Mr. Jim Breslin:

I thank the Senator for his questions. I will ask people to contribute as we go through them. The question on what might change was helpful. People may not have seen it, but I saw a headline in The Timesof London. It summarised, albeit inaccurately, the position outlined in my opening statement by saying that medicines would be fine but cross-Border services would be impacted. That is not what I said in my opening statement. I am happy to say that we do not expect the North-South arrangements to be affected by Brexit. That is not the basis on which either jurisdiction is planning. When I referred to the general proposition that Brexit would change our lives and have implications for all sectors, it was not the cross-Border arrangements that we operate that I was thinking about. I can provide examples of what I was thinking about, though.

We have strong North-South relationships. We have provided capital for the opening of the radiotherapy unit in Altnagelvin. We were there at the design stage and the commissioning stage. We pay for the service that we get, as we do for the primary cardiac catheterisation service at Altnagelvin and some other services in the North. Equally, our colleagues in the North are providing for the capital development of Crumlin so that children from the North with congenital heart defects can be treated at that hospital. The North will pay the revenue costs of that. All this is founded on the patient outcomes that can be produced by working together, and we are confident that the arrangements will be sustained through this period of disruption.

The arrangements are largely governed by service level agreements. In some cases, we have contributed to the capital costs. In many cases, we are meeting the revenue costs. Currently, they do not go up to Brussels and back down to the other jurisdiction. Rather, they go directly from the HSE to the facilities in Altnagelvin or elsewhere. We are confident in that regard. Mr. Hennessy can discuss the detailed engagement that has been happening.

The private health insurers have assured us that they are not planning for an impact on those with coverage. I will address an important point that did not come across in the question. I believe I am right in saying that the health insurance policy of an Irish person who is working and resident in the UK will be written in the UK. The VHI or another insurer would write insurance for people who were resident in Ireland, but if they were non-resident in Ireland, they would either get their insurance from the countries they were resident in or would get international health insurance policies. This issue is more likely to arise in respect of someone who is resident in Ireland but who, in the course of his or her business or leisure, is in the UK or US when something happens. That is something with which insurers are familiar. In general, people do not use their private insurance to access healthcare in the UK on a planned basis unless that care is not available in Ireland, in which instance specific arrangements apply. We have heard back from the insurers that there will be no change in this area. They have examined the issue.

Regarding the question on training, a great deal of work has been done by our professional regulators. This is an example of where Brexit changes the situation. If someone trains in the EU, his or her qualification is automatically recognised in other EU member states and no one in their regulators can raise an issue about it. However, the UK will become a third country and there will not be automatic recognition unless an overall deal is done by it and the EU to recognise qualifications. There have been discussions in the context of the future relationship. In the absence of a deal, we will put in place an administratively seamless approach between regulators. The Nursing and Midwifery Board of Ireland, NMBI, is already informing itself on the qualifications in the UK and will not have to go through a long check when it receives an application from a nurse trained in the UK. It will deal with that application within the current timeframes.

The Senator asked a good question about what would happen if the UK diverged over time. That does not relate to the EU's working time directive principally, as the UK could diverge from the directive without it having an implication for the quality of the qualification. Obviously, Ireland would stay with the EU standards. However, if the UK diverged in the period ahead - we have no indication that it will, and I am referring to years from now anyway as opposed to just months - and decided to define the qualifications to be a professional in a different way from the EU, rendering them no longer equivalent, it would raise issues for our regulators and we would have to re-examine the situation. Similarly, if the UK decided to diverge from EU food standards five or ten years after leaving, it would pose a risk for all of our interactions with it and is something that we would have to watch. It would not be an issue for 2019, but it would have to be examined and is likely to be one of the issues addressed in the future relationship between the EU and the UK.