Mr. Damien McCallion:

I thank the Chairman and committee members for the invitation to address them today. The purpose of this submission is to brief members on the operation of the Cooperation and Working Together Partnership. I am joined by my colleagues Mr. Neil Guckian, chief executive of the Western Health and Social Care Trust, who is the deputy chair, and Mr Bill Forbes, the chief officer of CAWT.

This opening statement describes CAWT’s cross-Border working arrangements and outlines health and social care services currently supported by the partnership through various initiatives.

Founded in 1992 with the signing of the Ballyconnell agreement, the CAWT partnership is a unique structure providing an overarching framework for the planning, management and implementation of cross-Border health and social care. The core purpose of CAWT is to support its partner organisations in the Republic of Ireland and Northern Ireland in their collective work to improve the health and well-being of the people living in the Border region and to enable better access to health and social care services. CAWT does not in itself deliver services.

In Northern Ireland, the CAWT partners are the Health and Social Care Board, the Public Health Agency, the Southern Health and Social Care Trust and the Western Health and Social Care Trust. In the Republic of Ireland, the partnership comprises the Border counties of the Health Service Executive.

North-South co-operation underpins all CAWT’s cross-Border health and social care activity, which is driven by the needs of the region and the health priorities of all the key partners, focusing on supporting the needs of people along the Border corridor. A key responsibility of the CAWT partnership is the provision of co-ordinated and strategic oversight ensuring work undertaken complements national Government and Department of Health priorities in both jurisdictions.

Significant EU grant funding totalling €31.1 million, under the current INTERREG VA programme, has enabled the CAWT partnership to demonstrate how investment in cross-Border health and social care services improves access to health services and enhances care, particularly for people living in rural or remote areas. The INTERREG programme is the fourth EU funding stream through which the CAWT partnership has successfully implemented projects to support the needs of local people on the Border corridor.

Preparatory work is under way in reaching a state of preparedness for the partnership’s application to the PEACE PLUS EU cross-border programme, the special EU programme body’s new funding measure which builds upon previous PEACE and INTERREG programmes. As members may be aware, the new PEACE PLUS programme is set to launch later this year. Under the six themes of the programme there will be up to 22 separate investment areas. The programme has not yet been approved by the European Commission, although it has been approved by the Northern Ireland Executive, the Government of Ireland and the North-South Ministerial Council.

Equally important, of course, is the commitment of the health services, North and South, to work in a collaborative way where a joined-up approach to service developments can bring mutual advantages.

Five projects, funded under the current EU INTERREG programme, are under way - four led by CAWT and one led by NHS national services in Scotland. In the interests of time, I will not read them out, but they include acute hospitals; community health; the innovation recovery project around mental health; multiple adverse childhood experiences, what is called the MACE project for children; and mPower, which supports older people.

In addition, the CAWT partnership facilitates other non-EU-funded cross-Border North-South activity, including all-island emergency planning, including joint academic learning and the delivery of humanitarian disaster assistance training. In November 2021, a very successful cross-Border humanitarian disaster planning course, hosted by the United Nations Training School in the Curragh, shared experiences and learning from a range of military and health contributors on the Irish-British response to Covid-19.

CAWT plays a key role in the facilitation of North-South health and social care co-operation supporting initiatives commissioned directly by the Departments of Health. This work has resulted in major developments such as the primary percutaneous coronary intervention, PCI, at Altnagelvin Hospital in Derry, which has been treating patients from County Donegal since May 2016 and the north-west cancer centre at Altnagelvin, which provides radiotherapy services to patients from Donegal, also since 2016.

Throughout 2019, 2020 and 2021 both the Northern Ireland and Republic of Ireland Departments of Health engaged in the preparations for the UK’s withdrawal from the EU. In 2018, both governments agreed to underwrite the INTERREG VA EU funding allocations, which was welcomed by all CAWT partners. As a result of these assurances, despite the uncertainty surrounding EU exit arrangements, the CAWT partnership remains cautiously optimistic that post-Brexit arrangements will not obstruct existing cross-Border and all-island health and social care service provision or limit future service developments.

Historically, when obstacles to the development of cross-Border services were identified, many practical solutions have been developed by the CAWT partnership. For example, a cross-Border indemnity agreement allows health and social care employees to work in both jurisdictions within a range of contexts described within the agreement. Regarding emergency planning, professional and regulatory bodies agreed for their registrants and members to provide services in the opposite jurisdiction in the event of a major incident while remaining accountable to their bodies.

To maintain and further develop the solid working relationships that are now an everyday experience in the health services, North and South, CAWT remains committed to its focus on key strategic goals including: achieving solutions to barriers to the cross-Border mobility of patients and professionals; actively pursuing collaborative strategic alliances; actively engaging with policymakers and other key stakeholders on the development and direction of cross-Border health and social care; and embedding cross-Border planning and implementation in core activities where mutual benefit can be gained through service efficiency and effectiveness.

Despite the uncertainty presented in recent years we continue to work collaboratively to improve the lives of people living in the Border areas.