The main barriers to co-operation between health services North and South have been underlined in the cross-Border report.
The barriers are highlighted by the case of Altnagelvin Hospital in Derry and Letterkenny General Hospital, Donegal, which have examined areas of joint working.
In a previous report, they highlighted cardiac angiography [a dye test for angina], oral and facial surgery, neonatal intensive care and the rehabilitation of brain-damaged patients as four areas in which they could provide joint services for patients. The cross-Border report strongly endorses this view.
An Altnagelvin/Letterkenny partnership has detailed the constraints on cross-Border co-operation in health care. Barriers identified include:
Developing hospital services at one site may mean either discontinuing or reducing services at another;
There are legislative differences regarding eligibility for services and licensing of products;.
Regulation of nursing, medical and allied professionals is carried out by separate bodies with different sets of requirements. This can seriously inhibit joint appointments and cross-cover arrangements;
Differences in pay scales, conditions of employment and job descriptions;
Medical malpractice insurance is operated by private providers in the Republic but by health authorities in Northern Ireland;
Undergraduate and postgraduate training is organised and accredited by different bodies and in many cases reciprocal recognition does not exist;
Funding arrangements are quite different and currency fluctuations and transaction costs are a problem;
The two jurisdictions have different clinical standards, protocols, guidelines and audit procedures.
The report also highlights differences in the public/private mix in both areas. Insurers do not always offer the same cover to patients availing of services outside their area of residence. Prescription and medical charges also differ and there is a question over the legality of prescriptions written in one area and dispensed in another.
The Altnagelvin/Letterkenny group and the authors of this report suggest concentrated efforts are required to identify and dismantle potential barriers to cross-Border health service co-operation.