Mr. Muiris O'Connor:

It is my synthesis of his point. I very much appreciate his instincts. In a way, Brexit is a moving feast and it has evolved. The Senator spoke about clarity in respect of the destination desired by the United Kingdom, and this is a difficulty.

In terms of matrices, in the interdepartmental arrangements there is a plethora of templates and matrices. As last year developed, on the back of inputs from the committee and others, there was a realisation that while we wished for benign outcomes we had to plan for the worst and work back from there. Disorderly Brexit templates have been filled out and assessed by all Departments. They are not shareable but they deal with a collapse in negotiations scenario and the contingencies and fall-outs that would happen. They have come in from all sectors.

Many of our worst fears have been alleviated to an extent by the commitments made in December. There were strong concerns in the committee's report of last May with regard to freedom of access and continuity of co-operation and we have come a long way in this regard. It keeps coming back to the common travel area, but we put a lot of store on the enduring rights that will apply to citizens and residents of Ireland and the UK to come and go to work and avail of social security and health services.

With regard to engagement we can do all the work on templates at our desks, and we are doing so very comprehensively, but the best approach to contingency planning is engagement with stakeholders and service providers. An awful lot of the co-operation of which we are most proud and which is most meaningful to citizens, particularly in a cross-Border area, have operated between the services and trusts in Northern Ireland and the HSE in the Border area. We have looked at all the various service level agreements, SLAs that apply, and we have come across 30 SLAs that operate in respect of the Border area. Some of these are very substantial, such as the North West Cancer Centre's 25 year time frame and huge shared capital investment. Others deal with a place for an individual in a better facility, which is more approximate to his or her home, in the disability sector or in the social care sector. We are looking at all of these.

With regard to the point on the lack of clarity of destination by the UK, this remains the case. As I understand it, the UK is being given the first quarter of this year to clarify its desires on an end game and future relationship. The EU is shoring up the withdrawal agreement on the basis of phase one, and the UK will set out its intentions. This will give us a lot more to work with in terms of reaching the desired destination.

It is not an easy thing to expect us to leapfrog the UK and bounce into European health care environments. It is probably not just about the cultural affinity and kinship we have with the UK. There is also the language.

It is probably also the case that clinician to clinician relationships are quite strong, which builds on the fact that often the people involved were classmates at some point and now have very good relations. I do not want to give the impression in any way that we are looking beyond the United Kingdom. Our key focus has been on deepening our engagement with health authorities in the United Kingdom. We have been reassured by their commitment to continue to allow access to their services, but there is an EU context in which we operate and we will have to look at whether a more bilateral arrangement is needed. That work is being done on a whole-of-government level to give effect to the commitment to continue to allow access to UK services. We will do both; we will deepen our links with European health facilities and work very closely with UK counterparts to maintain the access patients in Ireland have had.

Dealing with rare conditions brings home the very real benefits of the European Union as a whole. The 28 member states derive much better value, an impact and scientific progress from collective engagement in dealing with some of these challenges. As members are aware, he United Kingdom has played a critical role in leading a lot of the consortia in dealing with rare conditions. It is another one of those areas in which I presume it sees it as being in its own interests to maintain that engagement, but the level of its involvement is be determined. We will support having the closest possible connection between the United Kingdom and the European Union, but we will also deepen our engagement with European facilities such as bio-banking and clinical research facilities. We have it on our agenda to make sure Ireland will sign up fully and engage centrally in the European Union.

Deputy Bernard J. Durkan asked whether we had examined all of the risks and whether there would be a collapse. We have looked at the worst case scenario and stepped back from there. It is a concern that the United Kingdom will leave us in a position where there this will be an island off an island. I have heard it said Ireland is more exposed to the impact of Brexit than even the United Kingdom. We are very conscious of this. As well as the positive developments in respect of the common travel area and there being no hard border, there is an important paragraph many might not have noticed on this being an island off an island. In that context, the concept of a landbridge arises. We are looking further into it in the context of the importation of medicines at a high level. Somewhere between 10% and 15% of the drugs we use are imported from the United Kingdom; therefore, we are not as exposed as one might think. It is not like the position in agriculture. Only 6% of our pharma exports are to the United Kingdom as the industry is global. As I said, we are looking further into the matter because while there might be a modest amount imported from the United Kingdom, I presume the majority of medicines come through it on freight trucks. There is a live strand of negotiations between the European Union and the United Kingdom on a landbridge to facilitate the transportation of goods from mainland Europe to Ireland. On a practical level, it could involve the use of sealed containers that would not be opened while passing through the United Kingdom. Such practical issues are being addressed. It is reassuring that the negotiations on Brexit are getting down to the nuts and bolts which corresponds with the committee's push to have us get busy on what matters. We have done a little of it.

Deputy Bernard J. Durkan also inquired about medical science. We have enormous respect for the calibre of those involved in medical science in the United Kingdom and their leadership. We hope they will not seek to disengage from the European scientific community.