Brexit – Navigating in unchartered waters Andrew Dawson - Acting Director of Workforce Policy, Department of Health, Northern Ireland Danny Mortimer - Chief Executive, NHS Employers Damian McAlister - HR Director, Belfast Health and Social Care Trust Tom Daly - Assistant National Director, HSE (RoI)

Brexit – Navigating in Unchartered Waters Friday 19 May 2017 Tom Daly National Director, Health Service Executive & DG Co-Operation & Working Together

Key issues for Health and Social Care Introduction to work in RoI in general Joint working ambitions Potential Impacts

Brexit Preparation (A) An Introduction Strongly co-ordinated from centre of Government – Brexit Cabinet Committee chaired by An Taoiseach Led by Dept. of the Taoiseach with designated Leads in each Government Dept. All-Island Civic Dialogue initiated by the Taoiseach as part of Government’s consultation process in relation to Brexit 2 Plenary Sessions – November 2016 in Kilmainham and February 2017 at Dublin Castle A series of sectoral meetings led by individual Government Ministers commenced in December 2016 and are continuing. Topic areas dealt with include: Further Education & Training Tourism & Hospitality Children & Young People Energy Human Rights and the Good Friday Agreement Agri-Food Transport & Logistics Schools Jobs/Enterprise & Innovation Heritage, Culture & Rural Welfare Rights & Mobility

(B) Joint-Working Ambitions – Health Sector What is in place? Mature cross-border inter-Agency collaboration network for 25 years – CAWT/Institute of Public Health/NGO sector alliances Inter-Departmental Health Sector co-operation under aegis of North South Ministerial Council Functioning joint services arrangements including North West Cancer Centre; Emergency Cardiology (PCI) Service in North West; Renal Services; ENT and Ophthalmology co-operation; Paediatric Congenital Cardiac Care at All-Island level What is coming? €26m approved under Interreg VA Healthcare Measure …. Will commence this year [CAWT] €11m approved under Interreg VA Healthcare Measure with Scottish lead and North/South Partnership [CAWT] Further development of All Island Network for Paediatric Congenital Cardiac Services Continuing dialogue on potential new areas for co-operation

(B) Joint-Working Ambitions (Contd.) Further Ambitions The All-Island Feasibility Study on cross-border collaboration (2009) set out 37 areas for potential future collaboration. In 2016 the Minister for Health (NI) via the NSMC put forward a possible list of 13 areas for consideration. A recent internal review within the HSE established significant commitment towards progressing many of these areas. Services which received a High priority included, for example:- The Review of Major Trauma Centres Genomics Research Organ donation and transplantation Consolidation of the Paediatric Congenital Cardiac Services

(C) Potential Impacts Key priorities – ensure continuity in the provision of health services and avoid any change that would negatively impact on human health HSE designated a National Director to lead on Brexit preparations. Internal HSE Workshop conducted Dept. of Health appointed a Brexit Sub-Committee of its Management Board led by an Asst. General Secretary Ongoing work on risk analysis and preparation of negotiating position. Whilst consideration/deliberations continue areas of concern emerging include: Area of Impact Free movement of patients and clients where access to services is concerned Related Issues (examples) The Treatment Abroad Scheme EU Cross-Border Directive on Patient Mobility Special Arrangements for Healthcare (All-Island & UK) Eligibility for services All-Island Agency arrangements (e.g. Safefood Ireland; CAWT) Service users whose care relies on their legal status e.g. Mental Health & Child Care

Related Issues (examples) Area of Impact Professional Qualifications recognition Recruitment Persons domiciled in NI but working in the HSE EWTD (from the perspective that this may no longer apply to the UK The issue of the border between Ireland/N. Ireland is relevant. Look at health workforce supply and cross-border health workers. Public Health Screening Service Emergency Ambulance Transport Emergency Decompression Emergency Management – all Ireland Planning, Preparedness and Response Specific joint services underwritten by SLA’s etc. Procurement ICT Finance VAT implications and Indirect Taxes Effect on existing contracts for products, medicines and equipment Hazardous Waste Area of Impact Free Movement of personnel & recognition of qualifications Cross-Border arrangements for services Procurement of products/medicines/equipment etc.

Area of Impact Impact on existing EU legislation; Regulations standards & Directives EU Institutional Arrangements Related Issues (examples) Environmental Health Safety of imported goods, e.g. food, cosmetics Exports to the UK from Ireland Major Government initiative to have European Medicines Agency (EMA) relocated to Dublin (http://www.emadublin.ie/)

Next Steps Further analysis to develop a Position Paper HSE and Agencies provide Position Papers to Dept. of Health to inform the wider Brexit planning at governmental level HSE reviews and “Brexit-proofs” SLA’s relating to existing services and the development of new SLA’s