Mr. Muiris O'Connor:

It is a fact that Britain will remain within the common travel area. That is a given. The service level agreements that I have seen in respect of these additional services are on three-to-five year timeframes. That is not reflecting any pessimism beyond that. It is merely a manageable natural point of review and taking stock and it will allow us to see past the immediate phases of Brexit negotiations at the wider EU-UK level.

What changes could happen was a key concern. I suppose a key part of our work under the common travel area was to ensure the full awareness of the extent of the depth and breadth of health service co-operation North-South and East-West and the extent of the reciprocal rights. As part of the travel area and the Good Friday Agreement mapping exercise, we were able to reach a comprehensive shared understanding with the UK and our Northern Ireland health counterparts on what compromised the current co-operation and we reached high-level agreement that our shared objective was to protect all this as the UK departs from the European Union. Our objective is to maintain the full suite of services. As I stated, what we are trying to protect - we do not like the word "preserve" because it suggests something static - is a trajectory of deepening co-operation. Often, it is merely sensible, practical co-operation on a community basis. Also, we want to protect the East-West aspect because, as came up with Senator Colm Burke, we have relied heavily on the UK in terms of the treatment abroad scheme for specialist services, many of which are not available here.

As well as moving to ensure full engagement and a shared understanding and shared commitments with the UK, we are, of course, looking at how we can expand our links into mainland Europe. Sweden, the Netherlands and Germany are countries one sees in the statistics. We have probably 30 or 40 people going there. We would need to explore with those hospitals what additional services could potentially be available. It is important to note that the UK is leaving the European Union; Ireland is not. All of the European Union's health facilities will remain available to Irish citizens into the future.

In terms of pharma, it is important to note that the regulation of medicines and medical devices is very much a European-wide concern rather than a purely national concern. Our national regulator, the HPRA has been active in preparing for Brexit and its implications for medicines availability in Ireland. The HPRA is very much plugged in to the EU regulatory system via the European Medicines Agency and the Heads of Medicines Agencies network and its strong relationship with other national regulators. The HPRA is strongly represented at the EU and Ireland is very well regarded in terms of its regulation of medicines and contribution to the European approach to the regulation of medicines. In addition to that strong relationship with Europe, the HPRA enjoys a particularly strong working relationships with its UK counterpart, the Medicines and Healthcare products Regulatory Agency, MHRA. It fully intends to maintain this relationship, both before and after Brexit. Only last week, the MHRA, the British regulatory authority, issued a statement to pharmaceutical companies on its preparations for Brexit clarifying that the UK position on medicines regulation is that it will continue to work closely with its European partners in the interest of public health and safety. It is encouraging that the UK's regulators recognise the importance for them of maintaining the equivalence, and even their ambition to continue to trade in medicines would necessitate that from their own perspective. This follows on the joint report presented by the EU and UK on phase one of the negotiations which made clear that goods placed on the market before withdrawal would be allowed to remain on the market so that there would be no meltdown on the day itself. We will just have to monitor it. My expectation is that the UK will regard maintaining equivalent regulation as a necessity for itself. That is exactly the position we would want to maintain but we have to watch this. This is subject to broader EU-UK negotiations.

On the orphan drug situation, the Minister, Deputy Harris, has played a leading role internationally in this regard. The larger countries tend to have a look-after-themselves approach to these matters and that is what makes it so challenging for the smaller countries.

Therefore, in our international relations, our key approach has been to find like-minded health authorities in the European Union beyond Britain. The Benelux countries have an interesting set of ongoing co-operations to negotiate with-----