Brexit and all-island health

The uncertainty surrounding Brexit and its implications for health across the island is one of the lesser talked about but potentially most serious effects of the decision of Britain to leave the EU. Donegal pharmacist Tom Murray writes.

There are many serious potential impacts for health and we must to start the discussion about those now rather than allowing further uncertainty to develop. A number of reciprocal arrangements (which go largely unnoticed by the general public) ensure the smooth running of healthcare right across the island and more obviously in the border region. These arrangements are deep-rooted, longstanding and contribute positively to general health. They include several issues outlined below.

According to the Irish Medical Organisation (IMO), there are approximately 1.6 million people living in the border region whose health could be impacted by Brexit. Trevor Duffy, Chair of IMO International Affairs Committee, has outlined that people living around the border have a poorer standard of health, and this is supported by international research indicating a wider trend among those who live within border regions (outside of Ireland) generally suffer from poorer health outcomes.

The re-imposition of a border will have the potential for direct impact on health even before we discuss free movement of patients, health professionals or emergency services. John Woods, British Medical Association Northern Ireland Chair has stated that the North in itself is too small to efficiently provide certain specialist healthcare services.

Co-operation

The long-established Co-operation and Working Together (CAWT) partnership, supported by EU Interreg funding, has produced many successful care programmes following on from pilot studies. These include the Ear/Nose/Throat (ENT) programme in Cavan, Monaghan and Fermanagh which operates with the cross-border co-operation, providing services to patients on both sides. CAWT has also supported Donegal patients receiving radiotherapy in Belfast City Hospital, cross-border emergency response training and joint mental health protocols.

The two major developments which CAWT has supported include the North-West Cancer Centre and Emergency Cardiology Service, both based in Altnagelvin (Derry city) and both part-funded by Irish Government investment. These two services have been major advances in care for Donegal patients, especially in respect of cancer care as the alternative options of Galway and Dublin, requiring journeys of four hours each way, often necessitate patients to spend a week away from home. The convenience of daily short trips to Derry and back cannot be underestimated in their impact on the quality of life of vulnerable people.

Another of worthy note is the all-island based Congenital Heart Disease Network. This very significant programme, which guarantees access to top quality care and is provided through hospitals in Belfast and Dublin, initially focused on younger children and has expanded to include adults who have survived congenital heart defects.

Furthermore, in written response to a Parliamentary Question, the Minister for Health Simon Harris has confirmed that the new children’s hospital project will indeed provide tertiary and quaternary healthcare across the island of Ireland and benefit the healthcare of all, building on the work done in the congenital heart disease project. It is based upon the types of co-operation and mutual professional recognition which is common to the projects mentioned above.

However, this too is dependent upon the free movement of people, and as such is vulnerable to effects of any restrictions placed on the same post-Brexit. The Minister further states that his Department is working hard to avoid or mitigate against any changes to current practice which could negatively impact healthcare on the island. However, tacit in this reply is an acknowledgment that Brexit and any subsequent change in free movement could have a significantly detrimental impact on the provision of care and development of services on an all-island basis.

Freedom of movement

The free movement of people and goods are regularly talked about within the national discourse around Brexit giving rise to many questions relating to cross-border healthcare arrangements. What will happen to the patients who can’t cross the border easily; will they miss treatment due to significant delays at border crossings? What of the reciprocal arrangement enabling paramedic services attending RTAs to cross the border in order to improve response times to such events? What of the GP out of hours services provided in Castleblaney which currently treats many patients from Armagh? Many patients from the Republic travel abroad under the HSE’s Treatment Abroad Scheme (TAS), with 91 per cent travelling north or to Britain; what will happen to these arrangements post Brexit?

“Many patients from the Republic travel abroad under the HSE’s Treatment Abroad Scheme (TAS), with 91 per cent travelling north or to Britain; what will happen to these arrangements post Brexit?”

Likewise, further problems, invisible to the patient, may yet manifest. Under the new GDPR guidelines European data protection will change and the provision and sharing of data across eternal borders will be impacted. What then if Britain or the North fail to achieve the same GDPR status; will we then see patients moving across borders for treatment but without necessary sharing of patient data? Evidently, this is a dangerous and potentially fatal unseen consequence of Brexit, irrespective of hard or soft Brexit results: a seamless border isn’t seamless when it comes to transferring data.

Medicines

We may also see a significant increase in the number of medicine shortages that already affect patients in the Republic. Currently over 140 medicines are in short supply in Ireland, even when the Irish/British market is viewed by drug companies ‘as one’ for economic supply. This will worsen once the markets become separated and potential increases in cost of supply to the Irish market are incurred. Drug companies driven by profits will opt to supply only the larger more lucrative markets rather than Ireland. The Health Products Regulatory Authority (HPRA) have unpacked their concerns on this matter.

According to Lorraine Nolan, Chief Executive, HPRA: “Whilst the eventual outcomes of the Brexit negotiations are unknown, what we do know is that there are potentially significant implications for Ireland with its shared market place with the UK. This, combined with the fact that Ireland is a small market, can place pressures on the availability of certain products for our market. The HPRA’s priority is to ensure Irish patients will continue to have access to the medicines that they require post-Brexit.”

The continued uncertainty and questions raised by Brexit continue to be felt across all aspects of life on the island of Ireland and have the capacity to have a life-changing impact upon on health and care matters. I am certain that when voting for Brexit, the electorate were not aware of these issues, or made aware, and as such, their vote decision would may well have been different had the full implications been made known.