There is very little co-operation between the Republic and Northern Ireland on hospital treatment, despite the benefits there would be for patients from a better sharing of services, according to a report to be published today.
The flow of patients across the Border for in-patient services accounts for less than 0.3 per cent of caseloads, it confirms.
The "Cross-Border Co-operation in Health Services in Ireland" report is to be presented to Ms Bairbre de Brun, Northern Ireland's Minister for Health, in Belfast.
This very low level of "official" cross-Border health traffic does not take into account, however, a long established practice where residents in the Republic access care in the North through the use of an "accommodation address".
The report, commissioned by the Centre for Cross-Border Studies in Armagh, focuses on healthcare initiatives with the greatest potential for development. It also recommends ways for health service co-operation to be made more effective, both on a cross-Border and all-island basis.
Key healthcare representatives from Northern Ireland and the Republic were interviewed and asked to identify the advantages to be gained from cross-Border co-operation. The main themes to emerge were:
There are benefits from planning healthcare on an all-Ireland basis
The Border region is a "natural" geographic area
Collaboration will address the relative disadvantage of Border areas
Threats to health do not respect political boundaries
Cross-Border co-operation will bring faster response in an emergency
Patient benefits will accrue from exchanging good practice.
However, an initial analysis by the authors comparing mortality and hospital use failed to find particular problems of unmet need for hospital services in Border areas. The report did not find substantial evidence that a pooling of cross-Border populations to create a "critical mass" would produce economies of scale in the acute hospital sector. It notes that "economies appear to be exhausted at quite low levels of activity [around 200 beds]".
In addition, the authors found strong evidence that the further away a population is from a hospital, the less the hospital will be used - particularly among rural communities and poorer groups. The Centre for Cross-Border Studies was also asked to conduct a separate but complementary evaluation of the principal existing cross-Border initiative, known as Co-operation and Working Together [CAWT]. Its findings are included in today's report.
CAWT has been mostly project-focused and heavily dependent on EU funding, the authors note. They found that most projects concentrated on issues such as training as distinct from services. Projects which benefited individual patients included rural dialysis which much improved treatment for kidney failure patients in north Louth. A dermatology service reduced outpatient waiting lists on both sides of the Border.
The recently initiated general practice out-of-hours project, in which GPs in the North-Eastern Health Board and the Southern Health and Social Service Board will try to provide cross-Border emergency services, is seen as pivotal. It could address existing barriers such as the registration of professionals, medical insurance cover and GP referrals between different health sectors.
The report calls for statements to be made about problems which hinder the improvement of co-operation. It recommends assessment of the potential for co-operation on organ transplant services and paediatric cardiac surgery. There should be an assessment of how co-operation in emergency services close to the Border might be enhanced.
It calls for greater collaboration on evaluation and research into the effectiveness of the two healthcare systems. There should be greater co-operation in public health promotion campaigns. Provided barriers can be overcome, there is considerable scope for expanding staff secondments and joint training programmes, it says.
The authors say there should be increased co-operation in emerging health technology. They also note that, compared with the Republic, the North of Ireland has, per capita, 38 per cent more GPs and 43 per cent fewer consultants. Although both jurisdictions have about the same number of acute beds, the North has more than three times as many residential and nursing home beds and almost three times as much home-help provision.
The report can be accessed on the web at: www.qub.ac.uk/ccbs