Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

On behalf of the committee, I welcome the Minister for Health, Deputy Carroll MacNeill. She is accompanied by the assistant secretaries at the Department of Health, Mr. Muiris O'Connor and Ms Tracey Conroy, and the Chief Medical Officer, CMO, Professor Mary Horgan. I thank them all for their attendance.

The subject of health on the island of Ireland has been the primary focus of this committee since its formation last May. Health is a vital area of North-South co-operation that directly impacts on the daily lives of citizens across the island. We are delighted to welcome the Minister today. We welcomed her counterpart, the Minister of Health for Northern Ireland, Mr. Mike Nesbitt MLA, to the committee last December. These engagements build on the existing North-South health collaboration driven by the bilateral agreements, the North-South Ministerial Council, the shared island initiative, the cross-border EU funding initiative PEACEPLUS and the special EU programmes body, SEUPB. The Minister's continued support remains essential. As the PEACEPLUS programme evolves, her leadership will be paramount in ensuring the system effectively knits together and optimises all healthcare options and outcomes.

The format of the meeting is that I will call on the Minister to make an opening statement followed by questions from members. Each member will have between five and seven minutes inclusive of questions and answers. I remind members of the constitutional requirement that in order to participate in public meetings, they must be physically present within the confines of the Leinster House complex. Members attending the meeting remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that members participating in public meetings be physically present within the confines of the place where the Parliament chooses to sit.

In this regard, I ask any members participating via MS Teams to confirm that they are on the grounds of the Leinster House complex before making their contribution to the meeting. Members and witnesses are reminded of the long-standing parliamentary practice to the effect that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. If their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks and it is imperative that they comply with any such direction. As the Minister will be aware, the committee will publish her opening statement on its website following the meeting. MPs participating in this session from outside the jurisdiction of the State are advised that they too should be mindful of domestic law and how it may apply to their participation.

I now invite the Minister to make her opening statement.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Having been a member of this committee for some years, it is wonderful to join members again. As the committee will be aware, there is a long history of co-operation between the Departments of Health in Ireland and Northern Ireland and between the HSE and the six health and care trusts in Northern Ireland. At the outset, I acknowledge the strength of my relationship with my counterpart, the Minister for Health, Mr. Nesbitt, who has already addressed this committee. He and I have had an immediately warm and very productive relationship to date and I thank him for his engagement. As I understand it, in attending this committee he was the first unionist member to address any meeting in the Houses of the Oireachtas and it is important that he be recognised for that. Our collaboration has grown into a really warm and constructive partnership. We have quite a lot of work to do and have been able to progress some things together. Senior officials and clinicians meet regularly and work together to improve health and social care provision for the benefit of patients across the island. The newly appointed Secretary General of my Department, Mr. Derek Tierney, has met with his counterpart in Northern Ireland, Permanent Secretary Farrar, in recent weeks and continues to strengthen the relationship between the jurisdictions. A further meeting is planned for June.

There is wide-ranging existing North-South collaboration on health through bilateral agreements and cross-Border initiatives, such as the North-South Ministerial Council, NSMC, the shared island initiative, and the cross-Border EU funding initiative, PEACEPLUS. There are quite a number of agreements in place covering specific specialist cross-Border initiatives that ensure patients can receive a range of medical services as close to home as possible. For example, there is the all-island congenital heart disease network, where 1,880 procedures have been completed since its establishment, and the north-west cancer centre at Altnagelvin, where over 4,200 patients have received radiotherapy treatment locally. Both are based on agreements and underpinned by service level agreements between our respective health services North and South. The committee has already heard from some of the stakeholders working on these valuable initiatives.

As part of a broader commitment to deeper co-operation on specialist paediatric care, agreement has also been reached to work together on perinatal and paediatric pathology. I welcome the fact that detailed discussions on the potential for an all-island service in this area are progressing. This is a very sensitive area and perhaps not one we would like to start with but it is an area of great need. Closer co-operation has the potential to reduce distress for families and improve how we respond to a highly specialised service needed on this island.

Encouragingly, the HSE have also been engaging with colleagues in Northern Ireland on discussions to further enhance co-operation on cross-Border and all-island specialist services in recent months. For instance, an acute services scoping exercise has commenced to examine opportunities for deeper collaboration in both scheduled and unscheduled care, the aim of which is to build on existing cross-Border pathways and identify areas where joined-up planning could further improve access and resilience. This reflects a broader shared focus on identifying practical areas where co-operation can improve patient access, make better use of available capacity and support more sustainable service delivery in Border regions, such as collaboration between the National Ambulance Service and the Northern Ireland Ambulance Service in emergency response and planning for cross-Border urgent or emergency ambulance calls or urgent incidents.

Work has also been commissioned in related areas. Under the shared island initiative, for example, work is continuing on the construction of the new Daisy Lodge centre in Cong, County Mayo, which is due to open to the public in spring 2027. This shared island funded project will double the capacity for families affected by childhood cancer to benefit from short therapeutic breaks. Proposals for other health related all-island investment or co-operation projects under the shared island initiative are being explored. They are considered on an ongoing basis in co-operation with our counterparts in the Northern Ireland Executive. We want to deepen collaboration between healthcare services on the island. Stakeholders are also continuing to work together on cross-Border EU funded programmes.

PEACEPLUS, a programme valued at €1.1 billion overall, includes substantial investment of €97 million in projects focused on healthy and inclusive communities and on collaborative health and social care. I am really pleased that the 11 health-related projects selected are beginning to move into the delivery phase. PEACEPLUS builds on earlier programmes that supported large volumes of cross-Border care and helped establish trusted networks of providers working collaboratively between the jurisdictions.

One of the main vehicles through which we co-operate with Northern Ireland on health is the North-South Ministerial Council, which is something that I take very seriously. I have not missed an opportunity to attend or to work with my counterpart. At the most recent sectoral meeting in January the Minister, Mr. Nesbitt, and I formally approved a revised health work programme. That work programme identifies key areas of health co-operation that could be mutually beneficial and have significant impacts. We intend it to be a living document. The priority is to convert all of this goodwill into practical enablers of co-operation.

Future areas of cooperation have been organised under three broad themes: acute services; health inequalities and population health; and the future of healthcare, which includes, among other things, closer work on digital systems and secure data sharing and interoperability, so that patients who access care can have a more joined-up service cross-Border. There is also huge scope to explore co-operation in areas such as genomics, clinical research, clinical trials and other specialist pathways where shared expertise and population scale can achieve better outcomes for patients in both areas.

Our co-operation is not just about service delivery. It is also about addressing inequalities that are often most acute in some Border communities and about supporting prevention, early intervention and resilience. That is particularly important where some communities continue to live with the long-term, intergenerational impacts of trauma, disadvantage or social exclusion. I am hopeful that the work programme will provide a useful framework for engagement and will drive health collaboration between Ireland and Northern Ireland for years to come. I look forward to reporting progress on that.

It is very important to mention Safefood, which is one of the North-South implementation bodies under the NSMC that plays an important role in the promotion of food safety and healthy eating on the island of Ireland. It is a trusted and well-known source of information for the public on food safety and it builds practical skills and knowledge. Safefood has an excellent new CEO who came from the Department of Health, Dr. Joanne Uí Chrualaoich, which is a very welcome appointment.

The Minister, Mr. Nesbitt, and I are very keen to remove any potential barriers to co-operation. At the January NSMC sectoral meeting, we instructed officials in our Departments to examine some of the issues we had come across relating to divergence in professional regulations between our jurisdictions. The aim is to make it easier for therapists and other professionals to work in either jurisdiction and to ensure that it would not be a barrier to expanding the workforce or expanding care. The intention is to produce a joint paper before the autumn sectoral meeting. This work is important because while goodwill is all well and good, practical and regulatory issues can slow the delivery of care and that is not what we want. We have committed to working to ensure that professional regulations and all other areas of possible divergence are understood and pragmatically managed so that we can deepen our co-operation.

I thank committee members for the opportunity to be here. We are very excited to answer questions. We welcome the committee's feedback and ideas. North-South co-operation is a priority for our Department. I am delighted to be here with my senior officials and the Chief Medical Officer who will be delighted to take questions and explore ideas that members may have. There are some practical barriers to advancing the scale of ambition that we would wish for. We recognise that there are different funding situations in the two jurisdictions. but we really are trying to work as practically as we can to achieve the most harmony between the two jurisdictions as possible.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for taking us through that overview of her work and her engagement with the Minister, Mr. Nesbitt, who she rightly said made a unique appearance here at this committee. We greatly appreciated that, as well as the candid nature of his engagement with committee members. That engagement was quite broad in terms of the issues we dealt with. As the Minister will be aware, the committee is also compiling a report on all-island healthcare. We are actively engaging with various groups and stakeholders on that, as alluded to by the Minister in her opening remarks.

It is seven minutes per member; I call Deputy Maxwell.

David Maxwell (Cavan-Monaghan, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for attending. Last Thursday and Friday, the North-South Inter-Parliamentary Association met in Dublin. Cancer services were the main topic of discussion. I will ask about child cancer services in Northern Ireland and southern Ireland. What came out of it was that in Northern Ireland, they have to send patients to Manchester for genome testing. In Dublin, we are investing in it. It is somewhere the two can work together because the bigger pool of patients allows us to make that investment. Post mortems are all sent to the UK from Northern Ireland. That was another discussion. As I said on Friday, I do not think anybody minds whether that treatment is south or north of the Border when it is cancer treatment. It is something we need to look at through shared island or some other initiative. When Mike Nesbitt, the Minister in the North, was here, he was very open about discussing collaboration. I know the Minister is working with him.

I have to go parochial now. I live on the Border. Monaghan hospital has been off call since 2011 as a hospital with an accident and emergency unit, although it has a minor injuries unit. We have Daisy Hill, Craigavon, Enniskillen and Altnagelvin hospitals along the Border. Cavan and Monaghan hospitals operate as a one-site hospital. Some people cannot understand how that works. Monaghan provides day-care services and day procedures. It does it very well and is busy, but if you go up to Monaghan hospital tonight, it will be empty. The day services finish at 5 o'clock. Craigavon, Enniskillen and Daisy Hill hospitals are all under severe pressure in their accident and emergency units. If we consider Armagh, is there a possibility there for Monaghan to increase the population it serves? People would have a 24-7 accident and emergency department or minor injuries unit closer to hand and nearer the patient. We cannot have acute or specialised services in every parish. That is a given. Maybe Daisy Hill hospital would get one service while Dundalk would get a different one. It would move about, from Craigavon, Monaghan and Enniskillen hospitals up into Sligo hospital and Altnagelvin hospital. Is it on the Minister's radar to look at cross-Border work on the hospitals that people say have been downgraded since their accident and emergency units closed and to give them a new lease of life?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Ms Conroy will speak on cancer and Mr. O'Connor will speak on genomics. As the Deputy is aware, Monaghan is one hospital over two sites. Monaghan has been the beneficiary of considerable investment in terms of funding and people. I am disappointed to hear services are finishing at 5 o'clock but I now realise I have a follow-up set of questions for Monaghan.

David Maxwell (Cavan-Monaghan, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is 5 or 6 o'clock. It does day-case procedures.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Nevertheless, that is not what the contracts enable us to do. We will have a look at that. Cavan will be the beneficiary of a slot in the new surgical hub in Swords. That is important in giving a surgical pathway, which is additional capacity for the whole hospital. The local injury unit is working well. The Deputy has highlighted how it could be extended further.

Mr. Muiris O'Connor:

Genomics and genetics is an area that is explicitly called out in the future of healthcare paper. The Deputy made the point that the two jurisdictions together create the critical mass needed for that kind of future of healthcare. Application of whole genomic sequencing is clinically most effective in cancers and rare diseases. I heard the Minister, Mr. Nesbitt, convey real enthusiasm for co-operation there. As part of the European arena, there is a €1 million-plus genomes EU initiative. We have a "Genome of Ireland" contribution to that and it is our intention that would be an all-Ireland approach.

Ms Tracey Conroy:

We have a long and proud history of collaboration on cancer. It is an area I have personally been involved in since 2001. I am really ageing myself now. The all-island cancer consortium was established in 1999 and is credited with saving lives and enhancing quality of life. The memorandums of understanding there were refreshed in 2021 and 2023. We have the north-west cancer centre at Altnagelvin hospital and we have Daisy Lodge, a shared island-funded project. We are in constant engagement with our counterparts in Northern Ireland around cancer services. We are looking at CAR T-cell therapy at the moment and at the feasibility of cross-Border access for Northern Irish patients, pending the establishment of Northern Ireland CAR T services. Obviously, we need to build up the services in advance of that.

The Deputy mentioned childhood cancers. We are engaging in perinatal and paediatric pathology. There are close and positive engagements with counterparts there. As the Minister mentioned, that is a sensitive area. We are very mindful of the new children's hospital and the enormous potential there for collaboration. Children's Health Ireland CEO Lucy Nugent and her team have good engagement with counterparts in Northern Ireland on a range of services and there is openness to further collaboration and harnessing the benefits of the new children's hospital.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Increasingly, people are coming to the conclusion that the best future for healthcare in Ireland is on an all-island basis. We have seen positive outcomes when the resources of the two healthcare systems on the island are pooled and work together. The Minister mentioned that in her opening statement. I applaud the work being done on heart disease and adult cancer services.

Children's cancer is on our minds because we had the North-South meeting on Thursday and Friday. Clearly the system is working for adult services but we need to beef it up in relation to children. We heard stories of people having to travel to England. They were saying there was no proton beam therapy on the island of Ireland and speaking of the importance of co-operation on that. I spoke about a child in my constituency with Duchenne muscular dystrophy. A codified all-island approach would allow that child to access treatment in the North that is unavailable in the South and that has potentially life-changing results.

The point that came out of the debate on Thursday and Friday was we have a small population compared to our closest neighbours Britain and France, which makes it difficult to attract trained specialists in key areas and sensitive areas like paediatric pathology, where we seem to be really struggling to recruit. The point was made that if we were working on an all-island basis, it might be easier to recruit. I would be interested in the witnesses' views on that.

For children with serious conditions, the point was made that where you live affects access to services. Whether their geographical location is in the North or South, people should not be denied access to healthcare. There has been major investment in IT systems by the HSE in the South and Health and Social Care in the North. It makes sense in terms of underpinning all-Ireland provision that the two IT systems could interact and talk to each other. I know there are challenges in relation to that. I attended St. James's Hospital for cancer treatment.

One system was in St. James's Hospital and the other was not. I know it is a big challenge. In relation to that, they have a patient identifier number in the North and we are still working on that. I know that when Mr. O'Connor came into the health committee he would give us an update on that. How is that system? What are the barriers in relation to the two systems talking to each other and continuing that co-operation? Is it the GDPR? I believe the GDPR can be waived in relation to health areas.

On the issue of radiotherapy, again people mentioned Altnagelvin hospital and the system working. Follow-up treatment in many cases was happening in Galway or Sligo and people were saying that they were travelling from Donegal and passing Altnagelvin hospital to get that follow-up treatment. If does not make sense in relation to that. If the idea is that the system works why could we not continue with that?

When I was the Chair of the Oireachtas Joint Committee on Health in the last Dáil, it was the first time the two health committees actually met. It was the first time we actually visited Altnagelvin hospital and the first time we went to the national children's hospital as well, as successful as that is. I am just saying that we probably need to do more of that. Huge money is being spent, North and South, on these issues and I think there is a responsibility on us all. Collectively we all want this to work and it is about identifying the barriers and trying to work on how we can move those barriers or move over those barriers.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Of all the different issues the Deputy has raised, I am just trying to see which to answer. Does Mr. O'Connor wish to answer on the data piece and some of the practicalities of that?

Mr. Muiris O'Connor:

Data and digital is an area where we are explicitly committed to full alignment. We regard it not as a barrier but as an enabler of closer co-operation in healthcare. The exchange of digital records is something that we are planning for and working with, not just North-South but also with England, Scotland and Wales. Our own document, Digital for Care: a Digital Health Framework for Ireland 2030, was developed in close consultation with our counterparts in Northern Ireland. Covid threw us together in a very close way and those relationships have really been sustained. The North of Ireland is ahead of us with their encompass programme where they have digitised across their integrated regions. We are investing in the same thing but we are absolutely committed to interoperability and we are very positive about its feasibility. There are not barriers, even with GDPR which would still apply in the North. If it is purposeful and intentional explicit use of data, then it is very clear. The Health Information Act, which was enacted by the Minister recently, provides explicitly for data to be integrated and data to be shared with third parties. We had Northern Ireland in mind in framing that legislation.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Perhaps Professor Horgan will speak about the all-island paediatric network. That probably covers best what the Deputy is raising.

Professor Mary Horgan:

We have had an expansion in the number of trainees across all disciplines within the country, particularly with paediatrics, so there is a lot of shared training in Northern Ireland and in Ireland. The network of paediatricians North and South is very strong. We have a deputy chief medical officer, CMO, in child health here who has a big knowledge in metabolic disease and rare diseases. The other focus is on training people ourselves so that we are self-sufficient within the island and can provide those services. More recently, the focus is on paediatric and perinatal pathology, for the reasons the Minister has outlined. It has been a focus of the Department to expand the workforce, and that can be seen in the expansion of the medical workforce.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Cuirim fáilte roimh an Aire and I thank her for coming in. To date we have worked on a huge body of work with regard to health issues here. It has been fantastic engaging with some of the people and the groups that have been mentioned, including the All-Island Congenital Heart Disease Network and the All-Island Cancer Research Institute, with amazing cross-Border work. This is what we want to foster. We want to try to get whatever lessons we are learning from them and try to expand it.

It is almost impossible for me not to be parochial when I am talking about some of these issues. I am based in the Border county of Louth so I have grown up with that Border, which can be very fluid at times. Sometimes you can find yourself crossing the Border not even noticing it, but sometimes you can also see that it is not just in Louth. We have a very busy maternity unit. Given what has happened over the years, for example with the downgrading of Navan hospital and the closure of the Monaghan acute services in 2009, we can see the pressure that is being put on the large facilities in Border counties. I can often see that it is not just in Louth. In any of the Border counties, communities can often experience poorer access to healthcare even though there could be fantastic healthcare just across the Border in the jurisdiction on the other side. What other practical barriers can we work on to try to ensure that Border communities can get access to the best healthcare that is right on their doorsteps?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am looking at it from the funding and delivery of the different regions, looking in particular at what is being highlighted here in Dublin and the north east, with the allocation of resources and the focus and increased investment that has gone into that, and then how can we support services being delivered to facilities that have been closed in Northern Ireland that are not in the same funding position. A number of emergency centres closed, which is unfortunate. It is not that I cannot do anything about it but I cannot put it any further than that. We are trying to find different ways to work together.

The perinatal pathology piece is really difficult because North and South there is a shortage of people in that space. We are genuinely trying to work together. On one of the pieces of work, and the members have highlighted congenital heart disease and other paediatric programmes, I want to give Ms Conroy the opportunity to speak to that. Those sorts of specialist areas are where we have really been able to make progress rather than providing a whole-of-Border acute service, which has not been the focus of what we are trying to do, respecting the two jurisdictions' competencies.

Ms Tracey Conroy:

It is widely acknowledged that the All-Island Congenital Heart Disease Network has overseen what we would characterise as transformative change for those services since 2015. We have the transferable Northern Ireland emergency, urgent and new elective surgery at Children's Health Ireland, CHI, at Crumlin in Dublin; the opening of the newly refurbished children's heart centre at the Royal Belfast Hospital for Sick Children, and the establishment of a network of regional centres across the island where care can be delivered closer to home and by paediatricians with special expertise in congenital heart disease. I have been involved in that since the outset. There are lots of things happening with really close and deep collaboration between the teams in Crumlin and in the North, and with some longstanding relationships and really good engagement between the departments and between the Executives North and South. That has just grown and developed over the years. It is an example of what can be done. As the Minister has said, some of these services are very sensitive. There are constraints funding-wise but also staffing-wise. These are the kinds of things that we are looking at. When we look at paediatric and perinatal pathology, what we are doing there is looking at the design of the services. We are stepping back and looking at how we can design the service in a way that benefits North and South. We are starting that from the outset.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

There is a perception, I think, that the level of service or professional care is better north of the Border. As we have learned, the child, baby and infant mortality rates in the North were shocking compared to those south of the Border.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not know where that perception comes from. The Minister of Health in Northern Ireland, Mr. Mike Nesbitt, has spoken about his real concern around health inequality in Northern Ireland and very significant life expectancy in different regions, and some of the reasons behind that. A lot of those reasons are structural reasons that need a lot of attention. Certainly Minister Nesbitt's focus in his conversations with me is around health inequality and what we can do to try to get services to areas that are under greater pressure and how we can collaborate on that. For example, how can we do better with lung cancer screening? Are there different ways of involving mobile clinics? Are there ways we can reach communities we are not currently reaching? I think it is fair to say, as the Senator said, that there has been a perception about Northern Ireland having a different level of service that is not borne out in the facts.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

In her statement the Minister mentioned professional regulatory divergence. I suppose we are really talking about the rules governing healthcare workers.

Can the Minister outline the significant divergence that really hinders perhaps that cross-Border movement of staff? As she said, there can be a shortage of staff in certain areas. Is it going take some sort of regulation or legislation to improve that pathway?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is as much about the regulatory approaches. For example with CORU, which is our own regulatory body for much of the health and social care professionals, we are constantly looking at this. We are looking at the opportunity for EU physiotherapists, for example, to work in Ireland; how the qualifications work; how they are aligned and how we govern that. To take an example that is not actually true, why is it so difficult for a French physiotherapist to work in Ireland and why are the standardisations different? We are spending all of this time working on making sure that the EU pathways are clear and it was really only as the Minister, Mr. Nesbitt, and I were considering the opportunity for the movement of people on the island to work in different ways that it became apparent to us quite how divergent we were - not in terms of clinical standards but just in terms of the process of registration - and the question arose as to how could we align that better.

Professor Mary Horgan:

When it comes to the medical workforce, there is a lot of reciprocity between the Irish Medical Council and the General Medical Council. It is mainly seamless from that perspective. From an undergraduate point of view, there is a very close relationship between the new school in the University of Ulster - and obviously the well-established school at Queen's University - with the six medical schools down South. There is a lot of elective activity. The RCSI even has placements in Enniskillen, so there is a lot of collaboration from a medical point of view.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

We have funded a lot of training places; nursing, medical and otherwise. It depends. It ebbs and flows. Particularly on the nursing side, we are funding those training places in universities and training centres in the North to have better collaboration but also to access those services too. The important point is that we are funding them.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I better wait for my other questions if there is a second round.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

Everybody recognises that good work is happening on a health basis North and South and we very much welcome that. I am just trying to get my head around numbers. The Minister probably does not have these numbers but could we get the number of Southern patients treated in the North and vice versa maybe 30, 20 years or ten years ago compared to now? We know there is quality but I am also interested in the quantity to see how much physical treatment is happening across the Border. I imagine the Minister does not have a figure to hand.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not. I am just trying to think about the different ways in which that would be constructed. There might be NTPF-funded projects that should reasonably go to centres in Northern Ireland while there might very well be a very strong paediatric pathway this way. It is very hard to account for that, for example, in urgent or emergency care such as people presenting to Drogheda and so on. I can get the Deputy the best numbers that I can but I am not sure that I would be constructing a narrative from it of any kind. Of course, it recognises the different population as a proportion of population over time as well. I can get the Deputy the best numbers that I can but they would be heavily caveated as to placing any sort of interpretation on them

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

I understand the caveats - there is no doubt about that - but I still think it is good for us as a committee to understand the quantity of of people being treated on both sides of the Border. That is important as well.

We need to get to a very simple model, which is the closest hospital model. The person gets treated in the closest hospital for the ailment he or she has North or South. I will give an example, with which I think the Minister is familiar. It involves a woman by the name of Catherine Sherry from Newry who, unfortunately, got lymphoma in 2024. She could not get treatment in the North of Ireland because the service was not available in the North. The service was available in the South but as it was not part of the North-South cross-Border reimbursement scheme, she had to go to England. She had three lovely sons and the treatment she had to get in England was really physically difficult, as was the travel back and forth. Her illness obviously made her very weak. Newry is probably an hour and a half from Dublin if there is not much traffic and it would have been wonderful if she could have been treated here. This is obviously logistically much more difficult to do than to say but could we get to a situation where if Catherine needed to be treated in Dublin then Dublin would invoice the health department in the North of Ireland or if something else happens, invoices would just be made out to the other jurisdiction for whatever treatment happens? Is that something we can work towards?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not have any particular objections. I can think of lots of practical difficulties with it but I certainly have no ideological objection to trying to provide people with the care that they need in every possible way. Although I do not wish to put words in his mouth, if the Minister, Mr. Nesbitt, was here, he might say that he would like to be able to deliver those services in Northern Ireland. His network is slightly different and we are trying in different ways to support that, as has been seen. Does Ms Conroy wish to come in on that?

Ms Tracey Conroy:

We have reciprocal arrangements in place that support patients and accessing planned treatment across jurisdictions where eligibility criteria apply. It has to be part of the ongoing consideration of deeper collaboration. I am very conscious from an eligibility point of view that there are constraints in that regard.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is already difficult with regard to CAR T-cell therapy. We would like to do more in St. James's Hospital but we have an obligation to look after the people who are resident here in the first instance. I do not wish to speak to any particular case and I do not know the particular circumstances about her diagnosis, what pathway was available here and what pathway was available elsewhere. Of course, Sláintecare is the essence of people being treated as close to home as possible but I am conscious that we have our own eligibility structure here as well.

Mr. Muiris O'Connor:

The closest hospital model is what is happening with the north west cancer centre at Altnagelvin hospital for the people of Donegal, Leitrim and Sligo, as well as percutaneous coronary intervention, PCI, for interventions in cardiology.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

If we strip everything back and just put the patient and the illness being treated in the centre, the closest hospital model is the best way to treat a person. Everything else is a man-made or woman-made constraint on that objective. Regarding Catherine's case, I think the Department of Health says there are no plans for the treatments to be made available as part of the cross-Border waiting list reimbursement scheme so there is obviously a significant negative human impact from the lack of that closest hospital model being there. There was a massive negative impact in that case for sure.

Mr. Muiris O'Connor:

Networking of hospitals is happening in both sides of the Border and specialisation as appropriate in the larger centres ,so it is not always the exact closest hospital but I get the Deputy's point more generally.

Ms Tracey Conroy:

A lot of engagement is happening at service level with more than 24 formal health agreements in place. Some of them are locally developed service-to-service arrangements while others by necessity are more high-level and are underpinned by eligibility and other considerations.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

We have done a bit of work over the past few years on pathology with regard to the death of children at birth. Right now, most parents have to go to Alder Hey Children's Hospital in Liverpool. I know the Minister has been working on this. Are there any updates in terms of providing a service on the island for these parents?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Our clinicians have been working on this together. I will ask Professor Horgan to update the Deputy on that.

Professor Mary Horgan:

There has been great progress on this. It is a particularly difficult time for parents when they have a child who dies and needs a pathological examination for many reasons so there is a focus on that and what it requires. What is ongoing at the moment is training and upskilling pathologists in a particular field. People become general pathologists and then train in that specific field and that number has expanded. The plan would be to be able to deliver that service on the island given that it is a particular area of expertise in pathology.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not wish to understate how difficult it is to recruit in that specialism and the global shortage in that profession. That is something that is having an impact - not on the paediatric side but on the adult side with post-coronial post mortems and so on. I know the Department of Justice, Home Affairs and Migration is working on legislation to reduce the number of post-coronially directed post mortems because they are way in excess of what is necessary and our pathologists are working on trying to, for example, identify cancers when people are diagnosed with different things.

That is also the work of the pathologist. It is not just the post-mortem side of things; it is an area where there is a global shortage. It really is difficult. I understand the heartbreak of having to travel to Liverpool but I know the Minister, Mr. Nesbitt, would say that Alder Hey Children's Hospital is excellent.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

I will briefly squeeze in one more question. Sometimes there is a problem with critical mass along the Border in that if a service is delivered on both sides of it and the critical mass needed to run a service is not there, then the service does not exist. A colleague of mine, Emmet Doyle, is working on an inpatient detoxification service in Derry. They have managed to make good progress on it, but if that service was for all of the north west, including Donegal, it would reach the critical mass needed and make funding and resources easier as well. What is the Minister's view in relation to that?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not have the details on that so I cannot answer it on the hoof.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

I will submit a parliamentary question to the Minister.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We will now go online to Mr. Dáire Hughes.

Mr. Dáire Hughes:

I thank the Minister and her team for attending the meeting. I apologise that I am unable to attend in person. The Good Friday Agreement specifically cites healthcare as an area for cross-Border collaboration. We know that so much more could be done to internalise this as a practice for the benefit of all citizens.

I will start by building on the comments of Deputy Maxwell and others in relation to North-South cancer care and paediatric pathology. I had planned to raise the specific provision of CAR T-cell therapy on a North-South basis, so I was heartened to hear one of the officials in the room state that they are looking at providing that service on a North-South basis. That is very welcome. I encourage expediting that. I will also provide the Minister and her team with an opportunity to briefly elaborate on that if they could, given the tragic case of Catherine Sherry from Armagh, which was cited, and the family's campaign.

The second question is a practical one for the Minister in respect of the reference she made to the specialist cross-Border services and the bilateral agreements that underpin them. Could a detailed list of those agreements and services be provided to this committee? It would be very useful in compiling our final report on North-South healthcare.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Yes, of course, we can provide such a list. My officials will follow up on that without difficulty. I will make a short comment about CAR T and then I might ask Ms Conroy, as a cancer specialist, to speak to it in more detail. CAR T-cell therapy is available in Ireland - in St. James's Hospital since 2021 and for children since 2022. We are trying to develop additional capacity in Galway. The service at St. James's Hospital is at capacity, which is the way it is, but the two Departments - North and South - are working on the issue and keeping it under review. The medium-term objective is to try to increase our domestic capacity here and then see what options are possible for supporting patients in the North. Of course, that principle applies to other areas. Ms Conroy will have a more detailed answer for Mr. Hughes.

Ms Tracey Conroy:

Not really. As the Minister has said, the treatment was provided in St. James's Hospital for the first time to adults in 2021 and children in 2022. We are working here to increase capacity to meet domestic demand for the service. The Minister mentioned Galway in that regard. We are at capacity in St. James's. What we are doing is keeping the feasibility for cross-Border access for Northern Ireland patients under review, but that is pending the establishment of the Northern Ireland CAR T services. It is a relatively new service. We are very open to it, but the constraints are clear.

Mr. Dáire Hughes:

I appreciate that. I also appreciate there are capacity issues but the capacity for the North to provide such a service will not be online for several years yet. Whatever exploration can be done, it would be most welcome if it could be expedited in terms of the feasibility of citizens from any part of the island accessing those services.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank Mr. Hughes for that. I appreciate it.

Noel McCarthy (Cork East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister and her officials for attending the meeting. I compliment her on the work she is doing. In her opening remarks she said she is working closely with her counterpart in Northern Ireland. That was very good information. It is good to see there is good co-operation between North and South.

I was reading something over the weekend and I thought I would raise it when I knew the Minister was coming in here. I hope it is the right place to bring it up. It relates to concerns about tobacco products, North and South, and the price differential between the two, especially when it comes to vaping. We have done everything we can here. We have raised the price of vaping products to a level where young people should be deterred from using them. Unfortunately, they are cheaper in the North and they are coming over the Border. The article I read suggested it is causing concern.

We all know about cigarettes and the health issues they can give rise to but vaping is also a concern. I know people who are vaping who never smoked. It has become the thing to do for young people just to feel good. It is a real health worry. I do not have all the facts. Is there something that could be done if the Minister were to work with her counterpart in Northern Ireland? Could we bring it to their attention that we have addressed it here in some ways, which was the right thing to do? Could they also look at their pricing structure in Northern Ireland? We have no Border and we cannot control it that way but could something be done to bring it to their attention? It is a concern on both sides of the Border. We have addressed it in some way. Could this be looked at by the Minister? That is really the question I am asking because it is a concern that young people are using vaping products for no reason other than they think it is a cool thing to do. I am concerned about it and I know a lot of people are.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

That is very fair. I thank the Deputy for the question. There is a cross-Border element given the different treatment of vapes and tobacco products generally. It is a huge concern on this island. It is a huge concern for us from a European perspective. The Deputy might be aware that I have been raising repeatedly with the Commissioner for health, Olivér Várhelyi, the need to reopen the tobacco services directive at European level for precisely this reason. Ireland and other countries have taken the strongest measures we believe we can get away with to try to get rid of vapes - banning colours, taste and smell - and to make it as difficult as possible to sell nicotine-addiction products to children, which, in essence, is what they are, and the other products like them. It is so difficult to stop that in continental Europe, given the different treatment of those products in neighbouring jurisdictions where there are land borders. It is very easy to do precisely what the Deputy is suggesting is happening here, North and South, in jurisdictions right across the EU.

Of course I can speak to my counterpart about it. I am conscious that we are moving into some of the Brexit-type territory that is sensitive in lots of different ways but I will speak to my counterpart about it. He is very committed to public health and reducing health inequalities. He is also very interested in reducing the incidence of lung cancer. He is an excellent Minister of Health. He is operating within a whole range of constraints. I will highlight to him the work that we have done on this side of the Border, the work that we are continuing to try to do and the work that we are trying to shift at a European level. I am sure the Minister, Mr. Nesbitt, and others would love to be more aligned with the EU and possibly lots of other people, but this is an area where real synergy is possible.

Noel McCarthy (Cork East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister. It is good to hear that response because it is a concern for a lot of people. It would be very beneficial for everybody if the Minister were to bring it to the attention of her counterpart in Northern Ireland. I know the work the Minister has done at European level and the work she has done here. It is only right that we should try to provide every prevention measure we can to stop young people vaping. I am so flabbergasted that I asked one person in particular whom I know why he does it. The answer is that it was just the cool thing to do. My concern is that people get addicted to it. I thank the Minister for her response.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank Deputy McCarthy for those questions and for raising that issue. It is a topic that we have discussed and that will be on the work programme as well, in particular the cross-Border smuggling element, among others.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Gabhaim buíochas leis na finnéithe go léir as ucht teacht isteach. As the Minister is well aware, we had the Minister, Mr. Nesbitt, here in December. He spoke in very glowing terms of his relationship with the Minister, Deputy Carroll MacNeill, and how well things were going in the North-South Ministerial Council.

One of the things he spoke about in some depth were the healthcare inequalities that exist. He spoke about healthcare inequalities that exist within jurisdictions. He spoke about the likes of healthcare inequalities and the huge discrepancy in life expectancy between those who have their home on the Malone Road versus those who have their home on Sandy Row in Belfast, and about the North-South health inequalities. Will the Minister give us a little bit of a flavour of the progress being made in the cross-jurisdictional area of healthcare inequalities that exist North and South?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

What we are observing, and this is specific for this committee, are some areas of acute deprivation or health inequality, particularly along the Border and where there has been a background of trauma or addiction. The Senator can understand some of the reasons for that. The Minister, Mr. Nesbitt, is deeply committed to reducing health inequalities in Northern Ireland. I think he was surprised by the scale of it and the different life expectancies in different communities there. Of course, we have worked very hard to try to reduce health inequality here. We are a jurisdiction with one of the longest life expectancies in Europe. We have put enormous effort into prevention, particularly for preventative health benefits for patients at the lower end of the economic scale. Our chronic disease management programme, for example, is targeted towards patients on the General Medical Services, GMS, scheme. A question for me is whether that is an equitable approach. What about all of the other patients? We have targeted our health interventions in ways that try to support communities with the least, not communities with the most. We will probably have to balance that out a little bit ourselves.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

In relation to Safefood, a number of members of the committee are also members of the British-Irish Parliamentary Assembly, BIPA. We had the chief executive officer of Safefood, Dr. Joanne Uí Chrualaoich - who the Minister mentioned in her opening address - speak at the most recent plenary meeting in Tralee in March. Will the Minister give us a little bit of an outline? For the work of Safefood to be successful, it needs buy-in at lots of different levels. "Where science meets practice" or "where science meets behaviour", which is an expression I may be misquoting, was used by Dr. Uí Chrualaoich. On Safefood 2036 as a strategy, what progress do we envisage making and how can we help as elected representatives?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will ask our Chief Medical Officer to answer.

Professor Mary Horgan:

The Chief Medical Officer, his office in the North and the office of the Chief Medical Officer down in the South meet about every four to six weeks. One of the key areas we have been engaging with is on Safefood. The other is the All Island Institute of Public Health. Its function is to target those groups that are at highest risk of health inequities. When it comes to Safefood, it is about ensuring the education that is given to particularly at-risk groups is heightened. We have already met the new CEO who, as the Minister said, is a former employee of the Department of Health. She is very science and research orientated. Everything will be scientifically driven so there is a robust policy when it comes to ensuring that safe foods are delivered to everybody but particularly to those most at risk. That deals with a lot of the health inequalities. Professor McBride and I are due to meet tomorrow. I will go up to Stormont at the end of June with a team. We have a very close engagement on everything from vaping to health security, when it comes to infection, to issues around safe food and areas where we can exchange ideas and work collaboratively, such as Safefood and giving our input into future policy in that area with the new CEO.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will ask about PEACEPLUS. We had two representatives from PEACEPLUS in last week, as Deputy Crowe referenced, at the North-South Inter-Parliamentary Association. They expressed confidence in the next two phases of funding. The fact that underpins the commitment in both jurisdictions to sustaining the peace that has built up over the past 28 years since the Good Friday Agreement cannot be taken for granted. In relation to the 11 health projects referenced by the Minister, will she give a little bit of an update on the progress on that? Are there any concerns in relation to the longer term PEACEPLUS funding as a result of the UK withdrawal from the European Union, or is that something we are confident will be maintained and sustained?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is important to say that PEACEPLUS is not being treated as a series of isolated projects, although there are 11. We do not regard them as isolated. We are trying to build up a network to test and deliver scalable projects where both systems face common pressures. Some of those projects are around adult and youth mental health, neurodevelopmental supports, obesity management, frailty, addictions, prescribing optimisation, which is a big thing, and digital inclusion. There is a range of different projects where you can see how you would develop further integration for prevention, management and a whole range of different areas. They are all capable of being scaled and they are all about integrated health. I have a lot of confidence in it.

Does the Senator want some of the details of the specific projects or the names of them? I can give those to him rather than take up his time.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

My question was just a request for a general progress report on the health-related projects under PEACEPLUS.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I would be delighted to provide that to the committee to provide more detail, if that is okay.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

That would be great.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

As for the future funding, I think it is very clear that we are continuing to support it. We cannot speak for the UK because some of their politics change.

Mr. Muiris O'Connor:

The European Union is very supportive of continuing its support for this.

Going back to some of the topics earlier, on the communities each side of the Border feeling somewhat peripheral from some of the main acute facilities, PEACEPLUS really does invest in co-operation at community health level and, as the Minister said, in mental health, suicide prevention, addiction and obesity management. A lot of the joint efforts to manage health inequalities and keep people healthy and well at community level are supported through PEACEPLUS. The 11 projects are a new tranche. We hear they are getting teed up and ready to be implemented.

Garret Kelleher (Fine Gael)
Link to this: Individually | In context | Oireachtas source

That is certainly the sense I got last week but it is good to hear it again.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

In regard to the Minister's opening remarks, she alluded to some of the projects, including Daisy Lodge and other capital investment projects close to or on the Border. Does she have a scale as to how much investment is coming from her own Department? The Minister can come back to us with a note on it if she likes. In regard to the investment that has been made and her engagement with the Minister, Mr. Nesbitt, when he initially appeared in the committee, he referred to starting with a blank page regarding the point of other members about bringing healthcare closer to the patient. Ideally, between the two jurisdictions, we could relocate services but it is not that easy, as the Minister well knows. Ultimately, in the co-operation between the two jurisdictions and Departments, there is a lot of positivity and it is about building on that. I was particularly glad to hear the piece mentioned about congenital heart disease care and the progress that has been made there. It is very strong and it shows there are other areas of co-operation. I know some areas are a bit more tricky than others, for various reasons, as was alluded to. Funding is one of them.

In terms of the shared island initiative and the funding of research that is being done, at this point I think there are about 14 different bodies of work that have been completed and published due to shared island funding. That has highlighted a number of areas, as the Minister referenced, with regard to inequality and disadvantage. The Minister, Mr. Nesbitt, also alluded to that in regard to care and health outcomes in certain areas. That is a challenge but how we work together is obviously of utmost importance to this committee because, as the Minister rightly highlighted, we want to have better engagement from all the community in Northern Ireland with the South on things like digital health, the data sharing Mr. O'Connor alluded to and the general data protection regulation, GDPR. These are issues that have come up before the committee around how we can best make progress.

On the unique patient identifier in the North, we were shown an app - I think it was called encompass - which has been transformative. They have taken a leap ahead of us in technology. Hopefully if there is a timeframe to that for the South, I would like to hear it. All patients in the South would be very happy to hear the progress on it and in the digital strategy.

The other question I have is about broader cross-Border collaboration. Professor Horgan mentioned the all-island institute of health and the regular ongoing meetings between officials, which is good. She might elaborate a little bit on that all-island initiative. We have a body of work here before the committee, probably after the recess, which is looking at existing all-island institutes and organisations that are working exceptionally well, many of them without much fanfare. It is good that they are working so well. It reminds me of the North-South Ministerial Council, which works exceptionally well. Some of the feedback we receive is that it is like Groundhog Day in terms of the agenda, that it is back to square one. Hopefully that is not the case in health, but we want to make greater progress and see greater outcomes from those regular engagements. The fact that they are happening is very positive. The Minister might come back on capital, the cross-Border element, and digitisation.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will ask Professor Horgan to speak to the all-island health initiative and then I might wrap up, if that is okay.

Professor Mary Horgan:

The all-island public health institute is an exemplar of how good the co-operation is between North and South. It is an all-island body where we and the CMO's office in the North agree on a number of projects, an example of which would be breast feeding. The rates are low on both sides of the Border. This is a joint venture to get the reasons that is the case and how we can intervene. Not breastfeeding can ultimately be a poor indicator for many people when it comes to health inequities. That is an ongoing body of work. They have also done work on an all-island approach to alcohol minimum unit pricing. Flour fortification, which happens in Northern Ireland but not in the Republic of Ireland, is preventative when it comes to neural tube defects. The two offices co-operate really well in working with the institute to decide on priority areas that really deal with health inequities. Other examples are areas like immunisation, where we want the rates much higher. The working relationship we have with our counterparts in the CMO's office is really strong. We benefit by having a united approach when it comes to food policy direction, say, but also with the institute of public health. It is really important when we make policy decisions that they are grounded in good science and good data that is pertinent to our population, many aspects of which are very similar. There are really good outlets from the institute of public health. They have benefited from PEACEPLUS funding of €2.4 million recently in conjunction with University of Ulster and Trinity College to have a public health knowledge hub. That sharing of knowledge is exactly what we want to see for a common goal of improving population health.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Between the PEACEPLUS projects and what Professor Horgan is describing in the all-island health programme and institute, we are trying to make every effort we can to develop a population-based, integrated health approach - not a health system but a health approach - that is complementary and addresses what are obviously shared needs between all of the communities on the island. We recently had the momentary threat of hantavirus and there is a current threat in relation to ebola. Disease does not see borders, as the committee will have heard many times before. We have to work as an island, as we have to work through Europe, to get the best health outcomes for all of us. As we share this island together, we have a particular imperative to do that.

There are some constraints. There is no point in being too airy-fairy about acknowledging them. There are practical constraints and it is important that the committee hears and acknowledges them. There are two different health systems, and jurisdictional and sovereignty questions that are difficult to step across to advance certain practicalities. That is a functional reality. We are in the lucky situation at the moment of being in a very good budgetary position but there is no point in saying it any other way: the Minister, Mr. Nesbitt MLA is an excellent Minister of Health but he is operating in an economy that is not well resourced at this time and does not have the capacity to support its people in the way I know the elected representatives would want. That is a material challenge. While we are trying to advance as many projects as we can through shared island funding, I imagine the committee would have questions were we to be funding everything to 100% or 110%. How does that provide respect or not to what is another jurisdiction? There is no point in saying otherwise. These are real things that are material considerations. We have developed very good capacity within the Department of Health and the HSE and we bring the best energy we can to developing proposals with our counterparts in the North. They also have constraints and challenges in what they are doing and I want to acknowledge that.

I really want to compliment the Minister, Mr. Nesbitt MLA, an extremely proactive Ulster Unionist Party politician who has leaned into this body of work. He has been at every meeting that I have been at. He has taken every initiative that he can within the constraints he is operating with. So the committee is aware, I have invited him to the informal meeting of EU health ministers in Dublin as a mark of respect to him and to the work we are trying to do. It is important that I acknowledge the differences. Health inequalities are largely reduced through the injection of funds to support people most at need. The very sharp reality is that the funds we provide by way of fuel support, working family payments and all the different social transfers we are able to provide to different communities are there because we have an economy that is in a different position. The scale of transfers and supports we are able to provide our communities most at need are greatly different from those in the North. That either exacerbates or softens the impact of difference and health inequality. That is important to acknowledge. That situation might be inverted on a different day, and I say it with no arrogance. It is a factual reality of the different situations of the two jurisdictions at this time.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The officials might come in on the digitisation timeframe.

Mr. Muiris O'Connor:

The timeframe for our digitisation.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When can we look forward to picking up our phone and having our-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

A Chathaoirligh, I know that you have downloaded the HSE health app and are an active user of it. I have seen you promote it so thank you very much for that. We are introducing a shared care record, which enables that single patient identifier model, which we are rolling out in the south-east region and will be rolling out throughout the rest of the regions within this calendar year or very shortly thereafter, which is the basis for a single identifier system. We have also enacted the Health Information Act, which gives us a statutory basis to gather information in the way that is necessary as well. It is certainly true to say that the North is further ahead on that piece than we have been but we have well over 100,000 active users of the HSE health app. As its functionality increases, I know they will want to book their hospital appointments through the app and so on. It will become equivalent. The sharing of data is crucial. If your or I turn up at a hospital in Belfast, I want them to have our data, and vice versa. There are EU implications of how that might be done in terms of how data is captured, stored and managed. That introduces new questions of interest.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The issue raised its head with us as a committee very clearly so I can appreciate that. The new legislation allows for third-party data sharing and it is important to see progress being made. Maybe the next time we meet, we might have a further update.

Mr. Muiris O'Connor:

We are going to market for a full electronic health record system. That is at an advanced stage and moving along. The commitment is there, supported very strongly by the Oireachtas. We have built capability in the HSE and we have legislation in place through the Minister. Ourselves and the North really are close on the commitment to data and digitisation. We support one another. In a potential "best of both worlds" post-Brexit scenario, we sit with the North along with England, Scotland and Wales to ensure that data can flow not just North-South but along all strands of the Good Friday Agreement, east-west as well.

It could diminish. There is an interest at clinical and official level. The UK, as a whole, recognises the importance of EU standards and ambitions in digital health and wants to be a part of it.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

That is good to hear. I thank Mr. O'Connor for that update.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Mr. O'Connor mentioned critical care and specialist care and that capacity is so important. He talked about the idea that there are available resources in one jurisdiction or the other. We visited Daisy Hill Hospital and the team there said they had theatre time. We were hearing in the South from specialists that they could not get access to theatre time. With all the meetings back and forth, has a collective audit been carried out of the services and resources that are there, including specialists and so on? We are talking about capacity and the idea of recruiting specialists for particular areas. Has that ever been done? Would it be a way forward to look at what is and is not available in the two jurisdictions, for the benefit of patients North and South?

Mr. Muiris O'Connor:

The HSE is working with its counterparts in the North, subsequent to the refreshment of the North-South work programme, on the issue of acute services and where to map opportunities. There is very little spare capacity. We are looking at variously sized waiting lists and waiting times for hospitals on both sides of the Border. It is being looked at afresh and with the impetus that the refreshed work programme has given, we will be taking reports from the HSE and its counterparts, and working with officials in the Department of Health in the North to explore this, as part of the commitment to deepen and strengthen co-operation.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Would the witnesses be open to doing an audit of the resources that are potentially there?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

We are always open to everything. At the moment, we are doing our own audit of theatre utilisation and the way in which theatre times and start times for shifts are organised. I do not believe we are currently getting the best out of the resources we have. There is no difficulty with theatre capacity if the theatres are closed after 5 p.m. anywhere. We need to look to our own use of resources first. We certainly have no difficulty with the Deputy's suggestion. We used National Treatment Purchase Fund, NTPF, structures for availing of that sort of opportunity in the past, but we certainly have no difficulty with that. The difficulty is not with the audit or identifying the information. It is the operability of how those systems develop synergy of any kind, and how you access and purchase that. The Deputy will understand that we are trying to maximise capacity within our own system first, but I do not have an objection to his idea as such.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

It just struck me. In Daisy Hill Hospital, there are challenges relating to oral health in that locality. There is a theatre there. The staff are there.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Why are they not doing the work? I know that they need this. I do not understand. I am not suggesting any malfeasance on their part, of course, but how is that-----

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Daisy Hill Hospital just does not have the money to keep it running. That is the challenge.

Mr. Muiris O'Connor:

There was a pilot initiative to send some patients from County Louth up that direction for orthodontic treatment. I would have to look into it.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I was just giving that as an example.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is a great example.

Seán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

There is potential there. I mentioned the Altnagelvin hospital situation and the fact that people are passing it for follow-up treatment. You get a certain attachment when you are getting treatment in a particular area, but people are having to go on to Sligo or Galway. It is a matter that could be sorted out if we make it simpler for the people involved.

Ms Tracey Conroy:

There is ongoing work with the service in Altnagelvin hospital. There is a lot of close collaboration in relation to that service. We renew the memorandums of understanding, MOUs, all the time and there is good engagement between the services in trying to address some of the issues that the Deputy has described.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The dental one that the Deputy raised is particularly interesting. At the moment, we are developing a major plan for trying to address our own dental shortlists and waiting times for dental surgeries, in particular orthodontic surgeries for children. We are open to everything. I am very conscious of the impact on children in Northern Ireland of accessing or not accessing, and I do not want to usurp capacity for the benefit of children here. I would have that consideration, as well as everything else, but I am certainly open to everything.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

During my first round of questioning, we spoke about professional regulatory divergence. I will touch now on clinical regulatory differences. If the witnesses will indulge me, I will use a personal experience that may resonate with other women. We have done incredible work and have come along leaps and bounds in women's health, particularly in the realm of hormone replacement therapy, HRT. I benefited from one of the HSE cross-Border initiatives to get knee surgery. I had been on a lengthy waiting list here so to go across the Border was absolutely amazing. However, shortly before the surgery, I was told that regulations are very different north of the Border and south of Border. I was told I would have to stop HRT immediately and go cold turkey. My consultant said that was absolutely not the case and I would not have to do that. My consultant said that was old-fashioned, traditional and unnecessary. However, the only way I could get my procedure was to stop. That is just one example of something that is vastly different in the two jurisdictions. We are talking about a 20-minute drive up the road. Is there any way that could be looked at and we could perhaps get some uniformity? It might sound like a small thing on the surface but to go cold turkey on HRT can have a major impact. However, I did not want to forgo the surgery.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will defer to the excellent Chief Medical Officer on that particular question.

Professor Mary Horgan:

The models of care change across various jurisdictions and things are done slightly differently. I am not too sure what the particular issue with HRT and knee surgery was at the time. Most of the time, the models of care and delivery of care are very similar on both sides of the Border. I am not too sure if that was in the care plan or there was a particular reason for it.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

They say it is a blood clotting issue. It is quite personal to a surgeon, or whatever, but if there were some sort of base-level regulations to which everyone adhered, it would make cross-Border surgery easier. I can only speak to my own personal experience. There may be other medications where there are vast differences either side of the Border.

Professor Mary Horgan:

There is engagement between clinical services North and South. There would be co-operation when it comes to clinical guidelines and approaches to the assessment of the treatment of a patient. Most of the time, they are similar but not absolutely the same, depending on what condition is being treated or what surgery is being done. Where the same clinical services are provided in the North and in Ireland, in general, the approach is the same. I am not too sure about this particular instance. I understand the increased risk of clotting and deep vein thrombosis, DVT, after knee surgery. There might have been some guidelines produced by the orthopaedic association in the North that are different from what is done in the South. Other than that-----

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Everyone looking at-----

Professor Mary Horgan:

The standard of care and approach to care would mainly be very similar.

Alison Comyn (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I appreciate that.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I apologise in the first instance because this meeting clashed with a meeting of the Committee on Defence and National Security. That meeting has just finished. We were going through the UNIFIL mission and what is happening there. I thank the Minister for being here. Her contribution to what we are trying to achieve at this committee, in looking at the all-island health service, is very important. Her role is equally important as that of the Minister, Mike Nesbitt, who was here and who has contributed to the report. I hope we will have a robust report.

If these questions have been answered already, I will get them from the record so the witnesses do not need to repeat, in that sense. One of the outstanding things for me from the clinicians and experts who contributed to the committee was that they could not possibly deliver optimum outcomes without working on health on an all-island basis. Perhaps the Minister will comment on that, in the first instance. I know that, as the Minister, she obviously wants to deliver optimum outcomes.

The Minister may have already outlined what barriers are there, but are there any other barriers that have not been talked already?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I have no difficulty with that. By way of background, we have spoken about a number of different things like the paediatric model of care, some of the cancer work we are trying to do collectively and a lot of the integrated health measures that we are trying to do to advance population health generally. We have also spoken about the All Island Institute of Public Health and Professor Horgan spoke about some of the work it is doing. I might ask Professor Horgan, as the Chief Medical Officer, to speak to the clinical aspect of how we can advance care together.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Are there any barriers that the witnesses are coming across that can be addressed?

Professor Mary Horgan:

As the Chief Medical Officer, I have to talk about prevention because that is a particular focus of the work that we do in the offices of the Chief Medical Officers in the North and South of Ireland. We really try to focus on the population health approach to giving everyone the best opportunity possible and really looking at investing in communities. One good example that we do down here and that we share in our colleagues in the North is our healthy communities initiative, one of which recently opened up in County Louth. We invest in local authorities and provide peer support to improve health when it comes to parenting and promoting healthy eating and physical activity.

When it comes to clinical care, the outcomes for the provision of care in both jurisdictions are excellent. The quality of the healthcare staff that we have is very high. My colleague will talk about the cancer care services in Altnagelvin as a good example, but I can say that the quality of service provided by top-class health professionals on the front line, whether it is in primary care or in hospital care, is excellent.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

In terms of the healthy communities initiative, do they do social prescribing in the North as well?

Professor Mary Horgan:

Yes, they do social prescribing, and they engage with the communities in the North and target areas that are the most socially deprived, based on census data. We know that the life expectancy in those communities is significantly lower than a few miles down the road in other communities.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Is there a statutory right to social care in the North?

Professor Mary Horgan:

I do not know the answer to that.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

It has been covered by colleagues in terms of the IT systems, but is the Minister happy that there is sufficient collaboration across the two jurisdictions so that we have systems that are talking to each other or will be able to talk to each other in the future?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context | Oireachtas source

We are as happy as best we can be. I know that Minister Nesbitt addressed that when he was here as well. We are working within the European legislation, whereas Northern Ireland is not necessarily doing likewise. In whatever we do to try to integrate the systems, there is a political question as much as a health interoperability question because of the way in which the rules need to be adapted on an all-island basis in order to work from a European health data space perspective and all of the regulatory structure that goes around that. I am not trying to create a barrier of any kind; this is just the practical reality. If I was in a car accident in Belfast, I would like it if they had access to all of my medical records so they can treat me they best way they can. The same would apply if Minister Nesbitt happened to be in a car accident in Cork. That is the value of interoperability and data sharing, but one is within the EU rules and one is not. That has meaning, and it is fair to say that we are trying to test how far we can go with that and where it will land as we are not exactly sure.

Mr. Muiris O'Connor:

The commitment to interoperability at official and clinical levels is really strong. We hope that sense is maintained at the political level. There is really strong interest in the European developments across the official and clinical communities, not just in Northern Ireland but also in England, Scotland and Wales. I spoke at a digital conference in Wales just last week, and they were extremely interested in the European developments. They have opted back into the Horizon Europe science investment funding in the EU and that is another reason for them to maintain comparability, not just for direct care but also for research, supporting innovations in population health and life science industries. We have a lot of common interest in data being interoperable. We work hand in glove with our Northern counterparts. They support us and we support them. They had an input into our digital strategy, and we engaged with them at a very deep level, including east-west as well as North-South.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

That is good to hear, and the Horizon Europe programme gives us some opportunities there. This may already have been asked, but is there a comprehensive list that we can use in our report of the cross-Border initiatives already done and the ones planned for the future?

Mr. Muiris O'Connor:

Yes.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the witnesses for that. I also thank the Cathaoirleach for letting me in.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for that and for making the meeting. I know that she had a conflict at the start.

I thank the Minister and the officials for their time this evening. I thank them for taking the time to give such a broad range of answers to a broad range of questions, as well as dealing with them diplomatically because there are sensitivities and we appreciate that in this committee. We have been faced with it in our dialogue and discussions with the various groups and individuals. I thank the witnesses again for their time this evening. No doubt we will engage again over the next little while.