Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I welcome this opportunity to speak on the health-related provisions of this Bill. I thank the officials in my Department, along with officials right across the Civil Service who have worked so hard to ensure that the Bill was prepared to cater for a situation which we never wished to face but one for which we must prepare.

Brexit has undoubtedly raised a number of issues for health services that need to be addressed. My priority is to ensure continuity in the provision of health services and to avoid any changes to the current situation that would have a negative impact for our patients. In that context, the Irish and UK Governments have committed to the shared objective of maintaining the common travel area arrangements, which have long facilitated Irish and UK residents in accessing health services in each other’s jurisdictions. It may be useful to take this opportunity to set out the healthcare arrangements currently in place which will help demonstrate the importance of preserving many of the beneficial healthcare arrangements between Ireland and the UK.

The treatment abroad scheme is an extremely important service that enables patients in this State to access specialised care in the United Kingdom which is not available here. This enables patients to access key services such as paediatric organ transplantation, cardiology services and oncology services to name but a few. These are vital services to which access must be protected post Brexit. In 2018, there were 663 approved applications under the treatment abroad scheme with the vast majority, 89%, being treated in the United Kingdom.

Similarly, the cross-border healthcare directive is another arrangement which, although more recent, has proven to be beneficial to patients in this State. The cross-border directive enables patients to access care in another EU or EEA member state which patients pay for upfront but then can then be reimbursed by the HSE. Since its inception, the number of Irish patients accessing care under this scheme has grown substantially from just over 150 approved applications in 2015 to over 6,700 in 2018. Crucially, the United Kingdom, particularly Northern Ireland, is the primary location where Irish patients choose to access care. In 2018, over 6,300 applications were for the United Kingdom with 97% of those treatments reimbursed being accessed in Northern Ireland.

These schemes, together with the ability of our residents to access emergency, necessary healthcare in each other’s jurisdictions when on a temporary visit demonstrate the extent to which our health systems are interconnected and our patients are dependent. It is therefore necessary that these healthcare arrangements be maintained to the greatest extent possible following the United Kingdom’s exit from the EU.

It is against this backdrop that my officials have been undertaking extensive contingency planning to prepare for the various scenarios of the post-Brexit landscape. This is the purpose of Part 2 of the Bill. This Bill gives the Minister for Health the power to make an order or orders and regulations which will ensure that healthcare can continue to be provided to the same broad categories of people for whom it is currently provided and reimbursed. This includes continuing existing arrangements for health services which are currently 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.

The matters which will subsequently be provided for by way of regulations can be summarised as follows. Full eligibility for healthcare in Ireland will be granted to frontier workers working in the UK and residing in Ireland and Irish posted workers working in the UK. Full eligibility for healthcare in Ireland will be granted to UK State contributory pensioners resident in the State. Eligibility for certain healthcare in Ireland will be granted to UK temporary visitors and students. Where applicable, eligibility status will be granted to the dependants of such persons.

The regulations will also enable the HSE to authorise persons from Ireland to access, in the United Kingdom, planned public healthcare and to reimburse the United Kingdom providers of that healthcare. The regulations will also enable persons resident in the State to access routine healthcare from both public and private providers in the United Kingdom and to enable the HSE to reimburse persons the cost of that healthcare. The regulations will further enable the HSE to exchange and process data for the purpose of implementing and operating the healthcare arrangements between the State and the United Kingdom. The regulations will also give the Minister power to set out the operational and administrative procedures to allow for the reimbursement arrangements with the UK of the cost of healthcare and benefits-in-kind provided.

I will outline the various health provisions in the Bill. Part 2 provides for an amendment to the Health Act 1970 with the insertion of a new Part IVA dealing with arrangements relating to health services. Section 75A enables the Minister, with the consent of the Minister for Finance and Public Expenditure and Reform, to make an order or orders that may be necessary to continue into being reciprocal or other healthcare arrangements that were in place with the United Kingdom prior to its withdrawal from the EU. The order can specify the persons and categories of health services to which it should apply.

Section 75B enables the Minister to make regulations which will seek to set out arrangements for assessing the classes of persons who can access health services in the State and in the United Kingdom, any necessary administrative arrangements required by the HSE to enable access, the reimbursement and charging arrangements of the State and the HSE for the provision of healthcare both within the State and the United Kingdom, including determining the classes of persons, and categories of healthcare for which payments will be made and the methodology for determining charges and reimbursements. Section 75B also provides for penal clauses for persons who may contravene a provision of the regulations.

Section 75C relates to the powers under these regulations of authorised officers appointed by the HSE. This seeks to replicate the requirements provided for under the EU cross-border healthcare directive.

Section 75D is a general provision which relates to the laying of orders and regulations in the Houses of the Oireachtas.

Those are the general provisions of the healthcare arrangements in the Bill. It should also be noted that this legislation has been prepared on the working assumption that the UK will negotiate and enter into reciprocal arrangements with this State.

It is important that I take this opportunity this evening to highlight that there are many areas of healthcare that do not require legislative changes but for which extensive planning has already been undertaken to ensure continuity in the provision of services. This includes the security of supply of medicines, recognition of professional qualifications, food safety and maintenance of other service level agreements for the provision of health services.

My Department is working closely with the Health Products Regulatory Authority, HPRA, and the HSE regarding the supply of medicines and medical devices. An expert group of officials from the Department, the HPRA and the HSE is conducting a criticality assessment exercise to seek assurance about medicines sourced from, or which transit through, the UK and to identify medicines vulnerable to disruption due to Brexit. This group is engaging with industry and clinicians on mitigation measures such as alternative sources, alternative transport routes and alternative medicines or treatment regimens to ensure that patients continue to receive the best possible care. It is important to say that, to date, no critical supply issues have been identified but we continue to be vigilant.

It is important to note in this context that Ireland has a different supply chain model than the UK and we hold more stock in the supply chain than is the case in the UK. This is why we do not need to stockpile medicine and it is important that individuals do not do so as this could disrupt normal supplies.

The Bill does not contain any provisions relating to the future recognition of health professional qualifications. However, given its critical importance to the health sector, a number of measures are being advanced to address this. In particular, the UK has recently published its draft European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018, which it is intended to bring into force in the case of a no-deal Brexit.

This legislation will enable Irish qualifications to be recognised in the UK. The Irish health professional regulators each have third country recognition routes which apply to qualifications which are obtained in countries other than within the EEA or Ireland. They have considered these third country recognition routes with the objective of ensuring efficient routes for recognition of UK qualifications, while ensuring it is done in an objective and non-discriminatory way. The Irish regulators are satisfied they can continue to recognise UK qualifications in approximately the same timeframes and the same level of application fee but now under this different legal base.

Both the Irish and UK Governments are fully committed to continuing existing cross-Border health service arrangements such as cardiology and cancer treatments in Altnagelvin Area Hospital, Derry, and paediatric cardiology and associated maternity services in Dublin. These are managed by service level agreements, which do not require any legislative changes in the event of a no-deal Brexit.

The withdrawal of the UK from the EU and its new status as a third country will have implications for the official food control system in Ireland, as the importation of food is subject to EU legislation. Additional resources have been provided to conduct the appropriate checks where Ireland is the first point of entry to the EU. Preparations are also under way in the event that the UK should decide to require export certificates for certain food products. To facilitate these preparations, my Department is working closely with the relevant agencies and has approved additional resources for environmental health service staff, the Public Analyst's Laboratory and the Food Safety Authority of Ireland.

I hope I have addressed some of the health issues raised earlier in this debate, including those by Deputies Maureen O’Sullivan and Broughan. Deputy Howlin queried whether Part 2 could be unconstitutional as it provides for the making or repealing of primary legislation by statutory instrument. I assure him that the Attorney General, having examined available options, concluded it would be feasible to grant the Minister an order-making power to enable the current healthcare arrangements necessitated by EU law to continue to apply to the UK post-exit day.

While it is not possible to completely eliminate all risks or adverse impacts to public health on foot of Brexit, I assure the House that my Department and its agencies are fully engaged with Brexit planning. However, it is important we all recognise that a Brexit of any kind will mean change and will impact to some degree all sectors, including health. Accordingly, managing a no-deal Brexit is an exercise in damage limitation. Part 2 of this important legislation, which we hope never needs to be enacted, is a further step in the contingency planning process to ensure that there is minimal disruption to the current healthcare arrangements between Ireland and the UK.

See this speech in context