Professor Deirdre Heenan:

I will try to cover all of those issues and perhaps the Chairman will tell me if I have not. Yes, we have some very good examples but is this as good as it gets? That is a fair question. When I hear politicians North and South talking about all-island co-operation, they are going back to those two examples. There are very few new examples. Consider, for example, the transplant situation on this island. We are told healthy organs are being disposed of because we do not have an appropriate transplant system. This is shocking. When we look at it and talk to consultants, their answer is there is no-one driving this. Health ministers North and South are looking at their own systems, their trolley waits, and their accident and emergency departments, and their heads are down and their heads are in. Who has the time and the space to look up and out and say we could be doing this in a better way? The Senators are asking what this committee could do. It would be fantastic to hear them say someone must drive this agenda. I hate to say the word "czar", because we seem to have czars for everything, but if we had an all-island health czar, I would be delighted because that person would then be the person saying this is what we are doing, this is the timescale, these are the outcomes and, importantly, here is the evidence to suggest this is better in terms of outcomes.

I will go on to some other examples. We know from the work we have done post Covid that we have an issue with toxic masculinity and high suicide rates among young men. What we knew through Covid, which we did not know before, was that those men are happier to have counselling online. They prefer it than face-to-face counselling. Does it matter if that counselling is delivered from Dublin, Donegal or Dungiven? I do not think it does if it is available on an all-island basis. We have, however, become so consumed with healthcare systems that have deep-seated problems that no-one appears to have the time and space to say we could be doing this in a different way, which would be better and which would actually save money. The answer is we really need someone driving this.

There is a belief that in both North and South there is a lot of lip service, a lot of memorandums of understanding being signed and people saying that they had a phone call in the last six months. All that does not really cut it in terms of what we could be doing.

To give a nod to Professor Doyle, more evidence is really important because in every conversation we hear about constitutional issues. Invariably, top of the list people say that they would not want to leave the UK because the NHS is the jewel in the crown and "down there, they are paying to see the doctor". However, actually there is no discussion about health outcomes or access to health in the North, and the fact that it is free at the point of delivery if one cannot actually access it and how far that is true across the piece.