Mr. Bill Forbes:

From an ambulance service perspective, involving the National Ambulance Service in the Republic of Ireland and the Northern Ireland Ambulance Service, co-operation between both services is second to none. There was an issue a number of years ago around dual benefits for both organisations and we progressed two memorandums of understanding. One was on the response to any major incident and the other was on a request for mutual aid. They have been invoked on a number of occasions, including in quarter 4 of 2020 and quarter 1 of 2021, when the Northern Ireland Ambulance Service experienced extreme pressures and the National Ambulance Service in the Republic of Ireland was asked to provide resources into Newry, Enniskillen and Derry. That was done over a number of days and weeks and that memorandum of understanding is still in situ. To reinforce it even more, we do joint training, joint exercises and joint academic learning to ensure it works. The clinical directors from both organisations and both Departments have agreed that this mutual working across the Border is indemnified for the benefit of patients.

The other piece is that we do not work in silos. We also work with the Western Health and Social Care Trust and we have trauma bypass protocols which allow us to take very critically ill patients, if they are geographically closer to Altnagelvin, straight there without any clinical issues. The other big programme is the north-west percutaneous coronary intervention, PCI, programme where patients are being transported and treated across both jurisdictions, travelling from Donegal straight into the primary PCI centre in Derry without any sort of indemnity issues, stopping or having to switch vehicles, staff or patients. That whole piece on the front line works very well.