Michael Collins (Cork South West, Independent)
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We appreciate the Ceann Comhairle allowing this matter because it is of significant importance. The Minister of State is well aware of the cross-border directive that has been in place for a number of years and the fact that people have availed of procedures that can be carried out in the North. Has the Government put into the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Bill 2020 a provision or an arrangement to allow the cross-border directive, under which more than 5,000 people from the South have had eye-saving surgery, hip and knee operations in the North, to remain in force? If not for this directive, thousands of people, mainly from west Cork and Kerry, would have gone blind or been left in severe pain. Deputy Danny Healy-Rae and I have taken more than 2,000 people for surgery and we want to know if this will continue. We have been led on a merry dance for the past couple of months and no clear answer has been given.

Danny Healy-Rae (Kerry, Independent)
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I thank the Ceann Comhairle for the opportunity to raise this important matter. I have been taking people from Kerry and Deputy Michael Collins has been taking people from west Cork to Belfast to get their sight restored, have hips and knees replaced, have operations on shoulders and other ailments and, for youngsters, to have their tonsils removed. I took a child of eight years of age to get cataracts removed from both eyes so that he could go back to school and I took a man as old as 95. Is the Minister for Foreign Affairs, Deputy Coveney, replying?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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It is the Minister of State, Deputy Feighan.

Danny Healy-Rae (Kerry, Independent)
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When he was in the previous Government, the Minister for Foreign Affairs promised that he would put in place legislation to allow a bilateral arrangement between the UK and the South of Ireland so that this service could continue. Will the Government put this bilateral arrangement in place? The Tánaiste, Deputy Varadkar, gave an assurance that patients from the North would be reimbursed if they had to be treated in the South, so why can people from the South not get similar reimbursement if they have to be treated in the North?

Mattie McGrath (Tipperary, Independent)
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Deputies Michael Collins and Danny Healy-Rae have done much work on this matter. They have brought thousands of people to Belfast to have operations performed in order to stop them from going blind or to replace hips. I have had a number of people from Tipperary accommodated and they got successful treatment. With no disrespect to the Minister of State, it is a scandal that neither the Minister for Foreign Affairs nor the Minister for Health is here to answer this. This has been kicked around on the head of a pin for the last several months because we are frightened. People are ringing every day to try to get in before 1 January. We have all the bilateral agreements and everything else, and people can come here, rightfully so. This Government seems to be making an effort to stop this because it is embarrassed. It would rather let people go blind and have issues with hips, knees, backs, scoliosis, tonsils and everything else, rather than accept what the rural Independent Deputies are doing, which is the Government's job, and help people to get services that they should be getting here. It is an embarrassment that they have to go to the North. We have to have a clear and definite answer, and at least a month's moratorium for January, because there are queues of people waiting to go. It is totally unfair to them. They are sick.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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For clarification, this has nothing to do with the Minister for Foreign Affairs who is here. It is a matter for the Department of Health.

Mattie McGrath (Tipperary, Independent)
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It is a matter for the Minister for Foreign Affairs. The Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Bill 2020 should have been used to address it but that has not happened.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We are dealing with it as a health issue and the Minister of State is here to deal reply. I am sure he will be more than able to do so.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputies for raising this issue. The directive on patient's rights in cross-border healthcare, commonly called the cross-border directive, provides rules for the reimbursement to patients of the cost of receiving treatment abroad where the patient would be entitled to such treatment in his or her home member state. The directive seeks to ensure a clear and transparent framework for the provision of cross-border healthcare within the EU for those occasions where the care patients seek is provided in another member state rather than in their home country.

The EU cross-border directive which has been implemented in Ireland since 2014 has enabled many Irish patients to access health services in many other EU member states. Geographic proximity to Northern Ireland and the UK means that the vast majority of Irish patients tend to access care in that jurisdiction. That is why the decision of our neighbour, the UK, to leave the EU has a very real impact on our citizens. As the cross-border directive is underpinned by EU legislation, from 1 January next, the provisions of this scheme will no longer apply to Northern Ireland and the UK in general. This is an unfortunate and undesirable consequence of Brexit that is outside the Government's control, but the Minister for Health is acutely aware that patients and Deputies are concerned about the loss of access to services, particularly in Northern Ireland, which are accessed under the directive. As part of Department officials' Brexit planning, there has been extensive examination of this matter, which has raised a number of key policy and legal issues.

Noting the importance the Department places on ensuring that Irish patients will continue to access this capacity, the Minister has tasked officials with examining the feasibility of implementing a unilateral arrangement similar to the cross-border directive to provide that Irish residents can continue to access services from private health service providers in the UK post the end of the transition period. That work, which is detailed and complex, is ongoing. I reassure Deputies that it is the Minister's intention that Irish patients should be able to benefit from accessing these services in future. It important to restate that patients will still have recourse to access health services under the EU cross-border directive scheme in 30 other countries from 1 January 2021.

Danny Healy-Rae (Kerry, Independent)
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I thank the Minister of State. His reply was a bit confusing in that I am not so sure that the bilateral arrangement will be secured or about what will be covered. He stated that there is an option to go to mainland Europe. I do not think it is fair to tell someone in their 80s or 90s to get on a plane to travel abroad to get a cataract removed, while it is not an option at all for those seeking to have hips and knees replaced or for children of eight years of age.

For such a child that might have cataracts, that is not a real option. I am asking the Minister of State to pull out all the stops to ensure that we get a bilateral arrangement which will ensure that people will be reimbursed.

Michael Collins (Cork South West, Independent)
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I appreciate that movement is taking place and it is urgent movement that is desperately required at this stage. I know that other Deputies and councillors besides those of us here are inundated with urgent phone calls from people. They are frantic to get to the North before 31 December because they are going blind. We need 100% confirmation that this scheme or a scheme like it will continue and that people can go to the private hospitals in the North regardless of where they are so that this can continue. I am not making this up because if the Minister of State came down to the lower floor of the Chamber to me later on I will show him a list where over 100 people have phoned me over the last week begging me to take them North because they think that the scheme is going to end.

Mattie McGrath (Tipperary, Independent)
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I appreciate that the Minister of State, Deputy Feighan, is here but the Minister, Deputy Donnelly, should be here to answer this. He runs like a scalded cat every time we have a question or a motion down to talk to him. It is a total disrespect to the Rural Independent group. A scalded cat would not go through the skylight as fast as he has gone and he is like snow off a ditch on other occasions. The answer given by the Minister of State is condescending to older people. My colleagues here bus people to the North. Unfortunately we do not have the technology to enable buses to travel on water to go abroad and to tell people that they can go there. We have to tell people at the 11th and a half hour that the Government is looking at a bilateral agreement. It had two years to do this. The Government never accepted that the British were going to go. It should have in order to be ready. We are closing the stable door when the horse has well bolted. We want certainty and to know that people can go.

First, these people should be treated in Ireland and it is the Irish taxpayer who pays for this. It is a mockery that they have to go there but the opportunity was there and I want to thank Niamh and all of the staff in Kingsbridge Private Hospital for being so helpful and to thank Deputy Michael Collins and others who have organised this, together with the staff in Deputy Collins’s office who run around in the middle of the night picking up people to bring them to a bus in Cork. The Government has no idea the effort that goes into this. It is worth it because people can see, stand up and walk and live with some modicum of quality-of-life. This is not acceptable at this point in time. It should have been in the omnibus Bill.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I fully understand the reasons why the Deputies have raised this issue. The decision of our neighbour to leave the EU will have unfortunate, negative implications for Ireland that are outside our control. This includes the loss of access to healthcare services currently provided for through the cross-border directive, CBD, representing a substantive and real loss of access to healthcare services for Irish people. As I said, the Department of Health officials are continuing to examine this matter with a view to ensuring that access to services in Northern Ireland and the UK might be retained in 2021.

Separately, it is useful to note that we have a memorandum of understanding with the UK that will be signed shortly which will ensure continued access for Irish residents to essential healthcare in the UK post the end of the transition period. This is a very positive outcome in terms of the Irish and British Governments’ commitment to maintaining, insofar as possible, the current healthcare arrangements under the common travel area. In addition, on behalf of the Minister, Deputy Donnelly, I assure Deputies that both the Irish and UK Governments are fully committed to continuing existing cross-border health services like cardiology, cancer treatment services in Altnagelvin Hospital in Derry and paediatric cardiology and related maternity services in Dublin and to ongoing health service co-operation into the future.

Finally, the Minister, Deputy Donnelly, will keep Deputies updated on progress as to the examination by Department officials of the feasibility of implementing a unilateral CBD type arrangement.