Mr. Muiris O'Connor:

I wish to begin by thanking the committee for inviting us to talk about the implications for the health sector of the United Kingdom's decision to withdraw from the European Union. I will introduce myself and my colleagues. I am Muiris O'Connor, assistant secretary in charge of the research and development and health analytics division in the Department of Health. I am joined by Fergal Goodman, assistant secretary in charge of the primary care division, along with Tom Monks from the eligibility and primary care policy unit, Kieran Smyth, head of the international unit in my division, and Sarah Rose Flynn, also from the international unit. I will begin by setting out the wider context of the Brexit challenge. I will also use my opening statement to briefly outline the principal impacts for the health sector and the work we are undertaking to examine and address those impacts.

The overall priorities of the Government regarding Brexit are clear. They are to minimise the impact on trade and the economy, protect the Northern Ireland peace process, maintain the common travel area and influence the future of the European Union. Preparing for Brexit is a whole-of-Government task. The Department of Health is participating fully in the structures co-ordinated centrally by the Department of the Taoiseach to ensure a joined-up approach. It is worth remembering that we are at an early stage in the Brexit process. The UK has not yet notified the EU of its intention to leave by invoking Article 50 and negotiations have not yet started. When negotiations do begin, Ireland will participate as one of the 27 member states remaining in the European Union. A great degree of uncertainty surrounding Brexit still remains. For example, we do not yet know what new arrangements may emerge as regards the UK's future relationship with the EU. We also do not know whether transitional arrangements will be put in place to bridge the gap between the UK's exit from the EU and the conclusion of an agreement on its future relationship with the EU, or how long a period such transitional arrangements would cover. This context of uncertainty makes conducting work to examine and address the implications of Brexit challenging. It also means that a definitive analysis is not possible at this stage. Nevertheless, our preparations are ongoing. The Department of Health will continue to revise and update its analysis as matters become clearer over the period ahead. As the committee will be aware, the Government is determined that all possible preparations will be made ahead of the UK leaving the EU and that the focus will be on protecting and advancing the interests of Irish citizens, within the context of this country's continuing membership of the European Union.

I will now set out some of the potential principal impacts of Brexit for the health sector. Firstly, however, I wish to note that the UK has not yet left the EU and remains a member, with all of its existing rights and responsibilities. This means there have been no immediate changes in the area of health care, nor are any expected during the negotiation period. The Department of Health has put in place a process and work is under way to examine and address any implications for the health sector over the longer term. All our work relating to Brexit is informed by the following key priorities: to ensure continuity in the provision of health services; and to avoid any changes to the current situation that would have a negative impact on human health. I will give an overview of some of the issues we have identified in our analysis, which will be deepened and refined as time goes on.

The principal impacts of Brexit for the health sector cover a number of areas including free movement, rights to health services and regulatory issues. Brexit raises a number of issues relating to free movement and these affect all sectors. In the area of health, issues such as emergency ambulance transfers between Ireland and Northern Ireland and mobility for cross-Border health workers will need to be given due consideration. Regarding health services, ensuring that there is minimum disruption and that essential services are maintained on a cross-Border, all-island basis and on an Ireland-UK basis will be the key concern for the Department of Health over the period ahead. In particular, the Department is conscious that the operation of the EU treatment abroad scheme and the cross-border directive under which Irish patients currently enjoy the ability to access health services in the UK, in particular in Northern Ireland, may be affected by the UK leaving the European Union. The common travel area has been in existence since Irish independence. It allows freedom of travel between the two jurisdictions for Irish and UK citizens and provides for largely reciprocal benefits of citizenship in terms of entitlements to reside, work and access services. These arrangements stem from the close historic relationship between the two countries and predate the entry of both into the EU. Both the Irish and British Governments have set out their desire to maintain these arrangements, and this will have relevance for the health sector.

Regarding regulatory issues, it is clear that having a single set of rules across Europe is enormously helpful to protect human health, ensure consumer protection and provide a level playing field for industry. A UK move away from a harmonised regulatory system in respect of food safety standards, pharmaceuticals, medical devices and cosmetics could disrupt trade between Ireland and the UK or necessitate increased certification requirements. It is important to remember that there are other issues that will affect the health system but which may not necessarily be led by the Department of Health. The Department is working closely and collaboratively with other Government Departments to examine and address these issues, including through the interdepartmental group on EU and UK affairs. Cross-departmental work is essential in resolving issues. For example, the Minister for Public Expenditure and Reform and his Department have successfully secured certainty for the EU-funded cross-Border co-operation programmes PEACE and INTERREG, which includes a number of health projects, up to 2020. The Government is committed to securing EU funding for successor programmes post-2020. The strength of the relationships between Ireland and Northern Ireland and the UK will be of benefit as we work to find solutions to any problems that arise for the health sector as a result of Brexit. There are already effective partnerships and working arrangements in place and many examples of practical and effective co-operation between the jurisdictions for mutual benefit in the health sector. The Department of Health remains strongly committed to continued co-operation with Northern Ireland and the UK in the health sector.

As well as preparing for the challenges posed by Brexit, we are pursuing opportunities. The Government decided late last year that Dublin should be proposed as a very suitable location for the European Medicines Agency, EMA, which will need to move from its present home in London once the UK leaves the EU. The EMA is responsible for the scientific assessment with respect to the authorisation, maintenance and supervision of medicines in prescribed areas developed to protect human and animal health by pharmaceutical companies for use in the EU. The EMA is also responsible for monitoring the safety of all medicines authorised in the EU. Detailed work is under way under the auspices of an interdepartmental and inter-agency group led by this Department. An extensive programme of ministerial and official-level engagement is also under way in support of Ireland's bid. I would be happy to expand on this if the committee so wishes.

I will turn now to the programme of engagement under way on Brexit, the structures that have been put in place across Government Departments and the work the Department of Health has carried out to date. An extensive programme of Government engagement is under way on Brexit, led in particular by the Taoiseach, Minister for Foreign Affairs and Trade and Minister of State with responsibility for European affairs. Ministers are meeting their EU counterparts at Council meetings and other events, while officials are maintaining contact with their counterparts in other countries. The Minister for Health has met with the European Commissioner for Health and Food Safety twice in recent months to discuss the impact of Brexit on Ireland and the health sector and to discuss Ireland's bid for the European Medicines Agency. The Minister also met his Northern Irish counterpart at the North-South Ministerial Council health sectoral meeting in November, at which a paper on "Implications of the UK Referendum" was discussed. He has also discussed Brexit with the UK Parliamentary Under-Secretary of State for Health, the UK Secretary of State for Health and the Scottish Cabinet Secretary for Health, Wellbeing and Sport. At official level, this Department has proactively engaged with officials in the Northern Ireland and UK Departments of Health. The potential impact of Brexit on health services has been examined and explored. It is intended that this engagement will be ongoing and will be strengthened as we get more clarity on the actual Brexit arrangements that might emerge.

Ireland's preparations for Brexit continue to be strongly co-ordinated from the centre of Government through the new Brexit Cabinet committee chaired by the Taoiseach. The Department of Health participates fully in the senior officials group on EU affairs, the interdepartmental group on EU-UK affairs, and its work groups established to support the Cabinet committee on Brexit. The Department established a management board sub-committee on Brexit in advance of the UK referendum to examine the implications of a decision to leave the EU. The sub-committee is chaired by my colleague, Deputy Secretary General Colm O'Reardon, and made up of representatives from across the Department, as well as from the HSE, which is represented by the national director of primary care. Our preparations for Brexit are under way and progressing well. The Department of Health is building on initial work undertaken to conduct a more detailed analysis on the impacts of Brexit in the area of health. Individual units in the Department and agencies are conducting analysis and continuing their contingency planning to identify the best strategies to mitigate each of those impacts. In addition to regular contact with agencies, Brexit is now being formally included as a standing item on the agenda of governance meetings between agencies and their responsible line units in the Department. The sub-committee serves as a co-ordinating body to pull the various strands of this work together and facilitate information-sharing.

Our continuing assessment of the implications of Brexit in the area of health is part of ongoing Brexit analysis and scenario planning for input into larger Government deliberative processes. Until such time as the UK’s relationship with the EU following its withdrawal becomes clear, the precise implications of Brexit for the area of health will remain unclear. A comprehensive analysis of the health implications of Brexit will have to be informed by the UK’s intentions in this area. Our focus will remain on ensuring that services for patients are maintained and human health is protected.

By way of conclusion, the Department of Health, in co-operation with its agencies and other stakeholders, will continue to deepen its analysis of how best to mitigate the impact of Brexit for the health sector over the period ahead. We will continue to engage with our EU partners, the UK and Northern Ireland, particularly as positions crystallise on areas of shared interest relating to the health sector in a post-Brexit context. I hope my opening statement has been helpful and I look forward to the committee’s questions.