Professor Deirdre Heenan:

I thank the committee for the invitation. Providing healthcare services commands one of the largest allocations of public funding on both sides of the Irish Border and concerns over the efficiency and effectiveness of these systems are perennial.

Health is already an established area of North-South co-operation. The North-South Ministerial Council, NSMC, established under strand two of the 1998 Good Friday Agreement, brings together the two Governments on the island of Ireland to develop consultation, co-operation and action within the island of Ireland and health is one of the six agreed areas of cooperation. Despite this, cross-Border health is a woefully underdeveloped area of public policy and there appears to be little appetite to address this by the Administrations on either side of the Border. Aside from the notable exceptions of the congenital heart disease network and the North West Cancer Centre at Altnagelvin, which were developed over a decade ago, there has been relatively little activity in this key policy area. Following these much-lauded initiatives, the approach to date has been minimalist and often project specific.

When compared to other European countries, both jurisdictions have relatively poor population health outcomes. The main causes of premature deaths are the same, namely, cardiovascular disease, cancer, accidents and suicide. Notwithstanding the differences in structure and funding mechanisms, the two healthcare systems suffer from similar problems in the form of lengthy waiting lists, staff shortages, a lack of focus on prevention and resources spread thinly across too many hospitals.

Given the dominance of healthcare issues in the politics of Ireland, North and South, the lack of knowledge and research is extraordinary. While this may be partly explained by the political sensitivities of all-island working, it does not explain why the potential benefits and barriers have not attracted substantial political and policy attention. Major policy reviews on both sides of the border have paid scant regard to the potential of cross-Border working.

The limited existing research identifies a number of key barriers to collaboration including a lack of leadership, difficulties in comparing data and limited opportunities to share knowledge. It also identified a range of potential benefits to be gained from increased collaboration in healthcare. Key acute healthcare services, including cystic fibrosis, ear nose and throat surgery, orthopaedic surgery, treatment of rare diseases, cancer care and acute mental health services, were identified as possible areas of focus.

Additionally, the South West Acute Hospital, SWAH, in Enniskillen presents substantial opportunities for innovation in respect of service provision on a cross-Border basis. This work concluded that working together to address major health issues has the potential to deliver significant additional gains for the population of each jurisdiction that could not be achieved by each system working in isolation. Frequently, co-operation and collaboration are used interchangeably by politicians but in policy terms they mean very different things. Co-operation is where the respective jurisdictions act independently to achieve a parallel and mutually beneficial outcome. An example of co-ordination is the development of the M1-A1 dual carriageway. Collaboration is where the individual jurisdictions work together and combine their resources in a particular initiative with a common goal in view, including working sufficiently closely to manage risks, achieve economies of scale, overcome obstacles and eliminate administrative duplication. An example of collaboration in this context is the North West Cancer Centre.

All-island approaches have the potential to address some of the current issues and ensure Ireland as a whole is well placed to deal with future challenges. However, without a framework and a vision for collaboration, interventions will remain fragmented and piecemeal. Robust mechanisms and policies are needed to tackle systemic and complex healthcare challenges, assess potential economies of scale and support the work of clinical staff with scarce specialist skills. Given the similar health challenges faced by each jurisdiction, working collaboratively in order to maximise the potential for service planning and delivery should be a policy priority.