Mr. Fergal Goodman:

If Mr. O'Connor does not mind, I might touch on one or two of the issues mentioned. I was not inclined to cut in while he was speaking, but I will elaborate on one or two points.

The first relates to the scenario when Brexit happens. As was said in the introductory statement, much of this will revolve around what happens with the common travel area. If this goes in one direction, we have a rather favourable outcome. If it goes in another direction, things could be far more difficult. I agree that we need to plan for the scenarios and consider the spectrum of things that might happen. That is what we are doing. However, at a certain point it becomes speculative in respect of what any of us believe will happen. We are dependent on what direction things move in that regard.

When it comes to professional mutual recognition and so on, Ireland is not the only country affected. We feel an especial closeness and there is a good deal of collaboration backwards and forwards. Irish students are training in the UK and they then want to practice here and so on. That is a matter of great consideration and importance for us. However, Ireland is not the only country of the remaining 27 countries so affected. We do not have a solo position that we can put out and run with. As was said at the outset, we are part of a wider engagement process between the EU and the UK. Department of Health officials and our Minister have to be cognisant that we are part of that overall framework.

North-South issues have been touched on to a considerable extent. I am aware from speaking to colleagues in the Department who are involved and, as Mr. O'Connor has said, from contact with counterparts in Northern Ireland that there is a strong desire to maintain the cross-Border collaboration relating to Altnagelvin and paediatric care issues in particular. It is important to note that these are not carried out or provided for under the EU directives. They are not part of the treatment abroad scheme, for example. They are predicated on memoranda of understanding or service level agreements between the statutory health authorities on the two sides of the Border. If we take the travel permissions issue out of it, there should be few, if any, impediments to the continuation of the arrangements. This is the view of officials in the Department of Health. Certainly, that is the objective we strive to achieve. In other words, regardless of how Brexit plays out, we will maintain and continue those services, some of which are still only in the developmental phase.

It is important the committee understands the strength of our determination to ensure we adapt to what might come out of the Brexit process. We cannot predict it at this point. I fully admit that.

Reference was made to the treatment abroad scheme and the cross-border directive. We undertook some initial analysis of how these are working. The cross-border directive is rather new. Deputy Kelleher asked whether it was being promoted. When the directive was developed, there was a general consensus across EU member states that the scheme was not to be strongly and highly promoted by national health systems. That was the consensus view at European level and we need to respect that. However, it has been promulgated to the medical associations. It has been promulgated at operational level, in other words, at hospital level and hospital group level, in terms of making information available to patients. Also, the HSE has a particular national contact point and considerable information is available on the HSE website. It is still in the early years of implementation. Certainly, it is instructive to look at the analysis of developments on the cross-border directive. We would be happy to share the data with the committee. We can provide it afterwards, if members wish.

A total of 237 inpatient treatments were done and reimbursed under the cross-border directive in 2016, with 213 done in Northern Ireland. Therefore, 90% of inpatient cross-border treatments went to Northern Ireland. Outpatient and day cases are lower at 31%. We do not know how much of the remaining 70% or so outpatient work went to other parts of the UK. Intuitively, one would feel that it could be significant. We do not have that data yet. We are seeking that detail from the HSE's analysis but it is fair to assume that the cross-border directive - for cultural and other convenience reasons - operates primarily as an Ireland-UK facilitation.