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    Commenting on a paper published today which suggests that the UK government does not want any border posts between Northern Ireland and the Republic of Ireland post Brexit, Dr Andrew Dearden, BMA treasurer, said:

    “We absolutely agree that we should maintain a soft border after Brexit to help ensure that cross-border health services and patient access to healthcare are not affected by leaving the EU. Introducing border restrictions would risk reversing this progress and damaging patient care.

    “As separate health services, Northern Ireland and the Republic often do not have sufficient demand to provide cost-effective, highly specialist medical services, such as the all-island children’s cardiac service. The only viable way to provide these services to patients is to deliver them on an all-island basis, and to do this we would need to ensure that doctors and patients can move freely across the border.

    “Over the last two decades, a significant growth in the provision of all-island healthcare has improved care for patients and allowed both Northern Ireland and the Republic to retain highly trained doctors, who otherwise may not have had the patient demand necessary to warrant their full-time expertise.”


    Notes to editors

    1. The BMA has previously warned that cross-border health services and patient access to healthcare, including the cooperation of emergency services and other organisations in response to major emergencies and public health risks, must not be impeded following Brexit.
    2. The BMA is also calling on the UK government to safeguard the future of vital health services by ensuring that doctors in Northern Ireland and the Republic of Ireland maintain the ability to move freely between both countries, and that mutual recognition of professional qualifications between Northern Ireland and the Republic of Ireland continues.
    3. Cross-border co-operation with regards to healthcare has increased in recent years. Figures show that between 2003 and 2015, more than €40m was invested in cross-border health and social care initiatives via CAWT (Co-operation and Working Together), with additional projects amounting to €53m submitted in relation to acute hospital services, prevention and early intervention, tackling health inequalities and other services.
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    An announcement by Justine Greening, Minister for Women and Equalities, on 29 June indicated that Northern Irish women will no longer have to pay to access terminations in England. Motivated by the proposed amendment of backbench Labour MP, Stella Creasy, the government avoided a vote in the Commons on the issue and declared instead that they will pay for Northern Irish women who travel to mainland UK for abortions.

    Such an announcement is to be welcomed. Northern Ireland was never covered by the 1967 Abortion Act which allows for terminations in England, Scotland and Wales. Although there has been a Marie Stopes clinic in Belfast since late 2012, it operates within an incredibly restricted legal framework which only allows for abortion in cases where there is a long-term risk to the woman’s health. As such, around 1000 women travel to England every year to access terminations. Depending on their personal circumstances, such a procedure can cost between a few hundred to a few thousand pounds. This ruling will therefore substantially diminish the financial impact that Northern Irish women seeking terminations face.

    Abortion is politicised in Northern Ireland in a manner that does not compare to the rest of the United Kingdom. Protests continue to occur regularly outside the Marie Stopes clinic in central Belfast and Northern Irish politicians openly espouse anti-abortion sentiment that would rarely be heard in Westminster. Whilst there has been a steady drip of legislative action encouraging change (in late 2015 a high court judge in Belfast ruled that the legal situation in the province regarding abortions contravenes human rights law), on 29 June 2017 the Court of Appeal in Belfast ruled against the 2015 judgement. It argued again that this area was for the devolved Assembly to rule on, and could not be changed by the courts.

    Earlier in June 2017, in relation to the case of a 15-year-old girl who had travelled to England for treatment, the Supreme Court in London ruled that women in Northern Ireland were not entitled to free abortion treatment on the NHS. Creasy’s amendment emerged in response to this. In the light of these judgements, her actions in the Commons and the declaration by the government take on even more importance. The legal system appears to have been exhausted as an avenue for change, so political action on this is to be welcomed.

    Such action has been seen before, but has, until now, been unsuccessful. In 2008, Diane Abbott MP fronted a similar amendment to the one that Creasy argued for, proposing that the 1967 Abortion Act be extended to Northern Ireland. Then, however, the Labour-led government of the day aligned with the argument made by Northern Irish MPs (and courts, in both judgements referenced above), that this matter was entirely devolved and should be left to the attention of the Assembly.

    Whilst it is true that abortion law has been devolved to Northern Ireland since 2010, national Parliament at Westminster could have made the decision that it made this June at any point since 1967. In light of the negative attention that the Conservative-DUP deal has received due to the very conservative beliefs of the DUP regarding abortion and LGBT issues, it is hard not to see the recent decision as damage limitation. Accused of making deals with a party which appears to espouse ideas antithetical to the majority of British voters, the Conservative government can now hold up this funding announcement as a way to both distance themselves from the DUP’s social conservatism and illustrate their own liberal values.

    This move also illustrates once again the weakness of the current government. Creasy’s amendment looked set to pass easily, with substantial support from Conservative members. Will there be more backbench opposition challenges like this? It would appear likely, especially in light of a fractured Conservative party, reeling from the poor General Election result.

    The government’s recent announcement does nothing to change the legal situation regarding abortion in Northern Ireland. Abortion will remain illegal (including in cases of rape, incest and fatal foetal abnormalities) except in extreme physical or mental circumstances. And although it now appears that Northern Irish women will not have to pay for the terminations they seek in England, they will still face substantial costs in terms of travel and accommodation.

    In addition, this decision does not remove the more fundamental injustice of this situation. Women will still have to travel, leaving family and support networks behind. Women with complicated citizenship statuses, caring responsibilities or those in abusive relationships may find it impossible to travel at all. The decision by the government is to be welcomed, but it does not place Northern Irish women on an equal footing with their English, Scottish and Welsh counterparts. They still deserve better.

    This first appeared on the British Politics and Policy blog

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    A world class health service

    Health matters to each and every one of us in Northern Ireland. All of us, either directly or through a close friend or family member, rely on our Health and Social Care system on a regular basis.

    The importance of Health and Social Care to everyone in Northern Ireland has been reflected by the priority given to it by the Democratic Unionist Party in this Assembly term. During the past 5 years, the DUP has produced a record to be proud of during its time in charge of the Department of Health, Social Services and Public Safety.

    People are living longer. Key mortality rates like cancer mortality in under 75s and avoidable mortality are falling;

    • We have invested over half a billion pounds more in Health;
    • We have employed 275 more consultants, 1,200 more nurses and midwives, and 500 more allied health professionals;
    • We have delivered over £800 million in efficiency savings to reinvest in the frontline;
    • We have built new, state of the art health and social care facilities such as the new Critical Care Building at the Royal Victoria Hospital, new Health and Care Centres in Ballymena and Banbridge, the Radiotherapy Unit at Altnagelvin and large scale redevelopment of the Ulster Hospital and
    • We have developed new services like a HEMS air ambulance and a world leading mental trauma service.

    We recognise that our NHS in Northern Ireland is under pressure and faces a range of tough challenges now and into the future. Yet, the focus of some on what isn’t perfect within the system distracts us away from what is working well and the many improvements that have been made. Ours is a Health and Social Care system which, in spite of the many issues it must contend with, has improved performance and increased productivity over the past 5 years.

    Under DUP leadership:

    • the number of people admitted to hospitals in Northern Ireland has increased by over 25,000 between 2010/11 and 2014/15;
    • the average length of stay in hospital has fallen from 6.7 days in 2011/12 to 6.0 days in 2014/15;
    • the number of domiciliary care contact hours has increased by 12% from 2011 to 2014 and
    • the Ambulance Service has responded to 13,000 more Category A emergency calls between 2010/11 and 2014/15.

    However, we must continue to improve. For example, much needed guidance for our health professionals dealing with terminations has been provided. An expert panel on the issue of pregnancies with severe life limiting conditions has been established.

    The DUP has a vision for a sustainably financed Health and Social Care system that puts quality, safety and the patient at its centre by providing world class outcomes for our population. This is our Plan to achieve it.

    The DUP pledges to seek to increase spending on Health by at least £1 billion by the end of the next Assembly term to specifically help in tackling waiting lists and investment in innovation and reform. We will continue to invest in the transformation of Health and Social Care services by ensuring that a Transformation Fund of at least £30 million remains in place for each year of the next Assembly term.

    The DUP will invest more resources in increasing frontline staff numbers and will employ at least 1,500 more Nurses and Midwives and 200 more Consultants by the end of the next Assembly term.

    We will continue to increase spending on mental health each and every year of the next Assembly term. We will appoint mental health champions across the public sector and establish a world leading mental trauma service.

    The DUP will reduce bureaucracy and encourage innovation by passing legislation through the Assembly to close the Health and Social Care Board, moving responsibility for commissioning services primarily to the Department with more autonomy for the Trusts in certain areas. We will support the work of the Expert Panel led by Professor Rafael Bengoa as they seek to remodel Northern Ireland’s Health Service to overcome looming challenges like our growing and ageing population, the rise in the number of chronic conditions and the impact of unhealthy lifestyles.

    The DUP will support the additional investment of a minimum of £80 million to tackle waiting lists in each year of the next Assembly term. This extra money will be focused on increasing capacity inside the Health Service in Northern Ireland but will utilise the independent sector where and when appropriate. It will help people to get close to 200,000 appointments, treatments and procedures each year with the target of getting waiting lists well below 2013 levels by 2021.

    The DUP will establish a Commission on Adult Care and Support to provide expert, independent analysis of the challenges facing the system and to think radically about what changes must be made to safeguard it for future generations. The Commission on Adult Care and Support will be tasked with producing a set of recommendations to reform the system and its funding structures to ensure its future sustainability. We will pay particular attention to ‘best practice’ examples like the acclaimed Buurtzorg community care model in the Netherlands and Italy’s new models of care in managing the chronic conditions of its ageing population and we will actively examine the opportunity for rolling out similar models in Northern Ireland.

    The DUP will further support primary care by working progressively towards having 110 GPs a year in training by 2020, continuing to support the development of GP Federations, implementing the recommendations of the GP Working Group and maintaining a Financial Transactions Capital funded GP Modernisation Scheme. The DUP will support the Northern Ireland wide roll out of the physiotherapy direct access scheme and will develop similar projects in other specialisms.

    The DUP will develop a new Electronic Health and Care Record for Northern Ireland to help revolutionise the delivery of health and social care for patients. This would provide accurate, up-to-date and complete information about patients at every point of care, reduce discharge delays and enable safer and more reliable prescribing of medication as well as increase the time that doctors, nurses, therapists and social workers have to spend with patients – allowing the use of data analytics to improve population health and care planning and it will help our Health and Social Care system to become ‘paperless.’

    The DUP supports a continuation and amplification of the cross-Departmental approach to tackling health inequalities in Northern Ireland, building on the progress made by the Making Life Better public health strategy, as part of the next Programme for Government. We will also consider the success of initiatives like South Australia’s Health in All Policies (HiAP) and examine if a similar approach could work in Northern Ireland.

    The DUP will provide support for further investment in improving healthcare facilities across Northern Ireland. This includes the new regional mother and children’s hospital at the Royal Victoria Hospital, further redevelopment of the Ulster Hospital and redevelopment of Craigavon Area Hospital. We will also take forward the development of more Health and Care Centres in Lisburn and Newry and examine the scope for places like Newtownards, Bangor, Armagh, Dungannon, Lisnaskea, Carrickfergus and Larne.

    Public debate has focused on the needs of women who are pregnant with a child diagnosed with a severe life limiting condition. The DUP believes that women who find themselves in these most difficult of situations need the best medical and emotional support. The DUP is committed to establishing a perinatal hospice care service or facility in Northern Ireland.

    The DUP will continue increasing investment in cancer care by at least an additional 10% and introduce a new comprehensive cancer care plan for the next decade. We will endeavour to improve 5 year cancer survival rates by 20 percentage points from the establishment of devolved government, continue to promote awareness and prevention, establish further innovative new services and provide more nurse specialists.

    The DUP recognises that the contribution made by nurses and midwives is invaluable to the functioning of Northern Ireland’s Health Service. Equally, we acknowledge the pressures facing the profession especially around staff numbers. We are proud to have worked closely with the Royal College of Nursing to address a range of challenges facing nurses. During the next Assembly term, the DUP will support nursing by implementing the recommendations of the newly created Nursing Task Group, retain Nursing Bursaries in Northern Ireland and continue to increase the number of nurses and midwives in training and practice.

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