Mr. Muiris O'Connor:

I thank the committee for inviting the Department of Health to talk about the implications for the health sector of the United Kingdom's decision to withdraw from the European Union. I am assistant secretary in charge of the research, development and health analytics division in the Department of Health. I am joined by Kieran Smyth, Judith Szlovak and Sean Howlett from the international unit in my division. I will begin by outlining the programme of work undertaken by the Department of Health and developments since our last appearance before this committee. I will then discuss objectives at that time and what has been done to meet those objectives, specifically the Department’s response to the recommendations made by the committee in its report, but I might abbreviate that section because I expect it will be of interest in the questions and answers. I will also use my opening statement to outline the Department’s current objectives and work programme.

I will start with developments since our last meeting. These provide the context for both the objectives we have met and the current work at hand with regard to the implications of Brexit for the health sector. The Minister of Health and the Department of Health lead on dealing with health related issues involving Brexit. In this capacity we feed into the Government's response and negotiations led by the Department of Foreign Affairs and Trade. We also oversee and co-ordinate the work of the Health Service Executive, HSE, and other agencies in the health sector in dealing with the many challenges resulting from Brexit. The work at Cabinet level is being prepared through cross-departmental co-ordination structures. These represent a frequent and active channel through which Departments are providing their research, analysis and overall policy input to the Government’s wider response to Brexit, including its priorities for the ongoing negotiations.

For the Department of Health, the maintenance of the common travel area, CTA, was identified as a vital component in avoiding disruption to our health services as a consequence of Brexit. The Department of Health fully supported the Government in the intensive work with the EU task force and EU partners to ensure that the CTA issue, along with Ireland’s other unique concerns, was fully understood and reflected in the EU’s negotiation position.

It was this level of co-operation, of which we were a part, that helped yield results in December. The joint report from the EU and UK negotiators of 8 December includes a recognition that Ireland and the UK can continue to make bilateral arrangements between themselves relating to the movement of people between their territories, while respecting Ireland's EU obligations. There is a commitment to the continuation of the common travel area, CTA, and associated rights. In plain terms, this means that across sectors, including health, there will be no change in the right of Irish citizens to move freely North and South, east and west and to live, work, study and access health and social benefits in the UK on the same basis as UK citizens. Reciprocal arrangements will apply to UK citizens in Ireland. Particularly important from a Department of Health perspective is the commitment on the maintenance of the common travel area in terms of access to health care and allowing the freedom of movement that we currently have for Irish and UK citizens.

I will now outline the Department's important role in the work on maintaining the CTA. The Department of Health worked successfully within the cross-cutting Government structures to ensure that the rationale for reciprocal health entitlements and health co-operation being a core part of the CTA was understood and accepted. Ensuring that the EU and the UK, including Northern Ireland, had a common understanding of the health dimensions of the CTA and of their importance was a key objective for the Department. The Department has been involved in bilateral discussions with its UK and Northern Ireland counterparts, first, to ensure that there was a shared understanding of the health aspects of the CTA and, second, to reach agreement at a high level on maintaining them. Now that a high level agreement has been reached on maintaining the health aspects of the CTA, the Department will undertake further detailed work with the UK, including the steps necessary to maintain the existing arrangements. The Department has also worked closely with the Department of Foreign Affairs and Trade to ensure that the EU has had a full understanding of what was involved and of its importance in the context of the first phase of the EU-UK negotiations.

Since we were last before the committee, the Government has secured clear and strong commitments on the Border. The UK has given a guarantee that a hard border, including any physical infrastructure and associated checks and controls, will be avoided and has committed to how this will be achieved. The UK's intention is to achieve this through the wider EU-UK future relationship agreement, which is also our preference, or through specific solutions. If these do not deliver on the overarching commitment of avoiding a hard border, the UK has committed to maintaining full alignment with those rules of the Internal Market and the customs union necessary to protect North South co-operation, the all-island economy and the Good Friday Agreement. This brings us to a good place in respect of the freedom of movement issues and the access to services which featured prominently in the committee's report. As members of the committee will know, health is a very significant focus for North-South co-operation so clearly this commitment is important across a range of issues, including food safety, procurement and regulation of medicines. This is welcome and the Department of Health is now deepening its engagement with other Departments, the HSE, the Health Products Regulatory Authority and the Food Safety Authority of Ireland to ensure that detailed health issues are covered fully.

The agreement on citizens' rights in December is also important from a health perspective. This agreement means that the rights of EU citizens already living in the United Kingdom or of UK citizens already living in the EU 27, who meet the qualifying residency criteria, will remain the same after the United Kingdom has left the EU. In effect this means, for example, that a qualifying Irish person resident in the UK at the date of withdrawal will continue to have a right to access health care after the UK has left the EU. The withdrawal agreement will copperfasten these. There are two key messages we wish to give from a health perspective. First, currently there are no changes to patient care, as the UK continues to be a full member of the EU. Indeed, it is important to reiterate that until the UK formally withdraws from the European Union, it remains a full member with all its existing rights and obligations. Second, we have in principle, through securing agreement on the common travel area, avoided the worst case scenario, so long as the commitments are followed through, including the detailed work to maintain the operational arrangements in this next phase.

The Department's response to the committee's recommendations are set out in the opening statement. I will skim through them. There are a number of important issues which will arise during the question and answer session. The Department welcomed the report produced by the committee following our last appearance. It not only captured the key issues, but raised awareness among stakeholders of the importance of Brexit for health and of health for Brexit. The committee made seven recommendations to the Department of Health in its report. At this point I wish to provide a response to these and I hope to show how the recommendations have been addressed.

The first recommendation related to the committee's request that we get full capture and reporting for a proper handle on the quantum and scale of services currently being provided under the treatment abroad scheme and the cross-border directive. In June last year, we submitted a detailed report on those figures and in advance of today's meeting we sent the committee a further update of the figures. We are happy to return to that during the questions session.

The committee's second recommendation was that the Department make an informed estimate of the total number of residents of Ireland who receive health care in the United Kingdom each year and plan for alternative provision of that care in case availing of health care in the United Kingdom becomes significantly more difficult. The agreement reached on maintaining the common travel area and associated rights is very important in this context as it allows Irish citizens to travel freely to the UK, and vice versa. The further technical work conducted by the Department of Health with its UK and Northern Ireland counterparts on the maintenance of bilateral health co-operation under the common travel area and associated rights, referred to earlier, is allowing these issues to be fully examined.

Third, the committee recommended that in the case of the introduction of border checks between Ireland and Northern Ireland, we were to devise a system to ensure that border checks do not cause delays to travel for health care purposes, as such delays could impact negatively on health outcomes. Again, the agreement in December, with the clear and strong commitments on the border issue and the avoidance of a hard border or any associated checks and controls, provides the reassurance that those delays would not materialise.

Fourth, the committee recommended that the Department ensure the continuation of cross-border health care agreements which are working well and saving lives, even in the case of significantly curtailed freedom of movement. The agreement that has been reached on the continuation of the common travel area and associated rights as it currently operates is important in this context as arrangements for Irish citizens to travel freely to the UK, including Northern Ireland, will be maintained. That agreement also facilitates the maintenance of the extensive co-operation on health that takes place between Ireland and the UK on a North-South and east-west basis. While further detailed work needs to be undertaken in this context between the Department of Health and counterparts in the UK and Northern Ireland, both sides are committed to maintaining bilateral health service co-operation into the future.

Fifth, the committee recommended that the Department pursue further co-operation with Northern Ireland in terms of public health policy, health promotion and health research, despite the UK’s impending withdrawal from the EU. We are responding very proactively here. The Department of Health continues to deepen and develop co-operation on health with cross-border stakeholders and the Department of Health in Northern Ireland in these and other areas. Certainly we need to be cognisant of the impact of Brexit in this context. Regarding public health policy, we have a very strong track record of co-operation around services, for example, the new radiotherapy unit at Altnagelvin hospital in Derry, which offers cancer patients from Donegal access to radiotherapy across the Border in Derry, reducing their travel time significantly; the new hybrid cardiac catheterisation laboratory which opened at Crumlin hospital in Dublin in July 2016 and which provides emergency surgery to babies born with congenital heart disease in Northern Ireland; and the primary percutaneous coronary intervention, pPCI, services in Altnagelvin hospital to which Donegal patients having a STEMI heart attack now have 24-7 access. This is critical in terms of providing highly specialist services in Donegal and the Border region.

Work has taken place under the North-South Ministerial Council to identify further opportunities. Contacts continue and are positioned to develop further in the context of the re-establishment of the executive. Irish researchers and research funding agencies have developed much collaboration internationally which provides important opportunities to leverage expertise and funding, to develop joint working between researchers within academia and with industry and to collectively tackle major health challenges. There is currently a significant level of engagement between the UK and Ireland, for example, through funding programmes, policy initiatives and organisational memberships. The EU INTERREG funding has been a key enabler of North-South health co-operation. As regards INTERREG, there is security in respect of the current programme and a positive shared commitment that possibilities for future support for future programmes will be examined favourably by both the EU and the UK. That is in paragraph 49 of the joint report and gives us encouragement.

Sixth, the committee recommended that the Department minimise disruption which could be caused by divergence in registration and recognition of health workers across jurisdictions.

The Department of Health acknowledges the importance of the issue of the mutual recognition of health professional qualifications, which is a part of the wider issue of the mutual recognition of qualifications more generally. It has been engaging with the professional bodies such as the Medical Council and CORU, which regulates the health and social care professionals on the issue.

The agreement achieved on citizens' rights in the joint report has addressed one aspect of the recognition of qualifications. Paragraph 32provides for the "grandfathering" of qualifications which were recognised before the withdrawal date or where applications are in process on that date. This means that qualifications recognised before the withdrawal date remain recognised for those EU citizens resident in the United Kingdom and for UK citizens resident in a member state.

The Department of Health is working closely with the Department of Foreign Affairs and Trade, the Department of Education and Skills and other Departments to see how best the issue of the mutual recognition of qualifications not covered under the joint report may be advanced in the next phase.

Seventh, the committee recommended that the Department should minimise disruption which could be caused by divergence in regulation of medical products across jurisdictions. We have set out in some detail in the written statement the way that is being done and how it is being led by us, in conjunction with the Health Products Regulatory Authority, HPRA, and the Health Service Executive.

As well as the work at European level, at a national level the HPRA is taking a proactive approach to Brexit preparations, with a focus on protecting the availability of medicines for Irish patients and the integrity of our medicines market, even if the UK fully exits current regulatory systems in March 2019. Over the past year, the HPRA has stepped up its engagement with pharmaceutical companies and other stakeholders, offering practical support in managing the regulatory challenges of Brexit. Among other measures, the HPRA is investigating opportunities for joint labelling of medicines with other markets, increasing its commitment to medicine assessments within the centralised EU network, and working directly with companies looking to transfer some or all of their operations to Ireland.

The EU’s negotiating position on this also reflects that the withdrawal agreement should address issues arising from Ireland’s unique geographic situation, including transit of goods to and from Ireland via the United Kingdom. Discussions on the land bridge, which is an important issue for the pharmaceutical and medical devices sector, are continuing during phase 2 as part of the Irish-specific strand of issues and the Department of Health is playing and will continue to play its role in this context.

Regarding current objectives and our work programme, it is noted that the next phase of the negotiations will see an intensification of preparations for the discussions on the framework for a future EU-UK relationship. This is hugely important for Ireland. The European Council guidelines reaffirm the EU’s desire to establish a close partnership with the UK. This is very much in line with Ireland’s objective of having the closest possible relationship between the EU and the UK.

The Department of Health will continue to prepare for the UK’s exit, as part of and in parallel to work in Brussels. This includes contingency planning for all possible scenarios.

Brexit is specifically identified in our business planning process. The Department's Management Board and its Subcommittee on Brexit continually review the implications of Brexit.

Brexit is also specifically identified in the HSE's service plan for the year ahead. The HSE has established a steering group to prepare for the UK’s withdrawal from the EU and its EU-North-South unit has taken on a project management role. It has a number of work streams that are set out in the statement and it contains a full and comprehensive approach to Brexit preparations across the Department and all our agencies.

Following last month's agreement that the common travel area, CTA, can continue, work is ongoing with a view to ensuring that the arrangement and its associated rights and entitlements, including in the health area, will remain effective and function at a practical level post-Brexit.

The UK has committed to maintaining full alignment with those rules of the Internal Market and the customs union necessary to protect North-South co-operation, the all-island economy and the Good Friday Agreement. How exactly this will work will be the subject of the UK-EU negotiations as the process moves into the next phase.

Engagement with stakeholders is an important pillar of the Government’s domestic response. Within the framework of the All-Island Civic Dialogue on Brexit, three plenary dialogues and 20 sectoral dialogues have taken place in locations across the country.

Since we were here last, we have intensified engagement with stakeholders. The Minister, Deputy Simon Harris, convened an all-island civic dialogue on Brexit and its implications for cross-Border health co-operation in Dundalk in September last year to discuss and share views on the possible implications of Brexit. The sectoral dialogue meeting was very well attended, with over 80 participants from the North and South. Participants were from a wide range of backgrounds including health service delivery agencies, service commissioners, business associations, patient representative organisations, local authorities and non-governmental organisations active in health and social care. The Minister gave the opening address at the dialogue and participated in five break-out discussions, taking the opportunity to sit with each of the five groups and listen to the points raised regarding the implications of Brexit for cross-Border health co-operation.

By way of conclusion, we are in a better position in terms of the Government securing concrete commitments on the maintenance of the common travel area as well as clear and strong commitments on avoiding a hard border.

The agreement reached in December is very significant for everyone on the island of Ireland, the UK, and our fellow members of the EU.

From a Department of Health perspective, we are pleased to be able to report progress in ensuring a comprehensive appreciation of the depth of health services co-operation on a North-South and east-west basis and a fuller understanding of the reciprocal rights associated with health care as part of the common travel area.

Working directly with health counterparts in London and in Northern Ireland, as well as with the EU taskforce through the Department of Foreign Affairs and Trade, we have established a shared understanding of the scope of health rights and health co-operation and, importantly, we have explicit commitments to maintaining the service-level co-operation and the reciprocal rights that apply between Ireland and the UK.

Looking ahead, the Department is continuing to intensify the work as the negotiations move into the next phases. This will involve deeper examination of the issues, identifying contingencies and continuing liaison with all relevant stakeholders.

It has been agreed that Irish specific issues will continue to be taken forward in a distinct strand of the negotiations in phase two. This will ensure that they will not be overlooked in the next phase and that work will continue on how to protect the Good Friday Agreement and the peace process and avoid a hard border, based on the agreements reached in phase one, in parallel with the wider negotiations on scoping out the EU’s future relationship with the UK.

The committee can be assured that the Department of Health will play its part in ensuring health related issues are fully understood in this phase.

Again, I want to say that we genuinely recognise the valuable work of the committee captured in its report and I thank the members for the opportunity to be here again today. We look forward to the views and questions of the members.