Cross-Border Healthcare Cooperation Advances as Ministers Reaffirm Commitment to All-Island Paediatric Services
Health ministers from Northern Ireland and the Republic of Ireland have reaffirmed their commitment to deepening cross-border healthcare cooperation, with plans advancing for children from Northern Ireland to access specialist cardiac surgery at the new National Children's Hospital in Dublin once it is fully operational — part of a broader all-island approach to paediatric and cancer services that both jurisdictions see as essential to optimising limited resources and improving patient outcomes across the island.
Background
Healthcare cooperation between Northern Ireland and the Republic of Ireland has a long and complex history, shaped by the political division of the island, the different funding models of the NHS and the HSE, and the practical challenges of coordinating services across a jurisdictional boundary. Despite these challenges, there is a strong clinical and economic case for all-island cooperation in healthcare, particularly in specialised services where the patient population in either jurisdiction alone may be too small to sustain a full range of expertise and facilities.
The Good Friday Agreement of 1998 created a framework for North-South cooperation across a range of policy areas, including health. The North-South Ministerial Council has a specific health strand, and there have been various initiatives over the years to develop shared services and cooperative arrangements. However, progress has often been slow, hampered by political sensitivities, funding constraints, and the practical difficulties of aligning two very different health systems.
The post-Brexit period has added a further layer of complexity. The cessation of the EU Cross-Border Healthcare Directive, which had provided a mechanism for patients to access care in other EU member states and seek reimbursement, removed one of the key frameworks for cross-border patient movement. A direct reimbursement scheme between the Republic and Northern Ireland was closed in 2022 due to a lack of funding, leaving patients without a clear pathway to access care across the border.
Key Developments
The most significant development in cross-border healthcare cooperation is the plan for children from Northern Ireland to access specialist cardiac surgery services at the new National Children's Hospital in Dublin. Paediatric cardiac surgery is a highly specialised service that requires a significant volume of cases to maintain clinical expertise and outcomes. Northern Ireland's patient population is not large enough to sustain a standalone paediatric cardiac surgery service, and children from the north have historically been referred to centres in Great Britain for this care. The plan to use the National Children's Hospital as an all-island resource for this service would provide Northern Ireland children with access to world-class care closer to home, while also helping to build the case volume that the Dublin centre needs to develop and maintain its expertise.
Discussions are also advancing on the creation of an all-island paediatric pathology service. Pathology — the laboratory analysis of tissue samples — is a critical component of cancer diagnosis and treatment, and the development of an all-island service would allow both jurisdictions to pool their expertise and resources in a way that benefits patients on both sides of the border. Enhanced cooperation on cancer treatment is also being explored, with both health systems recognising that the sharing of expertise, data, and facilities could improve outcomes for cancer patients across the island.
Northern Ireland Health Minister Mike Nesbitt has been a strong advocate for cross-border cooperation, arguing that the practical benefits for patients should take precedence over political considerations. His counterpart in the Republic has expressed similar enthusiasm, and the two ministers have met on several occasions to advance the cooperation agenda. The Shared Island initiative, funded by the Irish government, has provided some financial support for cross-border health research and planning.
Why It Matters
Cross-border healthcare cooperation matters because it has the potential to deliver real and tangible benefits for patients on both sides of the border. Northern Ireland has the longest NHS waiting lists in the United Kingdom — a situation that has persisted for years and shows little sign of improvement in the short term. The Republic has its own capacity challenges, with nearly one million people on hospital waiting lists. In this context, the sharing of resources and expertise across the border is not merely a political aspiration but a practical necessity.
The all-island approach to paediatric services is particularly compelling. Children are among the most vulnerable patients, and the quality of their care should not be determined by which side of a political border they happen to live on. The plan to use the National Children's Hospital as an all-island resource for paediatric cardiac surgery is a concrete example of how cross-border cooperation can deliver better outcomes for patients, and it provides a model that could be extended to other specialised services in the future.
Local Impact
For families in Northern Ireland whose children require specialist cardiac surgery, the plan to use the National Children's Hospital represents a significant improvement in access to care. Currently, these children must travel to centres in Great Britain — typically Great Ormond Street Hospital in London or the Royal Hospital for Children in Glasgow — for their surgery, a journey that is stressful and expensive for families and that separates children from their home communities during a period of acute vulnerability. Access to the National Children's Hospital in Dublin would reduce travel times significantly for families in border counties including Armagh, Down, and Fermanagh, and would provide a more culturally familiar environment for many Northern Ireland families. The Belfast Health and Social Care Trust has indicated it is working closely with the Children's Hospital Group in Dublin to develop the referral pathways and clinical protocols that will be needed to make the arrangement work in practice.
What's Next
The National Children's Hospital is expected to be fully operational by 2027, at which point the all-island paediatric cardiac surgery arrangement is expected to come into effect. In the interim, the two health systems are working to develop the clinical protocols, referral pathways, and data-sharing arrangements that will be needed to support the cooperation. The North-South Ministerial Council's health strand is expected to meet in the autumn to review progress on the cooperation agenda and to identify further areas where all-island approaches could deliver benefits for patients. The Shared Island unit has indicated it will provide additional funding for cross-border health research in the 2027 budget.
