Dr. John D. Woods:

I thank the Chairman and the committee for that welcome. I begin by thanking the committee for the opportunity to come here today and give evidence on behalf of the British Medical Association in Northern Ireland and to outline the potential impact of Brexit on doctors and patients on both sides of the Border. I appreciate that some of the committee are perhaps less than familiar with the BMA. The BMA is an apolitical organisation. It has the dual functions of being both a professional association and a trade union. We represent 160,000 doctors and medical students across the UK and have more than 5,500 members in Northern Ireland.

Northern Ireland's health and social care system, similar to that of the Republic of Ireland, is currently under unprecedented pressure, trying to meet the needs of a growing population with increasingly complex illnesses against a backdrop of strict financial constraint. BMA Northern Ireland is very concerned at the UK's decision to leave the European Union and believes that unless appropriate agreements are implemented, there will be a substantial negative impact on doctors' working lives. This will detrimentally affect patient care on both sides of the Border.

Given the committee's familiarity with this issue I will be try to be concise in outlining what we see as the direct challenges to the medical profession in Northern Ireland and how we think these challenges should be met.

The first significant challenge we have identified is the threat to effective cross-Border co-operation in providing health care. Northern Ireland and the Republic of Ireland are smaller health economies and both have difficulty independently providing some highly specialist services efficiently. By pooling our resources we can provide high quality specialist care across the island. In recent years, such services have been developing and are providing significant benefits for patients throughout Ireland.

An example with which the committee is familiar is the paediatric cardiac surgery service based in Crumlin in Dublin, which enables children from Northern Ireland and the Republic of Ireland to receive treatment for heart conditions without having to travel abroad, and there are others. I am a consultant kidney doctor and my colleagues on both sides of the Border are exploring whether it is possible to provide some very specialised kidney transplant services together.

Our health services also co-operate in providing high quality medical care to patients who live close to the Border. Good examples are in cancer care and cardiac care. The new radiotherapy unit in Altnagelvin Area Hospital in Derry will provide access to radiotherapy services for over half a million people in both Northern Ireland and the Republic of Ireland. A cardiology service based at the same hospital provides primary angioplasty, which is the best treatment for heart attacks, for patients in Donegal and saved 27 lives in its first nine months of operation. These services directly benefit Irish citizens living in the north west of Ireland. The existing open Border arrangements facilitate such co-operation between our health services.

The committee is aware of the Cooperation and Working Together, CAWT, project and the role it plays in funding cross-Border health and social care initiatives, and of the EU's related projects via the PEACE and INTERREG funding programmes. Between 2003 and 2015, more than €40 million was invested in cross-Border health and social care initiatives through CAWT. Additional project applications, amounting to €53 million, have been submitted for a wide variety of health-related services. The UK’s future financial liabilities to the EU and participation in its funding programmes are a matter of some sensitivity and debate. However, given the relatively small sums involved and the return on investment see, we ask that the Irish and UK Governments give serious consideration to continuing funding of such initiatives after Brexit.

Another issue is cross-Border workers. Committee members are aware there are literally thousands of cross-Border workers in Ireland. More than 13,000 people live in the Republic but work in the North, returning home daily or weekly, and more than 3,000 people from Northern Ireland do the reverse. Many of these people work in health care and make a very important contribution, particularly in Border areas. Cross-Border co-operation and the delivery of health care, particularly in Northern Ireland, would be impossible without the free movement of these people. To secure our ability to continue to provide high quality health care we need to put in place agreements to permit the ongoing free movement of doctors and health care workers. Maintenance of the common travel area would enable health professionals based on both sides of the Border to travel freely to work and to co-operate in joint initiatives.

I am less familiar with workforce issues in the Republic of Ireland, but Northern Ireland faces some critical shortages of doctors, particularly in primary and secondary care. Doctors who obtained their primary medical qualification from other EU states are an important part of the medical workforce in the United Kingdom. For those doctors, concerns about their future residency status and rights mean that many of our members from other EEA states are planning to leave. The BMA recently carried out a survey of our members in this position throughout the UK. We tried to shed further light on their experiences and perspectives. These European doctors make up approximately 7% of doctors in the NHS. Of the 1,200 respondents, four out of every ten EU doctors reported that they were considering leaving the UK post-Brexit. The resolution of this issue is, for once, relatively simple. Permanent residence should be granted to EEA citizens working as doctors in the UK, and vice versa, even if they have been resident for less than five years. Michel Barnier, who spoke to the Oireachtas last month, shares this view and has specifically referenced this issue as a priority within the negotiations.

Another challenge we face is mutual recognition of professional qualifications. A total of 9% of the doctors in Northern Ireland secured their primary medical qualification in another EEA state, with a large number of these doctors having qualified in the Republic of Ireland. Mr. Molloy mentioned the welcome Irish universities extend to students from Northern Ireland and I am one of the people who benefitted from this. I went to Trinity College. There are also doctors from the UK who work in Ireland. They account for approximately 4% of the total number of doctors registered with the Medical Council of Ireland. We understand that an extension of the EU directive is unlikely, but the European Commission's recently published draft negotiating directives state "the withdrawal agreement should continue to provide the same level of protection for EU citizens in the UK and UK citizens in the EU" and specifically referenced recognition of diplomas, certificates and other qualifications. We hope this provision will be agreed and will include medical qualifications. Failure to do so would threaten Irish students' ability to practise medicine in their home country or elsewhere in the EU, and could prevent Northern Irish students currently studying medicine in the Republic from returning home to practise. This would certainly have a detrimental effect on workforce planning and threaten the diversity of our medical schools.

At present a variety of patient safety measures exist. These depend on the mutual sharing of information across Europe. A good example of this is the sharing of information between European regulators when restrictions are placed on a doctor's ability to practise. We believe it is imperative that such safety measures, and other efforts to ensure minimum standards in medical education and training, are maintained and agreed between the respective regulatory and educational authorities.

I appreciate that time does not allow me to go into greater detail, or cover all of the issues impacting the medical profession, but I hope the written evidence BMA Northern Ireland has also submitted will be useful in addition to my contribution today. I thank the committee for its time and I am happy to take any questions.