Mr. Liam Doran:

I will begin by thanking Senator Buttimer for his kind comments. I am not going until the end of the year. I am worried now that something is happening around me. For light relief, Ms O'Brien mentioned borders. As far as I can remember, Cork has had a big border around it for years that people have never managed to get through.

I will divide my answer into two parts. One part is generic and the other part is about specifics. Let me be quite clear: from our perspective, there are no upsides whatsoever for health care, health services or health users from Brexit. Whether it is a soft or a hard Brexit, there are no positives. As health care evolves, its essential requirement, particularly in specialist and tertiary services, is critical mass. One of the best things that Ireland did in the many years of humps and hollows was the development of centres of excellence in oncology services. We have world-class oncology services, though they are in need of review and so on. One of the reasons for that is that we have critical mass. We bit the bullet and said that if we are going to have the best possible patient outcomes, we have to have a service that has the diagnostics, the capital infrastructure, the human infrastructure and the best clinicians, nurses and specialists that will give us the best chance.

We have 4.6 million people in Ireland and 1.9 million people in the North. Whether it is the brilliant work in Crumlin on an all-Ireland basis in cardiac and congenital heart disease, in oncology or in respiratory heart disease, we need to work together every day of every week to ensure that all of our specialist services are subject to critical mass. That does not only mean North and South. It also means east and west. We cannot think that we can be stellar over here while 100 miles away in Cardiff there is also a stellar facility costing a fortune. We must bridge those things. Brexit drives a coach and horses through that. There are no winners. In particular, the patients will lose because neither country, North or South of the Border, will invest in health.

I will be more specific in terms of the questions about travel and professionals moving and so on. I have to be quite blunt. Britain has always relied upon immigration to staff many parts of its health system, full stop. That has been generated simply by the history of the Commonwealth, as well as the EU and so on. The response of the population at large to Brexit in terms of health care has been a 90% drop off in registrations from outside the EU into the UK health system within months of the vote. Britain normally gets 1,500 registrations a month. That went down to 150. In terms of scale, we have to remember that Britain employs 500,000 nurses. We employ 35,850 nurses. Britain is 54 miles away by sea.

What Britain has done quite clearly is reduce the bursary for nurse education. It is training fewer nurses and people are coming into the country. Whatever they do with Brexit, hard or soft, the UK authorities will have a common travel area for Irish nurses because it is a tap. Irish nurses are degree-level, English-speaking people who land running. Britain will incentivise their recruitment. Senator Mulherin asked whether they will not pause for thought. The journey our nurses travel is quite simple. It is not to the EU but to the UK they go to within the EU. Outside of the UK, they go to Australia and North America with some transitory passage to the Middle East. The impact of Britain leaving the EU will not have any consequence for the nurse who wants to travel and work in the UK if they cannot get work here or because of shorter hours, better staffing levels or better career opportunities elsewhere. The door to that will remain open wide. I genuinely and sincerely suggest to the committee that it will actually be embellished, because Britain will need that flow even more because the flow from outside the EU to the UK is going to dry up.

When we graduate 1,500 nurses a year, that is the entire pool we have, whereas 1,500 nurses is a drop in the ocean to Britain. It will take every last one. We could use the example of Great Ormond Street, which is a brilliant and world-class facility. It went into Cork a few weeks ago and took every last one of the graduating nurses. We have a four and a half year degree programme in general and children's nursing. It is a brilliant programme. It is brilliant for the graduate because he or she can walk anywhere and be taken into employment. Great Ormond Street took the entire class. The nurses have not even registered yet. We trained them and the UK took them. Do not get me wrong, being hired by Great Ormond Street is like being asked to play for Real Madrid on a free transfer if one is a soccer player or for Kilkenny if one is a hurling player.