Mr. Fergal Goodman:

The key point about the cross-border directive is that it is an EU regulation and applies only within the EU.

If the UK exited in a hard form, it would be outside the directive. It is a recent development at EU level and there was no reimbursement scheme prior to its institution. The challenge is to see if we could have a bilateral arrangement with the UK to maintain such a provision. Our overall objective is to maximise the continuity of the arrangements we have at the moment but the question of whether the cross-border directive would continue to involve the UK is an EU-UK discussion point. We are in a unique position in having a land Border with the UK but the cross-border directive also operates between the UK and the rest of the EU.

I want to be clear about the treatment abroad scheme. This is arranged on a consultant-to-consultant basis and operates when a treatment is required but not available in Ireland, or only available outside the time required. We are very dependent on the UK for the scheme and in 2016 there were 636 cases, of which 574, or 90% went to the UK. We are particularly dependent on the scheme for paediatric, liver and cardiac transplants. The scheme will continue to operate within the EU but, as it is for services that are time-critical such as transplantation, it will be difficult to use France or other places in such cases. In the interests of continuity of quality and accessibility of service we will strive for an arrangement whereby we can continue the scheme but we cannot predict this and since it operates under EU regulations we will not have the facility to make a bilateral international agreement. We need the Brexit process to move on somewhat before we have greater clarity as to how we should move on this matter.