Beyond the Border Poll: Why Regulatory Convergence Matters Now…

After a lifetime in pharmacy and healthcare politics, in which I like to think I was able to hold my own, I now realise I vigorously avoided engagement with politics more generally. For good reason, too. I knew no matter how difficult health politics might be, party politics is a wholly different game and fraught with more pitfalls and dangers. From my teenage years I had little love for party politicians and where 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.

In N. Ireland, especially in the years I grew up, party politics and religion were so firmly welded that it was impossible to have rational and civil discussions on deeper issues and for those who did and whose job it was, 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 of 1998 was that point. (Seamus Mallon rightly said it was the Sunningdale Agreement for slow learners). A masterfully deceptive document, the GFA allows two views of N. 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, 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 so much a safer term than United Ireland, a slogan many 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.

Fintan O’Toole makes a case that many of the reasons for the creation of N. Ireland one hundred years ago, no longer exist. Ireland, one of the most liberal places in Europe, is no longer the Catholic State that northern Protestants needed protection from. A Protestant majority in the N. Ireland, essential in 1922 and the reason Donegal, Monaghan and Cavan were set adrift from the new state, no longer exists. Finally, there is no longer strong support for the Union from British political parties who were happier to deliver Brexit. For this latter reason, there is a border down the Irish Sea which requires me, for example, to complete torturous documentation for certain medicines I get from Great Britain. This outcome is the consequence of Brexit, which ironically makes the case for Irish Unification more practical and logical when the plan initially was that Brexit would strengthen a border on the Island.

Yet the Brexit project provides a very clear warning. Simply asking a population to vote in a referendum when the details of what is being voted for or against is not only unclear it is largely unconsidered. Brexit was a foolish and destructive thing to do and as it turns out 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 landed in reality. The objective that Sinn Féin promotes for a Border Poll where 50% + 1 means yes or no, would be, like Brexit, a disaster and possibly much worse, a violent disaster. As is largely agreed all the people of N. Ireland need to be persuaded that this project would be in the round a good thing for all of us.

Most civil and professional institutions on the island will need revamped and it needs to be made clear how they will function if a new political entity on the island is to emerge. This work must begin now with open and free discussion.

For me the question of how pharmacy would be regulated is a question for the profession North and South. It needs serious consideration at this time not when there is a scramble to catch up and implement.

I have already discussed on this platform how the Pharmaceutical Society of N. Ireland 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 a local group of pharmacists that ensured there was a separation of professional standards setting on the Island 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 representatives of pharmacy bodies. Pharmacists across the island were first regulated and controlled by the Pharmacy Act of 1875. This Act set up the Pharmaceutical Society of Ireland (PSI) and all pharmacists north and south were licensed by it. The Pharmaceutical Society of N. Ireland (PSNI) was set up by the Pharmacy and Poisons (N. Ireland) Act 1925. The aim of PSNI was similar to the parent body PSI, to ensure regulation of pharmacists, including 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 the PSNI to acquire membership of IPS and vice versa. Now many pharmacists enjoy free movement to practice 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 N. Ireland.

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 and there may be others.

Regulation of pharmacists and pharmacies will simply come about through an amalgamation of the two Societies. As each organisation is currently different, there will need to be convergence on how a new single body operates. This will require a new legal framework but that will be easy enough to create. But there is a need to have these discussions now and for each other professional regulatory bodies to likewise begin this conversation. If there is to be a new arrangement on the Island of Ireland, the public deserves to have confidence in how it will all fit together and continue to be to the public benefit.

So, there it is, 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 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.”

Mark Twain.