Background

The Committee heard of a number of challenges in the health sector described during its hearings, one of the most serious of which is the access to healthcare for those living in the Border regions. Particularly for areas where the closest hospital or emergency care is located on the other side of the border, this is vital. The  Government has acknowledged that “a key issue for this sector will be to ensure that there is minimum disruption to health services and that essential services are maintained on a cross-Border, all-island and Ireland-UK basis”.

Summary and Potential Solutions

Cross Border Health Care
– The most important solution is to ensure that there are no new obstacles to the access to healthcare on the island of Ireland and that the status quo is maintained.
– The maintenance of the CTA may be a very important aspect to ensuring this care,
particularly in ensuring that healthcare professionals travel freely to work and cooperate in joint initiatives.
– The Irish and UK authorities should ensure mutual cooperation in the healthcare sector through bilateral arrangements. This could include the establishment of negotiating bodies
between Ireland and the UK to replace negotiations that would have happened at EU level, which could be explored provided it is compatible with Ireland’s continued membership of the EU.

Rights of Healthcare Workers

– The retention of the rights of UK and EU citizens in each others’ jurisdictions post-Brexit, with particular rights to permanent residence granted to doctors, including those in the UK for less than five years.
– The mutual recognition of qualifications must be retained.
– While there are concerns over the number of Irish medical professionals moving to the UK, particularly nurses and midwives, further incentives to keep such workers in Ireland could be explored. The importance of UK programmes in training healthcare workers should also be recognised

Regulation

– There are concerns that common European rules on pharmaceuticals, medical devices, data protection, as well as legislation aiding the movement of health care professionals may no longer apply, and not be replaced by something similar.
– It is imperative that common standards on patient safety, medical education and training are maintained between the EU and the UK post-Brexit. The cross-border recognition of patient prescriptions should be maintained, as well as arrangements for the secure transfer of patient data from one side of the border to the other.

European Medicines Agency
– Ireland’s bid for the relocation of the European Medicines Agency (EMA) is welcome and could present a number of opportunities and benefits for Ireland and Northern Ireland.

Cross Border Healthcare and Irish-UK Cooperation

A key concern is the provision of health services on an all-island basis. The Committee heard that careful planning must be undertaken to ensure that cross-border cooperation in health care continues. One solution proposed is the establishment of a cross border committee which would include political leaders and stakeholders, to examine the impact of Brexit on both existing and future health care services, with a view to ensuring that watertight agreements are in place for
future collaboration.

Particular concerns arise in the access to health care for those living in the Border regions. During hearings, this Committee heard that 53,000 people in the Border areas benefitted from health and social care services under the INTERREG IVA Programme. The Committee also heard that there are 30,000 frontier workers who are entitled to access care in both jurisdictions and both UK and Irish nationals are entitled to access necessary care under the European Health Insurance Card.

The Joint Committee on Health also highlighted the possible impact of border checks in its recent report. The Committee heard that the HSE purchases a number of treatment services from the UK, including organ transplants and the treatment of lymphoedema, as well as the purchase of care from the UK under the waiting lists initiative and on a case-by-case basis. This included 574 patients under the treatment abroad scheme.
With respect to collaborative arrangements, the Committee heard that:

– Future scenarios should be developed to assess risks and barriers to patient care and ensure that access to services, treatment and follow on care is seamless;
– Long-term cost and funding arrangements for current and future collaborative care must be secured; and
– Mechanisms must be put in place to ensure the timely movement across the border of ambulances, patients and healthcare professionals post-Brexit.

Central to this, the Committee also heard that where the EU facilitated cross-border healthcare through common rules, ongoing cooperation must be ensured through bilateral cooperation.

Rights of Healthcare Workers

There are two central issues concerning the rights of healthcare workers following the UK withdrawal from the EU:
1) The right to work and residence
2) The mutual recognition of qualifications.
This first concern is in the area of citizens’ rights, particularly in the rights to work and to residency.

The Committee heard that permanent residence should be granted to EEA citizens working as doctors in the UK and vice versa. The Committee also heard that if such workers are resident for fewer than five years, it should not become an obstacle to this. The Committee heard that traditionally, there has been a very healthy ‘sharing’ and movement of medical professionals between Ireland and the UK, whether this is for training or long term work, with many Irish specialists spending time in the UK before returning.

In the case of nurses and midwives, the Committee heard that many Irish nurses and midwives move to the UK to work and that Ireland has had challenges in retaining them.While the issue of incentivising Irish nurses to stay in Ireland is separate to Brexit, the Committee heard that it is unlikely that the UK will not recognise qualifications because it needs nurses from abroad. A particular point brought to the Committee’s attention was that, in the case of doctors, the situation is very much the reverse, with 8% of the UK’s workforce coming from other EU Member States,
rising to 15% for some disciplines.

Regarding the second main issue, the importance of retaining the mutual recognition of qualifications was stressed to the Committee. In May 2017, the Joint Committee on Health recommended that this is retained, so as to minimise any possible disruption to health services.

As an additional solution, the Committee heard that practices undertaken by doctors and medical professionals aimed at improving standards across Europe, e.g. the European Union of Medical Specialists, should be protected.

Regulation

Following the UK’s withdrawal from the EU, it is possible that there will be divergence of regulation between the UK and the EU, which could disrupt trade and result in additional requirements in certification and clearance, including for pharmaceutical and medical devices. The potential withdrawal from the UK from agencies such as the European Centre for Disease Prevention and Control and the European Medicines Agency, could have implications for the maintenance of
common standards.

Particular reference was made to patient safety measures, which the Committee heard, depends on the mutual sharing of information across Europe.153 One particular example given was the communication of restrictions placed on a doctor’s ability to practise. It is imperative such measures are maintained and agreed between the respective authorities post-Brexit. The Committee heard that in the cross- border context, the mutual recognition of prescriptions should be maintained.

European Medicines Agency (EMA)

A possible opportunity arising from Brexit is that EU agencies based in the UK will have to remain within the EU and therefore move. The Government has identified the EMA as one such agency that could be accommodated in Ireland, making a number of arguments in favour of its relocation here,including its proximity to London, the quality of life in Ireland, the availability of world class talent and a dynamic life sciences sector.154 In relation to this issue, the Committee heard that the EMA would have a positive effect on the pharmaceutical industry and medical research.

The Committee also heard that it could have a positive impact on collaboration between Irish and Northern Irish universities, as well as new opportunities in areas such as clinical trials.

This Article draws on Seanad Special Select Committee Withdrawal of the United Kingdom from the European Union Brexit: Implications and Potential Solutions June 2017. Irish public sector information is reproduced pursuant to PSI Licence; Conditions of Re-Use of Public Sector Information. The Legal Materials contain Irish Public Sector Information licensed under the Irish Licence which is at http://circulars.gov.ie/pdf/circular/per/2016/12.pdf.

Contact McMahon Legal 

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