1. 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)

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

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

4. 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

5. (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

6. (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

7. (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

8. 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.

9. 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 (

10. 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