorities in both jurisdictions have agreed that exploratory discussions should now proceed regarding the potential for extending the service on a trial basis to Blacklion in County Cavan and Pettigo in County Donegal, whereby patients from these areas could avail of an out-of-hours service in Enniskillen, County Fermanagh, or in Omagh, County Tyrone. Initial discussions took place with local GPs, but it was not possible to progress the matter at the time. However, the HSE has now put arrangements in place with Caredoc for the commencement of a new out-of-hours GP service in the Sligo-North Leitrim area later this year. That will allow discussions on the potential extension of cross-Border out-of-hours services in Enniskillen or Omagh to recommence, so they will have another go at that.

On the all-island measures on alcohol and obesity, in respect of alcohol in particular, we try to ensure we implement minimum unit pricing at roughly the same time and rate so that we do not have huge numbers of people crossing the Border to buy alcohol where it is cheaper. That would totally defeat the purpose of doing it. On obesity, we have had discussions but not many. It is important to bear in mind that we are different jurisdictions. We have a plan for alcohol and we are pressing ahead with it. We know what we are going to do this year and enact next year. We will have a plan on obesity this year and we will start implementing it next year. The risk of having an all-island strategy is obvious: everything gets paused, a year or two is spent developing an all-island approach and what inevitably happens is that we have all the stuff we want to do, they have all the stuff they want to do, but all that makes it into the strategy is the crossover, so the sum of the two parts is actually less. If it were a Venn diagram, instead of doing everything within the two circles, we only end up doing the things in the small overlapping section. It would be a great strategy and we could all say it is wonderful and launch it and so on, but would it actually produce better results than us all doing what we want to do anyway? It is probably better that each jurisdiction does what it wants to do on alcohol and obesity and we try to co-ordinate in a practical way, rather than having a lowest common denominator strategy, which would have the problems I mentioned.

The cost of medicines in Ireland is now coming down, largely because of reference-pricing of generic medicines and the various agreements with the Irish Pharmaceutical Healthcare Association on patent medicines. Ireland spends about as much on medicines now as it did ten years ago, which is not the case in most other countries. We came from a very high base, but most countries are still going up, while we have been flat for the best part of ten years. The exception is the very high-tech medicines, which happen to be very expensive. They are only made by one manufacturer, which generally has us over a barrel when it comes to pricing. Members will have seen that with Soliris and some other medicines in the last few months. In theory, medicines could be procured on an all-island basis. That would make them cheaper here but more expensive in the North. I am not sure the North would be up for that.

The best option for us would be for the Republic of Ireland to buy into the NHS purchase system to enjoy the economy of scale of a population of approximately 60 million between Britain and Ireland. One could get a much better price with that kind of buying power but why on earth would the pharmaceutical industry want to do that? We cannot force the industry to agree to purchasing across two countries. Perhaps we would need to unify Britain and Ireland before we could do it because we cannot force somebody to make an agreement. It suits the pharmaceutical industry to have different agreements with different countries and, often, to pick off the smaller ones with the highest prices, with a view to setting a benchmark price for those with the buying power. We are, however, starting to procure certain very expensive medicines on a Europe-wide basis. A European directive has been introduced which specifically permits us to do that. For example, as vaccines are more or less the same and used similarly in every country, procuring them with a buying power of 500 million people is obviously much better than a buying power of 5 million or 60 million people. A similar approach may be adopted in respect of hepatitis C medicines, which we would purchase with the buying power of 27 countries rather than the alternatives of one country and a province or two countries.

The children's hospital project began before I came into office. I am not sure whether Ms Miriam Joyce wants to comment on that project. The children's hospital is designed for the Republic of Ireland rather than for all of Ireland. A major children's hospital would still be needed in Belfast given its catchment population of 1.5 million. We would like to provide some of the high level specialist services for all of Ireland in the new hospital. Paediatric heart surgery is already agreed and I think we could also provide other services, such as transplants. That has to work three ways, however, because in some cases services will be provided out of Belfast or Dublin for all of Ireland, out of Derry for all of west Ulster and, where we do not have the population for certain very rare procedures, it makes sense not to provide them in Ireland at all. They would instead be provided out of Birmingham, Newcastle or Great Ormond Street in London. There are, therefore, two dimensions of co-operation, namely, east-west and North-South.