Brexit and child health - Northern Ireland: briefing for members

Northern Ireland is the only part of the UK with a land border with another EU member state. Given that there has been significant integration between Northern Ireland and the Republic of Ireland on a range of areas including health and social care, paediatricians here need further assurances on how leaving the EU will affect them as professionals as well as services and patients.

Following the agreement reached by the UK Government and the European Union in December 2020, some clarity is available on certain aspects of the concerns for paediatrics from a Northern Ireland perspective. There are areas where further analysis is required before the impact of the agreement becomes clear. We will update these pages as new information becomes available.
Last modified
25 January 2021

Shared health services on the island of Ireland

Strand 2 of the Good Friday Agreement 1998 provides for the creation of the North/South Ministerial Council to facilitate cooperation between Northern Ireland (NI) and the Republic of Ireland (RoI) and currently covers collaboration on various cross-border healthcare services.

The Department of Health NI expects that all cross-border services which are arrangements between NI and the RoI under this framework to continue unaffected as they do not rely specifically on EU legislation to function. This includes the Paediatric Congenital Heart Service, cross-border radiotherapy service in Altnagelvin and many others.1

Reciprocal healthcare

Workers who commute across the border in Ireland will be covered for planned cross-border treatment. 

Free movement of people

The introduction of the EU Single Market in 1993 resulted in the closure of customs posts on the Irish border. Post-Brexit, the internal Irish border will become an external border. The Centre for Cross Border Studies estimates that between 23,000 and 30,000 people are cross-border workers. The CSO Cross Border Commuters 2016 Report shows significant movement from RoI to NI in the following regions: Donegal to Derry, Monaghan to Armagh and Cavan to Fermanagh. Overall, from all industries surveyed crossing the border to access work, approximately 19% are health and social work professionals.

Common Travel Area (CTA)

The Common Travel Area (CTA) is an arrangement between the United Kingdom (UK) and Ireland that gives a variety of rights to citizens of those countries. It includes more than the basic right to travel freely between both countries. The CTA is not dependant on the European Union and the continuing membership of both countries.

Both Governments signed a Memorandum of Understanding in May 2018 to reaffirm their commitment to the Common Travel Area and identifying the rights and privileges of Irish and UK citizens within the CTA. It also reaffirms the commitment to maintain the CTA following Brexit.2.

Mutual recognition of qualifications

An agreement was in place to recognise professional qualifications prior to and during the transition phase. There is no longer an agreement to mutually recognise professional qualifications and instead the agreement provides a framework for professional regulators (eg the General Medical Council and the Nursing and Midwifery Council) to cooperate with their EU equivalents to agree a process for recognising professional qualifications in one another’s territories and form a Mutual Recognition Agreement (MRA). Members must have their qualifications recognised in each member state they wish to practice in.

Driving cross-border

NI Direct Government Services has a webpage dedicated to Travel and transport - EU exit information

On this page information can be found on the following topics.

  • NI citizens driving in the EU
  • Motor insurance
  • EU citizens driving in NI
  • Travel insurance
  • Emergency healthcare

It is advisable that you check the regulations in your jurisdiction and with your insurance provider.

3. EU funding

NI and RoI border counties have benefitted greatly from sources of EU funding, mainly INTERREG and PEACE. The region was allocated €283m of INTERREG VA Programme funding (2014-2020) designed to help overcome the issues relating to the existence of a border. €240m was provided through the European Regional Development Fund, the remaining €43m was match-funded by the Irish Government and the NI Executive.

The content of this Programme has four core objectives which includes providing health and social care services on a cross-border basis which ideally will be mainstreamed into core services after the funding period. Various services have been rolled out by Cooperation and Working Together including Childhood Multiple Adverse Childhood Experiences programme which secured €5.01 million and the Acute Hospitals Services project ‘Connecting Services, Citizens and Communities’ which secured €10 million have been established through this funding.

Since the Good Friday Agreement in 1998 the region has received PEACE funding from the Special EU Programmes Body (SEUPB) designed to support peace and reconciliation. The most recent round, PEACE IV invested €270m, €229m was provided through the European Regional Development Fund the remaining €41 is match-funded by the Irish Government and the NI Executive. This funding is inextricably linked to mitigating the social determinants of mental and physical health and wellbeing in this region.

It is anticipated that funding programmes will continue after Brexit through a single PEACE PLUS programme as part of the EU funding budget 2021- 2027. The UK Government has given their commitment to the PEACE PLUS Programme and it is hoped that sufficient allocation of funds will be forthcoming.