Mr. Jim Breslin:

I will ask my colleague, Mr. Goodman, to come in on this. We have previously supplied to the committee data on the activity under those schemes. It is notable that while, as EU citizens, we have entitlement to travel for treatment abroad or to avail of the cross-border directive across the EU, the majority of people are accessing care in the UK or Northern Ireland under both schemes. For the treatment abroad scheme, as I noted in my statement, that is because our specialist links are most developed with the UK. Mr. Hennessy mentioned Great Ormond Street. There is a range of institutions in the UK to which we are very connected. That will continue after Brexit. We are confident about that for two reasons. The level of engagement Mr. Hennessy has described with those institutions indicates that they completely understand the patient rationale here. It is to their advantage that we form part of the catchment area for very highly specialist care and that we are able to feed in our patient to give them a critical mass of treatment within these islands. If they were to lose some of that critical mass it would undermine their services. They want to continue that relationship with us not only for altruistic reasons, which are very important, but also for the reputation of their units. That is the very positive message we have received in our interactions with those facilities.

The heads of the Bill that have been published will give us the legal authority, subject to the drafting and progression of the Bill, to reimburse those facilities for the care they give. At the moment, that is done completely through an EU-wide process where there is low administrative overhead and pretty well-established rules as to how it happens. In a post-Brexit situation, the UK will no longer be part of the EU-defined treatment abroad scheme but we will have an equivalent arrangement with the UK. We will reimburse them, not as we currently do through the EU, but directly, for the care that they give.

In respect of the cross-border directive, the legislation also has an enabling provision which would allow the Minister and the HSE to meet the travel costs of Irish citizens to access treatment on an equivalent basis to the cross-border directive. Currently, if someone goes to an EU member state and pays for their cross-border care, they can come back to the HSE and have that reimbursed. We would seek to put in place a similar scheme. It will not be the EU cross-border scheme but a similar scheme that would allow Irish citizens to continue to travel to Northern Ireland or the UK and be reimbursed by the Irish Government. The UK authorities have indicated to us that they would be interested and prepared to facilitate continuing access under those arrangements.