What would Irish reunification mean for pharmacy and the general population, wonders Terry Maguire
Vote early, vote often
Up North, even if we pretend that we aren’t, we are watching with considerable interest the election for the President of Ireland. We just love elections. At the time of writing, the outcome is unknown but one candidate is very clear on her wish to have a border poll on unification during her Presidency should she win. The other candidate has impressive Ulster credentials that might see her more opposed to a border poll should she take up residence in Phoenix Park.
Now you might say that pharmacists in pharmacy magazines should perhaps stick to matters pharmacy — but sometimes the bigger picture does come into our sphere of comment, and perhaps this is one such time, as it might have implications for pharmacy.
Don’t talk politics
After a lifetime in pharmacy and healthcare politics, in which I like to think I was able to hold my own, I now realise that throughout my professional career, I vigorously avoided engagement with political matters. For good reason too. I knew no matter how difficult health politics might be, party politics is a wholly different game, fraught with more pitfalls and dangers.
From my teenage years I have had little love for party politicians and when I have strong personal political convictions, like most, I choose to follow Mark Twain’s advice to “never discuss politics or religion in polite company”. No matter how certain one is in one’s views, in politics and in religion, it is too easy to make enemies even with a well- intentioned proposition. On the other hand, maybe this is just cowardice.
Too political
In Northern Ireland, especially when I was growing up, party politics and religion were so firmly welded that it was impossible to have rational and civil discussions on deeper issues. For those who did (and for some it was their job), it was too often corrosive and destructive. But to some of them, I am grateful. Their perseverance and tenacity shone through and they helped us reach a point of peaceful agreement.
The Good Friday Agreement (GFA) of 1998 was that point. (Seamus Mallon, the SDLP deputy leader, rightly said that the GFA was the Sunningdale Agreement of 1974 for slow learners). A masterfully deceptive document, the GFA allows two views of Northern Ireland to exist at one time. Both traditions are assured that their long-held values, traditions, and perspectives are enshrined with the necessary guarantees and respect.
Listening recently to a talk by journalist and author Fintan O’Toole at Keele University, I was coaxed into thinking beyond the safe politics of pharmacy and health to the wider politics to be addressed, if indeed we move to a New Ireland. ‘New Ireland’ is a safer term than ‘United Ireland’, a slogan most middle- class professionals from a catholic and nationalist background avoided and largely still do, in spite of wishing for it. But things have changed and it is easier to at least consider and discuss this prospect and not feel like a drunk at Rebel Sunday in the Rock Bar on the Falls Road.
The Brexit effect
O’Toole makes the case that many of the reasons for the creation of Northern Ireland 100 years ago no longer exist. Ireland, one of the most liberal places in Europe, is no longer the Catholic State from which northern Protestants needed protection. A Protestant majority in the North, essential in 1922 and the reason Donegal, Monaghan, and Cavan were set adrift from the new State, no longer exists.
Finally, British political parties no longer strongly support the Union — they were instead happier to deliver Brexit. For this latter reason, there is a border down the Irish Sea which requires me, for example, to complete tortuous documentation for certain medicines I obtain from Britain. This, of course, is the consequence of Brexit that, ironically, now makes Irish Unification more practical and logical, when the plan initially was that Brexit would strengthen the border on the island.
Yet Brexit provides a very clear warning on what can happen from asking a population to vote in a referendum in which the details are unclear. Brexit was a foolish and destructive thing to do and has become an act of considerable self-harm. So, if the reality of a New Ireland, or a United Ireland, is to be achieved, there will need to be some serious and grown-up discussions about how that project might be grounded in reality. A border poll, such as promoted by Sinn Féin, in which 50 per cent +1 means ‘yes’ or ‘no’, would be, like Brexit, a disaster and possibly much worse, a violent disaster. As is largely agreed, most of the people in the North need to be persuaded that this project would overall be a good thing for all of us.
Most civil and professional institutions on the island would need be revamped in a New Ireland and it needs to be made clear how they will function. This work must begin now with open and free discussion.
Healthcare on the island
There is already considerable sharing of healthcare resources between the jurisdictions. Neonatal cardiac surgery for all of Ireland is commissioned in a specialist unit in Dublin. This works well, as does the commissioning of cancer services from Altnagelvin, Derry, for people living in parts of Co Donegal. In addition, through a European directive, patients in the North can access surgery in the Republic (as they can in any part of Europe) and have the cost of the surgery refunded by the NHS.
However, these are small steps compared to the challenge of creating and envisioning an all-island healthcare system that ensures fair access to all citizens on the island. Yet, would it be really that difficult, through a commissioning process where the commissioners can recognise and be assured of the quality of services provided, to have a system in place in short order. The more that Northern Ireland moves, mainly by stealth, to a semi-private health system due a lack of funding and investment for over 15 years, the more there will be a fit with the Health Service of the Irish State.
The partition of pharmacy
For me, the question of how pharmacy would be regulated is a question for the profession both North and South. It needs serious consideration at this time, not when there is a scramble to catch up and implement.
I have previously in this column discussed how The Pharmaceutical Society of Northern Ireland (PSNI)
came into existence in 1925. It was the inactivity of the existing Pharmaceutical Society of Ireland (PSI) in Dublin at that time, perhaps by being too polite, and the prompt passionate action of local groups of pharmacists that ensured there was a separation of professional standards in Ireland as the new state of Northern Ireland came into existence.
In 1924 a Ministry of Home Affairs conference on the future of pharmacy in Northern Ireland was held with the representatives of pharmacy bodies. Pharmacists across the island were first regulated and controlled by the Pharmacy Act of 1875. This Act set up the PSI and all pharmacists North and South were licensed by it.
The PSNI was set up by the Pharmacy and Poisons (Northern Ireland) Act 1925. The aim of the PSNI was similar to the parent body PSI — to ensure regulation of pharmacists, including the provision
of pharmacy education, in the newly- formed State. From a conference to an Act in 12 months was pretty impressive by any government standards.
That separation was firm until the 1970s, when European free movement directives were introduced and it was possible for those registered with PSNI to acquire membership of IPS and vice- versa. Now many pharmacists enjoy free movement to practise across the Island in spite of regulatory divergence in medicine and healthcare legislation. What Brexit might mean for this free movement
has surprisingly never been discussed. Wages in the Republic are much higher now so, at times, free movement creates a shortage of pharmacy manpower in Northern Ireland.
Regulatory divergence
Regulatory separation in the 1920s didn’t happen to the accountancy profession, where an all-Ireland regulatory body continued to exist following Partition and — in spite of significant regulatory divergence in the law, tax, and practice — there still exists a common regulatory body for accountants. There has always been a Northern committee that tends to mitigate regulatory divergence and support practitioners. Journalism also has a common body.
Regulation of pharmacists and pharmacies will come about through an eventual amalgamation of the two Societies. However, as each organisation is different, there will need to be convergence on how a new single body would operate. A new legal framework will be required, but that should be straightforward enough to create.
But these discussions need to start now, and likewise for each other’s professional regulatory bodies. If there is to be a new arrangement on the island of Ireland, the public deserves to be confident in how it will all fit together and be of public benefit.
So, I have ventured beyond my comfort zone and area of competence to discuss politics more generally and in ‘polite company’, I might regret it.
I therefore must again take comfort from Mark Twain, who suggests that serious objection and vicious criticism, if it comes, might be from ideology and its staunch ally, ignorance.
“In religion and politics, people’s beliefs and convictions are in almost every case gotten at second-hand, and without examination, from authorities who have not themselves examined the questions at issue but have taken them at second- hand from other non-examiners, whose opinions about them were not worth a brass farthing.”
Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.
