Professor Deirdre Heenan:

To answer Ms Cullen’s question, the lack of information and data in this key policy area is extraordinary. Many times, when we hear people talking about it, it is on their received wisdom, anecdotal evidence or long-held views, rather than anything that could be described as evidence. For example, the prevailing view in the North is that the healthcare system is far superior to the one in the South. We frequently hear mention of the fact that this is because, “You have to pay down there to see the doctor or access services.” We want some up-to-date information about access to services. On the one hand, it is fantastic that we have a National Health Service that is free at the point of delivery, but the issue, as Ms Cullen rightly highlighted, is access. We have people waiting for surgeries and elective care for seven or eight years. We have children on mental health waiting lists for years. There is some work being done, but frankly it is tinkering at the margins because we have not addressed the bigger question, which is transformation of our health and social care system.

Ms Cullen will be well aware that we have had seven major reviews in the past two decades. These reviews, such as the Donaldson review, the Appleby review, Transforming Your Care and, most recently, the Bengoa review, have all pointed to the same direction of travel - that we do have enough money for a world-class healthcare system but we simply do not have enough money for the system we are currently running and we really need to make changes. That has been dodged for all sorts of reasons. We could have a long discussion about that, but we are where we are. Instead of depending on anecdotes, it is time that we have serious research commissioned at governmental level on both sides of the Border. This has to be led at least at ministerial level in order that we can agree on the information we want to collect.

My particular interest would be on access to healthcare services. We know we have different systems. We know about the theoretical advantages and disadvantages of those systems. If we were to speak to people who are trying to access those healthcare systems on the ground, we may get a very different picture. I do not just mean access in terms of elective care; it is access to a GP in a timely fashion and access to screening. For example, in the North, bowel screening is at age 60. This is ten years later than it is in other regions of the UK. Why is that? Why are we a decade behind? As Ms Cullen mentioned, Professor Mark Lawler and I have been funded by the analysing and researching Ireland North and South, ARINS, project to undertake work on all-island cancer care. We are particularly interested in what we could do in terms of a whole island approach to tackling cancer. We know that one in two of us are going to have cancer. We know that this is partly because of an ageing population, but we have to get serious about being proactive and preventative medicines.

We talk a lot of the shift left and moving resources upstream, but in fact we are firefighting every single day of the week. Unless we start to address that, we cannot hope to change health outcomes. That whole area of prevention and public health could be addressed on an all-island basis. For example, if a person has depression or a serious mental health issue, does it really matter if they are sitting in Derry or Donegal? What did we learn from Covid-19 about the importance of online services? We know that many young men, for example, would much prefer to have mental services, particularly counselling, available online, so it does not really matter where they are based. We have to think much more proactively. We talk a lot about the existing co-operation across this island. My contention is that it is not enough. We need real collaboration, which is a project where we put our resources together and have agreed objectives and outcomes in the area of mental health or cancer services, for example. We have a ten-year mental health strategy published in 2021 which does not mention the Republic of Ireland. It is as if it does not exist.