Mr. Jim Breslin:

I might ask the HPRA and the HSE to come in on the drugs supply issue as well. The starting point is that there is a significant routing of medicines from the UK, either originating there and landing in Ireland or being sourced from there. Up to 70% of medicines on the Irish market are manufactured in the UK or transit through the UK. When we talk about the supply chain, and modification of the supply chain, individual manufacturers have looked at that. Some have made arrangements, for example, where the drug is manufactured on the Continent and is moved through the UK landbridge, while some have made arrangements to come directly to Ireland.

Others have decided that where a product was previously contained within a drop for the UK and Ireland, they will now separate out those two loads and send them separately via the landbridge. Significant supply chain modification is under way. Much of that depends on the characteristics of the medicine. If a particular medicine has a long shelf life and little potential for disruption due to a delay at a port, then there is more flexibility on the part of the manufacturer and the distribution chain. Particular areas examined include medicines with a short shelf life, as Mr. Hennessy referenced. A delay could lead to a product expiring. The HSE and the HPRA have reached out to those suppliers in particular to seek reassurance and verification that arrangements in place will not be disrupted.

In general, the arrangements in place in Ireland for the supply of medicines are quite distinct from those in the UK. We are an island and we have a wholesale distribution system very different from that of the UK. We also have significant stocks held domestically within our supply chain. That will be the first port of call if any immediate issues were to arise. We are working with a range of stakeholders in the medicines industry to ensure they have the proper capability to respond to any disruption that might arise. The scale of the thousands of medicines involved requires individual level preparation and planning. In respect of critical medicines, we have an exercise under way to look at alternatives, to look at supply chains and to verify what is under way.

As of today, we have no issue which we are declaring will be a problem or disrupted. We will continue to engage right up to Brexit and beyond to ensure that stays the case. There is a background issue. The Irish market has been very intermingled with the UK market. Potentially, over the medium term rather than in the next weeks, manufacturers or suppliers may look at the Irish market as a smaller market post Brexit. We were part of a huge UK-Ireland market. For some people, we will now be an Irish market of 4.5 million people without a great supply requirement. We may experience a situation relating to our size, as other countries do, where some suppliers decide it is not worth supplying into such a market or they may want to supply on different terms. We will have to watch that in the medium term post Brexit. It is not an immediate issue.

Generic medicines are potentially an issue. Down the road, some suppliers might consider that extra work is required to get into this market, more documentation is needed and not much is sold. They might then question what is the point in continuing. We have to look at all of those situations. In many cases, because we are dealing with generic drugs, the active ingredients are being manufactured by others. One supplier, therefore, making a decision not to supply the Irish market might not be crucial if other generic suppliers provide the same active ingredient or the originator is still on the market. I ask the HPRA to expand on that matter. I ask Mr. Hennessy to speak about the children's services and existing linkages. Regarding our ability to conduct bilateral agreements, the EU-UK withdrawal agreement and the negotiations in Brussels specifically recognise the common travel area as a distinct feature of the Irish-UK relationship and gives us a licence to give that expression post Brexit.