Dr. Vytenis Andriukaitis:

Let me start by discussing specialised medicines and the possibility of helping Ireland cope with Brexit. I agree with what the Senator has said. We will need to share common themes and have concrete discussions because I worry about Brexit issues.

Today, frankly, nobody knows what the reality will be because the reality is not on the ground. Nobody knows what the concept will be on the UK side. If it will be a hard Brexit, there will be one tactic from our side. We need to address the issue, but I cannot imagine the possibility without a transitional period. In my portfolio I have many problems and many questions but there are no answers at present.

Animal health was mentioned. Today, Ireland and Northern Ireland are one island. People are producing on one side, processing on the other and then selling into the UK. Can one imagine a hard Brexit with customs and so forth? I do not know how to deal with food safety standards because it is up to the UK to say which standard it will keep on its market. At present, there are the same standards. It is the same when speaking about the cross-border health care directive. It helps us. We will address how to do it. On one side we will see how to help Ireland achieve treatments in our European centres more frequently. The UK is very close and language, culture and tradition all play a role. We know that very well. We must have the discussions in this way. Of course, I will be more than happy to communicate with the committee. If some problems start we will see all the hot potatoes on the table and we can look at them together. The main teams must be the same teams. I, Dublin and Brussels must be one team. Otherwise, there is no way.

On the other hand, we have a good opportunity to trigger and push possibilities to use European reference networks. We must encourage countries to use the Connecting Europe Facility instrument, building IT infrastructure in reality and workability between hospitals and around all 27 member states to guarantee tele-medicine, guaranteeing immediate treatment, advice, consultations, virtual debates, virtual clinical assessment and possibilities to keep people here but consulting from different angles. It means the Connecting Europe Facility must be on the agenda. We need to build a workable infrastructure with IT platforms, connectors, communicators, the same electronic signatures, patient registries and data. We need to have those issues in 2019. This is 2017. A lot of people in governments do not understand what this will mean, I am sorry to say, but we will address those issues only in this way - on the one hand strengthening links between Ireland and the Continent and on the other dealing with the UK in a more proper way together. However, all things will be clear after June when the new parliament will be elected in the UK. Then we will see their concept of the positions. Politically, today we hear a great deal about hard Brexit, but nobody knows. However, then we will start to do practical things immediately, addressing the issues together.

About training problems, the member's idea is excellent. First, I wish to draw attention to the lack of medical doctors in primary care. There is a need for 6 million doctors at present. There is a deficit of 6 million doctors.

Second, the average age of primary care medical doctors is 57 years is one country and 62 years in another. After five years, they will be retired. Who will replace them? It is nobody's care. It is like a slow tsunami. There is a deficit of 13 million nurses.

People refer to Pakistan and elsewhere. The richest countries are playing a game and one sees a real mess in different countries. There is training, of course. The country which is the best has five high schools which are able to produce excellent nurses with good experience. The nurses are very welcome in countries but it is a budgetary cost. On the other hand we will ask member states if it is possible to co-operate on training issues and to understand that health care workforce planning, recruitment and retainment issues must be discussed at Council level. I am so unhappy that we are so involved in our national problems while the tsunami is around us. Of course, e-health is another matter to address immediately but shortages of staff cannot be addressed immediately because six, nine and 11 years of education are required, followed by training.

I agree that it is a painful topic, but mainly it is in the hands of member states, and mainly it is up to subsidiarity. We will only have joint action by discussing health care workforce planning, training and of course the working time directive. However, that is not in my hands. Commissioner Marianne Thyssen is responsible for the working time directive. I am not deeply involved in those questions. Generally, however, our medical staff are exempt from that directive. The working time directive does not apply to medical doctors and nurses generally, but I do not know the details. I have to ask my colleagues from the DG for Employment, Social Affairs & Inclusion. It is not in my hands. Perhaps I will send the committee a written reply on the working time directive because I am not sure. Generally, I know it does not cover medical doctors.

On the matter of research co-ordination, I see big possibilities and opportunities if we join our research technology development, DG RTD, with DG GROW, DG SANTE and DG ENV and if we are capable of establishing the Digital Single Market, invest in infrastructure, build possibilities to have big data and invite our research consultants, our industries and our countries to pool resources and guarantee venture capital for our research. We must have a sustainable economic model for the development of research clusters that will be very compatible. Otherwise, the United States is in a much better position. It has excellent financial possibilities. Venture capital instruments are developed at a very high level in the United States.

We lack incentives and venture capital. Of course, the European Fund for Strategic Investments, EFSI, has a role in the risk management of projects to be leveraged between private and public capital. The EFSI is a really brilliant instrument. Once again, we need to know the worth of co-operation, co-ordination and responsibility, which are not empty words. Today all are ready to sign memorandums on co-operation and co-ordination, but it is true that nobody likes to be co-ordinated.