By Andrée Murphy.

As the debate on a united Ireland gains pace, while simultaneously the debate on Brexit grows ever more toxic, there are lessons for us all.

With Brexit we see the results of holding a referendum where there is no clear plan for what happens afterwards. In Scotland we saw the arguments for independence founder on the single question of what currency would be used in Scotland.

Here in Ireland, as we speak of a united Ireland, both of those examples are used in an attempt to persuade us that the time is not right for a border poll. Because there is no clear plan of implemented policy as to what a united Ireland would look like, the demands for a border poll are rubbished.

Of course, that is an excuse from many who never want to see a border poll at all or who view the growing coherent expression of Irish citizens for Irish self-determination as a threat to their cosy status quo. But as with many obtuse arguments, there is a element of truth to it that deserves attention.

Those of us recommending a border poll should put together a recognisable set of aspirations so that citizens can vote for something if and when the question is put.

Top of that list is what healthcare on the island should look like.

While there is discussion on the many economic gains that a united country would bring, for Irish citizens living in the North facing a united Ireland, there is a real and entirely valid fear that they will lose a national health service (the NHS) only to settle for the crisis-ridden service in the South.

Many of us who try to persuade for a united Ireland state that a new Ireland can mean a new health service. But this is easy to say. There have not been studies carried out to demonstrate how this can be realised, what this would mean in practice. A few articles, particularly on freedom of movement of nurses, have been written, but there is a need for more.

Efforts could be made to commission academic studies on how an all-Ireland health service might be developed. There is no reason why a scoping exercise could not take place, which would quantify the potential support in the South for an Irish national health service and the changes that would need to take place to make that happen.

In theory, with services such as children’s cardiac services and cancer care already being shared on the island, there is precedent for how this can be developed. Patients already travel south for procedures which face lengthy waiting lists or are not available in the North. These procedures are in theory paid for by the NHS, although it is rarely so straightforward. However, the rubicon has been crossed. All-island healthcare is possible.

Radical change as per the Bengoa Report needs to be implemented in the North. The failure to reignite the Northern institutions has prevented that from happening to date. Instead, we have creeping privatisation in the guise of addressing waiting lists and need – a pretence that hides the undermining of public healthcare.

In the South there is review upon review spun out as the Southern establishment struggles to establish an appropriate cost-effective service, instead relying on a public-private hybrid model. There have been decades of perpetual crisis, which sees Renaissance Ireland left with second-rate health statistics.

All-island review could be timely even without the united Ireland debate. However, it is an essential element of a strategic platform to persuade in that debate. Those efforts should come from the Irish Oireachtas.

However, if such an effort is not forthcoming from the political parties that resist all-island change then it should be initiated by those who are unafraid.

Civic and political spheres who are attempting to create a positive debate on unity should approach healthcare with the same vigour as they have the economy and citizens’ rights. After all, healthcare is an intrinsic part of the wealth, economy and rights frameworks of any country.

Andrée Murphy is a Belfast-based commentator, writer and regular columnist with the Andersonstown News. Her blog can be read here.

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