Mr. Liam Doran:

The Irish Nurses and Midwives Organisation, INMO, would like to begin this opening statement by thanking, most sincerely, the Chairman and members of the Seanad Special Committee on the Withdrawal of the United Kingdom from the European Union for the opportunity to meet today on this very important issue. The INMO is the largest representative organisation for nurses and midwives in this country, representing over 40,000 members working in all areas, both public and private, of health services here in the Republic of Ireland. The INMO has very strong, professional and binding relationships with the Royal College of Nursing and the Royal College of Midwives in the UK and we have worked closely with them on many issues of common concern over many years. The INMO and the Royal College of Midwives have held for the past 20 years an all-Ireland midwifery conference in October each year for the specific purpose of co-ordinating and enhancing midwifery services right across the island of Ireland. It is against this background of strong, vibrant links with our colleagues in the UK health system that the INMO has very serious and growing concerns about the impact the UK's withdrawal from the EU will have on all areas of our health services at cross-Border, national, regional and local level. The difficulty of the UK's exit from the European Union will not only affect health services north and south of the Border but also east-west between Ireland and the rest of the United Kingdom.

In the context of the withdrawal of the United Kingdom from the European Union, we bring a number of specific issues to the attention of the committee as follows. The island of Ireland currently has a total population of 6.5 million people and in this context it is imperative - this has grown in recent years - that we increasingly provide health services on an all-island basis in order that we maximise efficient and effective use of resources and, in particular, develop and deliver specialist and tertiary level services in the most quality-assured manner. We must move to minimise duplication of services, not only in the interests of cost containment but also to enhance the outcome for patients, and this should be done, in any sensible way, by providing such specialist and tertiary level services on an all-island basis.

We already have a number of cross-Border initiatives for health care well established and these include the Co-Operation and Working Together, CAWT, partnership between health and social care services in Ireland and Northern Ireland. This has facilitated a number of collaborative projects, particularly in Border regions, which has brought great benefit and can yield further benefit in the broad area of health and social care to the populations in this region. This has also involved other cross-Border services, including GP out-of-hours services and shared expertise, such as that used in dermatological clinics. Specifically, we have radiation and oncology services and emergency cardiology services at Altnagelvin Area Hospital, which services the population, regardless of on what side of the Border they live. As for specialist children's services, such as paediatric cardiac surgery and congenital heart disease, Our Lady's Children's Hospital, Crumlin, in Dublin, has provided all-island services for many years.

The committee is also asked to note that the largest capital development in the history of the health service, the planned national children's hospital, is also being built in a manner designed to provide all-island services to children. Nothing should be done that will in any way harm, restrict or impede the access of children in all Thirty-two Counties from accessing this world class service in the years ahead. It should also be noted that the recently published maternity strategy proposes the development of services to the mutual benefit of all mothers and children. This cannot be impeded by bureaucracy or imposed avoidable barriers to care and services.

The committee should also note that there are a number of other examples of cross-Border and east-west co-operation within the health system in such areas as the Health Service Executive purchasing care from Northern Ireland and Great Britain to address our waiting list difficulties and improve speed of access to services for patients, cross-Border health care for workers who cross the Border daily to and from work, and guaranteed access to public health care for all EU citizens travelling through member states, which, by definition, has provided access to health care for Irish people travelling to the UK and UK citizens coming to Ireland for many years.

The committee is also asked to note that from a more specific nursing-midwifery perspective, the following critical issues arise. Currently, we have mutual recognition and reciprocal arrangements for nurse and midwife registration for nurses and midwives who successfully complete programmes in Ireland and the UK. The removal of free movement of people, arising from a UK withdrawal from the EU, will see them depart from adhering to relevant EU directives pertaining to professional registration and this will have significant implications for health care manpower planning in both jurisdictions. The committee is asked to note that the number of applications for registration to the UK Nursing and Midwifery Council, its professional regulatory body, has dropped by over 90% in recent months. All this will do, in the context of Irish-registered nurses and midwives, is to increase still further the attempts by UK health authorities to fill their nursing and midwifery post shortage by aggressively recruiting here in Ireland. A simple example of this is the recurring practice of such great hospitals like Great Ormond Street Hospital for Children in London of coming to our graduates, particularly those who have just completed the joint general and children's nursing degree programme here, and recruiting them before they ever work here after registration. The pace and intensity of this recruitment drive by the UK will only increase as a result of Brexit as the numbers applying from within and outside the EU to work in the United Kingdom will fall due to concerns in a number of areas.

In addition, the committee is asked to note, particularly in recent years, the offices of the chief nurse in Ireland, Northern Ireland, Wales, Scotland and England have worked increasingly together to collectively strengthen the nursing and midwifery input into health care in all five countries. This has the potential to yield greater benefits in the years ahead but this may all be minimised by the UK departure from the EU and the introduction of hard borders and all of its implications. There is a determined effort by nursing and midwifery to develop the infrastructure on an all-island basis by our all-island joint midwifery conference each year, and this will inevitably be compromised in some way arising from a UK departure from the EU and the issues that automatically arise.

In response to all of the foregoing which is universally negative for health services, the INMO believes there is an absolute requirement for proactive engagement on this issue and that is why we welcome the work of this committee. In that context, we believe it is imperative that the Irish Government, as part of the multifaceted discussions which are taking place with regard to Brexit, must focus on the following issues. Regulatory bodies in both jurisdictions must work closely together to find a way to provide to the political system methods by which the movement of nursing-midwifery and other health professionals can continue unimpeded following any departure. Standards of regulation and practice must be maintained at the highest standards in all health care qualifications and other areas, such as medicines, medical devices, food safety and public health. Whatever final shape the departure takes, arrangements must be put in place so that health care, in the island of Ireland and, indeed, from Ireland to the UK, has no borders and every patient can access, without delay or bureaucracy, the highest quality of specialist services his or her condition warrants. In that context, we must continue to develop the centres of excellence servicing all on this island in the critical areas of oncology, cardiac care, children's services, public health and primary care, including care of the elderly.

The challenges to ensuring access to quality health care in the most efficient and effective manner possible are significant as we face Brexit. We must recognise and plan to meet all of these critical issues over the next two years in the interests of all citizens.

On behalf of the INMO, I wish to conclude this statement by thanking the committee for taking the time to invite us and for allowing us to present our views. We are, of course, available for questions.