Dr. Ann Hogan:

The Irish Medical Organisation, IMO, thanks the Chairman and members of the Seanad Special Committee on the Withdrawal of the United Kingdom from the European Union for the opportunity to come before it today.

The Irish Medical Organisation is the representative body for all doctors throughout Ireland. The organisation has close ties with our colleagues in the British Medical Association. Like our colleagues in the BMA, the members of the IMO have serious concerns about the impact the United Kingdom withdrawal from the European Union will have on the health and isolation of people living in the Border areas and on co-operation in health care delivery, especially between Ireland and Northern Ireland as well as between Ireland and the rest of the United Kingdom.

Membership of the European Union has facilitated co-operation between Ireland and Northern Ireland in the area of health care. The Cooperation And Working Together partnership between health and social care services in Ireland and Northern Ireland has facilitated several successful collaborative projects in health care in the Border regions by managing funding from the EU INTERREG programme and the Special EU Programmes Body. Approximately €47.5 million worth of EU INTERREG VA funding has been provided to support cross-border projects involving Ireland, Northern Ireland and Scotland until 2020. The projects supported include those aimed at the enhancement of acute services through new technology and e-health solutions, mental health services, supported living, early intervention services and projects aimed at reducing inequalities in health.

Under the EU INTERREG IVA programme 53,000 people in the Border areas benefitted from health and social care services. EU funding of €30 million supported projects in the areas of alcohol, sexual health, diabetes, obesity, eating disorders, autism and disability services. While many of the projects have been limited in duration, the majority have resulted in longer-term service level agreements. These agreements include: the provision of general practice out-of-hours services in Castleblayney in County Monaghan and in Inishowen in County Donegal; shared dermatology clinics at four sites along the Border; ear, nose and throat services at Monaghan Hospital as well as Daisy Hill Hospital and Craigavon Area Hospital in Northern Ireland; and renal services at Daisy Hill. Other cross-border service level agreements exist as a result of collaboration and capital investment from both sides of the Border, including radiation oncology services and emergency cardiology services at Altnagelvin Area Hospital and the provision of all-island paediatric cardiac surgery services for children with congenital heart disease at Our Lady's Children's Hospital Crumlin, Dublin.

The HSE currently purchases a number of high-tech treatments from the UK, including organ transplantation and treatment for lymphoedema. The HSE also purchases care from Northern Ireland and Great Britain under the waiting lists initiative and on a case-by-case basis, including 574 patients who received treatment in the UK under the treatment abroad scheme.

Significant scope exists to further develop services on an all-island and cross-border basis, especially in the area of high-tech tertiary care and in the management of rare diseases. There is also scope to further fill gaps in services to the Border areas. We estimate there are 30,000 frontier workers, many of whom are entitled to access care in both jurisdictions, while all Irish and UK citizens are entitled to access necessary care while temporarily in each jurisdiction with a European health insurance card. An increasing number of patients have taken advantage of the patients' rights in cross-border care regulations with 700 patients accessing care in Northern Ireland last year.

Of necessity, cross-border co-operation exists in the area of public health, especially in the area of health protection. It is essential for the health of the populations on both sides of the Border that this cross-border co-operation continues, especially in the areas of control of outbreaks of infectious diseases, which may have a cross-border dimension, and in emergency planning and response.

Currently, a total of 3,196 doctors who received their primary medical degree in Ireland are registered with the General Medical Council in the UK while 742 doctors who received their primary medical degree in the UK are registered with the Medical Council in Ireland. Many Irish graduates complete their post-graduate training or spend a period in the UK before returning to Ireland, although increasingly, fewer are returning.

The UK departure from the EU will have a significant impact on health and access to health care, particularly in the Border regions. A total of 1.6 million people live in the Border regions. The economic impact of Brexit will increase deprivation rates and isolation, with consequent impact on the health of individuals in the Border areas. The greatest challenges posed by the UK withdrawal from the EU will include ensuring ongoing and future collaboration in the field of health care as well as timely and seamless access to care for patients in Border areas. We cannot be complacent and assume that co-operation will continue in future once the UK has left the EU. Political interests and issues of funding may impact negatively on access and cost of care for patients on both sides of the Border. While INTERREG VA funding has been guaranteed to 2020 there is no guarantee yet of funding thereafter. We know that in the short term EU social security arrangements are to stay in place but in the medium term the rights of cross-border workers and patients' rights to access treatment on a cross-border basis are unclear. Regardless of how hard, or soft, a border will be in place in future, impeding the free movement of patients, ambulances and doctors across the Border will be problematic. Common European regulations relating to pharmaceuticals, medical devices and data protection may no longer apply. Legislation which has aided the movement of health care professionals may no longer apply. In addition to the rights of doctors to work in both jurisdictions, the automatic recognition of medical qualifications will no longer apply. Bureaucracy will affect the flow and training of medical professionals between jurisdictions.

Planning must begin immediately to ensure that patients, especially those in the Border regions, have ongoing access to vital health and social services. The IMO believes that, rather than adopting a wait-and-see attitude, careful planning is required to ensure that collaboration in the area of health care continues and develops in future. We recommend that a cross-border committee be established to examine the impact of Brexit on existing and future cross-border health services and to ensure that watertight agreements are in place for collaboration in future. The committee should include relevant decision-makers within each jurisdiction as well as stakeholders with practical experience. For each collaborative arrangement, every possible future scenario should be developed to assess potential risks and barriers to patient care that may develop and to ensure that pathways for accessing services, treatment and follow-on care are seamless. Long-term cost and funding arrangements for current and future collaborative projects must be secured. Mechanisms must be put in place to ensure that patients, ambulances and health care professionals in both jurisdictions can move in a timely manner across the Border. Where EU legislation has facilitated cross-border health care, bilateral agreements must ensure ongoing co-operation. For example, regulatory bodies in Ireland and the UK should work closely together to ensure the recognition of qualifications and to facilitate the movement of medical and other health care professionals across jurisdictions to avoid duplication of legal requirements.

Future regulatory requirements must ensure that high standards are maintained in respect of medicines and medical devices and food safety. Arrangements must ensure that prescriptions written by medical professionals on one side of the Border are recognised on the other side. Future regulatory arrangements and e-health standards must ensure that patient data can be securely transferred between health care settings from one side of the Border to the other side. Finally, the North-South Ministerial Council should develop a proactive strategy to ensure ongoing and future collaboration in the development of cross-border and all-island health care services.