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 Chair, Deputy Chair and members of the Health Committee for their contribution to the debate. I will make a few comments on the contributions made. Mr McGrath said that we must put our trust and optimism in the scientists and virologists as they seek to develop our medications, as we did especially during the development of our COVID vaccines. Others talked about the ability to improve access to the specific medications that are being brought forward. My officials and I look forward to engaging with Ms Bradshaw, through the APG on rare disease, on how moving EAMS on to a statutory footing can make a difference. The statutory scheme will continue to be open to any medicines that meet the EAMS criteria.”
“The new regulations allow us to build on that solid foundation and to deliver a scheme that goes even further in boosting access to life-changing treatments while, at the same time, enhancing safeguards to protect patients and driving forward opportunities for innovation and the development of new medicines. <BR /> <BR />At an evidence session with my officials on 3 February 2022, the Health Committee was content with the policy intent of the draft regulations, and on 24 February 2022, the Committee raised no issues with the content of the regulations. With the Committee's support, I commend the draft regulations to the House.”
“Overall, there was broad agreement, including from Northern Ireland stakeholders, that introducing the core principles of the EAMS on a statutory basis would provide legal clarity, which would benefit industry, patients and healthcare professionals alike. While some respondents focused on the procedural elements of the scheme, it is intended that those will be addressed through the provision of updated, bespoke EAMS guidance to supplement the new provisions. <BR /> <BR />The EAMS has already demonstrated its enormous value in transforming the lives and health outcomes for hundreds of patients throughout the UK as a whole. Already this year, scientific opinions for new, innovative medicines to treat sickle cell disease and chronic myeloid leukaemia have been issued.”
“Following extensive stakeholder engagement and a public consultation, it is now proposed to amend the HMRs in order to, first, provide clarity around EAMS medicinal products and establish EAMS licensing authority functions; secondly, to allow for the manufacture, assembly, importation, distribution and supply of EAMS medicinal products; thirdly, to set out pharmacovigilance compliances; fourthly, to introduce the new and important arrangements for the collection of real-world data; and, fifthly, to provide for transitional arrangements prior to the regulations coming into force. <BR /> <BR />A UK-wide consultation took place on the proposed amending regulations during August and September 2021. My Department ensured that the consultation was circulated as widely as possible in Northern Ireland.”
“<BR /> <BR />Placing the EAMS on a statutory footing allows us to maximise the benefits of this valuable scheme for patients and pharmaceutical companies, ensuring that the EAMS remains an attractive option for companies to provide medicines to patients prior to licensing. It will also make the EAMS more visible to those who are developing medicines and will ensure that the UK remains internationally competitive in the pre-market medicines access landscape. <BR /> <BR />It is proposed, therefore, to mandate the scheme by making specific legislative provisions for the EAMS in the human medicines regulations (HMRs).”
“Approximately 500 patients with advanced melanoma received that medicine when no other treatment was available to them. <BR /> <BR />It is, however, the case that, at present, there is no UK legislation that specifically covers EAMS, and the scheme is entirely non-statutory. The supply of EAMS products is regulated by exemptions in the Human Medicines Regulations 2012 that govern the supply of unlicensed medicines in certain circumstances. Those regulations have a much wider remit and are not tailored to EAMS specifically. There are some aspects of EAMS that would benefit from clarification in law.”
“Significant numbers of patients in all parts of the UK, across a range of conditions including cancers and rare diseases, have benefited from more than 40 scientific opinions issued by the regulator. During the EAMS period, the EAMS medicines are provided by the company free of charge to Health and Social Care (HSC). Once a marketing authorisation has been granted, arrangements are put in place for existing patients to continue to receive supplies free of charge. Access to new patients is governed by existing HSC processes for the managed entry of new medicines into the health service. <BR /> <BR />Even just one new product made available through the EAMS can benefit hundreds of patients. For example, through EAMS, UK patients were amongst some of the first in the world to access the breakthrough treatment of pembrolizumab.”
“I am seeking the Assembly's approval of the regulations, which will put the existing early access to medicines scheme (EAMS) on a statutory footing. <BR /> <BR />The EAMS aims to give patients with life-threatening or serious debilitating conditions early access to promising new medicines that do not yet have marketing authorisation. Under the scheme, the Medicines and Healthcare products Regulatory Agency (MHRA) gives a scientific opinion on the benefit-risk balance of using a medicine. That opinion provides independent assurance to prescribers, who may wish to prescribe an unlicensed or off-label medicine in cases where there is an unmet medical need. <BR /> <BR />Since its inception in 2014, the EAMS has acted as an important regulatory flexibility for early access.”
“Those programmes are well-established in the public health response to many concerns in Northern Ireland. <BR /> <BR />I commend this SI to the House.”
“I thank the Health Committee Chair, Deputy Chair and members for their contributions. The importance of the vaccination programme has been well rehearsed, not just today but throughout the past number of months. I thank Members for their contributions and for how they approached the SIs. I have heard the SIs described in the past, and in this debate, as offering a practical and flexible approach and as sensible and efficient, and that is why I thank Members for supporting this SI. <BR /> <BR />Ms Bradshaw encouraged everyone to come forward and take the opportunity to get vaccinated. That applies not just to the COVID vaccine, should that be the first, second or booster dose, but to our flu vaccine programme, our HPV programme and all the school programmes, including meningitis programmes, that we have running.”
“<BR /> <BR />Finally, and before this important debate is opened up, I firmly believe that these provisions are vital and should be made permanent or extended as proposed. The vaccination programme in Northern Ireland has made extensive use of the flexibilities, and their cessation, even if temporary, would cause significant disruption to the programme. If the regulations are approved by the Assembly and by each House of Parliament, the provisions will be extended or made permanent, as I outlined, and will continue to apply after 31 March. Officials from the Department of Health and Social Care advised that the regulations will be debated in the House of Commons on 8 March and in the House of Lords on 15 March. I commend the motion to Members.”
“Both provisions that have been extended to 31 March 2024 will be reviewed prior to that end date to decide whether they will be made permanent, another temporary extension will be sought or they will lapse at that stage. The emergence of the omicron variant and our critical ongoing booster campaign, which urges everyone eligible to get their booster dose, have further highlighted the importance of why those key regulatory flexibilities cannot be allowed to stop having legal effect from 1 April 2022. <BR /> <BR />My officials attended the Health Committee meeting on 27 January to respond to questions on the policy intent of this UK-wide statutory instrument, and, on 24 February, the Committee raised no issues with the content of the regulations. I bring this statutory instrument before the Assembly today with the Committee's support.”
“<BR /> <BR />Secondly, we propose to extend to 31 March 2024 a provision that will relax some of the governance rules on the assembly, preparation and labelling of medicinal products and the need for manufacturer's licences and marketing authorisations. That enables the necessary actions taken by pharmaceutical companies and healthcare professionals specifically to prepare COVID-19 vaccines for administration to the public. Those relaxations were under the proviso that the actions were completed under the health service arrangements. <BR /> <BR />Continuing flexibility for a further period will be of benefit to public health, and we therefore propose to retain those provisions until 31 March 2024.”
“If such a licence is not held by the organisation because it is not required for normal business, that can lead to problems with and delays in moving the vaccines between such service providers, and it runs the risk that patients could not access the vaccine that is necessary for public health protection and that vaccines could be wasted. In providing that flexibility, an important mitigation of any risk has been the provision of guidance to providers on maintaining safety and product integrity throughout the COVID-19 and flu vaccination programmes. Continued flexibility for a further period will be of benefit to public health, and we therefore propose to retain that provision until 31 March 2024.”
“The first allows for flu and COVID vaccine stocks to be shared between locations without the need for a wholesale dealer's licence to be in place. Licensing and marketing authorisations are important parts of the medicine regulation regime. However, situations can arise during mass vaccination programmes where there are more vaccines than are needed in one healthcare organisation and too few in a separate healthcare organisation. <BR /> <BR />The supply from one organisation to the other is classed as a wholesale distribution supply and, normally, requires a wholesale dealer's licence under the HMR.”
“<BR /> <BR />Engagement with stakeholders has been very positive about retaining the ability for community pharmacies to deliver vaccination services from different premises on a permanent basis. It remains the case that that remains an enabling provision only and that community pharmacies are in no way required to provide services in that way, but, by making that provision permanent, we can ensure that the public health benefits are maintained throughout the roll-out of COVID-19 and flu vaccinations while maintaining rigorous standards of oversight for vaccines to be given safely and effectively. <BR /> <BR />Two temporary provisions are due to lapse on 31 March 2022, which we propose to extend to 31 March 2024.”
“<BR /> <BR />The third provision to be made permanent enables community pharmacies to deliver flu and COVID vaccine services outside their normal registered premises. This provision has facilitated new deployment models by community pharmacies, such as the delivery of flu vaccinations to care home staff at the care home site or the delivery of COVID-19 vaccines at pop-up clinics. Community pharmacies across Northern Ireland now play an important role in offering the annual winter flu vaccination service and the COVID-19 vaccination service. That flexibility will be essential to support the vaccination of care home residents by community pharmacies as part of the upcoming spring COVID-19 booster campaign.”
“<BR /> <BR />Making the second provision permanent will continue to allow registered health professionals to supply or administer injectable prescription-only medicines under a patient group direction (PGD). This provision has provided the legal basis for the administration of the COVID vaccine by health and social care trusts in our mass vaccination centres and has been critical to supporting widespread protection from COVID-19 and flu among the general public. Without that flexibility, significantly fewer professionals would have been able to administer vaccines, which would have led to vaccine wastage, a slower pace of vaccine administration and a need for more prescribers to be diverted to the vaccine programme, thus creating an additional drain on healthcare capacity.”
“Prior to the 2020 temporary changes, the only people authorised to administer injectable prescription-only medicines as part of an occupational health scheme were doctors and nurses acting under the written instruction of a doctor. Should the provision be allowed to lapse, we would return to the position where only doctors and nurses operating under the written instruction of a doctor would be authorised to administer injectable prescription-only medicines in occupational health schemes, which could cause delays in vaccinating the health and social care workforce during future vaccine campaigns. Making the change permanent will help to ensure that we have the workforce needed to continue to deliver a mass COVID-19 vaccination programme as well as an enhanced flu vaccination programme to health and social care staff.”
“The SI will make permanent three of the temporary provisions made in 2020 and will extend two provisions until 31 March 2024. <BR /> <BR />I will begin with the three provisions that, it is proposed, will be made permanent. The first will help to maintain an expanded workforce by allowing registered nurses, registered midwives, operating department practitioners, paramedics, physiotherapists and pharmacists to be classed as occupational health vaccinators. That will enable those groups to administer influenza and coronavirus vaccines under occupational health schemes operated by the health service or a local authority. <BR /> <BR />Flu and COVID-19 vaccinations for health and care workers are often administered through occupational health schemes.”
“Mass vaccination roll-out on the scale and at the pace that has been possible to date will not continue if the statutory instrument (SI) that is before the Assembly today is not approved. Moreover, from 1 April, the COVID-19 and flu vaccination programmes will not be able to continue running as they currently do, and it is not likely that they could be re-established at the pace and scale that were so vital to the success of current campaigns. <BR /> <BR />I will now set out the proposed amendments to the regulations and explain why the temporary provisions are still needed. Following review, stakeholder engagement and a UK-wide public consultation, on 7 February, the UK-wide statutory instrument was laid in draft before the Assembly and in both Houses of Parliament.”
“<BR /> <BR />When the Human Medicines Regulations were amended in 2020, some of the temporary changes were given an end date of 31 March 2022, either because there was an expectation of reverting to the business-as-usual model, which, under normal circumstances, we would want to retain, or because they were new and would require a review of their practical implications and safeguards following implementation. <BR /> <BR />Given the experience arising from the pandemic, we needed to retain flexibility to deal with the unknowns. We now know that the vaccines have more than proved their worth. It is, therefore, important that we retain the flexibility and ability to deliver the mass vaccination programmes that the temporary provisions have afforded us.”
“The amendments, which had the effect of increasing the vaccinator workforce and giving greater flexibility to deployment arrangements, were applied to the flu vaccine as well, the overarching policy objective being to facilitate the deployment of safe and effective COVID-19 and flu vaccines in order to protect public health. The health service in Northern Ireland has made use of the full range of options available to it, as enabled by the 2020 amendments to the Human Medicines Regulations, to safely vaccinate staff and the wider population with the aim of minimising disruption to normal health services.”
“The Human Medicines Regulations (HMR) 2012 governed the arrangements for the licensing, manufacture, wholesale dealing and sale or supply of medicines for human use. Those UK-wide regulations were amended in late 2020 as part of the response to the COVID-19 pandemic to add flexibility to some of the normal rules that would ordinarily govern vaccine supply to patients. <BR /> <BR />The 2020 changes were made to facilitate the mass vaccination campaigns that have been taking place for seasonal flu and COVID-19 once vaccines became available.”
“I seek the Assembly's approval of this set of regulations that contain important provisions relating to the continued support of the COVID-19 and flu vaccination programmes across the United Kingdom. <BR /> <BR />I am sure that Members will agree that the vaccination programme has been an outstanding success and has helped us to take significant strides towards the more normal life that we want to see return. With the recent lifting of COVID restrictions, that is now within our sights. We have, undoubtedly, made progress on pushing down omicron numbers, thanks to the efforts that everyone has made and the rapid roll-out of vaccine boosters. However, we must not lose sight of the fact that COVID-19 can still cause devastation to families and communities.”
“It is critical that all patients deemed medically fit for discharge vacate their hospital bed as quickly as possible to make way for those who are more acutely unwell.”
“I thank the Member for her question. I know that she has been following up on this in a methodical and astute way. Timely discharge is essential to effective flow through our hospitals and to avoid overcrowding. To tackle the issue, the Health and Social Care Board and the Public Health Agency established a regional discharge group, and that has identified three priorities to expedite discharges. That is on top of the investment of £23 million in November to improve the terms and conditions of domiciliary care workers in the independent sector. The aim was to add capacity to the system and facilitate timely discharge, and early feedback suggests that the intervention is beginning to make a difference. The wider population also has a role to play in improving the timeliness of discharge and the flow through our hospitals.”
“The final running order has not yet been agreed, but, as I said in response to Ms Erskine, the value of multidisciplinary teams is about making sure that we have the available workforce as much as the available funding and also capital investment because with multidisciplinary teams comes the need for an increased footprint where additional patients can be seen by additional medical professionals that multidisciplinary teams bring onto a site. <BR /> <BR />It is about making sure that we get those three tracks running at the same time where we have the staff, the funding and the footprint for as many patients as possible to be seen.”
“Ongoing engagement among the Health and Social Care Board, the Royal College of GPs and the BMA's Northern Ireland general practitioners committee continues on the additional support that we can provide. As I said, we supplied additional funding, especially to get them through the winter period. That allowed an increase in investment in telephone services and other additional supports that our GP practices can use to make sure that they can contact and support as many patients as possible.”
“It is part of the discussions that we have had in developing the commissioning plan for 2022-25. As I said, we have agreed what the commissioning plan will look like, but it is subject to the agreement of a funding envelope. The three-year plan aims to consolidate and build on the services that we have seen in the past two years and the good working relationship that my Department, the Health and Social Care Board and Community Pharmacy NI have had, especially over the past two years.”
“They have been, and continue to be, the most accessible healthcare professionals on the front line of community health services during our response to the virus. <BR /> <BR />As we look to the future, it is important that we continue to work together to build on the significant successes that community pharmacy has had and continues to have.”
“That ensured that local pharmacy services were available to meet the needs of the people of Northern Ireland and to support the pressures in our health and social care system. <BR /> <BR />We have agreed a three-year commissioning plan for 2022-25, but, again, it is subject to the agreement of a funding envelope. That three-year plan aims to consolidate the build on the considerable advances seen in community pharmacy services and the role of local pharmacists and pharmacy teams from which the population has benefited in the past two years. <BR /> <BR />Community pharmacies have played a pivotal role in delivering health services to communities in Northern Ireland during the pandemic.”
“I thank the Member for that. I am due to meet Community Pharmacy NI towards the end of this week or the start of next week regarding the commissioning plan for 2022-25. My Department and the Health and Social Care Board have been working with Community Pharmacy, which is the representative body for community pharmacists, on the development of a commissioning plan for community pharmacy services. <BR /> <BR />In 2021-22, the focus was on the provision of core services, including dispensing, repeat dispensing and adherence and some activities and services that ensured access to medicines and advice for the public, including vulnerable groups and those receiving end-of-life care.”
“As I said, the speed at which any agreed plan can be implemented, however, will depend on the availability of appropriate funding, which includes capital funding, and suitably qualified and experienced staff.”
“That is challenging, given the current uncertainty over the Budget and the known workforce issues in key professions. However, I am pleased that, recently, the programme team has been able to agree a draft running order for how the programme would be rolled out across Northern Ireland. In that running order, the South West GP Federation has been identified as one of the areas for early further expansion. The programme team will engage further. Detailed work is ongoing and involves key stakeholders, GP federations, Health and Social Care trusts and professional leads to complete the work on the roll-out plan, which includes a high-level timeline for completion.”
“I thank the Member for her question on MDTs. Again, she will be aware that, with the primary care multidisciplinary team programme, over 620,000 citizens now have access to physiotherapy, social work or mental health services in their local GP surgeries. Currently, there are around 320 whole-time equivalent front-line staff working across 99 GP practices in seven GP federations. I fully recognise the significant challenges that are faced by primary care colleagues in incomplete or non-MDT areas and their eagerness to begin introduction or to complete the roll-out of the MDT model to help to stabilise vital primary care services to their communities. <BR /> <BR />I am committed to extending the model across Northern Ireland. Work is under way to develop a plan for the further roll-out of the MDT model.”
“The Member has given a positive portrayal of GP services when so many others have taken the opportunity to criticise them for the work and support that they have continued to provide throughout the pandemic. I thank her for that. I will check up on her request for a meeting.”
“My apologies: I am unaware of the request for a meeting, but I will get back to the office and follow that up for the Member, because what she has brought to the table in any engagement that we have had with her about health provision in the west, particularly, has been productive. I will follow that up for her. <BR /> <BR />The Member led an Adjournment debate on GP services towards the end of last year. A number of initiatives, models and support mechanisms were raised at that point that still stand in regard to the additional funding that has been put in place to support GPs over the winter period, and also to how we look to ingrain and enhance the services that they provide.”
“The Member has raised that issue a number of times with regard to the rebuilding of services. When the trusts publish their rebuild plans, he will be able to see the steps that are being taken. The indication and commitment that were given by the Northern Trust set an example and lead for the other trusts to follow in regard to their ambition and desire to get those services back to pre-pandemic levels as quickly and safely as possible.”
“I thank the Member for his very specific question. I do not have a specific answer, but I will get that number to the Member in writing as soon as I can.”
“I can give the Member that commitment. This was a joint initiative between the Northern Ireland Fire and Rescue Service and the Northern Ireland Ambulance Service. It was the Ambulance Service that was providing that specific training for cardiac response. It provided those reassurances. The chairs and boards of those organisations worked together to make sure that they were both satisfied that the training being provided was up to a standard that provided them with the reassurances that they, as boards, need in order to provide me with the reassurance that they are content that we can make sure that we get people seen as quickly as possible, which is the aim of Maggie's call. I am sure that the Member will support me in achieving that aim.”
“I thank the Member. I am aware that there is correspondence from the Chief Fire Officer about legal issues that have been raised by the Fire Brigades Union with regard to Maggie's call. It is unfortunate that that stalled what has been a very proactive campaign by Maggie Black's family and the willingness by the Carnlough brigade and station especially to roll that out as quickly as possible.”
“I thank the Member. With regard to the BMA report on consultants, active recruiting to permanent vacancies is led by each trust. In the longer term, that is done through increased investment in pre-registration education programmes which create the labour supply that is necessary to meet the growing demand for services. The ability to grow our workforce supply depends on the availability of significant recurrent investment in pre- and post-registration training. I continue to strive to ensure that the Department receives the financial resources required to make that essential investment. I also recognise that the ongoing significant increase in agency and locum expenditure is not sustainable, particularly at a time of serious budgetary pressures across the health services.”
“I do not have an update on Ravara House, but I will write to the Member on that. With regard to the outline business case, as soon as it can be brought to my Department, we will consider it in regard to the budget process that we are currently going through. <BR />As I said earlier, funding for the hub schemes will be considered alongside other capital priorities as my officials continue to evaluate what can be funded from within the draft budget 2022-25 settlement. Allocations will remain subject to final confirmation of that budget and the Health Minister's approval.”
“I do, and it has been the direction of travel, not just for me but for my Department, as regards the development. That is why the outline business case will be of specific importance. Until the outline business case process is complete, detail regarding the plans for a primary and community care centre in Bangor cannot be provided at this time but will be examined in detail at that stage. As the Member understands, it is not possible to pre-empt the outcome of the business case process at this point.”
“<BR /> <BR />The outline business case currently being developed will fully explore the service need and accommodation requirements for a full range of services to be delivered as part of the future service model for the Ards and North Down area. It will take advantage of the existing estate where possible. <BR /> <BR />The purpose of an outline business case is to consider all the various options available so that an informed decision can be made on what option provides the best value for money to meet the identified needs and objectives of the project. As the Member will be aware and will understand, it is not possible to pre-empt the outcome of the business case process at this time.”
“Plans to replace Bangor health centre and Bangor Hospital with a new primary and community care centre were included in the primary care infrastructure development strategic implementation plan. That will create an integrated model of care in an environment that will maximise multidisciplinary and professional team working and encourage shared opportunities for developing links within health and social care and with external health care partners. <BR /> <BR />The plans envisage a new centre in Bangor and assume that accommodation will be required for at least five practices to service approximately 30,000 patients. That will be in the new Bangor primary and community care centre.”
“I thank the Member. As he knows, the consolidation of the Bangor and Ards minor injuries unit on the Ards Hospital site remains under continuous review as part of the trust's plans for rebuilding services, but, due to the ongoing impact of COVID, the trust is unable at this time to provide a definite date for the reopening of Bangor minor injuries unit.”
“<BR /> <BR />Funding for hub schemes will be considered alongside other capital priorities as my officials continue to evaluate what can be funded with the draft 2022-25 budget settlement. Allocations will remain subject to final budget confirmation and, it says, "my approval", but it should say "the Minister of Health's approval".”
“That includes a minor injuries unit to be delivered as part of the future service model for the Ards and North Down area, taking advantage of the existing estate where possible. Until the outline business case process is complete, detail regarding the plans for a primary and community care centre in Bangor cannot be provided at this time as it will be examined in detail at the outline business case stage. <BR /> <BR />The trust remains committed to working with the Health and Social Care Board and my Department to progress this project as soon as possible, to deliver new primary and community care infrastructure for the population of Ards and North Down.”