Professor Trevor Duffy:

I suppose I have a couple of comments. First, on the North-South Ministerial Council, very much as Dr. Hogan has said, it will certainly have a much more significant role, but it is important to see this as not only a North-South issue. A significant component of our health care co-operation exists with mainland UK also. For example, historically, one thinks of transplant programmes, such as lung transplant programmes that would have worked through places such as Newcastle. That council could probably do with being broadened to work across the UK.

Taking both drug regulation, availability of new innovative products, etc., and the EMA together, undoubtedly, if the EMA were to relocate to Ireland, it would have all sorts of positive knock-on effects, not only economic. Specifically, within health care, one would hope it would give Ireland a reasonable voice at the EMA. If it leaves London and goes to mainland Europe, we would certainly have to fight to maintain a voice at the EMA.

If the EMA resides in Ireland, one would hope it would have a knock-on impact on clinical trials that happen in Irish hospitals. Currently, the clinical trial activity within the hospital sector is probably 30% of what happens in comparators, such as Denmark. There is clear, well accepted evidence now that research active hospitals, that is, hospitals that engage in not simply education but clinical research, have significant mortality and morbidity advantages over non-research active hospitals. It is a strong drive for organisations, such as the HRB, to increase trial activity.

The European Medicines Agency would have significant positive knock-on effects all the way through to new drug opportunities and availability. While I put my hand up here as being quite ignorant of the details of this, I want us to consider the potential of having the EMA here, the potential of the UK leaving and the effect this might have on drug pricing here. Drug pricing is something we obviously struggle with. It has an EU flavour when we talk about the reference pricing across the basket of 14 countries and so on.

There are two sides to implications for medical professionals. There is certainly an unhealthy exodus of medical professionals from Ireland at the moment, not just to the UK but across the English-speaking world in particular. That is a different day's work. There has traditionally been a very healthy sharing of medical professionals between Ireland and the UK. All the way through the training cycle, for example, our higher surgical training schemes are very much co-governed between the UK and Irish colleges. Many of our specialists spend some time on fellowship training in the UK. I can think, for example, of one patient in particular who attends us at present with a complex immune disease. Through contact with one of our own trainees who is now a consultant in one of the London hospitals, we were able to gain advice and that patient is now going to seek a very considered and planned consultation in London. The hope is that that trainee will eventually come back to take up a post and bring those skills back to Ireland with her. It is a very healthy exchange.

Given the tightness of training, one could paint a possible scenario that if the UK loses many of its other EU graduates, its French and German graduates for example, that it might try to fill that gap with Irish graduates. There is potentially a downside to the number of doctors suggesting that they might leave the UK.

One thing that we have been good at within the medical profession, both here and with our colleagues in the BMA, is really seeing the value of the larger European project. We are very well acquainted with each other through organisations like the European Union of Medical Specialists and the approach that organisations like that take to trying to improve the standardisation of postgraduate qualifications across Europe. That side of our work and engagement also needs to be protected through the course of Brexit.