James Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the Bill and, as with everyone else in the House, I hope we will not have to rely on it. It is good that we are debating the issue today. If other parties in the House had got their way, we would all be out knocking on doors this week.

Health is covered in section 4. The Minister for Health will be given the power to make an order, or orders, and regulations under the Bill to enable necessary healthcare arrangements to be maintained between Ireland and the UK. The objective is to support the maintenance of existing common travel area arrangements. This includes continuing arrangements for health services that are in operation between the State and the UK, for example, access to health services in the UK for persons in the State, access to health services in the State by persons from the UK and reimbursement arrangements. Continuity is critical and this is especially true in healthcare.

We have a population of 4.6 million people and there are approximately 1.9 million people in the North, but there must be close co-operation to achieve economies of scale on the island. We may not have enough expertise on either part of the island but collectively we have a critical mass in the area of rare diseases, not only with respect to the number of people with rare diseases but, more importantly, with respect to clinicians and specialists who would be able to operate on an all-island basis.

We all know that North-South collaboration on health is real and that significant benefits can be realised for patients. There are many examples that illustrate the level of co-operation between the North and the South on health issues. Significant projects have been undertaken in recent years and they have made a difference to the lives of patients. For example, Altnagelvin Area Hospital's radiotherapy unit, which was completed in 2016, gives access to radiotherapy services for people in the north west of the island, including people in this jurisdiction. Other examples of cross-Border collaboration include primary percutaneous coronary intervention services, also known as stenting, in Altnagelvin. The arrangement allows Donegal patients to have access to these services on a 24-7 basis. In July 2016, we saw the opening of the hybrid cardiac catheterisation laboratory at Our Lady’s Children's Hospital, Crumlin. This laboratory delivers emergency surgery to babies born with congenital heart disease in Northern Ireland as well as in the South. These are excellent examples of how North-South collaboration can produce the critical mass of patients required to make services of a specialist nature viable at local level.

The 2019 HSE service plan states Brexit has potential risk implications for continuity of existing service arrangements and for official controls, in particular the controls for food imports and exports for which the environmental health service has legal responsibility to enforce. Is this dealt with in this Bill? The Minister might advise the House. What we do not know, of course, and, as I have said, it is hoped we never will, is the possible impact of a no-deal Brexit on health. The Lancethas said no deal would cause significant damage to Britain’s National Health Service. It states there is no good Brexit for the NHS but that a no-deal scenario, which is what we are dealing with in the Bill, would have negative effects on staff, financing, the availability of medicines and vaccines, the sharing of information and medical research. Is it possible that the impact of no deal on the NHS might have a consequential impact here? I ask this in the sense that the NHS could come under such pressure that, despite anything in the Bill or legislation in the UK, it could become more difficult for people in the Republic to access health services in Britain and the North.

I understand that in 2017, under the cross-border directive 2,011 applications were reimbursed, of which 1,741, or 86%, accessed treatment in the UK, and of this number 1,660 accessed treatment in Northern Ireland. The vast majority of these were outpatient procedures. In 2017, there were 632 approved applications under the treatment abroad scheme, of which 565 were in the UK, and of this number 20 were in Northern Ireland. There must be a possibility that no-deal mayhem or bedlam in the UK could impact on the availability of these services.

We are voting to put the arrangements in place. Is the Minister for Health able to state what engagement he has had with his counterpart in the UK as to when it will put in place reciprocal arrangements? Last month, at a meeting of the Committee on Health, the Secretary General of the Department of the Health stated, "It is recognised that managing a no-deal Brexit would be an exercise in damage limitation and it would be impossible in a no-deal scenario to maintain the current seamless arrangements between the EU and UK across a full range of sectors which are currently facilitated by our common EU membership." What difficulties does the Minister for Health envisage in the event of no deal? What damage will we be limiting? The Secretary General also said, "Ireland is unlikely to face serious general medicine supply issues in the period immediately after 29 March." How long does the period immediately after it last? Is it a week, a fortnight or a month? I acknowledge that it may be hard to quantify but people need to know.

I want to address mental health. The placement of Irish citizens with UK healthcare providers for the purpose of receiving mental health treatment has involved an application on behalf of the HSE to the Court of Protection in London for recognition and enforcement of orders of the Irish High Court. The legal mechanism that facilitates recognition and enforcement of Irish court orders by the UK Court of Protection is under the UK's Mental Capacity Act 2005. This Act, in turn, gives effect to the Convention on the International Protection of Adults, which is a convention of the Hague Conference on Private International Law, HCCH, which is the World Organisation for Cross-border Co-operation in Civil and Commercial Matters. The HCCH is not part of the EU and should not, therefore, be affected by the Brexit. However, as it is my understanding that the mechanism under which children are referred to the UK for mental health treatment is actually done by way of EU regulation and not the HCCH and, therefore, it may be affected, I seek clarification from the Minister of Health on this matter. As long as the Government fails to provide appropriate care for mental health patients in this country, it is critical that any steps needed to be taken are taken to ensure the HSE can continue to refer patients to the UK for specialised care, as deemed appropriate, once the UK leaves the EU.

I will put on my Wexford cap. Rosslare Europort is owned by the Fishguard and Rosslare Railways and Harbours Company established in 1898 under a UK statutory instrument. Its future is effectively controlled by the UK Government, which could dissolve the company tomorrow morning if it so wished. The British Government may like the idea of having a port in the European Union post Brexit. The Minister for Transport, Tourism and Sport, Deputy Ross, has never raised the issue of the ownership of Rosslare Europort with his UK counterpart despite promising to so do. When I raised the matter with the Tánaiste and Minister for Foreign Affairs, Deputy Coveney, a couple of weeks ago, he bizarrely claimed to know nothing about it in spite of the multiple parliamentary questions I have tabled on the issue for his response. He could probably plaster his office with the questions I have submitted. A report on the issue was published on the front page of The Sunday Business Posta few weeks ago. The Tánaiste has not raised the matter with his UK counterpart either. Brexit provides a unique opportunity to resolve the issue of the ownership of Rosslare Europort, which is a strategic national port. A similar situation would not be tolerated in the case of Dublin Port or Dublin Airport, so why is it tolerated for Rosslare Europort? The Minister, Deputy Ross, admitted that the unusual legal status of the port has often been identified as a factor inhibiting its development. Why have the Minsters and the Government continually failed to grasp the opportunity to address the issue of the ownership of Rosslare Europort with their UK counterparts?

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