Ireland-Australia Digital Health Exchange Wrap Day 3

After crossing from Northern Ireland and into Ireland the delegates began asking themselves the key question:?

Which market should I prioritise... Northern Ireland or Ireland??

When deciding between settling in Northern Ireland or Ireland, Feargal McCormack , Managing Partner at FPM Accountants, informed us these are the five things that people typically consider:

1. Technical expertise, and skills required: for example, Belfast has globally leading expertise in cyber security. The labour force of all of Europe is theoretically available in Ireland (no work visas etc.). The map below is an outline of the areas of skills clusters in Ireland.
2. Is the business people heavy? Wages are lower in Northern Ireland and staff retention rates are higher.?
3. Will the business be high profit? Ireland has attractive tax systems. In Northern Ireland, the corporate tax rate is around 25% with income tax around 45%, while in Ireland company tax is 12.5%. Businesses must have a “permanent establishment” to qualify but this does not need to be a HQ.
4. Will the business be capital intensive? Likely to be a better incentive in Northern Ireland.
5. Are you selling a product? If you are selling a good from Northern Ireland, you can sell to both the UK and EU thanks to the Windsor framework (see below for Keiran Daly's additional considerations for these markets).

Why Ireland?

• Ireland has consistent policies on tax, visas and spending to provide certainty to business.
• Ireland is the 7th most competitive economy in the world.
• Ireland is already home to 195 companies engaging in digital health, 450+ MedTech companies (including 9 of the top 10), 100+ pharma companies (including all 10 of the top 10), and 900+ tech companies (including 16 of the top 20). Partnerships play a vital role in the success of digital health businesses and solutions.
• Business-friendly government, policies and incentives.
• Low tax rate.
• English-speaking access to the EU.
• Ireland is super flat, and it’s easy to access people, including major stakeholders and government, and payers.
• Ireland has the youngest population in Europe, but also the most rapidly ageing with a 35% increase in the ageing population.
• Ireland has the highest life expectancy in Europe, and with budget in surplus is keen to focus on early intervention and prevention.
• There has been a large commitment of capital spending recently with three new elective hospitals and six new surgical hubs budgeted.?

Former Federal Chief Medical Officer, and now partner at EY, Ronan Glynn, candidly took us through some of the challenges and opportunities in the Irish healthcare sector and answered the delegates' questions about the system:

• Public < > Private balance: around 45% of the population have private hospital insurance. Like Australia, there are some tax loadings that incentivise this. An estimated 15% to 20% of the health system activity is delivered privately.?
• Ireland is phasing out the current practice of treating private health patients in public hospitals.
• This will result in an increase in the number of private healthcare facilities and potential opportunities in these new facilities.
• New 2023 Slaintecare Action Plan reforms are currently underway to improve the healthcare delivery structure in Ireland. Currently, underneath the Health Service Executive (HSE), there are six hospital networks and nine community health organisations. Improvements are coming which will map Hospital Networks geographically to 6 community health organisations, streamlining care.
• The Irish government is increasing free access to GPs, lowering the free GP age below the current 65 years.?
• Opportunity: With more GPs required, an increase in the number of private telehealth GPs is predicted.
• Unfortunately, Ireland does not have a national digital healthcare record and very poor interoperability. By 2030, all EU citizens will have to have access to a shared care record and €2 billion have been earmarked for hospital electronic health record.
• There is a new pilot pathway that has only just had its first cycle called “Innovation Evaluation Panel” (IEP) This panel meets to assess innovations and create a pathway to a business case and link with HSE support for piloting.

Ronan’s top tip is to get through the IEP and have a clinical champion.

“In Ireland, having strong clinical advocacy is crucial.”

A green theme to note:

Ireland, and indeed the EU, have a much more sophisticated and mature understanding of sustainability. Many sustainability things are mandated, and sustainability affects purchasing decisions. Companies entering the Irish market must consider sustainability and check which mandated sustainability items will affect their business.