Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and thank them for the presentation. Like all the debate around Brexit, uncertainty is the major backdrop in all of this. Very often, we are potentially planning in the dark but we must anticipate certain issues that may arise and have contingency plans in place. If there is potentially to be a hard Border of some form or another, the issues of concern are that there could be difficulties with the free movement of goods and services between the Republic of Ireland and the North, creating difficulties for commerce, movement of services and people. That could have a potential impact in the health area as well.

We have referenced rare diseases on numerous occasions. We have a population of 4.6 million people here and there are approximately 1.9 million people in the North but there must be close co-operation in order to achieve economies of scale. We may not have enough expertise on either part of the island but collectively we have a critical mass in the area of rare diseases, not only with respect to the number of people with rare diseases but, more importantly, of clinicians and specialists who would be able to operate on an all-island basis. If we ever get our children's hospital built, for example - I assume it will happen at some stage - this issue may arise more frequently due to the fact that we would have a centre of excellence in Dublin that might be able to address some issues in the North as well as the South, with clinicians in both areas working in collaboration. I have referenced rare diseases and the issue of paediatrics but that could be broadened to other areas, such as transplanting and other high-end areas. What observations do the witnesses have in that respect? With regard to the registration of medical practitioners, such as consultants and nurses, etc., we have two administrative areas. Do the witnesses foresee any difficulties in that context with regard to registration and people living in the North and working here or vice versa?

Reference has been made to the treatment abroad scheme on a number of occasions, as well as the cross-border health care directive. In fairness to the Department of Health and HSE, it does not seem to advertise that much for fear people might find out about it. There are two schemes. The first is the treatment abroad scheme, for which people can make an application if the consultant can verify it is clinically acceptable and treatment cannot be provided in this country. Alternatively, the cross-border health care directive allows for a person entitled to public health care here to avail of it elsewhere if he or she so wishes. Do the witnesses foresee any difficulties in that area?

There is the issue of public health policy in general and health promotion in the context of wellness and having a healthy lifestyle. There is also the issue of vaccines. The greater the core of a population that is vaccinated, the more impact there is. Has anybody considered this issue with regard to development of vaccines down the road and all that flows from it? The more people who partake in a vaccination programme, the greater the coverage and the smaller the risk of cross-infection etc. Has any thought been given to that? I do not expect full and detailed answers but the issues have been brought to my attention by clinicians and professionals.

Clinical research is sometimes bolstered by co-operation between industry and colleges. We have a reasonable footprint of pharmaceutical and medical device companies that co-operate with universities and institutes. The larger the pool of research available, the better the chance of superior outcomes. I hope those issues are kept to the fore in Brexit discussions to ensure we can manage them.