Professor Deirdre Heenan:

I thank the committee for the invitation. It is very rare to hear people so delighted to see so many academics in the one room. That is generally not my experience.

I want to talk about cross-Border health. It has been identified as a key area of increased co-operation in the North and South for two decades. The research I want to talk about provides an overview of this policy area. It aimed to identify the key themes in this significant but poorly understood policy area. It is not advocating any particular constitutional position but assessing whether further co-operation has the potential to improve health outcomes on this island. Covid-19 pushed this issue up the policy agenda and reminded us frequently that disease knows no borders. The research was based on in-depth interviews with 49 individuals working in the area in the North and South. They included policymakers, hospital consultants, academics and professional bodies.

In the research, there were a number of recurring themes. First, there was overwhelming support for increased collaboration. Co-operation, collaboration and multidisciplinary working were viewed as natural in healthcare. In fact, they were referred to as the DNA of healthcare. People were not asking "Why would you?" but "Why would you not?". Of course, there was a belief that co-operation could introduce economies of scale, ensure value for money and allow specialisation on this small island. History tells us it can attract universal political support. The North West Cancer Centre is one example and the All-Island Congenital Heart Disease Network is another.

Second, there was concern that an overarching strategy framework to support this policy area is lacking. Who is driving this? This is a significant obstacle to progress. It is not deemed a policy priority in the North or South. Medics, in particular, say that, without a proper strategy, this area of policy is actually driven by well-meaning, committed individuals with their informal networks, and they describe it as pushing water up a hill.

We have all heard about how exhausted our healthcare professionals are and that they are burnt out. How can we expect them to find the time in their working day to do this as well? They mentioned co-operation and working together, CAWT, which attracted great praise, but they also felt that was a kind of get-out-of-jail clause for both Governments to say, "Look over here at CAWT. Look at what we are doing". In fact, it is not mainstreamed but is project and time specific. There were pros and cons to CAWT, which is important.

The third issue was the sharing of knowledge and an absence of a vehicle on this island for the dissemination of knowledge and good practice. How do we know what is happening? How do we know what someone else is doing? How can we form partnerships when there is no way of having up-to-date information on research projects and what people are interested in?

Fourth, data sharing is a recurring theme in working across borders. The data infrastructure on this island is described as weak, which makes meaningful comparisons very difficult. There is no common language and progress, although much talked about, was described as glacial.

One area for future co-operation that was probably mentioned most repeatedly was mental health. People asked whether we really believed that mental health issues are different in Derry compared with Donegal. Have we learned nothing from Covid-19 in terms of online platforms, chatbots, how we can use our information, and that we do not necessarily have to physically be in the same space to share that information and share our expertise? People also talked about public health, rare diseases, transplant surgeries, training and education as areas for future collaboration.

There was a desire to tackle issues and a mutual concern around ageing societies, suicide levels and mental illness. There was a belief that working together can bring benefits, that we are facing similar issues, and that working together can enhance knowledge and drive progress. Even though there was frustration at the lack of impetus, there was also a belief that there is scope with cross-Border or all-island collaboration to make a real difference to the health outcomes of people living on this island.