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 will do my utmost. The Member asked that, I think, at the Health Committee. He mentioned the transparency and the challenge. The Member will also be aware that, since coming into office as Health Minister, I have announced public inquiries, under the Inquiries Act, into urology, neurology and especially into Muckamore Abbey. Work started on that inquiry in the past week. I encourage people to interact with that inquiry team. <BR /> <BR />Those three inquiries build on what I think all of us in the House want, which is for people to be reassured that the service that they get is safe, quality-approved and consistent, whether that is achieved through the different medical bodies, training colleges or professional standards. It is imperative that we give that reassurance and get trust back into the general population of Northern Ireland.”
“Again, workforce planning is ongoing. The Member knows that we set out a number of initiatives as a result of the 2026 strategy, which stated that there were to be three-yearly reports. The report that was due during this period has stalled due to COVID, but the one about workforce planning, additional nursing training places and the additional places and investment that we need to put in continues. I would like to be in a place to make an announcement about that, but I cannot give surety to the Member and do not want to mislead the House. That work will continue, however, and, if it is not done in this mandate, I can assure you that it will be ready for the next Health Minister, whoever that may be come 5 May.”
“A number of developments have been made with regard to stroke services, the accessibility of certain medications when it comes to stroke prevention or stroke reversal and how we support stroke patients <BR /> <BR />Apologies, Colm: what was the third area?”
“I thank the Member. Those are all major pieces of work that are either in the system or working their way towards my desk. I have received an initial response in relation to the duty of candour from the workforce and am considering what that can be. The question of whether I can make a fully informed decision between now and next Friday is challenging, given exactly what has to be done. I have to ascertain further sureties. <BR /> <BR />On stroke services, the Member will be aware that I have asked for additional work to be done on the numbers. At the start, the review of stroke services did not fully take into consideration the aging population in Northern Ireland.”
“<BR /> <BR />It is not about one part of the health service putting pressure on another; it is all under pressure. There is no spare capacity in our service that we can readily divert to help elsewhere. Especially over the last two years, we have all seen the health service come together and work as one, delivering for the people of Northern Ireland. It is challenging. The people who work in the health service know the pressures that they are under, but I have never seen a workforce, although tired and under pressure, that is more resilient, especially as we come out of this wave of COVID-19. The members of that workforce are keen to redress the situation and get back to the work that they want to do.”
“I thank the Member. He made reference to the specific point that was raised earlier about GPs and the work that they continue to do. A number of times in the House, I have addressed the misconception, or misperception in some cases, that our GP services are closed. The Member knows that they are not, but it is a narrative that is out there and that is hard to address. I would like to make sure that people are aware that there is access to GP services as necessary. <BR /> <BR />Recent figures on access to GP services indicate that, currently, practice teams carry out approximately 200,000 consultations weekly. Feedback from our GPs indicates that many patients, particularly those with chronic disease, are presenting with more complex needs, which is making it more difficult for GPs to see all the people who they would wish to.”
“There is no quick fix to this. No matter who you speak to across the medical professions, they will tell you that. It is about long-term development and investment, not just in our workforce but in our facilities, so that we can get on top of 10 years of underinvestment in facilities and workforce.”
“I thank the Member for his question. As he says, the hospital is in his constituency, but it borders mine and is a few miles from my home, so I am fully aware of the pressures and work undertaken there. <BR /> <BR />A trust or management team does not declare a potential incident lightly. Some members of staff referred to it as a flare-up, prompting the hospital to call and seek assistance. We have had a number of initiatives, especially over the past 18 months to two years, on how emergency departments work together through ambulance "smoothing". That is where ambulances are redirected to emergency departments, should there be spare and available capacity. However, there is not a lot of that in our emergency departments at the minute. <BR /> <BR />A major review of emergency medicine is due to be published shortly.”
“I can give the Member figures as of 31 December 2021, if he wants to make the comparison: 147,878 patients were waiting for a diagnostic service, of which 83,643 were waiting longer than nine weeks for a diagnostic test, and 49,632 were waiting longer than 26 weeks; 120,097 patients were waiting for inpatient day case treatment, of which 97,850 were waiting longer than 13 weeks, and 69,373 were waiting longer than 52 weeks. While the initiatives that I referred to see some of those figures hold steady, others are increasing. That shows how much the waiting list initiatives are needed, as an additionality to what we are currently able to provide in-house.”
“Unfortunately, because we do not have an agreed Budget, there remains a great deal of uncertainty about the implementation of the framework and for those patients who are waiting.”
“That is working extremely well and is supporting a range of specialties from across the region to undertake the most urgent clinical cases. We have also looked at opportunities to deliver more elective surgery on a regional basis, and we are exploring other units across the health and social care service. Those initiatives are aligned with the elective care framework that I published, which set out a five-year plan to systematically tackle the backlog of patients who are waiting. <BR /> <BR />I published an interim progress report on the actions in the elective care framework on 24 February. That report recognises the additionality of the non-recurrent funding that was made available in 2021-22 and was initially targeted at those patients.”
“I thank the Member for his point. The elective care framework that I announced at that time came with a requirement of £707·5 million over a five-year period. We were able to secure funding for the first year. The initiatives that were launched, and are under way, include the introduction of mega-clinics to maximise patient throughput; outpatient assessments being delivered by GP federations in primary care settings; a regional retention initiative for nurses and midwives; recurrent and significant use of the independent sector; the development of in-house health and social care capacity, including a workforce appeal and continued investment in staffing; and the implementation of green pathways and green sites. <BR /> <BR />Also in the elective care framework was the day procedure centre at Lagan Valley Hospital.”
“<BR /> <BR />The policy of making sure that those who need car parking are not penalised in any way is one that I support, but I want to ensure that such a policy is not abused. I hope that, in a spirit of willingness, we can meet the Bill sponsor, who picked up the private Member's Bill that Fra McCann introduced. Progress can still be made on that to benefit patients, visitors and the trust. There is a piece of work that can be done by the Department and trusts in partnership with the Bill sponsor.”
“Do not take that personally. <BR /> <BR />The Member referred to the private Member's Bill on hospital car parking charge. I have raised concerns about that, as have my Department's staff and trust officials, with the Health Committee and the Bill sponsor. I tabled a number of amendments at Consideration Stage, which were, unfortunately, not accepted in full. Those would have gone some way to addressing the concerns from a Departmental and trust point of view, and the Bill sponsor could have accepted them. We have tabled further amendments that, if made, will see a time frame brought in to allow trusts and the Department to introduce car parking charges that are in line with the intention of the private Member's Bill.”
“I thank the Member for his question. I look forward to the engagements across North Antrim that he mentioned, because they have always been engaging and positive, unlike those with some of our other constituency colleagues.”
“Should that service be removed due to insufficient funding, that team of staff would have to be redeployed into the corporate support services department. Free car parking will lead not only to a loss of income but there is potential for car park spaces, particularly on some hospital sites, to be used by commuters and staff as a park-and-ride facility. Patients and other service users may, therefore, be denied spaces when attending appointments with sick relatives. That issue has presented challenges to car parking provision on a number of hospital sites. There are also a number of hospital sites in the Northern Trust that do not charge for car parking, such as the Whiteabbey Hospital and the Moyle Hospital.”
“I thank the Member for his question. All income that is received from parking charges in the Northern Health and Social Care Trust is used for the operational upkeep of the car parking facilities. That includes the maintenance costs of parking assets, which include barriers, pay stations and CCTV. The removal of that income will require maintenance costs for car parks to be sourced from alternative trust funds. That will result in additional resourcing pressures and an inevitable impact on patient services. <BR /> <BR />Funding that is sourced from car parks also enhances security on acute hospital sites and provides a car parking team with a CCTV retrieval service as well as a car park patrolling function on the Antrim Area Hospital and Causeway Hospital sites.”
“That guidance will be for adults and young people who are post-COVID-19 patients and will be on safe and effective treatments for long COVID.”
“The Member will be aware of the standards in outcomes and practices that are being developed in Germany — I am not sure if she is directly referring to those — and that are already being accessed by some patients in Northern Ireland. The National Institute of Health and Care Excellence (NICE) is responsible for providing that evidence-based guidance and advice for public health and social care partners. <BR /> <BR />The post-COVID-19 services in Northern Ireland for managing long-term effects have been designed in line with the NICE guidance, and that guidance covers those who identify, assess and manage the long-term effects of COVID. Long COVID services in Northern Ireland will be continually reviewed and updated in line with any updates to NICE guidance.”
“We are seeing a slight delay in the establishment of our COVID clinics in the Western Trust, but that should not hamper the support that is available for patients.”
“I acknowledge the Member's point. There will be a further announcement of the next steps on MDTs and when we intend to roll those out. As I said in the Chamber last week or the week before, that will be dependent on the workforce and the commitment to financing over the next three years. The same applies to CAMHS. One of the things in the mental health strategy is the regional approach that we need to take to mental health when we reform it so that there is not a postcode lottery. Since coming into this post, I have been trying to make sure that there is not a postcode lottery across Northern Ireland, especially when we look to rebuild services, whether they are surgical, medical or mental health supports. <BR /> <BR />All trusts are progressing at a significant pace in the establishment of long COVID clinics.”
“At that point, I made £1 million of funding available for 2021-22, and a bid to maintain those services has been made as part of the budget process for the next three financial years, 2022-23, 2023-24 and 2024-25. The imaginative additional ones will look at how they can best intertwine their work with that of with our core delivery while we work in partnership with the voluntary and community sector. The Member will be aware that a core focus of the mental health strategy is how we work with our third sector partners to improve that service.”
“I thank the Member. She makes a point about the mental health supports that have been in place. The Member will be aware that that is why I established the mental health support fund. Charities and the voluntary and community sector are utilising that money to support individuals across society in a wide range of services. I have visited some equine support services, which provide great value to the patients who use them. I am not aware of the specific pet intervention that the Member mentioned, but, when I launched the dedicated assessment treatment service in November of last year, it was in recognition of the immediate need to establish those very important services.”
“Other elements will include bespoke pulmonary rehabilitation; a dysfunctional breathing service for patients with significant respiratory symptoms post COVID-19; additional support for COVID-19 and non-COVID-19 patients discharged from clinical care; strengthened psychology support to all trusts; and signposting and access to self-management resources.”
“From then to the end of January 2022, approximately 1,000 people aged 16 and over have been referred to the multidisciplinary assessment clinics across the region. Following consultation with paediatric specialists in Northern Ireland, post-COVID-19 services have been designed for people of 16 years of age and older, with the intention that children with persistent symptoms after diagnosis of COVID who require more specialist assessment can be referred to trust paediatric services in the usual way. COVID-19 in children is usually of a short duration, with relatively mild symptoms. However, I am aware that some children with COVID-19 experience prolonged illness and that the impact on them can be devastating. <BR /> <BR />The MDT clinic is one element of the suite of services being established for post-COVID-19 patients.”
“I thank the Member for her question. I appreciate that this continues to be a worrying and uncertain time for anyone who is experiencing long COVID, and I would like to take this opportunity to reassure Members that my Department fully recognises the need to provide support to those who are dealing with longer-term health impacts as a result of COVID-19 infection. <BR /> <BR />On 1 November 2021, I launched the first dedicated assessment and treatment service for post-COVID-19 syndrome in Northern Ireland, and those clinics allow people to have a comprehensive assessment of their condition and will help them to access the services and expert advice that they need to support them in their recovery.”
“I do not have that to hand now, but I will follow up on that for the Member.”
“The Member will also be aware that, in the meantime, we are looking at e-prescriptions, which can be easily transferred across all health sectors, especially into Community Pharmacy.”
“I thank the Member. I note her work as chair of the all-party group on community pharmacy and the engagement that she continues to have. I met the senior board and office bearers of Community Pharmacy last week to discuss how we look to the next three-year programme of work that it can do in partnership with us in the Department of Health and across the wider health sector. The Member is aware of Encompass, and I think that the Health Committee will receive an update in the near future on where that will be rolled out. The initial target is for it to be rolled out across all health and social care settings before we look at when it will be feasible and cost-effective to roll it out to the wider health family, which includes Community Pharmacy.”
“The curriculum of the graduate entry programme places a significant emphasis on primary care placements, with a high concentration on clinical placements in rural settings in the west. That will help to ensure that there is a supply of local students who wish to pursue a career in general practice in those areas. Other elements include the wider roll-out, as I said, of multidisciplinary teams, as well as the introduction of advanced nurse practitioners and additional general practice nurses, all of whom are making a difference.”
“My Department will continue to work closely with the Health and Social Care Board and GP representatives to consider how best to respond to the challenges that face general practices in Northern Ireland and to ensure that we have a GP workforce in Northern Ireland that is supported, motivated and sustainable, and that continues to provide quality care to patients. <BR /> <BR />We want to encourage even more highly capable medical students to choose a career in general practice. We recognise that positive experiences during clinical placements can have a major influence on such decisions. The commencement of the graduate entry programme at the Ulster University medical school in Magee is a significant development in that regard.”
“I thank the Member. I nearly set him up by referencing MDTs; he has been pushing my officials on that issue at the Health Committee. I hope to be in a position within the next week to state where that roll-out will be. <BR /> <BR />The Member mentioned GP services in the south-west. There have been significant GP workforce issues in the Western Trust area, particularly in the southern part. The Health and Social Care Board has been engaging with practices across the south-west area.”
“Work is under way to review the number of GP training places to ensure that we have the right number of GPs to meet our needs. That is part of a wider piece of work that my Department is taking forward to explore options for meeting our GP workforce needs in the most cost-effective way. It is important to note, however, that the increasing demand for primary care services cannot be met solely by increasing the number of GPs. It is also about other elements, including the wider roll-out of primary care multidisciplinary teams (MDTs) and the introduction of advanced nurse practitioners and additional general practice nurses. All that will make a difference to the way in which services are delivered in primary care and contribute to improved patient outcomes.”
“I thank the Member for indicating that this will probably be my last Health Question Time in this mandate. I will miss it greatly. <BR /> <BR />I do not put the blame for workforce planning and training at the feet of my Department. Having one-year non-recurrent budgets has made those challenges even more difficult. I fully recognise the need for additional GPs to be trained. As such, my Department, with the Health and Social Care Board and other stakeholders, has commenced work on reviewing the number of available training places for GPs in Northern Ireland. My Department has continued to invest in our GP workforce. It has increased the number of GP trainees by over 70% from 2015 levels. There are presently 111 new training places available for GPs each year.”
“<BR /> <BR />My Department recently commenced engagement with the GPC on the GMS contract for 2022-23. The negotiations are at an early stage. It is important to note, however, that GPs have continued to have a responsibility to provide core services to their registered patients and that the pandemic has not, in any way, negated that requirement. The service has been working hard to make best use of available resources for everyone seeking to access the care that they need.”
“There is scope, however, for optional and enhanced services to be negotiated annually in Northern Ireland between the Department of Health and the Northern Ireland General Practitioners Committee (GPC), and that allows us to identify local priorities for increased focus each year. Under the quality and outcomes framework (QOF), GP remuneration is tied to the provision of quality care against a range of clinically based indicators. At the outset of the pandemic, the Health and Social Care Board negotiated with the Northern Ireland General Practitioners Committee and my Department to stand down the QOF elements of the GMS contract in order to enable GPs to respond to the escalation of COVID by establishing COVID centres without suffering financial detriment.”
“GPs are often the first point of contact for many people seeking diagnosis, treatment and support. They play an important role in promoting health and well-being, supporting people to manage long-term conditions and coordinating patient care across specialities and sectors. They have also played a significant role in our response to the pandemic. That has included operating primary care COVID centres, undertaking an extended flu vaccination programme and playing a key role in the roll-out of the COVID-19 vaccine programme. <BR /> <BR />The general medical services (GMS) contract sets out the core elements of what GPs must provide to their patients. It is an agreed contract that covers all four nations of the United Kingdom.”
“I thank the Member for his additional question. At the end of my initial answer to him, I pointed out that the Finance Minister leads on negotiations and the fiscal policy regarding EU replacement funds. My Department continues to be supportive of the work being done. <BR /> <BR />Minimal information has been shared on the UK Shared Prosperity Fund's being able to match the required funding and infrastructure models that were previously met. Although the levelling up White Paper was published in February 2022, it lacks any confirmation of the quantum of funding for here to replace that £80 million a year. The Finance Minister is leading on that work. We have not had any direct engagements about organisations being funded by us or the ESF, because that fund is not directly managed by my Department.”
“The Finance Minister leads on fiscal policy and the negotiation of EU replacement funding with the UK Government. My officials continue to engage with the Department of Finance and Whitehall colleagues to ensure that the UK Shared Prosperity Fund will replace funding gaps created when the ESF ends. Officials continue to engage proactively with the Department for Levelling Up, Housing and Communities on that issue through established channels, and we will continue to make representation through the Department of Finance.”
“That is dependent on organisations securing the necessary match funding. Beyond that, arrangements post ESF remain unclear. That includes the role of the UK Shared Prosperity Fund as its replacement. The total value of ESF projects that specifically supported the disability sector is in the region of £15·6 million, and that supported 21 individual projects. Most projects have sufficient match funding in place to proceed after 1 April 2022, but I understand that a small number still have match funding gaps. All have a minimum of 81% of the funding in place and could be scaled back if necessary.”
“I thank the Member for his question and his enthusiasm. For over three decades, the European social fund (ESF) programme, funded by the European Commission, has been a key source of funding for disadvantaged people, including the long-term unemployed; ex-offenders; young people not in education, employment or training; and people with a disability. The ESF has enabled people with a wide range of disabilities to access and stay in supported employment, and that helps trusts to meet their strategic priorities as set out in the draft Programme for Government framework and related Regional Health and Social Care Board service delivery models. <BR /> <BR />The fund was due to finish at the end of March 2022, but the programme has been extended under ESF call 3 until 31 March 2023.”
“<BR /> <BR />One of the benefits that we have in Northern Ireland is that the Northern Ireland Fire and Rescue Service is under the Health portfolio. That is an advantage that many of the other areas or devolved nations do not have. We can see that co-working coming together a lot more efficiently. I would like to see the initiative that is referred to as Maggie's call rolled out as soon as possible.”
“The Member is touching on the initiative that has been referred to as Maggie's call and what we have been able to do in Carnlough station, initially, where we have seen the Northern Ireland Ambulance Service and the Northern Ireland Fire and Rescue Service coming together in response to a cardiac call. It is a system that has been progressed to the point where we have been able to launch it in Carnlough. It is something that I would like to see rolled out across all our stations, both retained and full-time, so that we can see the blue-light services of ambulance and fire brigade working hand in hand, especially in the areas that they can, such as cardiac response. It is the start of what I think can be a development.”
“I thank the Member for that point. I visited the Northern Ireland Ambulance Service towards the end of last week when the last cohort of its internally trained paramedics were coming through. Their enthusiasm, commitment and desire to be part of the NIAS workforce was a credit to them, their trainers and also the service and the investment that it is making to support the people of Northern Ireland.”
“There was ongoing engagement with the Northern Ireland Fire and Rescue Service (NIFRS) board and the main union on what is addressed as Maggie's call. We were in a position to go ahead with the Carnlough station as the first responder to Maggie's call. That was supported by the workforce in that station and joint working between the NIFRS board and the NIAS board. Those concerns were addressed at that point, and an additional concern has been addressed by the Fire Brigades Union at, I think, head office level rather than local level.”
“The assistance of voluntary and private ambulance services has been key in freeing up NIAS resources to respond to life-threatening or serious calls by providing crews to respond to low-acuity calls. I understand that, although crews respond to calls, Ambulance Service call handlers, including highly skilled paramedics, are available to provide telephone advice to callers.”
“That was the rationale behind the development of a new CRM, which ultimately aims to put in place a much more resilient workforce and a much more sustained performance against response-time targets in the longer term. In the past two years, those pressures have increased owing to higher rates of staff absence, the number of staff vacancies and the ongoing issues with lengthy patient handovers. Those handover issues are linked to a lack of capacity and patient flow right across our system. <BR /> <BR />In the meantime, I am aware that NIAS is recruiting and training as many additional staff as possible within the available resources and has diverted considerable resource from its non-emergency transport service to its accident and emergency response.”
“I thank the Member. I hope that he was trying to be flippant when he compared the Northern Ireland Ambulance Service to Domino's Pizza and was not undermining the Ambulance Service staff, who do an amazing job. <BR /> <BR />First, I recognise the hard work and commitment of NIAS staff, particularly in the past two years, when, in common with those in other areas of the health service, they have faced increasing demands on their services and challenges in achieving targets. Even prior to COVID-19, NIAS was experiencing steadily rising demand without its being matched by investment, and that made it increasingly challenging for it to meet performance targets consistently across all categories.”
“Although approval of the business case is entirely subject to additional recurrent funding, the funding required to deliver the CRM was introduced in my Department's additional funding requirements as part of the Budget 2022-25 exercise. <BR /> <BR />As Health Minister, I remain extremely concerned about the current uncertainty over the three-year Budget planning exercise as a result of the absence of a functioning Executive and the delay that that is likely to cause for key programmes such as the CRM. That will undoubtedly affect patient care. It is therefore vital that clarity be given on the Budget as soon as possible. In the meantime, the Northern Ireland Ambulance Service continues to recruit and train as many staff as possible within the available resources and to prioritise calls in line with the new CRM.”
“<BR /> <BR />The first key milestone in the CRM programme was achieved when NIAS introduced new evidence-based response targets, and that was done on 12 November 2019. Although there were some initial improvements in the response times to immediately life-threatening calls, overall performance across all call categories will not see sustained improvement until significant additional resources are in place. <BR /> <BR />My Department is currently reviewing a final draft outline business case (OBC) that was received from NIAS in December 2021 for the required investment. That will shortly be submitted to the Department of Finance for further consideration.”