I thank members for their attendance. Thanks also to the Leas-Chathaoirleach for taking the private session earlier.

On behalf of the committee, I warmly welcome the Minister of Health for Northern Ireland, Mike Nesbitt MLA. He is accompanied by Jim Wilkinson, deputy secretary for health care policy, and Jane Hamill, private secretary. They are all very welcome. Of course, the Minister is no stranger to these Houses, having been here before with this committee and to other events in the Houses of the Oireachtas. He is very welcome. I thank him for taking time out of his busy schedule to be here this morning.

The theme on health on the island of Ireland has been a primary focus for our committee since its formation in May. We welcome the Minister's engagement with our committee this morning. I look forward to strengthening co-operation with his administration. It is safe to say that we have the shared ambition of improving health outcomes for everyone on this island. Members look forward to engaging with the Minister and his officials in achieving that aim.

The format of the meeting is that I will invite the Minister, Mr. Mike Nesbitt, to make his opening remarks. This will be followed by questions from members of the committee. Each member will have between five and seven minutes to ask questions and hear the responses.

On parliamentary privilege, I remind members of the constitutional requirement that in order to participate in public meetings, members must be physically present in the confines of the Leinster House complex. Members attending remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that in order to participate in public meetings, members must be physically present within the confines of the place where Parliament has chosen to sit. In that regard, I ask any member participating via MS Teams that, prior to making their contribution to the meeting, they confirm that they are on the grounds of Leinster House.

Members and witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that could be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, I will direct them to discontinue their remarks. It is imperative that they comply with any such direction.

As the witnesses will be aware, the committee will publish their opening statements on our website following the meeting.

MPs participating in this committee session from a jurisdiction outside the State are advised they should be mindful of their domestic law and how it may apply to their participation in the proceedings.

With all that housekeeping out of the way, I ask the Minister, Mr. Mike Nesbitt, to make his opening statement to the committee.

I thank the Cathaoirleach. Good morning everybody. It is a great pleasure to be able to join members today. As the Cathaoirleach said, I have been here before. The genesis of that arrival, which was about ten years ago, was a phone call from Martin McAleese who wanted to know if I was aware that no unionist leader had ever engaged formally with any part of the Leinster House operation. I was not aware of that but we put it right with the appearance in front of this committee. I was glad to do that. Obviously, that was a party political appearance. This time, I am here as an Executive minister. I cannot separate myself from the fact that I am as wedded to the 1998 agreement, both personally and politically, as I was at the time. Actually, at the time I was a broadcast journalist. I spent interminable hours in the car park of Castle Buildings where the negotiations were under way. If I had been told then that I was going to end up in an office on the fifth floor of that building, some 30 steps away from the famous room where the deal was done on 10 April that year, I would have invited you to a random drug test. Such is life, and that is where I find myself today.

I will begin by saying what I said in the Northern Ireland Assembly when I first spoke as Minister of Health. It is something I have said at meetings of the North-South Ministerial Council and at one-to-one meetings with the Minister, Deputy Jennifer Carroll MacNeill, that is, that I have no ideological or political objection to further health co-operation between the two jurisdictions, in fact, quite the opposite. When we go to the Border for health meetings I discover that the Border is not defining difference but actually showing the similarities and challenges that are absolutely equal in both jurisdictions. I am always willing to explore cross-Border collaboration, particularly where there is a clear population health need and where we can do it in a sustainable, long-term manner. When it comes to health and well-being, doing what is right is my main priority.

From the start, my mantra has been better outcomes for patients, service users and the glorious people who deliver health and social care. Given that health services in countries throughout Europe are under pressure, some to an extreme degree, it makes sense that we work together in a mutually beneficial way to improve those outcomes, North and South. Let us not forget our shared experience of Covid-19, which underline the importance of North-South co-operation and relationships. The next pandemic, and there will be a next pandemic, will be no respecter of borders or boundaries. Having said that, it should not come as a surprise to members that when I talk about cross-Border co-operation I do so firmly in the context of two jurisdictions. We could spend the hour debating the merits of a single all-island, all-encompassing health and social care service, and I am well aware some members would be keen to advance that; however, my feeling is that it would be more profitable to focus on those individual health issues where there is a consensus around co-operation. When it comes to co-operation I am happy to do more when it leads to those better outcomes.

The main official channel for cross-Border co-operation is, of course, the auspices of the North-South Ministerial Council, NSMC, and my department works hard to further cross-Border co-operation in that space. The next sectoral meeting is scheduled for 14 January. One of the key aims will be the formal ministerial sign-off of a revised work programme. The Minister, Deputy Jennifer Carroll MacNeill, and I have already told our respective officials that we are content to approve it. The revised work programme groups potential areas for cross-Border co-operation under three main themes: acute services; health inequalities and population health; and the future of healthcare. It is intended to offer a high-level framework for identifying key health priorities for co-operation. It will be a living document. Detail and emphasis will be updated, as necessary, according to ministerial priorities at subsequent NSMC meetings.

I will highlight two areas that come under the future of healthcare theme. The first is digital and data. The starting point for this is the patient. Ensuring sound foundations in digital systems and data are at the heart of transforming the delivery of our health and care system. They provide patients with modern and sustainable services and improve the working lives of our workforce. They are also fundamental to ensuring we can provide services as efficiently and economically as possible. Many of our patients access services in the other jurisdiction, whether for specialist services, such as cancer or paediatric cardiac surgery, or general hospital services such as maternity care or attendance at an emergency department. It is likely the necessity for such cross-Border services will increase in the future, so it is vital that we quality-assure the delivery of these services by ensuring there is a free flow of data between our healthcare systems, taking into account relevant data protection legislation and the requirements of the European health data space regulations.

Officials from both jurisdictions have developed excellent working relationships. During the pandemic, liaison between our care systems enabled the rapid deployment of digital apps to support citizens, the development of systems to enable track-and-trace activities limiting the spread of the virus, and, critically, ensuring that systems were in place to support the administration and management of Covid vaccination. Such work will continue and will be a key part of the health programme going forward.

The second area I will mention is that of genetics and genomics. Genomics is one of the fastest growing fields in modern medicine. I believe we ought to work closely as neighbours to harness the potential of genomics and personalised medicine for the benefit of our patients and health systems. We should take advantage of our unique island-wide skill base, engaging with stakeholders, including our citizens, to advance research, discovery, innovation and implementation. My officials will be happy to meet with HSE colleagues to explore opportunities for collaboration in this area, potentially around shared clinical pathways, a common genomic test directory and cross-Border sharing of genomic data, to support further progress towards embedding this medicine in the delivery of healthcare for our respective populations.

It is all about better outcomes for patients, families, service users and our workforce.

There are, of course, challenges in cross-Border working, and I will illustrate this with reference to the ongoing co-operation between the Northern Ireland Ambulance Service and the National Ambulance Service. In recent months, both have made steady progress in strengthening joint arrangements for cross-Border emergency response under the North-South specialist ambulance response programme. A joint governance structure is now in place, with regular operational meetings, shared action logs and aligned escalation arrangements. Common incident management procedures have been agreed, including the use of shared terminology and updated control room protocols. Initial joint training has been delivered for commanders and call handling staff.

Work is progressing on harmonising clinical and operational procedures, updating the memorandum of understanding on mutual aid and improving control room interoperability. However, two regulatory issues are impeding progress, those being, temporary professional registration for cross-Border working and the carriage and use of controlled drugs. These remain under discussion at policy level, with both bodies supporting the work through operational evidence and risk assessment. We remain committed to addressing such obstacles to operation, but we cannot just ignore them or pretend they are always easily addressed. That is the reality.

Another reality is that my Department's budget is under immense pressure, and it will be for the foreseeable future. That inevitably means we are not always able to do everything we would wish to. That can in itself be a driver for closer cross-Border co-operation, for example, to benefit from efficiencies of scale, but it also requires us to prioritise, and it is not always the case that priorities will coincide. However, I want to leave the committee with the message that, in spite of any differences or difficulties, my Department and I remain committed to continuing and developing cross-Border co-operation, not only with the Minister for Health, Deputy Jennifer Carroll MacNeill, but also with the Minister for children and disability, Deputy Norma Foley, and others.

In conclusion, I thank committee members again for the opportunity to be with them today, and I look forward to our discussion.

I thank Mr. Nesbitt for those remarks and, indeed, the positivity he brings to the office and his approach to his work.

I had advised that speaking time would be between five to seven minutes, but given the numbers and attendance this morning, both here and online, it will be five minutes per speaker and questioner.

I have apologies from Senator Comyn, Deputy Gibney and Mr. John Finucane, and if there are any others, please let us know and we can have their apologies recorded.

The rota for speaking is starting off with Sinn Féin. I call Deputy Conway-Walsh.

The Minister and his colleagues are very welcome. We are really pleased to have them here. I also welcome the sentiments and expressions in the Minister’s statement. That gives us all hope for the future.

Previously, we heard from the All-Island Cancer Research Institute and the board of the All-Island Congenital Heart Disease Network, and they were emphatic that we could not reach the optimum healthcare system without an all-island approach. I wish to go to a couple of the key issues they spoke about. One was the necessity to include the population of the island as a whole to form the critical mass for clinical trials. The benefits of this are obviously not just confined to the innovative advancements in medicine. It also allows us to compete internationally for foreign direct investment. What is the Minister doing, or what can he do, to ensure that happens and what, in his opinion, needs to be done to enable it to happen?

My other question is around the data and the digital systems the Minister referred to. One of the overarching obstacles to the collaboration between the health systems in both jurisdictions is the sharing of data. On the Minister's end, what legislation would need to be implemented to ensure data sharing is done and there is security of that data?

On the workforce planning, the Minister is absolutely right. Recruitment, training and retention are some of the biggest challenges that we have here as well that we need to address to have timely healthcare delivery at primary, acute and community care levels. What changes does the Minister think we need to make to have uniformity and qualification recognition in accreditation and training opportunities to get rid of the obstacles that we have currently in recruitment, education and training?

I thank the Deputy. I will bring Mr. Wilkinson in at some point to tap into his expertise.

If we start with clinical trials, it is my impression from talking to those who know that Northern Ireland is actually the perfect size at 1.9 million people. However, there will be areas, such as rare cancers, where a bigger population would be needed, and that is where an all-island approach makes sense. We in Northern Ireland are missing a trick to a certain extent in terms of clinical trials. It is not that we do not do them, and when we do do them, they are very successful, but we could do more. I been speaking to people. There is a very good professor at Queen's University, Professor Ian Bruce, who came to us from Manchester. He is all across this and understands exactly the benefits of exploiting clinical trials for the benefit, not just of the health system, but of patients. To put it crudely, if a person is in a clinical trial, the health service may be providing them with a higher class of medication without even having to pay for it. What is not to like about clinical trials?

As the Deputy knows, we have now gone live across the five geographically defined trusts in Northern Ireland with the encompass system, which is for electronic patient records. That is now bedding in. It has been in a couple of the trusts for well over a year, so they are well-advanced. The last two trusts only came onboard on 8 May of this year, so they are still getting used to it. It is interesting. When I visit some healthcare settings, I ask somebody who is checking patients in what they think and it can be quite negative because they are not used to it yet. However, some of the clinicians will stop work, turn to me and say that they have worked in the health service for 20 years and it is the best thing that has ever happened. On my phone, I have the My Care app, which has all my stuff. I get the appointments, results and blood tests. It is remarkably efficient and just very comforting to have.

We have a small difficulty in terms of sharing data. We need to bring forward what would probably be a single-clause piece of legislation to fix an issue we have with the sharing of secondary information. However, that is for within Northern Ireland. In terms of doing it on an all-island basis, we would obviously be dealing with European legislation. I am not sure if Mr. Wilkinson is across that, but I will give him a moment.

In terms of the workforce, where we are having a real challenge, particularly in our Border areas, is with Sláintecare because the salaries are much more attractive than the salaries we can offer. Particularly with retention, Sláintecare is giving us a problem. We used to worry about doctors and nurses going to Australia. Now, we are concerned about them going to Athlone.

Do not be concerned. The Minister is welcome.

To add briefly to the Minister’s comments across those three areas, within our and the Minister's own recent strategy for health and our three-year plan, we see a big place for Northern Ireland to exploit the opportunities for clinical trials. Linked to that health innovation are economic benefits. As the Minister said, there are certain areas, particularly rare diseases, including rare cancers, where the ability to harness a bigger population is critical. There are technicalities to work through, but it is clearly an issue.

With our digital systems, there are three areas we need to look at. The first is the practical experience we can share digitally. As the Minister said, we have gone through the process of rolling out encompass across all our acute systems. That is something we can provide learning from as to how that works and how effective it can be. The second element is the exploitation of data. That means using the systems we have to better provide digital enhancements and improve the service. The third area is one we referenced, that being, looking at some of the barriers that will stop particular information flow. However, the first element of that is working with what we have to make the best effect we can.

In terms of workforce planning, there are three aspects we can help with, one that has been working fairly well over the last number of years, which is the ability to use capacity in our higher education institutes to provide learning and training for nursing, midwifery, allied professional and medical staff. That is something that has benefited in terms of providing additional capacity for needs within the health system here, but also in terms of using and keeping our capacity to teach and learn that number of medics.

There are, therefore, very practical things we are doing in the area of education and training.

On mutual recognition, we have areas where we can work, particularly joint registration for professional standards, but also areas we can exploit in terms of how we can produce that training. The barriers at the moment can be managed but we are always looking at ways to make it easier for doctors and GPs to register and move into areas across the island. We are working very closely on that. We are working collaboratively on training places and joint training and on addressing the qualifications issues. As we said, however, it is a marketplace where there is a scarcity of skills across both health systems and it is something to look at.

The Minister is most welcome. I thank him for his presentation and, moreover, his recommitment to the Good Friday Agreement. It is heartening to hear that. It is only right we again make the point that this committee on the implementation of the agreement rarely has unionist participation. Very few MLAs take part, which is an issue for us because we are not getting the unionist view. Without that view, we are not a finished article because we are not taking on the views of all the representatives on the island. It is something we miss very much down here and if there is anything the Minister can do to help that or work with the Chairman on, we would really appreciate it.

On the health presentation, as a Border representative, I appreciate the collaboration that takes place between Donegal, where I am from, and Altnagelvin Hospital in Derry on cancer and coronary services. The services are very much appreciated. They are not what we would like them to be because there are always constraints and where there are constraints, we are playing second fiddle. We understand that but we would like to make improvements. We are maybe inclined differently, as in the Six Counties versus the Twenty-six Counties. Problems along the Border are not that simple from my perspective. We need to change the blueprint because the area covers 11 counties, not six. Over a third of the island is the problem child when it comes to health and a whole lot of other issues. We need to start to realise the area is that big, one third of this island, because all the Border counties in the South are as badly affected. We are all fighting for services and closer to the Border, we get the lesser end of the services. That is where collaboration is all the more important. I have been in Daisy Hill Hospital with Justin McNulty a number of times. He had the previous Minister down there. There are so many opportunities along the Border to have centres of excellence in different areas. It does not have to all be just one centre. We should start moving them around. Is there any sign of collaboration from that perspective between the Minister and the Minister, Deputy Carroll MacNeill, or is there a possibility of doing that in future?

The Senator started with the agreement so he is tempting me into making a political comment. The three strands are equally important and it does not work if you ignore or disrespect any of those three strands. Upstairs, I passed the bust of David Trimble, which I was here for the unveiling of, and the John Hume bust is at the other end of the corridor. I was in London for the unveiling of Trimble’s bust in the House of Commons. It is a remarkable thing that one man is being honoured in the two Houses. I am with the Senator - the three strands absolutely count.

I am interested in what the Senator said about centres of excellence. We have consulted on what we are calling creating a network of hospitals for better outcomes. I am as guilty as anybody, having grown up basically in the shadow of one of our acute hospitals, the Ulster Hospital in Dundonald. I expect it to do anything I want in terms of health delivery. Whatever the procedure is, I want it to be doing it, but of course you cannot have an acute hospital at the end of every street. We are trying to condition people and educate them to think about hospitals as a network. With a very high percentage of people, if you tell them what they need is done once a week in their local facility but 30 miles away it is done ten times a day five days a week, they will say they want to travel. Again, the Border does not have to be an obstacle to saying there is a set of centres of excellence in Northern Ireland and then a parallel set of centres of excellence in the Republic. Paediatric cardiac surgery is an example. Jointly, we are having a huge issue with paediatric pathology. I think there is a global shortage of specialists in that area. We are sending patients to England, which is far from ideal. I think to begin with some people were choosing to fly, but someone who has just lost a baby could find themselves in the middle of a stag or hen party going to England for the weekend. Once people get to Liverpool, they get a first-class service but the situation is far from optimal. A solution on this island, wherever that may be, would be great. I spoke to Stephen Donnelly about this when he was health Minister and I have spoken to the current Minister. I think officials are still looking at that. That idea of having centres of excellence is the future, not just in terms of efficiency and value for money but in terms of the best outcomes for people. Does that answer the Senator’s questions?

Yes. I thank the Minister.

I thank the Minister for coming down to us and addressing us. On cross-Border healthcare, as someone from Monaghan, and knowing the way our hospital is operating, the issue is to teach people that there are different levels of hospital and we cannot have a centre of excellence at every street corner. When we look at the work that was done in Altnagelvin and the cross-Border element, it has been a success. It treats people from Senator Blaney’s area of Donegal. We have those hospitals on both sides. I add the caveat that I am all for centres of excellence but we do not want to see too many on one side of the Border and too many on the other. I understand Enniskillen hospital is not operating to its full potential. The Minister’s colleague, Diane Armstrong MLA, would be on to me to try to get that. We have Daisy Hill Hospital in Newry, Monaghan hospital, the Louth hospital in Dundalk and Cavan hospital.

I am glad to see the Minister is open and responsive to the cross-Border element. That is good to see. Going forward, as was said, when the population here and the Northern Ireland population are added together, that number may attract the top professionals to come and base themselves in Ireland. If they base themselves along the Border in the hospitals, it would be good for the population as it would allow us to get those high-end units into the Border area. For people in other parts of Ireland, Dublin is the big centre and nobody minds going to Dublin for a major operation but it would be great if clusters could happen along the Border.

With the cross-Border healthcare, every week I am dealing with people who are going to a famous hospital in Belfast to get eye surgery or ear, nose and throat treatment. They are coming from all parts of Ireland. Bus tours are going up weekly. It shows that is happening. I have heard of people coming from Northern Ireland to Dublin on the same reciprocal scheme. It is moving in the right direction, but we need to speed it up and get to a point where we will have centres of excellence dotted along the Border. That can be achieved with a bit of work. I commend the Minister on his attitude to getting there, as he said in his opening statement. I hope we will get there with him, the Minister, Deputy Carroll MacNeill, and subsequent Ministers sooner rather than later.

I appreciate that. The Deputy is taking me back to when I was preparing to take up the post. I closed my eyes and imagined a blank map of Northern Ireland - but it could be the whole island - with no health service. The first question to ask is whether you want to build a health service.

Everybody is going to say "Yes". The second question is a bit more challenging because it is of why you want to do that. Is it to keep healthy people healthy or is it to cure the sick? It is both of course, but you are now into a judgment call because no matter how much effort and resources you put into keeping people healthy, people will still get sick. As a result, you will still need all of the infrastructure right the way up to acute hospitals. The ambition is that those acute hospitals become less busy because by the time you get into one, it is normally to undergo a very expensive procedure. If you can shift the money left into prevention and early intervention, then you are delivering better outcomes and better value for money in terms of the service. That is true of this jurisdiction as well as ours.

I am trying not to focus so much on the acute hospitals or the infrastructure and more on the workforce and what it is delivering. You can have all the buildings, beds, equipment and medicine in the world, but if you do not have the workforce that is appropriately trained and motivated, it will not matter because you are not going to deliver.

I call Deputy Tóibín.

I thank the Minister and his team for coming along today. I compiled a report for another committee a number of years ago. I spoke to around 100 people across the Border. People agreed that if we plan together, fund together and deliver services together, there would be better services that would be more efficiently delivered. That is a good foundation from which to look at development into the future. The funding model for the health service and all other services in the North of Ireland is in trouble in terms of the block grant, etc. We need to move to more tax-raising powers for the Executive in the North similar to those that obtain in Scotland and Wales.

There are very few centres of excellence on the island of Ireland. There are plenty of centres of trolleys on the island of Ireland. We have had a process happen in the South whereby we consolidated or closed hospitals. This happened in Dundalk and Monaghan along the Border and, very much, in the mid-west around Limerick, which has led to enormous pressure being placed on other hospitals. I understand that emergency surgery no longer happens at Daisy Hill, Enniskillen and Causeway. That is leading to significant pressure on Craigavon Area Hospital. Last week, people had to wait up to 19 hours in the accident and emergency department in Craigavon for treatment. There were 40 ambulances stuck in hospital car parks on one particular day as their crews tried to get patients into those hospitals. The delays were caused by the pressure on those hospitals. There is a need for centres of excellence and hospitals with staff who are skilled in deal with issues relating to heart disease, trauma and stroke - the very high end of health - but there is also a need for emergency departments and emergency surgery for grannies with pneumonia who make up the majority of those who go through smaller hospitals and emergency departments. I worry that the North is working on a consolidation or retrenchment of services that in many ways will put more pressure on Craigavon or the Royal Victoria Hospital. Will Mr. Nesbitt address that matter?

In the aftermath of the Good Friday Agreement, there was a flourish of cross-Border co-operation and services. That was wonderful, but it has slowed down to an extent. I am thinking of one particular woman, Catherine Sherry, in this regard. The Minister is probably aware of her particular case. She was a 42-year-old woman who lived in Newry and who died as a result of lymphoma cancer. She was forced to go to London for treatment, even though the travel was very hard on her because of her ill health, and despite the services being available in the South. We need to get to a situation where there is almost a right for people on both sides of the Border to obtain treatment on either side of it if the relevant service exists. While there is great work happening in Altnagelvin, the majority of people in Donegal still go to Galway for their cancer treatment. That is my second question.

I agree with the Minister on paediatric pathology. We have submitted freedom of information requests in respect of this matter. Very few staff have been recruited since 2019 for paediatric pathology in the North of Ireland. The Minister mentioned the difficulty in recruiting such staff. Again, those services are available in the South. What kind of urgency can we inject into these heartbreaking situations where parents have to bring the remains of their children over to Liverpool from the North of Ireland? Could we have an all-Ireland bereavement approach to paediatric pathology on the island?

Starting at the end, I reiterate that the service at Alder Hey in Liverpool is first class. It is the travel that is the problem. I think I am right in saying that in recent years we have had several rounds of recruitment for paediatric pathologists. We did not meet with any success. I think it is the same here. This is a global issue. It is a highly specialised area. I would find it a very traumatic profession to work in, frankly.

On emergency general surgery, to be clear, the move away from South West Acute Hospital up to Altnagelvin is still a temporary move. It has not become permanent, and I have not received a proposal that it come permanent. In fact, I asked the trust to halt its consultation because I did not think it was fit for purpose. I have asked the trust to come up with a vision for the South West Acute Hospital because it does an awful lot more than emergency general surgery. That has become a focus for the population. We have to take the broader view. There may be a proposal to move emergency general surgery from Causeway down to Antrim, but that has not been approved. These are things that may happen but that have not happened.

Without commenting on either of the proposals or particular moves, the principle of separating emergency surgery from planned elective surgery makes sense. Imagine being on a waiting list for a number of years and waking up on the day you are supposed to go into hospital to a phone call to say that there has been an emergency, that the theatre is in use and that the hospital will be in touch with a new date. If we separate the two, that does not happen. The principle is reasonable.

The other point is to reflect that the biggest challenge in our emergency departments in the context of ambulance handovers and waiting times is less about the services that are being provided in the hospital and more about the ability to discharge those who are medically fit back into the general population. We have real pressure on both our social care and domestic care. That reflects a lot of pressures across all emergency departments. When we look at our emergency departments, we are focusing on ambulance handovers to try to get someone into the hospital. However, we are also looking critically at discharge and what we can do to have those community packages in place that allow people who are medically fit to be discharged to be sent home. More long term, in terms of our shifting left, we want to look at how much care we can give in the community to avoid those people attending emergency departments, particularly our elderly population for whom the emergency department might not be the best place to receive such care.

I call Senator Black.

The Minister is very welcome. I thank him for coming before the Good Friday committee. We warmly welcome him.

I have a couple of questions which I will just ask in order that the Minister will have time to answer. He might be aware of the report published by the ESRI earlier in the year entitled Economic overview of Ireland and Northern Ireland. It found some very worrying disparities in health outcomes between the two jurisdictions. Waiting lists are longer, infant mortality rates are higher and life expectancy is shorter for those living in the North. This committee has heard that health outcomes for people from marginalised communities or disadvantaged groups are significantly worse. Has the Minister’s Department considered commissioning a joint mapping exercise for health data across the island using universal metrics in order that we could identify interventions that would have the greatest impact across the island?

Over the summer, the Minister introduced the Adult Protection Bill in the Assembly. This is something really close to my heart and a topic I have dedicated a lot of my time in politics to. How is this Bill progressing? Has the Minister considered undertaking work on an all-island basis to create a universal culture of adult safeguarding which is vital? If not, does he think there is merit in doing so?

I will take the second question first. I have not given consideration to the all-island approach to the Adult Protection Bill.

In terms of its status, it is on its way. I would be very surprised if it does not pass before the end of the mandate in May 2027. The difficulty is the implementation because we do not have the budget to go straight to full implementation of that Bill. We have made clear, frustratingly, that it will be implemented in stages as the funding becomes available. I had the first-day brief and because health is so broad it seemed to last about six weeks. The one that really jolted me and stuck with me was health inequalities. Two babies born today, particularly two females, in one of the maternity units in Belfast could grow up in the city perhaps a mile or less apart, one in the area of the greatest deprivation and one in the least, for example, the Malone Road and Sandy Row, which are less than a mile apart. Their healthy life expectancy currently varies by over 14 years - in a First World country a quarter of the way into the 21st century. I do not even understand how we tolerate that. I have made it an ambition. We picked two areas of deprivation, one in Derry and one in Belfast, which we call demonstration areas because I wanted to demonstrate that we could get results. I will ask Mr. Wilkinson to go through the three lessons we picked out of that.

I want to go back to Executive colleagues because health inequalities are not just about health. In fact, our research suggests it is only 20% health interventions. It is 40% socioeconomic, 10% environment and the remaining 30% is behaviours such as substance use, smoking and vaping. The tobacco and vapes Bill coming through Westminster will be very helpful on that 30%. I would love to see minimum unit pricing on alcohol but I do not have full Executive support and I need it. I am beginning to think I will not get that this mandate. If we can take a lump out of that 14-year difference, what a difference we are going to make to the lives of those people living in areas of deprivation. To Executive colleagues, when I say it is their responsibility - the Ministers of education, housing and environment - I am not saying I want to use their budgets as well as me taking over 50% of the Executive budget. I am also saying that when it comes to educational underachievement, I know healthier children do better at school so it is my problem. It is not just the Minister of Education's problem. As for our rate of economic inactivity, 27% of people of working age are neither in work nor seeking work. The biggest single reason is ill health, mental and physical. It is not just the economy Minister's problem; it is my problem. These are three of the big sticky issues that have been around since before the 1998 agreement. What a difference it would make if, as an Executive, we collectively decided we would target those three issues and make lives better.

I call Mr. Hughes. He has five minutes.

I genuinely thank the Minister for engaging today and echo the sentiments of my colleagues on this committee in hoping that it can become a regular feature of this committee on health and other forums of North-South collaboration we move forward to explore. The experience of my constituents in Newry and Armagh shows the need for enhanced cross-Border collaboration on health. Our local hospital at Daisy Hill already offers renal and emergency services to citizens in the South but this can be built upon with enhanced capacity.

I have two questions for the Minister. The first is about access to cross-Border cancer services, specifically CAR-T cell therapy. He has heard the example of Catherine Sherry, who passed away in London earlier this year separated from her family after being forced to travel to Britain for that treatment which is available on this island. I know there is an intention to increase CAR-T cell therapy capacity in this State. Will the Minister confirm his support for citizens across the island having access to that treatment? Is he engaging with his opposite number here to prepare for that?

Second, to elaborate on the point of shared data, the Institute of Public Health - the Minister referenced public health challenges with tobacco, vapes and alcohol - and the All-Island Cancer Research Institute, in front of this committee, have bemoaned the lack of all-Ireland data sets being accessible and transferable across the Border. We can all agree that is essential for policy development, strategic planning and workforce planning. I am sure this would be of great benefit to the Minister in his department. I welcome the sentiments in his opening statement about developing that. Will he elaborate on action taken to enable this? In light of his stated intention to introduce legislation on the secondary use of data - that may be the single-clause legislation he referenced earlier - will he provide clarification as to whether this will simplify the existing processes for sharing data on an North-South basis?

I will start with CAR-T because there is some misunderstanding at Stormont. We do not offer it at the moment. We intend to do it as part of the reconfiguration of the haematology ward at the Belfast City Hospital. The ward currently is ward 10. I have visited it; it is not pretty. It is old and it is not good. The new ward will not be on stream until probably 2031, at which point we hope to be able to offer CAR-T. We cannot do it anywhere else because you have to have a clinically well-defined area for it. There is a lot of confusion because some MLAs ask me to please speak to Jennifer Carroll MacNeill and get patients sent down here. I have spoken about this with officials in the HSE - it does not have the capacity. It does not have any further capacity to deal with people from Northern Ireland. If you start today, we will get there quicker with the new haematology ward than you will down here.

We are using the most viable system at the moment, which is England. There is the issue across all our systems that there is huge pressures of capacity.

Apologies. I have just been advised we have this room until 12.15 p.m. because another committee is starting. This is not our usual slot. It is not as long as normal. We have seven speakers, including one or two online. Next is Ms Hanna. I will take a bunch of questions together and then we will time the Minister on his excellent responses to all questions asked, if he does not mind. We will come back to Ms Hanna. I think the problem is on our end because she is not muted. I call Deputy Shane Moynihan. He has one minute.

I thank the Minister for making the time to be here and for his openness. My question relates to structures. In Ireland at the moment, the HSE is undergoing a realignment of structure in various regions. In terms of the practical co-operation the Minister foresees, the health and social care trust system is how the health system is structured in Northern Ireland. What does that co-operation look like in that new reality? Is it just at departmental level or is it region-to-region engagement in both ecosystems in the health services in Ireland and Northern Ireland?

I welcome Mr. Nesbitt. As I think Deputy Conway-Walsh alluded to, we have had evidence from people dealing with oncology and congenital heart services. The professor dealing with congenital heart services outlined the process they went through over ten years in building trust in the services among patients coming from different jurisdictions. He also outlined that they had a principle that the merging of the services and provision of services in both parts of the island would not denude the service on either side. They were not asset-stripping one side for the benefit of the other. That principle has worked. He said they brought two average services up to a world-leading service on the island. The funding for that has been shared island funding. It struck me in terms of an invest-to-save-type process, there is clear evidence of a particular service that would benefit from the input of funding from both departments. He also made the point there are other areas of health provision which would benefit from the same approach. I ask the Minister to look at the evidence he gave and see how we can move that on from sporadic projects. As people mentioned, we have Altnagelvin and children's heart surgery but that is since the Good Friday Agreement.

Very little else has moved in that type of way since and I think it is a model worth looking at.

I thank the Senator. We still cannot get the sound for Ms Hanna. Sorry about that.

It was going to be a great question.

She will have another opportunity to ask the Minister. I call Senator Kelleher.

Like others, I would like to take the opportunity to welcome the Minister, Mr. Nesbitt, to our committee. As was mentioned earlier, he is not here in his capacity as leader of the Ulster Unionist Party, but it is fantastic to have unionist representation here, albeit in his capacity as Minister. It is very obvious he is on top of his brief. I know from conversations with the Minister for Health, Deputy Carroll MacNeill, that she is very grateful for the relationship she has with Mr. Nesbitt.

In that context, I would like to ask a question. We had representatives from the Institute of Public Health in before this committee. One challenge they referenced was the discrepancy or difference in data collection on statistics around healthcare and trying to compare healthcare outcomes in both jurisdictions. If there are challenges like that, to what extent are they are being addressed and what other challenges might lie in the way? It is very obvious from anyone we have dealt with that there is huge goodwill towards closer co-operation and the mutual benefit for both jurisdictions.

Good morning. The Minister is very welcome. On 24 June 2024, the Oireachtas and Stormont committee met for the first time and the Minister was good enough to drop into us that day for the meeting.

I want to ask about the co-operation side of things. The Minister will be aware there was a campaign on the Duchenne muscular dystrophy, DMD, and a young lad from Newry named Alfie Pentony was involved in that. The Minister has agreed to allow access to that drug, givinostat, which is a game-changer for children there. Unfortunately, in this jurisdiction, we are still going through the system of clearing that drug, which means children here have no access to it. It is a game-changer, as the Minister will know, for slowing down the muscular waste for those children. Would the Minister talk to his counterpart here, Deputy MacNeill, to come up with some sort of interim solution for children in this jurisdiction if that is at all possible?

I welcome the Minister and his officials. It is great to hear in his opening statement about the co-operation with our Minister for Health, Jennifer Carroll MacNeill.

The Minister talked in his presentation about the movement of drugs. Deputy Crowe mentioned it as well. The Minister spoke about the problems with it and how we cannot ignore that problem. Is there a lot of progress on that, or does the Minister expect it will be solved? I know the problem with it. All my colleagues asked the rest of the questions, but could the Minister answer that one?

God loves a trier. We will try to bring Ms Hanna in again.

I thank Mr. Nesbitt for his engagement. It is impossible to condense the issues in one minute. I do not think anybody in 1998 would have believed that this would be the level of co-operation we could achieve. It is minimalist. We have heard from previous witnesses in the last few weeks that it relies on very motivated individuals and goodwill rather than anything more structured.

We are rubbish in Northern Ireland at thinking in the medium term but would the Minister be open to setting out with his counterparts a ten-year vision on some of the issues around workforce and procurement co-operation, integrated networks and a ten-year partnership, to get into some of the practical low-hanging fruit, as well as opportunities around scheduled care, chronic diseases and things like diagnostics and imaging? The Minister has shown a real ability to strip out the ideology and just get down to practical co-operation.

The Minister mentioned the regulatory barriers on qualifications and controlled drugs. He said they were under discussion. Can he give us a bit more detail around that? Are the powers we need on the island or are there EU and Westminster dimensions that need to be got through to solve those two pressing issues?

I thank Ms Hanna. That was very succinct for one minute.

The Minister referenced the Good Friday Agreement and his sheer commitment to that, which is exceptionally welcome. He will be aware that the British-Irish Parliamentary Association met in Stormont recently. We had a very good discussion on the subject of energy. The challenges facing both jurisdictions in that regard are the same as in health. There is not an unwillingness in either jurisdiction to try to see how we can better co-operate. The Minister referenced the meeting he had with our Minister for Health, Deputy MacNeill, and the next one on 14 January. There is a part that the North-South Ministerial Council plays in this. We had a discussion in mid-November with the All-Island Congenital Heart Disease Network and others. There are blockages that the Minister, Mr. Nesbitt, referenced with GDPR and other issues being faced around data sharing between both jurisdictions. Earlier, he posed a question about where the situation would be and how we would do health services if we were starting out with a blank canvas. What are the top priorities to try to engage an all-island health service? How would that be done?

I thank Mr. Nesbitt for taking all of these questions. He can answer them however he may.

In terms of structures, I came to the conclusion very early on that we had vastly and grossly overcomplicated health and social care delivery but I am not going to tamper with the structures because I think that would be a distraction. The big structural changes we have had previously, such as turning 26 councils into 11, have not delivered what we thought they would.

Regarding information sharing, that should be as close to the ground as possible, if not on the ground. I will certainly look at that with Mr. Wilkinson.

Regarding an invest-to-save process, we are actually looking at an invest-to-shift process. The shift we want to achieve is a shift into the neighbourhood model, which is about prevention and early intervention. Anything we can do in that space, we will definitely do.

On data sharing, data is king. Data is going to be king. Now we have encompass, which gives us the ability to do public health initiatives and to isolate areas and say when we are seeing trends, either geographic or demographic. The data we get in Northern Ireland is good but there will be occasions when the data on an all-island basis is going to be much better. Sometimes, western European data would be good. I want to see information systems talking to one another in a way that allows us to do validated, authentic comparisons.

Regarding Duchenne muscular dystrophy and the drug treatment, I can take that question away and ask. I do not know what regulatory barriers there may or may not be. I suspect there probably are some, but we will certainly look at it.

Ms Hanna says we are rubbish at the medium term. All I can say is I have decided to tackle health inequalities. Between now and May 2027, people will not see a hell of a lot of difference. My ambition is to set in some infrastructure that compels the next Minister of Health to think they should continue on that journey. The former Secretary of State, Mr. Alan Milburn, was over from London in Belfast a while ago. We were talking about health inequalities and my desire in that regard. He said he really admired me because it was a 50-year project. I needed adult Pampers at that stage because I do not think it is going to take that long, but it is a long-term thing. I am thinking about long-term issues beyond my tenure in this post.

That comment was not directed at the Minister. It was directed at the body politic in Northern Ireland.

On behalf of the committee, I want to thank the Minister, Mr. Nesbitt, for taking the time to be here and for engaging with the members. I apologise to the members whose time was cut short. We were given this slot by the health committee, which we are grateful for. It is just a bit shorter than normal.