Mr. Liam Doran:

Therefore, we are up against it totally both in terms of patient care and in terms of efficient and effective use of resources. I am not saying that health is all about nursing and midwifery. It is a part of it. For my area of nursing and midwifery, Brexit is only bad. Britain will increase their incentives and thereby increase migration. We lost 7,500 nurses to the UK in the last six years based upon the certificates of verification. The reality is that movement will increase.

The issue that arises is the reciprocity of qualification. The EU did many things, but one thing it did was standardise via EU directives nursing and midwifery education. In fairness, medicine and other professions have it as well. There is no way Britain will lower its standard but we do not yet know whether it is going to respect the EU directives. It will want the 4,600 clinical hours and so on. Britain will always want that. It will want to offer pathways to train and pathways in which it can build up specialist programmes, because it can offer specialist programmes that we can never match. Without being smart for one moment, if I graduate in Cork and I am taken over to a great London hospital, Great Ormond Street, Manchester Royal Infirmary or any of those, I will be offered an incentive payment to go, accommodation for a period of time and professional development.

Providing I do nothing wrong, within 12 months I will access a specialist programme such as intensive care, coronary care, emergency department nursing, theatre nursing, ophthalmic or burns. When I have that and if I get tired of the UK, Australia and North America call me because they are English-speaking countries. We do not go to mainland Europe by and large. Australia and North America will want me to be experienced so when I graduate I might stay here for six or nine months. A total of 80% of last year's graduates have got certificates of verification to leave already. They have to pay for that and cannot do so unless they have money coming and unless they are going to use it. They are leaving.

The Senator says they will come back. I was educated in Richmond, Surrey, in England. I got home once a year. How many members have gone to London for a day? It is a different world. They can go to live over there, travel over on a Monday and back on a Friday but they will not come home. When they get the specialist qualification and go to Australia or North America, they can command very good money because there is a worldwide shortage of nurses and midwives. Britain has always been a place to which we migrate. Its attractiveness and aggressive recruitment will increase because it is not growing its own. It will rely more and more on Ireland and drain what is already a drained pool. The reciprocity of qualifications will be maintained because Britain will not worry too much about French or German nurses, it wants Irish or Commonwealth nurses. There is no upside.

I am not saying that because of the pounds, shillings and pence, but because it is true. We are absolutely banjaxed when it comes to nurse and midwife supply, recruitment and retention, and that has to be addressed. What the UK is doing in parallel with Brexit will exacerbate our problem. There will be no one pausing for thought. It will not change the flow because it will aggressively offer money and incentives to newly-qualified people who will then consolidate their skills, go to Australia or North America and there is no evidence that they come back in great numbers. The Bring Them Home campaign run by the HSE, which aimed to get 500 nurses, officially brought back 92 and, of those, 40 have gone away again.

Forgetting that for the moment, for the patient there is a lot of good cross-Border work, with co-operation in centres of excellence. Hard or soft, what are our strategies? We have to find a way politically to ensure that health care has no borders and that we have critical centres of excellence in specialist services. In doing that we save money, the economy thrives, and we provide optimum patient care on the island of Ireland. The east-west relationship should not be forgotten. I do not know whether the UK is willing to have that. I understand from the Royal College of Nursing and the Royal College of Midwives that they think the authorities are willing to have that kind of arrangement but politically it must be an imperative in the talks.