Mr. Damien Quigley:

I thank the committee for the opportunity to speak on this very important matter. I am the national support officer of PDFORRA and a director of the PDFORRA medical assistance scheme, PMAS. I am accompanied by my colleague, Mr. Martin Bright, who is deputy general secretary of PDFORRA and another director of PMAS.

PDFORRA is the representative body for enlisted personnel serving in the Defence Forces and we have a membership of more than 6,300 across the Army, Naval Service and Air Corps. For a significant number of years, PDFORRA became increasingly worried that a high percentage of our members who had become injured in service to the State were unable to continue in service in the Defence Forces because of extended waiting lists for medical treatment in the public health system.

Since 1994, new contract arrangements for enlisted personnel applied stricter health and fitness criteria for each period of re-engagement. Consequently, a member could be discharged and lose his or her job if medical treatment was not provided quickly.

This problem is not uncommon due to the intense and physically demanding nature of military service. Injuries and accidents happen and are part of life in the Defence Forces. In order to keep their jobs, those concerned relied on the military medical services and public health service for prompt treatment. The military medical service only provides GP and primary care, while the public health system, because of very long treatment waiting lists, is unable to provide medical treatment quickly enough.

Unlike commissioned officers, enlisted personnel are not provided with free private medical care and are not in a financial position to pay for expensive private health treatment. In the foregoing circumstances, PDFORRA established the PDFORRA medical assistance scheme, PMAS, as a not-for-profit company limited by guarantee to facilitate members who required prompt medical treatment. This was to ensure their continued service in the Defence Forces or indeed on overseas service with United Nations. The scheme facilitates members in securing medical treatment, mainly in Northern Ireland, under the European Union cross-border healthcare directive.

The financial model used is based on the member who needs treatment seeking sanction from the HSE to receive the treatment and borrowing the necessary finance from the ANSAC Credit Union. These loans are guaranteed by PMAS. Once the treatment has been received the individual will get a refund of most of the costs from the HSE. Where the refund does not cover all the costs the member receives money from the PMAS fund to cover the shortfall. The PMAS fund was initially established by a loan of €150,000 from PDFORRA and is maintained and added to through member subscriptions.

The first PMAS member received treatment in Kingsbridge Private Hospital, Belfast in July 2018 and to date over 250 PMAS patients have been processed for treatment under the scheme. Membership of PMAS has risen to just under 3,000. It would be fair to say that the scheme has been a success in the short period that it has been active with many careers secured as a result, but also many important interventions for individuals in terms of ending pain, suffering and anxiety. The military medical service in particular sees the benefits of the scheme and refers injured members for treatment regularly. It recognises PMAS as a pathway to solving medical problems, reducing sick leave and retaining enlisted personnel.

The success of the scheme saw PMAS plan to formally increase its staff and to expand membership to include family members. However, Brexit and the Northern Ireland protocol have presented a challenge we did not predict. PMAS thought that the cross-border directive would still apply to Northern Ireland because it has a similar status to the European Economic Area, EEA, countries such as Norway, where cross-border healthcare takes place under the cross-border directive. For reasons that PMAS does not understand, this route appears not to have been pursued. Instead, a temporary and comparable scheme has been put in place by the Government in respect of residents of the Republic of Ireland seeking treatment in Northern Ireland. It is known as the Northern Ireland planned healthcare scheme.

The temporary nature of the new arrangements has led to PMAS putting off any expansion plans in respect of staff and family membership. It is our understanding that the Government scheme will only last for the remainder of this year and may then fall and not be replaced on 31 December 2021. In theory PMAS members will be able to go to other countries in mainland Europe for treatment. However, this is considerably more difficult from a travel perspective and, crucially, very much more expensive for the individual as a result of travel and accommodation costs. PMAS is not sure it can deliver such a service and further believes that members will not opt for such an approach. The net effect of this will be more medical discharges of enlisted personnel and, PMAS believes, more individuals voluntarily leaving the Permanent Defence Force.

PMAS previously wrote to the Minister for Health, Deputy Stephen Donnelly, seeking the continued operation of the cross-border directive in respect of Northern Ireland as part of the Northern Ireland protocol after Brexit. We have again written to the Minister for Health to ask him to give the Northern Ireland planned healthcare scheme a permanent status. This action will give our members the security they need in terms of medical treatment and career certainty.

I ask my colleague, Mr. Martin Bright, to give an outline of the experiences some of our members have had using the scheme.