JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Thursday, 1 Mar 2012

Cross-Border Co-operation in Health: Discussion with Northern Ireland Assembly

Chairman

I remind members and those in the Gallery that all mobile phones should be switched off for the duration of the meeting. I extend apologies on behalf of Deputies Naughten and Ó Caoláin, who cannot be here today. I welcome, cuirim fáilte roimh, the members from the Northern Ireland Assembly committee dealing with health, social services and public safety. I welcome everybody to our Houses and this committee: chairperson, Ms Sue Ramsey, MLA; the vice chairperson, Mr. Jim Wells, MLA; Mr. John McCallister, MLA; Mr. Mark Durkan, MP, MLA; Mr. Sam Gardiner, MLA; Mr. Mickey Brady, MLA; and Mr. Kieran McCarthy MLA. I also welcome Dr. Kathryn Bell, clerk to committee, and Mr. Mark McQuade, assistant clerk.

I thank everybody for making the effort to come down and I hope this meeting will be the beginning of a series of meetings between the committees. It is important that we work on cross-Border co-operation in health matters. I acknowledge and thank the Institute of Public Health in Ireland for making a detailed submission to the joint committee on this matter. Members of our committee have been given a copy of that presentation and I thank Mr. Owen Metcalfe, Dr. Helen McAvoy and Ms Arlene McKay from the institute.

North-South co-operation is very important and there are currently two pertinent matters at the level of the North-South Ministerial Council and joint departmental projects. I hope we can add a new interparliamentary strand. Currently there are a number of collaborative projects which have been progressed by both Departments dealing with health, and the collaboration has been very good. Just last month we saw the Irish Minister for Health, Deputy Reilly, and the Northern Ireland Minister, Mr. Poots, involved with a task force on obesity. I thank our members for being present and they are welcome to join us for lunch at the conclusion of today's meeting.

It gives me great pleasure to ask Ms Sue Ramsey, MLA, to address the meeting. I should advise those present that they are protected by absolute privilege in respect of evidence and remarks given to the committee. If you are directed by the committee to cease making remarks on a particular matter and continue to do so, you are entitled thereafter only to a qualified provision in respect of your remarks. You are directed that only comments or evidence relating to the subject matter of this meeting are to be given. You are asked to respect the parliamentary practice to the effect that where possible we should not criticise or make charges against a member of either House of the Oireachtas or a person outside the House or an official by name or in such a way as to make him or her identifiable. I apologise for the legalese.

Ms Sue Ramsey, MLA

I can assure the committee I will not make any statement from my official notes that will cause controversy. God knows what we will say later. From the outset it is important to thank the committee and its staff for the warm welcome received from the time of our arrival this morning and especially our welcome in the Chamber. It is important that the committees, North and South, meet formally and informally where possible to try to work out areas of co-operation, as health is an issue that crosses the island. Both committees, in the Northern Ireland Assembly and in Leinster House, have met on a number of occasions and the Chairman mentioned some of the issues that will be dealt with at the North-South Ministerial Council. It is important to recognise the work of both Ministers in advancing some of those issues.

In speaking about the benefits of co-operation on both sides of the Border, it is important to mention the work of CAWT, which is Cooperation and Working Together. As a result of this, we are allowed to draw down European funding, looking outside the island as well to gather funding and deliver improved services for our people. The development of radiotherapy services at Altnagelvin will provide a different slant on services for cancer patients in the north west and save patients many hours and untold stress arising from having to either travel to Belfast or Dublin, as currently happens. That would also add financial pressure on patients and families, so this is a common sense approach to people in the north west.

Safefood has the responsibility for the promotion of food safety on the island, and it ran a campaign relating to obesity. At this stage I would probably need to declare an interest in talking about obesity. As a committee in the North we did a very substantial inquiry into obesity and there were some good recommendations. That means both committees can work to a common goal through bodies like safefood. A number of members of our committee have taken part in the "Stop the Spread" campaign with which safefood was involved.

In the North, the Minister, Mr. Poots, has recently produced the "Transforming Your Care" report into health and social care, which contains 99 recommendations. Some of the key themes are radical ideas to transform care within the health service and I argue that the majority of the recommendations could be endorsed individually and collectively by parties and this committee. Some discussion is needed on other proposals. However, there is an issue about moving away from hospital care into more local settings, either in general practitioner, GP, surgeries or people's homes, caring for people in their home for as long as possible and health and social care professionals working in a more integrated and joined-up way.

There are also some aspects of the review which deal specifically with cross-Border co-operation. With regard to specialist areas of care, for example, networks will be set up between health care systems on a North-South basis and an east-west basis. In terms of acute services, the review recommends we move to having between five and seven acute hospital networks and that local commissioning groups need to take account of the potential to provide services to the South, joint planning in areas such as shared opportunities for specialist care and procurement services in the new south-west hospital.

Today is a good opportunity for us to continue our discussions on the common problems and possible solutions we all face on a range of health and social care issues. Members of my committee have various issues they wish to raise and I look forward to our discussions. Again, on behalf of the committee and our staff, I acknowledge the warm welcome we received when we arrived in Dublin this morning.

Chairman

Thank you for those welcome remarks. I wish to acknowledge Mr. Owen Metcalfe, director of the Institute of Public Health in Ireland, IPH, and Dr. Helen McEvoy and Ms Arlene McKay, also from the IPH, who are in the Visitors Gallery. They are very welcome to the meeting. I invite the vice chairman of the health committee, Mr. Jim Wells, MLA, to make his opening remarks.

Mr. Jim Wells, MLA

It is a delight to be here, and is long overdue. I believe it is 18 months since we welcomed our colleagues from the committee to Stormont. The turnover in membership has been phenomenal, to the extent I do not know if any current member of the committee was at that event.

Chairman

Democracy is great down here.

Mr. Jim Wells, MLA

The grim reaper has truly applied and the result is that, unfortunately, we do not know the members of the committee as well as we should.

In the foyer of Leinster House there is a picture of Michael Collins. That picture has significance for me because my daughter, when she was aged 11 years, was handed a history text book for her examinations. It contained a page with pictures of four dead Irish political heroes, Michael Collins, Eamon De Valera, Edward Carson and myself. It was a picture of me protesting against the Anglo-Irish Agreement outside Hillsborough Castle which was taken in 1985. It is bad enough for an 11 year old child to be told that their father is in the history books, but she was also told her father is a dead Irish political hero. That is two insults, but I will not say which. Every time I see that picture I laugh. I am regularly stopped in the street by people asking me if I know my picture is beside the picture of Collins in the history book.

It is an indication of how there has been such a dramatic improvement in North-South relationships. I was in Leinster House for the first time two years ago. We had a lovely meal in Iveagh House. If members ever get a chance to lunch there, they should take it. The cuisine is extraordinary. I told the Deputies at that meeting that the last time I was in Iveagh House was in 1985, standing outside protesting that the gutless Unionist MPs were wining and dining in Iveagh House. Twenty years later, it was me wining and dining in Iveagh House with Deputies. Time passes and that gives an indication of how relationships between the North and South have improved beyond all recognition over the last 15 years. That is to be welcomed. There is much that unites us, as well as the odd thing that divides us.

In health, in particular, there are many issues of common concern. Diseases, parasites and viruses do not recognise borders and on issues such as swine flu, for example, we had to work extremely closely together. As the Chairman correctly said, matters have moved on since our last meeting. We have carried out a fundamental review of our health care in what is called the Compton report. I occasionally listen to RTE and I am a great fan of Vincent Browne's programme. I presume everybody is a fan of Vincent Browne down here.

Deputy Robert Dowds

He is the Jerry Springer of Irish politics.

Mr. Jim Wells, MLA

Is he? I find his programmes excellent. It is from listening to them that I am aware of, for example, Roscommon hospital, what has occurred there and the great pain it is causing the midlands. We are in a position now where the number of accident and emergency units in Northern Ireland will undoubtedly be reduced quite significantly. If some of our accident and emergency units, such as Altnagelvin Area Hospital in Londonderry and Daisy Hill Hospital in Newry, are to survive, there will have to be increased cross-Border co-operation. In Altnagelvin Area Hospital there is the wonderful news of its new radiology and chemotherapy unit. That will be enormously beneficial to the people of the north west, both for the Northern Ireland component and also Sligo and Donegal. We strongly welcome that co-operation. It is good common sense.

There is another example. In Daisy Hill Hospital in Newry, almost a third of the renal patients come from Louth and Monaghan. It provides essential services for both sides of the Border. If Daisy Hill Hospital and other Border hospitals are to continue to have a full range of accident and emergency facilities there will have to be greater input from our friends across the Border. That might not be good news for us, and it might cause problems for the South's accident and emergency units in those areas. One of the issues I wish to discuss today is how to resolve those difficulties. I also have been lobbied heavily by Deputy Joe McHugh, the Fine Gael Deputy from Donegal, on the issue of muscular dystrophy and the provision we make in Northern Ireland and the Republic of Ireland for that very distressing condition.

There are, therefore, many issues on which we can co-operate. We are doing so in an atmosphere of co-operation and friendship. Until recently that would have been rather different. That is good news. I hope we meet more often. It is regrettable that it is 18 months since we last met. There was also the irony of a DUP member of the health committee whipping people to go to Dublin to meet with the committee's colleagues here in Leinster House. I am glad there was a good turnout as a result of that exercise. We would be very keen at some stage, although I might be stepping on the Chairman's toes in this regard, if the members would come up to see us. We have so much in common it would be great to see them. That invitation is given without any authority whatsoever on behalf of the committee and will no doubt get me into hot water with the clerk afterwards. However, I hope it happens.

I look forward to today's meeting. I am sure there is a great deal we can explore in common.

Chairman

Thank you, Mr. Wells. You are correct that there are potential benefits from future and continuing cross-Border co-operation on health. Both jurisdictions face very strong challenges in the health area and it is important that we collectively and collaboratively improve our health service in many areas. I wish to acknowledge and welcome the presence of the chairperson of the British-Irish Parliamentary Assembly, Deputy Joe McHugh. I call Deputy Billy Kelleher.

Deputy Billy Kelleher

I welcome the delegation. It is appropriate that we discuss the issue of cross-Border co-operation on health. We have had some discussions on this in a roundabout way but it is important that we meet on a continual basis. Yesterday, for example, we had a meeting with representatives of organisations dealing with rare diseases and they are seeking the establishment of a national rare diseases centre of excellence. There is huge potential in those key areas for closer co-operation with regard to diagnostics and treatment.

As regards the issue of emergency medicine in the Border areas, we must be keenly aware that resources are limited and always will be in the provision of health care. There is a huge opportunity and great potential to work closely in the area of emergency medicine so people on both sides of the Border can access treatment in whatever jurisdiction as quickly and effectively as possible.

Like Northern Ireland, the Republic is going through economic difficulties. At such times we must start to think collectively about how best we can pool our resources to assist people. The issue of the national rare diseases centre was mentioned yesterday not only in the context of the island of Ireland and the United Kingdom, but also on a pan-European basis, where a pan-European centre for rare diseases has been established. The difficulty with rare diseases is that they are not really rare. There are many people suffering from rare diseases but the problem is that there are many different types of rare diseases, and we do not necessarily have the expertise on every aspect in terms of clinical supports, diagnostics and treatment. I believe this is a key area.

In general, this is a new time for all of us in the context of how we deal with the issue of health care. I am sure there is expertise from which we can learn, such as, for example, the special delivery unit, SDU, that was established in the North to deal with waiting lists. Dr. Martin Connor, who established the SDU in the North, is now assisting the Republic in dealing with waiting lists. We will have to wait and see before determining whether it is as successful as it was in the North.

There is not only the issue of the provision of health care, but also the issue of assessing how we best develop health care in terms of technology. People can now be diagnosed from a distance, for example, through MRI and X-ray. It is not necessary to have the radiographer in the room. Where we have the best clinicians and consultants, whether in the North or in the Republic, there should be easier ways of accessing their expertise on diagnosis and treatment thereafter. We will be delighted to have further discussions and my party is keenly supportive of stronger cross-Border co-operation, for no other reason than to benefit people on both sides of the Border.

I welcome the delegation and hope it has an enjoyable time. The delegation should not be worried about protests outside the gates of Dáil Éireann. It happens regularly and some people who protested outside the gates for many years are now inside Leinster House. We are democratic and always welcome peaceful protest. It is an indication of the changing times. As a public representative, I often find people are ahead of the politicians in their thinking on solutions to health care problems. They will travel to the North if they believe there are better facilities there or vice versa. We should be conscious of that in setting the agenda.

Deputy Ciara Conway

On behalf of the Labour Party and as Vice Chairman of the committee, I welcome the delegation. We must take time to get to know the delegates over the course of a productive and mutually beneficial relationship in the months and years ahead. I attended a friend's wedding in Clonmany on Inishowen and, unfortunately, my daughter fell ill while I was there. I experienced the co-operation of the out-of-hours primary care service in Derry. We were across the Border in 20 minutes and my daughter got great care and was well looked after. I have seen the co-operation working at first hand.

Mental health blights all of this island, particularly young men, and it is important to work on an all-island basis to prevent it. While diseases and infections see no boundaries, neither do social media and television promotion. One of the first topics for debate in this Dáil was mental health. I am pleased a budget of €35 million was ring-fenced to tackle that serious problem. I hope we can continue that important work into the future.

There are many changes in terms of the committee members and also those at the Cabinet table. For the first time, we have a Minister for Children and Youth Affairs and we are in the process of establishing a designated child protection and welfare agency. The joint committee needs to examine the flight of people from different social services and how we need to improve communications to ensure children's safety. I worked in the area as a social worker and I had difficulties tracking and tracing the protection and welfare of children. That should be at the top of our agenda. I hope this is something we can formalise and drive forward in the future.

The daughter of Deputy Dowds, who is sitting beside me, works as an occupational therapist in Daisy Hill Hospital, Newry. He has first-hand information on it and if anyone is looking to bump someone up the appointment list, he is the man. I thank the delegates for meeting us today and I look forward to working with them in the future.

Deputy Catherine Byrne

I am privileged to sit here as part of the new Government to welcome our counterparts to this part of the island. The more we share our experience, the better our chance of resolving our difficulties with the health services. When I was a child, I spent many happy days across the Border in Newry, Banbridge and Belfast city. Friends and family live there and, as a child, one of the big occasions was to visit the Giant's Causeway. I can account for every rock there. I am privileged to sit here, having been elected to Dáil Eireann, and to be part of the new Government, which I believe will take a new approach to how the health service is being run in this part of the island. We share a wonderful island with plenty of green grass, beautiful scenery and decent people who want to make every service work for our friends, relatives, neighbours and those who live in our communities.

I have never met the delegates present but my understanding is that we all have different talents and come from different levels of communities in different societies. We can learn that the differences we have will lead to a better understanding of how we choose to contribute to politics. We had a lovely cup of tea and a lovely bun and I look forward to sharing lunch in the afternoon and learning more individually about the representatives. It is important that we not only see one another as public representatives but also as individuals and share some information about our family background. I was struck by a quote said to me by a close friend, from the founder of an order of priests, who said that what we dream alone remains a dream but what we dream with others becomes reality. This morning is that reality, a coming together of people from various areas with one goal of having a better health service on this island together or as part of different Governments. I thank the delegation for the privilege of meeting at this committee and I look forward to the lunch where we can exchange photographs of our children.

Deputy Michael Colreavy

I apologise for having left the meeting earlier. Unfortunately, after speaking I must leave again because my speaking time in the Dáil was put back by 20 minutes. I apologise on behalf of Deputy Caoimhghín Ó Caoláin, the Sinn Féin spokesperson on health and children, who cannot be with us due to a family bereavement. This is a meeting he dearly wished to attend. On his behalf and on my behalf, we extend a warm welcome, céad míle fáilte, to our counterparts from the Northern Ireland Assembly health committee. I thank them for attending. This is an important and welcome engagement and one we hope will become a regular feature to monitor and report on increasing and developing co-operation in health between the two jurisdictions in Ireland.

The briefing compiled by the committee secretariat, the submissions from the Institute of Public Health and the North-South feasibility study published by the two Ministers last December provide us with a comprehensive overview of existing co-operation in health on this island and, most importantly, on the potential to expand co-operation. We commend the work of Cooperation and Working Together, CAWT. That organisation is at the coalface and is well placed to advise on how to expand co-operation for the betterment of everyone in our communities. The Institute of Public Health has provided a sound policy basis for co-operation and its continuing input will be important. I welcome the recommendations for expanded co-operation in the Institute of Public Health submission. The North-South feasibility study presents a programme for real progress in the development of health services on an all-island basis, with benefits for all who share this island. Some of the recommendations have already been acted upon, including the development of radiotherapy capacity at Altnagelvin Area Hospital, Derry, to improve access to radiotherapy for populations in the north west. This flagship project for co-operation is most welcome.

We would urge that progress be made on other key recommendations in the study, including that we work jointly on the transplant of less common organs, child protection measures and cross-Border foster care. We encourage progress also on the recommendations for the two departments and relevant agencies to explore approaches to improve access to services, including high quality primary and community care services, particularly for populations in remote rural or Border areas. I am a Deputy in the Sligo-North Leitrim constituency and live in Manorhamilton. Many people in such communities would prefer to have the option to choose to go to hospital in the North rather than to Galway or Dublin. I would much prefer to go to the Erne Hospital in Enniskillen rather than to a hospital in Galway or Dublin. I believe that people in the Erne catchment area would prefer to go for a procedure in Sligo Regional Hospital rather than to a hospital in Belfast. We need to explore these choices.

The development of out-of-hours cross-Border GP services is especially important and should be extended from the existing pilot programmes to areas the length of the Border. A strong message needs to go from our meeting today to encourage the Minister for Health, Deputy James Reilly, and the Minister for Health, Social Service and Public Safety, Mr. Edwin Poots, and all the relevant agencies to act in concert to implement the recommendations of the feasibility study and to put in place implementation plans in the coming months.

The safefood business plan 2012 has been signed off by the Minister for Health, Deputy James Reilly, and a review has been ordered by the Northern Ireland Minister, Mr. Poots. We believe the work plan for 2012 should proceed alongside any ongoing review. If momentum is lost, it would be difficult to regain it.

The next issue needs to be raised at EU level. A recent EU directive changes the qualification criteria for pharmacists in the South. This means the qualifications of somebody who did a four-year course in pharmacy in London or in Belfast and was qualified to dispense pharmaceutical products in the Twenty-six counties have been changed. The effect of this directive will leave many people caught between the old and new regulations. I ask that this be investigated both North and South. We do not want to erect greater barriers to co-operation and we should remove them where they exist.

I apologise but I must return to the Dáil Chamber.

Chairman

Before the Deputy leaves, I note from the North-South Ministerial Council meeting of 2 February that the safefood chief executive, Mr. Martin Higgins, made a presentation and they have agreed to come back to this topic again. The committee will take up that matter at a future date. safefood is a very good all-Ireland body, which does great work in the area of food and food safety.

Ms Sue Ramsay, MLA

I welcome the opportunity to comment on a number of points. What strikes me is that there is no difference between what we are now discussing and what our committee has been discussing in the past number of weeks. We have heard the concerns around safefood and yesterday, we had a session on pharmacies, but not specifically on the point raised by Deputy Colreavy. However, we are dealing with issues affecting pharmacists across the North. We also discussed rare diseases yesterday in Stormont. As the deputy chairman said, there are no boundaries on this issue and we must work collectively to ensure that our people will get the best outcome.

The deputy chairperson mentioned the whole issue of mental health. I represent a constituency that has probably one of the highest rates of suicide in the North and that is something that I know has been on the agenda of the North-South Ministerial Council meetings. Suicide, self-harm and mental health are key issues on which we can work together on all-island basis. Sadly I was at the wake of a young man in my constituency, and this is an issue we can deal with.

We had a debate in the Assembly two or three weeks ago on the issue of organ donation and retention. North-South co-operation on child protection is a key issue and when we look at what Europe is doing around child protection and ensuring that information is passed through different jurisdictions, it is important because some of these people are professional predators and are using the whole issue of North-South relations to their advantage. We should use the co-operation of our bodies, North and South, to our advantage and to close down that network.

I commend the Institute of Public Health for its proactive approach. We have a policy in the North on investing for health. Investing for health is about promotion and prevention and ensuring that we keep people out of the health system. That is a start in my view of a beautiful friendship and I think the deputy chairman is correct to invite members to Northern Ireland. As chairman of the committee, on my behalf and that of the deputy chairman and members of the committee, I formally invite all members to make a visit to Belfast to discuss health issues. We can build this relationship to target and to look at some of the issues. We have raised the issue of safefood too.

Mr. Kieran McCarthy, MLA

I thank everybody around the table for giving us a tremendous welcome this morning. It is a pleasure for me to join my committee colleagues here. There is so much that we can share and I hope we will share together to achieve better health facilities across the island.

My main concerns are mental health, learning disability and rare diseases. We had a conference yesterday on rare diseases, but unfortunately I was not able to attend. I must confess that my interest in rare diseases arose after the birth of my daughter 42 years ago. The term "rare disease" was not spoken about then but she suffers from Cornelia de Lange syndrome and was diagnosed with it a short time after she was born. The only thing Joanne can do is lift the cup and take a drink. Everything else has to be done for her. She is a brilliant child in every way. There are so many rare diseases.

That leads on to learning disability. My daughter has a learning disability and tremendous strides have been made in the service we provide for those with disabilities. I could not complain about the service Joanne gets and has got all those years.

Mental health services, suicide and depression, have been regarded as the Cinderella of the health service. It was always towards the bottom of the priority list. Professor David Bamford conducted a complete review of mental health facilities in Northern Ireland, which was completed in 2007. At that time it was estimated that it would cost £600 million to bring the service up to standard and we are not halfway there yet. We are making progress, but it would be beneficial if we could share ideas on mental health. We have all heard the expression"It's an ill wind that blows no good".

The Northern Ireland Assembly was promised millions from the Southern Government towards construction on the A5 road. I do not know where the A5 is as it is west of the River Bann and not in my constituency of Strangford, which is in County Down. The promise did not materialise and we were left with millions of pounds and did not know what to do with the money. It was a matter of balancing it out. A significant amount was spent on providing additional health facilities. The Ulster Hospital and two or three other hospitals received extra funding, which is in everybody's interests, although I accept that commuters have not benefited. I am pleased to be here and hope we can work together for the benefit of everyone.

Mr. Jim Wells, MLA

We have a phrase in Northern Ireland that the world ends at Glengormley, which is the view taken by most MLAs who live east of the River Bann. As a result, the poor west is forgotten about. I am delighted Deputy Joe McHugh has joined us because he knows the A5 road reasonably well. It is important that someone as powerful and important in his party as the Deputy is present.

I recently attended a conference at Stormont on muscular dystrophy. It was a powerful and telling meeting chaired by Conall McDevitt, MLA, one of the rising stars in the Assembly. I found it very touching to hear parents speak of the lack of facilities for muscular dystrophy, North and South. What made it more difficult was that some of them had the opportunity to visit Newcastle-upon-Tyne in England where they enjoyed the state-of-the-art facilities available in the city for people with muscular dystrophy. The meeting was informed that while there is a crying need for such facilities in Northern Ireland, the number of sufferers of this awful condition is not sufficient to warrant consideration of any such proposal. In discussions with Deputy McHugh I indicated that this may be the type of issue on which the synergies and quantum of sufferers justifies a facility, whether in the Republic or North, which everyone suffering from the condition could use. Any such decision would have to be driven by sufferers of muscular dystrophy and those who are caring for them.

I am being a little tactful when I say the Middletown experiment in the area of autism has not been what we had hoped for, perhaps because the centre for autism in the town was driven by Governments rather than those dealing with autism at the coalface. The various charities involved would have to buy into any measures in this regard. My suggestion on muscular dystrophy facilities is the type of practical issue on which our two committees could work together.

The problem with the folk from Northern Ireland who travel to Newcastle-upon-Tyne is that they return distraught, not because they did not receive wonderful treatment but because they know it will be many years before they have another chance to return to the city and they yearn for the type of treatment they obtain there. This is the type of issue the committees should consider because we can make a change in Government policy at that level. However, we will not have hundreds of millions of euro or sterling available for large accident and emergency centres.

I ask members to visit the amazing new accident and emergency facility in Enniskillen. One of our colleagues referred to where he would like to be treated. The only description of the new unit at Enniskillen that comes to mind is that it is accident and emergency meets Star Trek. It is the most incredible hospital I have seen. It cost £269 million and will be of benefit to folks in counties Leitrim and Sligo who live closer to Enniskillen than their local hospitals. I hope the committees will be able to work together on this issue and to ensure the bedding in of the Altnagelvin hospital chemotherapy unit project. We should make certain that cross-Border schemes which benefit all of us and threaten nobody proceed smoothly.

As I keep asking, is it still certain that money will be provided from the Republic for Altnagelvin hospital? Is this money tied down? I visited Dublin previously with a delegation from the Committee on Regional Development. One of the then Ministers, who is no longer either a Minister or Deputy, stated in this very room that the money for the A5 road project was as safe as the Rock of Gibraltar. It later disappeared. I wish to tease out whether we will definitely get the money from the Republic for its share of the Altnagelvin hospital chemotherapy unit. While I have not heard anything to the contrary, if the Government here is about to change its mind, we need to know very quickly because the project is about to go out to tender. I hope that is not the case. Let us consider my proposal on a muscular dystrophy facility which I believe could benefit desperately ill people, both North and South.

Chairman

The order of speakers will be three members of the Oireachtas followed by three members of the Assembly.

Senator Colm Burke

I apologise for not joining the meeting earlier. I was delayed in the Seanad where I raised an issue related to cross-Border health care. The specific matter I raised was an EU directive passed in February 2011 which I am pressurising the Department to transpose in law. The directive was introduced in response to a number of European Court judgments on the right of people who travel to other member states to obtain medical treatment to recover the costs of such treatment from the member state in which they reside.

We have not done enough on sharing services on the island of Ireland. For instance, I had to travel to the United Kingdom for medical treatment many years ago because the number of people in the Republic or Northern Ireland, when considered separately, was not sufficient to justify the purchase and operation of the relevant equipment, although the number of people, North and South, was sufficient to justify such a purchase. I am passionate about the sharing of services for this reason.

While much work has been done in this area, we must identify issues on which co-operation can increase. In the Republic we have a fund for treatment abroad which must approve applications from those who wish to avail of treatment abroad before they can travel. A complaint has been made that consultants in Cork will refer patients to the United Kingdom before they will refer them to a consultant in Dublin. This is a problem and much greater co-operation is required, not only between different areas in the Republic but also with Northern Ireland. We must ensure we expand services in both jurisdictions.

One of the areas in which the Republic has experienced significant problems in recent years is junior doctors. While I am not sure of the position in this regard in Northern Ireland, I understand the number of joint training programmes between the North and South is limited. Could joint training programmes be developed? If a trainee doctor in a three year programme were to train for two years in Dublin and one year in a Northern Ireland hospital or vice versa, services will grow much faster when he or she becomes a consultant because of the contacts that have been developed. This would have a much greater effect than meetings between public representatives. We have not worked on this type of co-operation at the initial stage of training. Could this issue be addressed in a much more comprehensive manner? What are our colleagues’ views on shared training programmes, whether of three or five years’ duration, in specific areas?

We should try to encourage medical professionals in nursing or maternity care to avail of placements in hospitals in the other jurisdiction. I thank our colleagues from the North for the contribution they are making. Ireland should be at the forefront of developing cross-border co-operation in health, which is also taking place at European level. We need to ensure we provide the best possible health service for people living on all parts of the island. Health care should, where possible, be provided on this island as opposed to having people travel to avail of services.

Senator Marc MacSharry

I extend a special welcome to Members of the Northern Ireland Assembly on this momentous occasion. Having listened to the contributions, I have no doubt a large amount of work can be done and much can be achieved through greater co-operation. I am pushing strongly for the radiotherapy centre. I am Sligo based and share many of the views expressed by Deputy Colreavy who also comes from the region. Much more co-operation in the medical field needs to be tapped into across the Border counties.

Today might not be the day for it, but perhaps the witnesses could reflect on the issue of cardiac catheterisation for one of our other engagements. I know that Altnagelvin Area Hospital has cardiac catheterisation facilities, but it does not have a 24-7 service. International best practice and interested actors such as the HSE inform us that when somebody has a heart attack, there is a 90 minute window between the heart attack and the insertion of a stent. The entire western seaboard is not very well served in this respect. Given the plans being implemented by the HSE, there will be no centre for the entire north west. I understand that there is a laboratory for this in Altnagelvin Area Hospital, but that it is not in use to the extent that it should be. Can we look into that and see whether at least a 12 hour service could be provided? In this way, people in Donegal and across the north west may be able to travel there to avail of such services in order that they could have the same survival capabilities as those closer to Belfast, Dublin or Galway.

The witnesses can certainly count on any support that I can give on funding for a radiotherapy centre in Altnagelvin Area Hospital. I would like the delegates to look into the cardiology area to see if work can be done on their side to improve that, and update us on what is happening there. We can then see what we need to do here to feed into that.

Chairman

To allay your mind, Mr. Wells, the Minister for Health has confirmed that the Irish Government is committed to providing up to one third of the capital costs, so-----

Mr. Jim Wells, MLA

Can we have that signed in his own blood, please?

Chairman

He will be happy to hear that.

Deputy Joe McHugh

I welcome the delegation. This is an important forum, but it is also a very important issue and I am glad to hear that rare diseases are being discussed here today. While we have certain services dotted between the United Kingdom and Ireland, some of us will be aware that Duchenne muscular dystrophy is a rare disease and at the moment, up to 12 boys are going to Newcastle and are receiving an excellent service. It is not just the expertise. There may be people with similar expertise in Dublin or Belfast, but it is about the range of care packages, experience, knowledge and the coming together of minds. The real debate has to be about whether we look at the United Kingdom and the Republic of Ireland on an east-west basis, or whether we concentrate our minds on a North-South basis to share services. If these services are being provided in Newcastle, do we automatically try to replicate those services on the island of Ireland, in Belfast and Dublin, or do we try to learn from the experience and expertise over a certain period of time and set out a map to replicate it in the future?

I say all this for the following reason. The boys who are going to Newcastle at the moment are used to going there. They are receiving an invaluable service. If that option was not available, which is a possibility in the future, they will not be comfortable with a service that is not being provided here at the moment. I propose that we learn a lot more from the services that are being provided throughout the United Kingdom, be it Scotland, England or Wales, and try to harness that knowledge through a proper communications system. Due to budgetary constraints and so on, we do not have a roadmap for this. It was very interesting to listen to Mr. McCarthy's personal story. Where is the roadmap for intervention, care, follow-up and communicating all these different services? We need to start a conversation on an east-west basis as well as a North-South basis.

I am Co-Chairman of the British-Irish Parliamentary Assembly, and I am glad Mr. McCallister, Mr. Wells and Deputy Conway are present today, as they sit on this body. In the spring we will have a discussion on rare diseases and the sharing of knowledge and services on an east-west basis and this will be on the agenda as a priority item at the plenary session. I will be asking that we work closely with your committee, Chairman, to forward what you are trying to do here, which is very laudable. I would like to work closely with your committee before and after the assembly meets, because we will be feeding this back into the Dáil after the plenary session for the first time. That has been confirmed, so proposals that come out of the plenary session will go back to the Dáil.

I am delighted to have this range of expertise present. We can work on a common agenda. We have already done great work on a North-South basis. Mr. Wells mentioned the issue of Altnagelvin Area Hospital and I am delighted that the Chairman has received confirmation from the Minister for Health on funding. I commend the work of the delegation's Minister, Edwin Poots, MLA, on his proactive work. It is not just a meeting of minds, because there is also much rolling up of the sleeves that needs to be done behind the scenes. That has been taking place, which is welcome.

Let us call a spade a spade. There are cultural barriers when accessing services on a North-South basis. People are not used to it. We need to take cognisance of those cultural barriers. The access issue for radiotherapy in Altnagelvin Area Hospital and the 30% threshold for Donegal patients needs to be in place, and I welcome that. However, we should also have a conversation about cultural barriers and cultural challenges. I wish the committee well in its work and I look forward to engaging with the Members from Stormont.

Chairman

Thank you. Our committee will be happy to work with you in any way we can to promote and maximise opportunities for the mutual benefit of all.

Mr. Mark Durkan, MP, MLA

Go raibh maith agat. I echo the gratitude of my colleagues for the very warm welcome we have received since we arrived. My party has long been a proponent of North-South co-operation in many areas, but none more so than in health care, given the huge portion of our respective budgets spent on health on this small island. Hunger is a great sauce, and the tough economic climate has worked well and is focusing minds on how efficiencies can be achieved. Not only can efficiencies be achieved through North-South co-operation, but improvements to health care and services can be achieved as well. That is even more important.

This is like playing word bingo. I have written down a few points that I was going to make, but if one of my crowd did not mention them, one of the committee members did. However, as a representative elected in Derry, I could not let today go without raising the issue of the radiotherapy unit. I am delighted to hear the reassurance from the Minister regarding the capital costs, but I have to emphasise the importance here of recurrent running costs and staffing costs. It is vital that this commitment remains as well. I look forward to seeing the project built. It will be a real tangible symbol of the benefits of North-South co-operation. It is important to emphasise that not only will it benefit my constituents and others in the north west, but it will benefit cancer sufferers right across the island, because it is going to reduce waiting times and free up beds in other centres in Dublin and Belfast.

Mr. Mickey Brady, MLA

Go raibh maith agat. I thank the committee for the welcome we have received. Like Mr. Wells, I have protested outside the building and this is the first time I have been inside. I hasten to add that it was not the same protest.

Chairman

We are all reassured by that.

Mr. Mickey Brady, MLA

As a member of an all-Ireland party, it is reassuring to come to Dáil Éireann and see so many party colleagues doing such an important job. As a representative of a Border constituency in Newry and Armagh, I think cross-Border co-operation on health issues is very important. Mr. Wells has already mentioned Daisy Hill Hospital. Last year, 36,000 people went through the accident and emergency department of that hospital, 3,500 of whom came from the Twenty-six Counties. There is obviously more potential here. The renal unit has been mentioned. The Compton report provides a great opportunity for cross-Border co-operation and the Minister, Edwin Poots, MLA, has taken a very pragmatic approach to that kind of co-operation. That is very welcome and it is to be hoped it will continue.

I attended the seminar on rare diseases yesterday. It was educational. I worked in an advice centre for almost 30 years in Newry and came across many people with fairly rare conditions. Mr. McCarthy mentioned a condition I have not come across. It raises awareness of what one does not know and what needs to be done.

One of the biggest challenges facing the health service North and South is care of the elderly. By 2020 the elderly population in the Six Counties will have doubled. People are living longer but not necessarily more healthily. In the North approximately 2% of the budget is directed towards social care, which has now been rectified in the context of the Compton report.

Mental health was mentioned and is important. Having worked in an advice centre, one of the things I saw was a proliferation of mental health issues in young people. It is something which has not been, but needs to be, addressed, and it is very important that happens. It is encouraging to be here today and hear the commonality of our problems. We will work towards common solutions.

Mr. Sam Gardiner, MLA

I thank the committee for its hospitality and warm welcome. I find it most interesting. In Northern Ireland, the health service we provide assists Newry and Londonderry in particular. I would like feedback on any major complaints with the treatment being provided or whether people are getting the service they require.

The health committee received a visit from Newry recently and discovered a robot had been introduced to do the rounds. It is a new development. The doctor can talk to the robot and it frees up doctors and nurses. I would find it scary to open my eyes and see a robot; I would think I had died and gone to the wrong place. We are advancing and are one of the first places to introduce it. Admittedly, at this stage it is on a trial basis but the progress we are making is worth noting.

We will welcome patients and constituents if we have to treat them. We would also like to hear about any major concerns in order that we can make improvements.

Mr. John McCallister, MLA

I thank the committee for the warm welcome. Mr. Wells spoke about history. I am a constituency colleague of his, although from a different political party. I have spent my life trying to consign him to the history books. I look forward to succeeding. We get on remarkably well, although he would not want me saying that outside this building.

Whether one lives in the North, South or UK, the focus must always be the same, namely, outcomes for patients, constituents and people who use the services. That has been reflected in everyone's remarks today. We all want to see heart attacks, cardiovascular issues, the care of cancer patients in the north west and child protection issues dealt with. We do not want to see anyone falling between two stools because of a political border. We want to make sure children are protected on both sides of the Border. Any perpetrator who moves over the Border should be pursued. It is something on which there is universal agreement.

Mr. Brady referred to care of the elderly, which is a major factor for many western countries in terms of how it will be paid for, who will pay for it and at what point we can continue with our NHS model of free health care at the point of need. It is something to which, generally, we are all very committed but we need to live with and pay for it.

The sharing of services in Altnagelvin or Daisy Hill is something which, as Mr. Wells said, threatens no one, rather it is about the outcomes for patients. If they are improved that should be welcomed across the board. The Erne Hospital will be a magnificent facility when it is up and running. There is potential to use it on a cross-Border bases because of its size and capacity.

We are pursuing tele-medicine. Mr. Gardiner referred to the robot model. It could be used to tackle some of the issues around care of the elderly. It is something we would welcome. Any innovation that can help to achieve that, help people stay in their homes for longer, look after people in long-term conditions and keep them healthier for longer would make a huge difference to our health service.

The model we have adopted in Northern Ireland, namely, the stand-alone public health agency, has received criticism in terms of the amount of funding it received. However, it sets public health on a new agenda and pursues some of the big issues Ms Ramsey discussed in her opening remarks, such as obesity, smoking, our binge drinking culture, which is reflected across the island, and sexual and mental health. There is a huge job of work to be done in tackling those areas.

Members of the committee in the Northern Ireland Assembly are happy to engage with the committee informally. It is useful and important to have meetings and build relationships.

Deputy Catherine Byrne

I thank the Chairman for allowing me to speak for a second time. I usually get lost talking about this country. I forgot to mention what I wanted to say. Perhaps in the future when we meet again we will be able to share information on the scourge of drugs and alcohol in this country, share ideas and consider some of the solutions we and the Northern committee have been looking at. I am very interested in the methadone treatment programmes in the North, how we deal with people involved in drugs and bring them out to the other side.

Deputy Charlie McConalogue

I join with my colleagues in welcoming the delegation. I come from a part of the country where cross-Border co-operation in all its facets, particularly health care, is more important than any other part of the country because of the distances involved and our proximity to health services in Northern Ireland. I would reach Altnagelvin hospital in half the time it would take me to reach Letterkenny General Hospital. It is a very important area and a lot of work has been done on it over the past number of years.

It is something on which the two Administrations need to show political will to work together on. We need to integrate our services in a way that ensures where possible the sharing of services. We need to ensure our two health administrations are linked and that the de facto consideration when rolling out health services across the country is what is available in hospitals and health services across the Border. We should try to come to arrangements which ensure we can share services.

I welcome the progress on the radiotherapy unit in Altnagelvin. It is something which can work very successfully in the coming years. It must be a two-way process in the context of ensuring that expertise is built up. For example, where expert services exist in Letterkenny, there must be a two-way flow across the Border.

As Senator MacSharry stated, there is a need to focus on the further development of cardio services. I am aware that there is a very good service at Altnagelvin hospital. In addition, a great deal of effort was invested in developing cardio services at Letterkenny General Hospital in recent times. As a result of the level of population required in Donegal and other Border counties in the Republic in order to sustain the services to which I refer, there is a need to combine our efforts with counties just across the Border to ensure that such services are both sustained and developed.

I look forward to working with and meeting our guests on a regular basis. Good progress has been made but a great deal more can be achieved.

Deputy Peter Fitzpatrick

I thank our guests for coming before us. They are a very friendly bunch of people. I come from the wee county of Louth and I live in Dundalk. I was surprised to hear Ms Ramsey state that one third of the patients in Daisy Hill Hospital come from either Louth or Monaghan. Our guests will be aware of the difficulties that are currently being experienced with the Louth County Hospital in Dundalk. I would be interested in meeting them at a later stage to discuss how both hospitals could work together. As far as I am concerned, many people are travelling from the South to the North in search of treatment. Perhaps it might be possible to encourage some people from the North to come down here for treatment.

Chairman

Mr. Wells indicated that he wishes to intervene. He is becoming very familiar with our procedures and also with the seats in these committee rooms.

Mr. Jim Wells, MLA

Yes, I am becoming too comfortable down here. There are three minor points which arise. I attended the event on rare diseases yesterday. Unfortunately, both my daughter and I have a rare condition called retinis pigmentosa. I bet members have never heard of that. It is another very distressing condition. Yesterday's event resonated with me greatly.

As regards Altnagelvin hospital, it is interesting that reference was made to the capital required but not to the revenue involved. I believe it was Mr. McCallister who referred to the latter. There is a commitment from the Republic not only to help us build it but also to help us run it.

Chairman

This is only the Joint Committee on Health and Children, it is not the Department.

Mr. Jim Wells, MLA

I would have preferred that statement to have been slightly longer. However, let us hope-----

Deputy Billy Kelleher

It will be possible to get two press releases out of it.

Mr. Jim Wells, MLA

Yes.

I wish to raise an issue which is somewhat more serious in nature and which is worth mentioning. When we were considering the establishment of the child protection board in Northern Ireland, we discovered an anomaly which I find quite shocking. I refer to the fact that a cleric or a teacher, for example, could abuse a child in Lifford and could then move across the Border and work in Strabane. That person's convictions or police record would not follow him or her. I understand that approximately one year ago the Republic was in the process of introducing legislation to plug this loophole. I do not expect an answer now but it would be useful if the Chairman could indicate where we stand in respect of this matter. The anomaly to which I refer is quite obvious in nature, particularly when one considers, in the context of clerical sex abuse, that certain individuals were moved by those on all sides across the island of Ireland. This is a major problem. I would be interested in discovering where the information to which I refer has gone because the problem was with the Republic sharing rather than vice versa. Members can understand why this is an obvious issue of concern. It arose on foot of an historical legacy but it is one we must well and truly resolve in order to protect our children.

Ms Sue Ramsey, MLA

On the point Deputy Fitzpatrick made, it is important that the committees should get together to discuss matters. When I mentioned the Compton review to our Minister, he stated that he will be examining the position with regard to hospital services south of the Border before making any decision on Daisy Hill Hospital. It is important, therefore, that we should give consideration to this matter.

Mr. Kieran McCarthy, MLA

Is there a representative from Kilkenny present?

Chairman

No.

Mr. Kieran McCarthy, MLA

I ask because Deputy Catherine Byrne referred to the issue of drug abuse. I was involved with a church group in Belfast which is extremely committed to helping people who are caught up in drug abuse. Those who run the group stated that there is a centre in Kilkenny at which fantastic services for drug addicts are provided and which we ought to visit.

Chairman

Representatives from the centre to which Mr. McCarthy refers made a presentation to the committee during its hearings on alcohol and drug misuse.

Mr. Kieran McCarthy, MLA

Really?

Chairman

Yes. They made an excellent presentation. If they so desire, I would be happy to provide any relevant information to our guests.

Mr. Kieran McCarthy, MLA

That would be extremely useful. I thank the Chairman very much.

Deputy Billy Kelleher

I was not here at the beginning of the meeting and I apologise to Ms Ramsey that I missed her presentation. In the context of obesity, we are all aware that there is a demographic timebomb waiting to explode because young people are eating the wrong foods. Obesity is a key factor in the context of the contraction of diabetes. Is there any way an advertising campaign - involving various rugby, soccer, Gaelic football and hurling stars and others - could be put together quickly in order to try to encourage engaging in healthy eating and leading healthy lifestyles? There would not be a need for a huge administrative push in this regard because we are all keenly aware that obesity is going to be a huge problem in the coming years. It will have major knock-on effects in respect of diabetes, blindness, limb amputations, etc., if we do not take action. The problem of obesity is already evident in the United States and it is becoming more prevalent in the UK and Ireland. Perhaps we might consider ways in which we might send out a strong signal to young people across the entire island. Anything we might do in this regard would be of benefit to everyone.

Chairman

To be fair, safefood has been doing a very successful job in this regard. In January, there was a joint initiative regarding alcohol. I would certainly subscribe to the view that there should be an all-Ireland approach to obesity. That is a very good suggestion from the Deputy.

Deputy Billy Kelleher

I thank the Chairman and I note the praise.

Chairman

Such praise does not come too often.

Mr. Mickey Brady, MLA

I wish to inform Deputy Fitzpatrick that in my youth I spent many happy hours in the Adelphi in Dundalk. That made me the rounded, balanced person that I am.

Chairman

I will now ask Ms Ramsey to conclude on behalf of the Northern Ireland delegation.

Ms Sue Ramsey

Go raibh maith agat, Chairman. What has happened here is an important step forward. We refer to co-operation on a regular basis but it is all about realisation for the people we represent and the communities from which we come. Mr. Wells is right to state that this threatens no one. After all, the matters we discussed ranged from public health to clinical need. It is important that the clerks from both committees are present because this is a process which we must seek to try to advance. We probably do not actually monitor what we are doing at committee level. Some of the points raised here have also been raised at the Assembly, which is not that far up the road. It is important that we should continue to have co-operation at secretariat level. In the interests of moving matters forward, the invitation is extended to the members of this committee to come to the Assembly and perhaps develop what we are doing into a working group to examine some of the key issues.

The deputy chair of our committee and others referred to Altnagelvin hospital. Concerns have arisen not only in respect of the capital for the project but also with regard to the running costs. Reference was made to what we might do in respect of issues such as mental health, learning difficulties and rare diseases. We must utilise the strength we have, namely, that offered by our MEPs and those elected from this State, in the context of how we might deal with some of the initiatives being brought forward in Europe. Perhaps we might use small initiatives to challenge the public health agenda and to take action in respect of alcohol or drugs misuse or obesity. We have discussed taking a joined-up approach and we all agree that this must be done. It is time now to move forward in order that we might make a difference on a couple of key issues.

Chairman

On behalf of the committee, I thank our guests for attending and for sharing information with us on a wide range of issues. As politicians, we have the capacity to build upon existing and create new alliances in the area of health. We must consider our efforts in this regard. As Deputy McHugh stated, it is important that we should continue to eliminate cultural barriers regarding access to health on either side of the Border and work together in areas of health promotion. We must also encourage continued co-operation in respect of a number of issues - alcohol and drugs misuse, obesity, the sharing of services and rare diseases - on behalf of all our people.

I thank the Institute of Public Health in Ireland for its contribution and briefing paper today. I hope that by building on today's meeting, we could invite Owen Metcalfe and the IPH to make a presentation to our committee on the matter of cross-Border co-operation. I invite the delegation to join us for lunch after our meeting and wish the delegates a safe trip home. I remind members we are going to Finglas tomorrow at 11 a.m.

Senator Colm Burke

In regard to the junior doctor issue, we did a major study on it last year. Are we close to putting a final document together?

Chairman

Can we agree to put that matter on the agenda for our private session discussion next Thursday morning? Agreed. We will also discuss the issue of the national children's hospital in our private session discussion next Thursday morning.

Senator Colm Burke

Okay.

The joint committee adjourned at 12.50 p.m. until 11.30 a.m. on Thursday, 8 March 2012.