S2 - Episode 5 - Jim Dornan

Holywell Trust Conversations

FULL EPISODE DESCRIPTION

“Epidemiologically, we're all one Ireland”

It is clear that health services in both Northern Ireland and the Republic will need to be reformed as our society recovers from Covid-19. They need to be more resilient and flexible to cope with both underlying existing demand and the capacity to cope with the current and possible future pandemics. Reform was already planned in both jurisdictions – the Bengoa plan in the north and Sláintecare in the south.

But could reform be even more effective – in terms of cost-effectiveness, efficiencies and quality of outcomes – if there was more cross-border integration of health services? Could there even be a merger cross-border single healthcare system, irrespective of the question of Irish unity? This was the theme of the latest Holywell Trust Forward Together podcast, with Professor Jim Dornan. Jim is a former clinical director and head of fetal medicine in the Royal Maternity Belfast Trust. He was also senior vice president of the Royal College, running its international office.

Jim played a key role in the development of cross-border healthcare provision in recent years, specifically the arrangements for children’s heart surgery in Dublin. “It seemed so very obvious,” he says. “I was around at the beginning of the very successful paediatric services for Ireland. I'm reassured by many others that that example has been followed in other areas, such as perinatal and mental health. I believe there are quite a few ideas bubbling around.”

The benefits of these arrangements have been improved health outcomes for children, reducing the risks for extremely ill patients undergoing difficult travel and also reducing the stress on parents, who otherwise would have had to travel or stay with their children in Britain after surgery.

In addition, specialist consultants improve their skills if they do lots of similar cases. “You don't want somebody not having enough cases so they might lose their experience,” says Jim. “But you don’t want to be flooded by having too many. Ireland is Goldilocks sized – not too big and not too small for its own health service. With a joint population of six million, that's about right.”

It is obvious that this is a moment to consider the future structure of healthcare across the island of Ireland. Jim says: “It was well put by somebody who said that epidemiologically we're all one Ireland, no matter what borders are there.”

Jim explains: “Both sides of the border, big decisions have to be made as to how much taxpayer money should be spent on health. It's really down to that at the end of the day. America has a wonderful health service for everybody except the twenty seven and a half million who don’t have health insurance. They use about 18% of their gross national product on health. Britain uses just under 10% of its gross national product for health. And the Republic, somewhere around about 7%.

“So it's a very simple thing - people must vote in politicians who are willing to put what the people have decided should be put into health going forward. The health service is a very hungry animal. People working in it on both sides of the border are doing their best. Medicine will always not be two-tiered, but a multi-tiered system - that's just a fact of life. But everybody must have access to life-saving medicines that are evidence-based and that we know work.”

He adds: “Personally, I can see no reason why both governments should not now try to look at where are the best places to integrate health. We don't have to wait for a political decision. For example, it is so obvious with paediatric surgery that having one successful unit is better than having two failing units…. There is no great clashing of cultures for us all to work together.”

Jim continues: “We're talking about efficiency. I think everybody in Ireland wants to have a health service that meets the needs of everyone, free at point of delivery based on need, which is the basis of the National Health Service. In fairness, that's exactly what the public side of the health service in the Republic is based on as well…. But you've got to be realistic. It's going to be more than one tier. It's idealistic to think of a one size fits all health system. There's no country in the world that does that.”

But moving towards more evidence-based policy-making with regard to the structure of health provision, means that arrangements need a level of flexibility and near constant change and reform. As new evidence emerges, as new treatments are proven to be effective, so health care delivery has to respond. This is uncomfortable for the health service, but essential for its future. It both permanent revolution and evolution, concedes Jim, who stresses that “everything has to be evidence-based”.

Jim has also been a strong advocate for reconsidering the constitutional position of Northern Ireland. “I 100% think that at some time in the next five years the border is going to have to be addressed. But I honestly think that it cannot and should not be addressed until we have all the answers on various options on major issues, like health, education, economics, culture. I feel that is the best way forward. Instead of just going narrowly into should we get rid of the border. With what is happening in Scotland and in people’s mind, we should be looking at the status quo, an independent Ulster, the union of Ireland, the position of Scotland, could we have a new federated Celtic islands situation? But let’s have an awful lot of facts…. This is where the universities can step forward.”

Disclaimer: This project has received support from the Northern Ireland Community Relations Council which aims to promote a pluralist society characterised by equity, respect for diversity, and recognition of interdependence. The views expressed do not necessarily reflect those of the Community Relations Council.