Ms Pat Cullen:

I thank the Chair. Good morning to Professors Heenan and Matthews. I thank them for both their submissions, which I found very interesting reads.

Recently, we in Sinn Féin were involved in and produced a discussion paper. If the committee and witnesses have not had an opportunity to read it, I would certainly be happy to share it with them. It sets out the case for an all-Ireland healthcare service. In that territory, we make reference to Professor Heenan's paper on cross-Border co-operation health in Ireland. I remember having conversations with her about that paper when I was the director in the college here in Belfast. In her paper, she rightly says:

The reality of the waiting lists in the north mean those who require elective care either pay for it or languish for years on a waiting list. The dreaded two-tier healthcare system has arrived by stealth. Unionists can no longer be assured that the NHS is viewed as an immutable asset.

Recent research by the ESRI has indicated the North and South have followed the same trajectories for outpatient waiting times. However, the North has a much higher percentage of people waiting in excess of 52 weeks. In addition, the ESRI found that, on average, people in the South could expect to live approximately 1.5 years longer than their counterparts in the North and people in the North live two years less than their counterparts throughout Britain.

We also know from the work of Mr. Ben Collins and others, which has been produced more recently, that healthcare staff are paid much more in the South than in the North, which has always been a bone of contention with ourselves in the college, and that this is a particular challenge along the Border areas. We know Mr. Peter Donaghy's work that deaths from cancer in the North are now 24% higher than those in the South. Our clinicians are constantly asking for more collaboration between the North and South, for example, people like Professor Mark Lawler from Queens University.

A small island with around 7 million people cannot continue to operate two separate healthcare systems. Duplication does not make sense and both witnesses have said that on many occasions. We have many more examples of where collaboration could work over and beyond the two Professor Heenan has referenced. I was lucky enough to be involved in the commissioning of the paediatric cardiac surgery and in the cancer services for Altnagelvin and across into Donegal.

I want to first ask Professor Heenan about research and evidence. I know she has said there is a lack of such, and I would agree with her, but what research and evidence should now be prioritised to set out the roadmap or framework for a comprehensive, collaborative, all-Ireland approach to health and well-being?

What are Professor Heenan’s thoughts on whose responsibility it is? Who will grasp the straw, take the ring and run with it?