Mr. Muiris O'Connor:

I thank the Senators. I will start by responding to Senator O'Reilly's questions on the general implications of Brexit for cross-Border health. I will go to Ms Donohoe for the issue of the continuity of access to services in the North and Ms Morgan on the ability of residents and citizens of the North to access services in the South and on the issue of European health insurance card, EHIC.

In response to Senator O'Reilly on the co-operation in healthcare and the implications of Brexit, Brexit, certainly on the face of it, presented many challenges for the continuity of care on a cross-Border basis, but in many other ways it has brought us even closer to our counterparts, both in the North and in the UK, because we recognise that under any circumstances we still are stuck together and we still are neighbours and always will be no matter what the wider political affiliations to the European Union will be.

I would describe the cross-border directive as perhaps the only aspect of the totality of the existing co-operation that required a special further arrangement. All of the rest of the continuity is protected in the Good Friday Agreement and it very much flourishes in the framework of the common travel area. It was not widely reported but, in May 2019, the Minister for Foreign Affairs and his UK counterpart signed a memorandum of understanding on the common travel area which included a reference to health. Between that time and December last, we worked intensively with counterparts in London and in Belfast to provide a basis independent of the European Union for the continuation of all reciprocal health rights and all the co-operation that existed. Under the common travel area, essentially, people on the island of Ireland and the island of Great Britain have the rights to travel, reside and work anywhere, and vote in each other's elections even. Particularly associated with the right to work are the importance of social welfare rights, and in the European framework health, rights are envisaged as part of social welfare rights. We have a basis for total continuity in co-operation.

Altnagelvin is absolutely secure and has a bright future. Our provision of emergency paediatric care to young infants from the North, from Crumlin now and soon to be from the children's hospital will continue to be on an all-island basis.

Something we were afraid of is that in our work to mitigate the implications of Brexit, we did not just want a pause, a freeze or to hold what we have because what we have in health is a trajectory of deepening co-operation. The Senator, from his neck of the woods, would see just how practical it is. It does not feel like international co-operation. It is community level health co-operation in most instances and it is thriving.

Peace Plus and the early commitment to it gave great reassurance around the Border area that there will be more investment from the EU, supported by London and Dublin, in that kind of co-operation. We probably know our London counterparts and Belfast counterparts better than we did before this, and the co-operation was excellent beforehand.

The cross-border directive, as I explained earlier, was one thing that was not reciprocal because the UK was not engaging with it and, therefore, it was not possible to encompass it in the wider agreement.

We were not to know this but in the end we were very reassured about how comprehensively the EU-UK deal between London and Brussels provided for continuity in health and social care. We had meetings with counterparts in London and Belfast as recently as last Friday. We now have to exchange letters and clarify legally which pieces operate on the basis of the European-UK deal and which pieces are in respect of the common travel area. In the future the common travel area agreement for full co-operation and reciprocal rights is enduring, irrespective of how the EU-UK relationship goes. We are very happy to be able to provide that strong assurance on that.

On public health, we are looking for areas to continue to co-operate, and public health is an obvious one. Cancer care is also an obvious one and there is much of modern health and precision medicine that requires scale of a level that neither the South nor the North has. The instinct to co-operate, therefore, is really strong. I will pass now or to Ms Donohoe who can speak on the continuity of access to cataract and the hip and knee procedures.