Northern Ireland

In Northern Ireland and Ireland, collaboration must remain the hallmark of health and social care services post-Brexit | Bernie McCrory


Solid working relationships between health and social care services in Northern Ireland and the Republic of Ireland are now an everyday experience. Bernie McCrory sheds light on recent initiatives and upcoming plans, and reads between the lines of the UK government’s position paper on the unique circumstances of Brexit on the island of Ireland.

Position papers are just that, a position at a point in time reflecting current thinking and intentions. The precise nature of Brexit and its potential impacts have yet to unfold. 

It is evident that Brexit poses risks to both formal and informal working relationships and arrangements that characterise cross-border health and social care activity. In the meantime, cross-border health and social care work will continue as normal, but with a sense that the landscape will change in the coming months and years. 

Welcome intentions
In relation to the UK’s position paper on how to address the unique circumstances of Northern Ireland and Ireland in light of the UK’s withdrawal from – and new partnership with – the EU, some believe it brings more clarity. Others have expressed that it is lacking in sufficient detail.

The paper sets out a number of high-level principles and criteria the UK and EU should discuss in forthcoming rounds, and includes the ‘crucial importance of avoiding a return to a hard border’. 

It focuses on aspects such as upholding the Belfast (‘Good Friday’) Agreement, maintaining the Common Travel Area and associated rights, avoiding a hard border for the movement of goods, and aiming to preserve North-South and East-West cooperation. These are all welcome intentions as the negotiations progress.

The paper does not contain a dedicated section or sub-section on healthcare. On maintaining the Common Travel Area, (a special border-free zone comprising the UK, Ireland, the Channel Islands and the Isle of Man), there is specific reference to the reciprocal rights for UK and Irish nationals, including the right to access health services.

In the EU’s own position paper, the bloc recognises that the solution for the border issue will need to be unique, perhaps even distinct from any arrangement between the EU and the rest of the UK. “It will require both sides to be flexible and creative,” the EU’s chief negotiator, Michel Barnier, said on 7 September.

It is to be welcomed that the UK wants to continue to protect reciprocal bilateral arrangements, which include facilitating the mobility of people across the island of Ireland. From a healthcare perspective in the Northern Ireland/Ireland border region, this is vital as many citizens cross the border daily, unhindered, both to provide services as health and social care staff and to receive services as patients. 

The continuation of this unrestricted travel in both directions will be important in enabling the maintenance of shared clinical services, the establishment of new shared services in the future and ensuring an adequate supply of qualified health and social care staff.

Collaborative arrangements
There have been several significant cross-border and all-island initiatives over the last couple of decades, with the early experience gained through local and regional pilot projects in the border area building the confidence to put more permanent collaborative arrangements in place for certain services. 

Taking its place within the broad spectrum of public agencies involved is the Cooperation And Working Together (CAWT) partnership, which has played a significant role over the past 25 years in promoting cross-border health and social care cooperation.  

Such practical collaboration has been greatly assisted by the availability of EU funding programmes, Interreg funding in particular, and by the commitment of the health services north and south to work in a collaborative way where a ‘joined-up’ approach to particular service developments can bring mutual advantages.

The CAWT partnership has a long history of managing cross-border health and social care programmes, funded by European Union programmes. For example, over the last 13 years there have been two significant Interreg funding programmes (IIIA and IVA) which ran consecutively. 

Both programmes included a cross-border health theme. In the 2003 to 2008 period of the IIIA programme, a total of €10.45 million was invested in cross-border health via CAWT. In the 2009 to 2015 period of the Interreg IVA programme, €30 million was allocated to the CAWT partnership for cross-border health and social care initiatives.

In recent months, the CAWT partnership has secured Letters of Offer for the latest EU Interreg programme to support four large-scale cross-border health and social care projects up to 2021. A maximum grant of €26.4 million has been allocated for these projects in the areas of acute hospital services, mental health, children’s services and community health and wellbeing.  

A fifth project, to the value of €7.9 million, in which CAWT is a partner, is being led by NHS Scotland and is in the area of primary care and older people’s services. 

The CAWT partnership expects this EU Interreg investment to lead to further consolidation of North/South cooperation in the health and social care sector in the future.

In addition to EU Interreg-funded programmes of work, CAWT has taken forward some specific cross-border projects directly commissioned by the Departments of Health in both jurisdictions, including Donegal patients accessing radiotherapy in Belfast City Hospital, cross-border emergency planning training and planning, an all-island conference on alcohol and work in the area of hidden harm. Other activities include cross-border dementia awareness training and mental health protocols. 

To maintain and further develop the solid working relationships that are now an everyday experience in the health services, North and South, CAWT will continue to focus on its key strategic goals.

Bernie McCrory is chief officer of Cooperation and Working Together cross-border health and social care. In Northern Ireland, the CAWT partners are the Health and Social Care Board, the Public Health Agency, the Southern Health and Social Care Trust and the Western Health and Social Care Trust. In the Republic of Ireland, the CAWT partner is the Health Service Executive (HSE).

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