Mr. Muiris O'Connor:

I thank the committee for inviting us back before it to provide an update on developments since our last appearance in March. I am joined by Ms Emma-Jane Morgan, head of our eligibility policy unit, and Mr. Jonathan Patchell, head of our international unit, in the Department of Health. I am also joined by Ms Catherine Donohoe from the HSE. We are here to give the committee an update on cross-border healthcare since the end of the Brexit transition period.

EU-UK relations continue to be a focus at EU level, with priority given to the effective implementation of the trade and co-operation agreement, as well as the protocol on Ireland and Northern Ireland. The Department of Health is continuing to monitor developments closely. The Northern Ireland protocol is the joint EU-UK solution to mitigate against the disruptions Brexit causes for citizens and businesses on the island of Ireland. The EU remains firm that the protocol cannot be renegotiated but it is focused on identifying pragmatic solutions, as we have seen. There has been consistent engagement by European Commission Vice-President Šefovi, including his recent visit to Dublin and Belfast, to hear directly from affected stakeholders. Technical engagement at official level between the EU and the UK is also ongoing. The Government is also paying close attention to developments in Northern Ireland and takes the concerns raised in respect of the protocol very seriously.

With regard to access to healthcare, the committee is aware that the utilisation of the EU cross-border directive by Irish patients has grown substantially in recent years. The loss of that access route to healthcare as a result of Brexit posed a real challenge. To mitigate this loss, the Government took a number of important decisions that have enabled our patients to continue to access private healthcare in Northern Ireland and the UK and be reimbursed by the HSE, provided such healthcare is publicly available within Ireland. First, a new Northern Ireland planned healthcare scheme was established on an administrative basis from 1 January and has been operationalised by the HSE. Second, transitional arrangements have also been put in place by the HSE to enable persons who had a legitimate expectation to continue to access care in the UK under the EU cross-border directive.

The latest data available from the HSE indicate that almost 2,000 reimbursements have been made so far this year for persons who have continued to access healthcare in Northern Ireland under either the cross-border directive transitional arrangements or the new Northern Ireland planned healthcare scheme. It is, therefore, welcome to confirm that despite Brexit, both these measures continue to ensure that patients have access to healthcare. I also note that patients are continuing to access care in other EU nations, as is their right, under the provisions of the cross-border directive. In establishing the new Northern Ireland planned healthcare scheme, the Government decided that it should be on an administrative basis, with the drafting of a general scheme to be prepared to place it on a statutory footing. Officials have undertaken detailed analysis to inform the design of the statutory scheme and that work is continuing at pace. It is likely, however, that this work will continue into 2022 but I can assure the committee that this remains a priority and the administrative scheme, which is operating successfully, will remain until such time that the statutory scheme is in place.

It is also useful to inform the committee that the Northern Ireland Executive has similarly introduced an administrative Republic of Ireland reimbursement scheme for a period of 12 months, which enables residents of Northern Ireland to access private treatment in this State. The Department is engaging with relevant counterparts in Northern Ireland to ensure a continued shared understanding of both schemes.

In terms of other issues raised at our last appearance before the committee, members will be aware of the data adequacy decisions adopted by the European Commission for the UK on 28 June 2021. These adequacy decisions facilitate the continued free flow of personal data from the EU to the UK so long as it benefits from an essentially equivalent level of protection to that guaranteed under EU law.

The trade and co-operation agreement, TCA, between the EU and the UK also provides for a continuation of healthcare rights when on a temporary stay in a state covered by the agreement. Residents of Northern Ireland can continue to use their current UK European health insurance card, EHIC, to access necessary care while on a temporary stay in an EU member state. When the EHIC expires, residents of Northern Ireland may obtain a new global health insurance card issued by the UK Government. As the trade and co-operation agreement has maintained the equivalent of EHIC rights, Northern Ireland residents will continue to be able to access necessary healthcare during a temporary visit within the EU and, therefore, it was not necessary to implement the Northern Ireland direct reimbursement scheme that we had prepared as a fallback.

I can also report that we continue to be in a good space in terms of medicines supply, given our preparation with suppliers and internally before the end of the transition period. In fact, many of the mitigations in place for Brexit served us very well in the fight against Covid-19.

As I mentioned at my last appearance, both the EU-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. The Government has maintained and is building upon existing healthcare co-operation through these frameworks. My colleagues and I will be happy to provide any further detail Senators may require and answer any questions.