Mr. Muiris O'Connor:

Good afternoon. I thank the committee for inviting me to attend today. I am joined by my departmental colleagues, Mr. Jonathan Patchell, head of our international unit, Ms Emma-Jane Morgan, head of the eligibility policy unit, and Ms Catherine Donohoe from the HSE. It is our pleasure to be here to give the committee an update on the cross-border healthcare directive since the end of the transition period.

As we all know, the UK’s withdrawal from the European Union has impacted across many sectors, including health. The Department welcomes the conclusion of the EU-UK Trade and Cooperation Agreement, TCA, in December 2020. The TCA, together with the withdrawal agreement which includes the protocol on Ireland and Northern Ireland, means that Ireland’s key Brexit objectives have been achieved in the area of health and social care. The agreement provides a new framework for the continuation of access to healthcare for Irish people who are working, visiting, or residing in the UK and vice versa. The TCA has protected many of the health rights that existed prior to the UK’s withdrawal from the EU, which will benefit residents in Ireland. I am also pleased to note that under the TCA, patients who require planned and often very specialised healthcare, as was provided for under the treatment abroad scheme, will continue to access that care in the UK.

Members will be aware that there has been a long history of cultivating and utilising our shared health services to enhance the health outcomes for everyone on this island. It is useful to outline here that North-South co-operation in healthcare continues to be delivered. For example, cross-Border health services such as the cardiology and cancer treatments in Altnagelvin and paediatric cardiology and related maternity services in Dublin will continue to operate on a cross-Border, all-island basis. A new EU programme, PEACE PLUS, is being developed to continue to build on the work of the current PEACE and INTERREG programmes. There was confirmation from both the EU and the UK, at an early point in the Brexit negotiations, of their enduring commitment to PEACE PLUS, which is a positive. A memorandum of understanding signed by the Chief Medical Officers of Ireland and Northern Ireland on 9 November 2020 provides a formal framework to manage the transfer of patients between jurisdictions in cases where critical care capacity has been overwhelmed in either jurisdiction. This is a concrete example of continuing co-operation in the pandemic.

Notwithstanding the extensive and welcome continuation of access to health services in the UK, one direct consequence of the UK’s withdrawal from the EU is that the EU cross-border directive, CBD, no longer applies to the UK. This directive provides for the reimbursement to patients of the cost of receiving treatment abroad in another EU member state, where the patient would be entitled to such treatment in his or her home member state. Since its introduction in 2014, cross-border directive has provided access to health services in Northern Ireland, in particular for persons in this State. In 2020, almost 7,850 CBD reimbursements were made in respect of treatments accessed in the UK, which represents 90% of all treatments accessed by Irish residents under the CBD across the EU. Of those cases accessed in the UK, 98% of the treatments reimbursed were accessed in Northern Ireland. These are treatments obtained from private providers.

However, as the CBD is EU legislation associated with the Single Market, the provisions of the CBD no longer apply to the UK, including Northern Ireland, since 1 January this year. This outcome was certainly not one desired by the Irish Government, and therefore mitigating measures have been put in place to address this loss of access.

First, the HSE has put in place transitional arrangements for certain patients who have a legitimate expectation of continuing to access care in the UK under the current provisions of the EU CBD scheme. This includes provision for reimbursement of healthcare costs by the HSE to persons who fall into certain categories, such as patients who can provide evidence that they had treatments booked prior to December 2020 for treatment in 2021.

Second, on 28 December 2020, the Government approved the implementation of a new Northern Ireland planned healthcare scheme. Persons resident in the State have since 1 January this year been eligible to be reimbursed for accessing private healthcare in Northern Ireland by the HSE, provided such healthcare is publicly available within Ireland. It is intended the new scheme will operate for 12 months on an administrative basis initially, and along similar parameters to the cross-border directive, with the drafting of a general scheme planned to take place on a statutory basis. This important step, taken by the Government, provides both new and current patients with certainty around their ability to continue to access care in Northern Ireland and be reimbursed for it by the HSE.

In conclusion, despite Brexit the Irish Government has ensured that persons resident in Ireland can continue to access and be reimbursed for the cost of healthcare obtained from private providers in Northern Ireland. The Northern Ireland planned healthcare scheme will provide certainty for patients if they cannot continue to access private routine and scheduled healthcare in Northern Ireland, particularly in light of the ongoing impact of the Covid-19 pandemic on access to non-Covid 19 care within the State.

Both the EU and UK trade and co-operation agreement and the Northern Ireland protocol provide for substantial continuity in the provision of health services between Ireland and the UK and the Government will maintain and build upon existing healthcare co-operation through these frameworks. We are very happy to take any questions or provide any further detail that the committee might require.