Robin Swann
North Antrim · Ulster Unionist Party · Northern Ireland
“I thank the Minister for his detailed statement. I know how passionate he is about the subject and how many times he has brought it to the Executive.”
“It has been reported that today will potentially be the warmest day of the year. As we move into the summer and our summer holidays, I want to raise public awareness of wildfires across Northern Ireland, which have been detrimental to farmland and our environment over the past number of years.”
“Wildfires are still having a detrimental impact on our environment and, occasionally, on livestock, but that reduction shows the impact of the Northern Ireland Fire and Rescue Service's proactive approach to educating the general public and engaging with rural communities and schools on its fire safety message, which is to stay alert, not…”
“There has been a lot of talk of sport in this place over the past few days, with everybody concentrating on UEFA. One sport that is going on across Northern Ireland at the minute is cross-community and goes across all age groups without fear, favour or distinction: pigeon racing.”
“I want to put on record that, since this place passed the amendment that recognised pigeon racing as a sport under the 2016 Act, over the past five years, pigeon racing clubs across Northern Ireland have been able to obtain £113,000 of rates rebates through the sports and recreation rate relief, allowing many of those clubs to continue ra…”
“There was much coverage on social media over the weekend of an incident in Staines in England, in which a police car rammed a young calf to bring it under control. It has restarted the conversation about animal cruelty. <BR /> <BR />I am dealing with a specific case in my constituency.”
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“I thank the Member for her supplementary question. She may be aware that another Member has tabled that question for oral answer. I will give her an initial answer in regards to the work that is being done. <BR /> <BR />Women affected by the review in the Southern Trust will receive letters from the trust in the next few days to update them on progress and further timescales. I will update later, if we get to that question.”
“I thank the Member for her point and for her support on the issue, because I know where she is coming from. Having listened intently to the deputy First Minister's answers on the need for a recurrent Budget, I ask everyone in the House to fully support and endorse that. We have always been vocal that a single-year budget does not allow the Department of Health to do the transformational pieces nor commit in the long term to the strategies that were costed when they were produced so that people knew how much they would cost and what they would get for their money. I am looking forward in anticipation to see what budget I will get next year, before I make any commitments about ring-fencing any allocation, unfortunately.”
“<BR /> <BR />Going forward, there is undoubtedly more to be done, but, with long-term investment in our cancer services, I am confident that we can start delivering improved cancer outcomes for the people of Northern Ireland.”
“Those centres allow people who would not otherwise be eligible for a red-flag referral to receive an earlier diagnosis of cancer, and that addresses the major challenges in haematology. A review of the three main blood cancers has recently been completed, and an implementation plan is expected shortly. In addition, a review of adolescents and young adults' cancer support has been completed and draft minimum standards for the treatment of adolescents and young adults developed. My officials have also encouraged partnership working with the voluntary and community sector and have fostered new ways of working that relate to pancreatic cancer. As a result, Northern Ireland was the first part of the United Kingdom to commit to implementing the pancreatic cancer optimal care pathway.”
“I thank the Member for her question. I am glad to have been asked about the cancer strategy, as I consider it one of the most important documents currently in my Department. As Members will recall, it was published in March 2022 with the aim of transforming our cancer service to ensure better care for those who need it, when they need it. With the crisis in cancer services being so real and serious, I am always clear that it cannot be allowed to become yet another strategy sitting on a shelf. The absence of an Executive, unfortunately, limited some of the potential, but, thankfully, over £11 million of annual recurrent funding has enabled work to commence on delivery of some of the actions. <BR /> <BR />In December 2022, rapid diagnosis centres in Whiteabbey Hospital and South Tyrone Hospital saw their first patients.”
“I thank the Member for his point, and I know where he is coming from. However, it is not about taking refuge. It is about identifying to the House and updating Members on the process that has taken place in England, where they are looking at a phased implementation strategy over the next five years. I need to be clear that significant additional investment will be required to support the implementation of a hybrid closed-loop system for people living with type 1 diabetes. Again, it is about how we look towards the phased implementation of this and at what can be best learned from colleagues in England.”
“I thank the Member for his question on how we look at our overall service of supporting people living with diabetes and their carers and for mentioning the NICE guidelines on changes in support devices, should that be closed loops or CGMs, that we must ensure are taken into a wider piece of work on where we sit. As I said earlier in regard to NICE guidelines on some of those additional devices, we are seeing what is being done in England, where there is a phased roll-out. No work is ongoing on a specific strategy, but all the other steps that I have identified in the work that is being done in my Department show that we are committed to supporting people with diabetes as we see the evolving set-up for how their treatment can be supported.”
“I thank the Member for her point. I am not fully aware of the 2016 recommendation, but we are taking steps to support people living with diabetes, including the regional pump framework that we have set up, and also in how we look at other advances and support mechanisms, whether that is the closed-loop system or other systems. I will take that on board and get back to the Member.”
“Therefore, the most appropriate system for each individual is the responsibility of the health and social care trusts and their clinicians to determine, in consultation with the person living with diabetes and their carer. <BR /> <BR />The strategic planning group in my Department commissioned stand-alone CGM devices, and this is in line with identified commissioning needs within limited resources and as recommended in the NICE clinical guidelines for people living with diabetes. There are CGM devices currently listed on the Northern Ireland drugs tariff. Other more complex CGM devices are not currently listed on that tariff and cannot be prescribed by primary care. I will follow up with the Member. If she has written to me, I will ensure that she gets a response.”
“I thank the Member for her point, which is in connection with the previous supplementary. Those continuous glucose-monitoring (CGM) devices are steadily becoming a more in-demand way of monitoring diabetes control for people on intensive insulin therapy. There are many such devices available to support people living with diabetes. The NICE resource impact report on continuous glucose monitoring devices, published in March 2022, states:”
“That will allow me to understand the implications of that decision for overall provision, consideration of priority groups, system costs and workforce and communication requirements to enable and support that. The information will inform commissioning arrangements for Northern Ireland and final decision-making on the implementation by my Department. It is worth noting, however, that NHS England developed a five-year phased implementation strategy in response to the guidance. That decision was taken in response to the scale and scope of the recommendation.”
“I thank the Member for her query about the closed-loop service. In December 2023, as the Member stated, NICE updated its guidance with recommendations on the use of a hybrid closed-loop system. The guidance provides evidence-based recommendations on hybrid closed-loop systems for managing blood-glucose levels in type 1 diabetes. Subsequently, Department of Health medicines policy branch, which sits within my Chief Medical Officer's group, reviewed that guidance and formally endorsed it as being applicable in Northern Ireland. <BR /> <BR />In line with NICE guidance and the recommendation, work has been undertaken by my officials to develop an options appraisal.”
“<BR /> <BR />I am pleased to report that, following successful steps to support those experiencing the longest waits, in the context of having an available workforce, the regional insulin pump service will be fully operational from today, Monday 4 March 2024. Without doubt, there is still much work to do, but we have built firm foundations, and, most importantly, work has begun.”
“Our service goal is to provide equity, reduce variability and enhance outcomes for people living with diabetes across Northern Ireland. Centrally, quality of life is a key consideration in pump decision-making. I am proud to report that Northern Ireland is the first of the regions across these islands to have made quality of life a key criterion. <BR /> <BR />Following a formal commissioning process, Belfast Health and Social Care Trust was selected to deliver the service. A regional multidisciplinary team delivers the insulin pump pathway, connecting with local health and social care trusts to provide a high-quality service. In year 1, the service has begun a rebalancing exercise across the region. That directly supports the ambition to have equity as our chief priority.”
“In January 2022, I formally announced the setting up of the regional insulin pump service to mark the 100th anniversary of the use of insulin to treat diabetes. That announcement was supported by £200 million of funding by my Department to enable that life-changing service to be established. The investment makes provision for pump devices and the specialist workforce required to support people living with type 1 diabetes to receive insulin pump therapy. <BR /> <BR />The aim of the regional insulin pump service is to improve the lives of people living with type 1 diabetes, and it was co-produced with people living with diabetes, clinicians and healthcare professionals across all health and social care trusts, alongside Diabetes UK.”
“I thank the Member. Before I left the last time, I commenced a piece of work on not just recruitment but retention across all health and social care workforces and all structures, so not just junior doctors but nurses, AHPs and other professions. I do not have updated detail specifically on junior doctors. The retention piece was high-profile work that my Department undertook.”
“I thank the Member. In this morning's debate, we spoke about the support that we need to give to our all our healthcare workers, including junior doctors. In my initial answer, I acknowledged that further action at this time will be highly damaging, because it will mean not just the removal of the junior doctor workforce from our wards, A&Es and GP practices but their posts having to be backfilled by consultants and other doctors, who will have to be moved away from their service. That is why I, again, ask the BMA to recognise the financial limitations that Departments are operating under and acknowledge that further action at this time, before a final outcome on pay has even been reached, will be highly damaging.”
“I would like officials to further engage with the BMA and junior doctors on those ongoing issues. It is not just about pay. There is so much more that we can talk about to support them.”
“I thank the Member for her valid point. Since I have come back into office, I have had the same conversations with some of our consultants who have travelled to other hospitals to provide support and been put into the inadequate, substandard accommodation that has been used by our junior doctors. We have a duty of care to provide comfort to our junior doctors and other health service workers who have to work weekends and night shifts and all the rest of it. <BR /> <BR />I think that it was raised in yesterday's debate that junior doctors are concerned about the fact that they cannot leave behind personal possessions — coats, handbags, purses, wallets and all the rest of it — because they are in fear of them being stolen when they are on the wards providing a duty of care. That has been raised with the trust.”
“The Member's last point is valid. As I said in my answer to Mr Chambers about looking at the contract, it is about getting a balance between their basic pay and the supplements they get and realigning that, similar to the way it is done in England. A considerable piece of work has to be done on that. The last contract review was in 2002, which is over 22 years ago. Some of our junior doctors would not have been about at that time. Something can be done on the contract. <BR /> <BR />As regards the spend of other moneys, I will always make bids for areas in which I think the money can be spent. I received £550·6 million in regard to those pressure points to honour the 2023-24 pay awards, which I am moving to do.”
“I have already received evidence from trainees and employers that indicates that that system of payment does not adequately reflect the work that is undertaken. The contract was changed in England to recognise that. It introduced a higher basic pay and a lower variable rate, which has provided trainees and junior doctors with a more stable income. I would like to review that in any contract negotiations.”
“I thank the Member for that valid point. I am very keen to discuss a new contract for our trainee junior doctors. Their contract was last updated in 2002. It no longer reflects the way in which a modern health and social care system works. The current contract gives a trainee junior doctor a basic salary, with an additional supplementary payment for out-of-hours work and the frequency of weekends that are worked. That supplements the ranges that I mentioned by anything from an additional 30% to an additional 100%. That is added to their basic salary as a multiplier of their pay point, which has resulted in a lower basic salary and a higher variable supplement. That has led to a large variation in pay.”
“My officials continue to engage with the BMA. I have a call out to meet the chair of the BMA council next week, and that will be scheduled for discussion when we meet. I have always had a good working relationship with all the healthcare sector unions. Our workforce is at the core of what we do. I have always been, and I continue to be, open to engaging with them, but there has to be a two-way street.”
“I will be honest. It has been impactful on waiting lists. That is why I encourage junior doctors not to take that industrial action in March. I am aware that the ballot was taken while this place was not sitting. That is the point that the Member needs to reflect on: two years have been missed. The DDRB and Agenda for Change pay awards could have been implemented during the past two years, rather than being left until this late stage.”
“The Member raises a valid point. I am keen to continue that engagement with BMA across its central committee and across all other disciplines to make sure that we, as a health service, recognise the pressures that staff are under. That pressure is because not just of the financial situation that we are currently in but workload pressure. We recognise how much we ask of those in our workforce and how much we depend on them. It is about how we engage in all aspects of those negotiations. That is why I am content to continue that engagement with BMA.”
“That is why I have moved to implement DDRB, which has moved the junior doctors to where they are now. I also continue to engage with all my Agenda for Change (AFC) unions to make sure that I get a proper recompense to them, as supported by Executive colleagues.”
“I appreciate the political points that the Members has tried to score on this issue. I can assure him of my commitment to all our health and social care workers.”
“I thank the Member for his supplementary. I will deal with the last point first. I do not have any allocation for next year, never mind honouring the pay commitments that I am making this year. Of the £660-odd million that was given out by the Finance Minister this year, I received £550·6 million for those pay awards and other pressures, and that allows my Department to move forward.”
“The debate this morning clearly illustrated the need to ensure that no opportunity for capacity is wasted, and that is why I again appeal to the BMA to recognise the financial limitations in which all Departments are operating and to acknowledge that further action at this time, before a final outcome on pay has even been reached, would be highly damaging.”
“The agreement on the allocation of £550·6 million to my Department for pay awards and other pressures allows my Department to continue to move forward in its negotiations with unions, and we remain hopeful that a satisfactory solution for all parties can be reached. <BR /> <BR />It must be recognised that the funding will have to be shared across all the different sections of the workforce. The reality is that implementing the recommendations of the independent pay review bodies to mirror the 2023-24 pay settlements in England is at the very limit of what can be afforded at this point. As Members, we should also be very mindful of the impact that the significant disruption of further industrial action will have on a wide range of our core health and social care services, not least on elective activity.”
“As Members will be aware, there is a different contract in place for junior doctors in England, so precise like-for-like salary comparisons are not possible. Basic pay, however, is not the whole picture when estimating take-home pay for junior doctors: all junior doctors receive further allowances, ranging from an additional 20% to 100% of basic pay, depending on their rota. <BR /> <BR />My Department has also engaged with the BMA to discuss the way forward on outstanding issues. That includes a commitment to further engagement on pay, and this will, of course, be better informed when there is greater clarity on the outcome of the current industrial action being taken by doctors in England. However, my Department is committed to ongoing engagement. Extra funding has been secured for public-sector pay for this year alone.”
“I am acutely aware of the pressures faced by doctors and the concerns raised about pay. I have been clear that resolving the ongoing pay dispute is my immediate priority, and that is why I have tasked my officials to move to immediately implement the Review Body on Doctors' and Dentists' Remuneration (DDRB) recommendations for 2023-24 pay for all doctors employed in health and social care. <BR /> <BR />For junior doctors, that will bring an average pay increase of 9·07% in 2023-24, with those in their first year receiving a 10·68% uplift. That is not an insubstantial pay award when viewed across the public and, indeed, private sectors, and will be backdated to April 2023. The award will bring junior doctor basic pay above the level in Wales and closer to the rate in England.”
“— paediatric orthopaedics. <BR /> <BR />I thank the Principal Deputy Speaker for her support in bringing the motion before the House. I also thank the Members who tabled the motion and the entire House for its support.”
“<BR /> <BR />In the meantime, work is under way to provide further building blocks to tackle waiting lists. That includes plans for service reviews in —”
“<BR /> <BR />As Members will be aware, as part of the elective care framework, I introduced the Republic of Ireland reimbursement scheme (RoIRS) on 30 June 2021. In June 2022, I announced that the scheme would be extended beyond the planned deadline until an additional £5 million of new funding had been committed. The scheme closed to new applicants on Wednesday 21 September 2022 when that additional £5 million of funding had been exhausted. I assure Members that I will leave no stone unturned as part of my broader consideration of resource investment to reduce waiting lists. I will invest what limited funding there is wherever it will have the greatest possible impact. The task ahead will be much easier, however, if all parties do all that they can to support adequate and multi-year funding settlements.”
“That is essential. We must take all measures and use all resources within our means to ensure the effective delivery of services, and that includes the use of our independent sector. That is what we have been doing with the limited additional resources that have been deployed for waiting list initiatives. We need greater investment in this area, and we want to achieve results and the impact on waiting lists that the people of Northern Ireland need and deserve. Maximum efficiency in the use of the independent sector can, however, be achieved only with multi-year contracts or at least contracts for three years from when they are agreed. That will also provide better value for money.”
“The action plan to tackle waiting lists in the health and social care system already exists. I do not want to waste time replicating what is already clearly set out in the elective care framework, because enough time has already been lost. It is, however, almost three years since the plan was published, and, as with all plans, it is important that it be reviewed to ensure that it takes account of relevant changes in our overall Health and Social Care environment and is updated to reflect those changes. It is for that reason that I have tasked officials with reviewing the framework. That review is ongoing and will be completed by June of this year. <BR /> <BR />The motion also stresses:”
“Other initiatives are the expansion of our preoperative assessment service to improve theatre productivity; building our own diagnostic capacity to reduce the reliance on independent sector capacity; and building capacity and throughput across regional elective care services such as urology, paediatrics and orthopaedics.”
“I not only acknowledge that but stress that investment is fundamental to the whole backlog problem that we face. The initiatives, for which confirmation of sustainable funding would allow further development, include the enhancement of that sustainable workforce capacity through expanding the skills mix and the development of specialist nurse roles and the allied health professionals across a range of specialities.”
“<BR /> <BR />The Members who tabled the motion asked me to acknowledge:”
“I highlight to Members key examples that are already in place: two dedicated day procedure centres at the Lagan Valley and Omagh hospitals; three elective overnight stay centres at Daisy Hill Hospital, the Mater Hospital and South West Acute Hospital; the expansion of 22 post-anaesthetic care unit beds for elective care across all trusts; three speciality centres for cataracts at the Downe Hospital, South Tyrone Hospital and the Mid Ulster Hospital; an orthopaedic hub at Musgrave Park Hospital, including the Duke of Connaught unit, which is a dedicated orthopaedic day procedure centre; two rapid diagnostic centres at Whiteabbey Hospital and South Tyrone Hospital; a regional extracorporeal shock wave lithotripsy centre in Craigavon Area Hospital; service reviews in general surgery, orthopaedics, urology and gynaecology, which will set the direction of travel for improvement; the introduction and the maintenance of our mega-clinics to maximise patient throughput; outpatients' assessments delivered by GP federations in primary care settings; the development of in-house health and social care capacity; and the continued investment in staffing.”
“<BR /> <BR />We know that we need to transform our health and social care system to become more effective and efficient, and we know what is required. It includes reform and innovation in such areas as our treatment capacity, outpatient reform, imaging, pathology and workforce, along with the protection of elective care from unscheduled care demands. That work is already well under way, and elective capacity has been enhanced through the continued development of our elective care centres.”
“That includes dealing with issues such as workforce pay and the pressures and capacity in secondary, primary and community care, and ensuring that we maximise the capacity that we have in the system. <BR /> <BR />When we see those shocking figures and the appalling waiting times, there is an understandable desire to see them reduced immediately. That requires a whole-system approach and not just piecemeal interventions that can only deliver small improvements in the short term or in isolated areas. That does not mean that there are no short-term measures that can be effective, but the key is achieving the appropriate balance between the short-term effective measures and those longer-term sustainable developments that bring about the optimum effect.”
“The Member will appreciate that I do not have a direct answer today, but I will write to her about that. <BR /> <BR />Tackling our lengthy waiting lists is undoubtedly a long-term issue that requires sustained and recurrent funding. It requires workforce development and system-wide transformation. Our health and social care system is complex, and waiting lists are just one component, as has been said today when we expanded the debate to include domiciliary care, care homes and GPs. That whole-circle approach to health has to be addressed. As such, our waiting lists cannot be addressed in isolation. Other fundamentals of the system must be considered and addressed simultaneously.”
“There has been an improvement in the number of people waiting more than 13 weeks, with 78·6% of patients waiting more than 13 weeks for admission compared with 79·8% on 30 September 2022. Over-52-week waits have also been reduced regionally, although they still remain far too high. <BR /> <BR />It is important to acknowledge and build on improvements to ensure that any momentum is not just maintained but increased. Those improvements alone will not address the backlog.”
“<BR /> <BR />In addition to the backlog of patients waiting, new patients, of course, continue to be added. The gap between demand and capacity inevitably means that waiting lists continue to grow. That said, I want to put it on record that there has been some progress. The fourth interim report on our elective care framework, which was published in January, highlights the start of small but tangible improvements in the waiting list position. As of September 2023, inpatient or day case treatment waiting lists have seen some promising improvements. While they are still at unacceptable levels, there has been decrease of 8·4%, which is just under 11,000 people, in those waiting compared with the same month a year earlier.”
“<BR /> <BR />In the absence of an Executive and, critically, the absence of any budgetary certainty, the framework has since been starved of the political leadership and the funding that it required. Regrettably, as we were halfway through the five-year time frame, my Department announced last year that its targets were no longer within reach. The situation that we face at present is terrible. At the end of September 2023, as has been said, according to the most recent validated figures, 430,000 patients were waiting for a first consultant-led outpatient appointment, 115,000 patients were waiting for inpatient or day-case treatment and just under 190,000 patients were waiting for diagnostic tests. Those are eye-watering figures for a population of our size.”
“I was heartened by the fact that the framework was agreed by all Executive parties and that commitments were made that the necessary resources, as set out in the accompanying funding plan, would be made available. <BR /> <BR />While there has been some progress, which I will touch on in a moment, no one, including the proposers of this important motion, can have missed the damage that the subsequent further political stalemate and interruption have inflicted. On my last day in office in October 2022, after six months of a non-functioning Executive, I said that patients and staff were being badly let down by the politics of this place. I hope that we will see a renewed focus from the outset on where we move in regard to supporting health.”
“I thank the Chair of the Committee for her intervention, and I look forward to working with the Committee. The £1 billion that was promised was also in the party manifesto of the proposers of the motion. I have already made it clear that that £1 billion financial gap is also what my Department is highlighting for next year to allow us to stand still. I genuinely look forward to working with all my Executive colleagues on honouring the commitments that they have publicly made. <BR /> <BR />I also made it clear then that delivering on that plan would require sustained investment to tackle the backlogs and, as I said, increase the capacity in our health and social care system.”
“I agree with the Chair of the Committee that it should be fully resourced, with a multi-year budget. In that context, Members will recall that, in June 2021, I published an elective care framework, which detailed a five-year plan that had that dual focus on reducing waiting lists and, at the same time, closing the gap between capacity and demand. That framework, costed at £707 million, contained a range of actions — 55 in total — aimed at reducing waiting lists and improving capacity across our elective care system. It also set out how we would invest in and transform services to allow us to meet the population's demand in future. I made clear that delivering on that plan would require sustained investment to tackle backlogs and increase overall capacity in our health and social care system.”