Lisa Chambers (Fianna Fail) | Oireachtas source

I have some questions. The witnesses have answered quite extensively on what the plan is for beyond the 12 month period. I was going to ask a similar question to Senator Dooley's. To pick up on what Mr. O'Connor said about the basis being there for total continuity, perhaps we do not want total continuity. Perhaps we want a slightly reworked system. Heretofore, we have been bound by the 2011 EU directive that put the scheme in place but now we have an opportunity to look at the drawbacks of the scheme, for want of a better phrase, and look to see how we can make it better and improve things.

Certainly my experience of dealing with people in my area is that there was a huge fear about borrowing to fund access to healthcare. We know that quite often what the State is willing to pay does not meet the full cost of the treatment and there can be a shortfall. Often, people do not know what that is going to be until they have embarked upon the process of engaging with the healthcare provider in the North. This is a disincentive to people accessing treatment. If one were to be very cynical it probably suits the Department and the State not to incentivise too many to take up this route because it is quite a significant cost to the health service. I hope it is not something that may be an underlying policy, whereby we do not want to encourage too many to avail of cross-border treatment.

We should look at streamlining it and making it a bit easier. We should not have a situation where politicians are bussing people to the North to get treatment. This shows there is a deficiency in the service. The reason there is such demand to go across the Border for healthcare is because our health service cannot cope with the demand that is here. Why can I purchase private healthcare in Northern Ireland and get reimbursed by the State but I cannot purchase it here in the Republic and be reimbursed in the same manner? We need to look at this, particularly because we know the colossal waiting lists that will be there after Covid. They are climbing all of the time. We are all very aware of this and familiar with it but at the end of the waiting lists are a lot of people who are really suffering and living in constant pain with a very poor quality of life. They also include many elderly people. I implore everybody working on this to try to rework the system and make it work for the patient not for the service provider. Really, the patient has to be put at the heart of this.

I want to touch on the need to provide certainty beyond the 12 month period. Senator Gallagher mentioned PDFORRA, the representative body for the enlisted ranks of the Defence Forces, whose representatives will come to our next session in the next hour. I am not sure which speaker described the medical assistance scheme in place as brilliant. The scheme has been put in place to bypass the barriers the State has put in place to access cross-border treatment. This particular assistance scheme allows members of the Defence Forces to get money from the scheme to pay for treatment upfront. The State then reimburses the scheme and any shortfall is met by the scheme itself based on people paying an annual fee. If we are describing this scheme as brilliant when it is there to bypass the barriers we put in people's way in accessing healthcare we have a problem. These barriers should not exist. It is the ingenuity of people responding to the needs of those they look after to try to get them that healthcare despite the significant barriers the State put in their way. Let this be a lesson to us that we have an opportunity now to remove these barriers.

One of the impacts is the uncertainty of this 12-month period. It is great we have a sticking plaster, if I could call it that, that kind of bridges the gap, and PDFORRA was looking to expand that scheme to take in family members, which is great because why not look after more people who need healthcare and keep them healthy? However, they are not in a position to expand because they do not know whether they can rely on access to treatment in the North beyond the 12-month period. Yes, they have acknowledged, as I am sure others will, that they can access treatment in Germany, France or other member states but, because the cost of travel and accommodation is not included in the reimbursement, travelling is not an option for many people, who can barely get the funds together to pay for the treatment itself.

Those are not so much questions but more statements and giving my own two cents on where we are at. I want to finish by thanking all four of the witnesses for taking the time to come to speak to the committee. This will form a significant and important part of our report when the committee comes to make its report before the summer recess. It is one of the areas that will be of most interest to the average citizen, who will be looking at the impact of Brexit across the country. I thank the witnesses and hand back to Mr. O'Connor.