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 his question. The South Eastern Trust is preparing an outline business case to consider accommodation requirements for a full range of services.”
“I would rather see Daisy Hill being utilised for the people of Northern Ireland — the people of Newry and Armagh and of South Down, who are paying into the National Health Service — rather than it being politicised because we are coming up to an election.”
“Once again, the Member is attacking the trust rather than supporting it in trying to recruit to positions that are at a premium, not only in Northern Ireland but across these islands. I am aware of the Member's statements about Daisy Hill and of the difficulties that he raises. I am also aware of his party leader's comments on the future of the health service. I think that he has conceded that the Republic of Ireland's health system is a major turn-off as far as reunifying the island goes, even for people who are convinced nationalists. <BR /> <BR />I see that the Member is trying to rebadge Daisy Hill as a hospital that will cover not only parts of Northern Ireland but parts of the Republic of Ireland.”
“Seeing an attractive site to work at and trust to work for is what helps, and a general message being put out by elected reps that a hospital or a trust is under threat or that a hospital is not an attractive place in which to work makes it all the harder for the trust to recruit.”
“I thank the Member for her question. Effective workforce planning is a key theme of 'Health and Social Care Workforce Strategy 2026: Delivering for Our People', which was published in May 2018, when there was no Minister of Health. The aim is, by 2026, to develop and sustainably fund an optimum workforce model for our reconfigured health and social care services. That challenge is across a number of surgical specialties. The surgical workforce review's current and planned action, which is being considered by my Department, includes, as of 8 February 2022, vascular surgery, general surgery, cardiothoracic surgery, ENT surgery, neurosurgery, paediatric surgery, plastic surgery and a number of other specialties.”
“I would like to see the same for Daisy Hill, which is why I have asked all elected reps to support us in that effort.”
“I definitely agree. We have been supportive of that for the entire time, but there are challenges in recruiting them. That is why I have asked that all elected representatives in the area play a positive role in making the hospital an attractive site to work at and the area an attractive place to be recruited to. <BR /> <BR />I see that your colleague Mr Storey is nodding behind you. He will recall that we had exactly the same challenges in North Antrim with the Causeway Hospital. It was through productive, positive engagement with elected representatives, working with trust management, the Health and Social Care Board and the Department of Health that a transformation has been seen in the outworkings for the Causeway Hospital.”
“<BR /> <BR />I appeal to local elected representatives to continue to work with trusts to promote their local hospitals and local areas and to help attract new staff. That action demonstrates the fragility of parts of the system. I have said before, and I will say again, that, if we are to deliver the step change in health services that we need, including for general surgery, that is critical to addressing our waiting lists, we will need every inch of capacity at all our hospitals.”
“I have also asked that fresh efforts be made to secure consultant general surgeons at the Daisy Hill Hospital site while the Southern Health and Social Care Trust develops proposals for a sustainable, long-term model of care for general surgery across the Daisy Hill and Craigavon hospital sites. <BR /> <BR />The trust has advised that it is due to commence recruitment for four consultant surgeon posts with support for specialty interests. Those posts will specify the need to work across all Southern Trust hospital sites, as the trust does not have permission from the Royal College of Surgeons (RCS) to advertise for consultant surgeon posts with support for specialty roles for Daisy Hill Hospital alone. I receive monthly updates on the situation, including progress reports on securing additional medical staffing for the site.”
“<BR /> <BR />It is an unfortunate reality that a number of our hospitals, particularly the smaller hospitals, face an ongoing challenge in recruiting and retaining specialist clinicians. Hospitals in other jurisdictions face similar issues. No amount of additional funding or workplace planning can resolve that challenge alone. I have therefore asked that the Health and Social Care Board and the Southern Trust take appropriate and feasible steps to ensure that the consequences of the changes are managed in a way that minimises both the impact on the local population and the risk of increased pressures on other health trusts.”
“I thank the Member for his question. It is not the responsibility of my Department to recruit health and social care staff. That responsibility lies with the employing organisation. It is unfortunate and disappointing that the Southern Trust had to take action on emergency surgery at Daisy Hill Hospital. I recognise, however, that that action had to be taken in order to maintain safe services. We cannot compromise on patient safety. It must always be our number-one priority. The operational decisions taken by the Southern Trust should be viewed in that context. It is a temporary change, and I expect that the Southern Trust will do all that it can to seek to recruit additional consultant general surgeons so that it might reinstate services as quickly as possible. I do recognise that that will be challenging and will likely take some time.”
“The Member will be aware that one part of the review concerned transport and not just the physical location at which respite care is being provided. That is therefore part of the implementation plan. The Northern Trust has given me a commitment that those services will be restored for adult day centres by 27 March and for short-break capacity by 11 April, but, as I said in my initial answer, that time frame is subject to further surges or localised outbreaks of COVID-19, of which I hope that we have none.”
“I thank the Member for his question. He will be aware that, during the rebuilding phase that we have been taking part in, and over the past 18 months especially, all trusts have been publishing in three-monthly chunks. As part of the review that I have asked all trusts to implement, I have asked that they also publish their plans for rebuilding respite care so that families are fully aware of the targets that have been set and of what I expect of the trusts.”
“I thank the Member for that valid point about those who have not been able to access the full gamut of respite services and support. When I asked the Public Health Agency (PHA) to conduct the review with the Chief Social Worker, there were four key guiding principles that I and the Chief Social Worker asked to underpin the proposed pathway to restate our services: that those services were person- and family-centred; that they promoted health and well-being; that they worked in partnership with families and service users; and that they were underpinned by the proactive surveillance that the Member referred to. That is to ensure that any service that an individual returns to is fit for purpose and meets their needs. It must be person-centred and specifically focused, and it must also support the family.”
“I thank the Member. I am aware that a number of inspections done in Rainbow Lodge by the Regulation and Quality Improvement Authority (RQIA) raised some concerns. The areas for improvement of care in Rainbow Lodge have been identified. My officials are working alongside the Health and Social Care Board (HSCB) and the RQIA to ensure that services that are delivered at Rainbow Lodge are compliant. <BR /> <BR />The Member will note that, in my initial answer, I indicated that the Northern Trust has given an indicative time frame for full restoration of services to pre-pandemic capacity in adult day centres: it is to be done by 27 March.”
“However, the trust's approach to provide as many people as possible with the opportunity to attend respite has meant that some clients have had a reduced number of attendances each week. The volume of day-care attendance is at 63% of pre-pandemic capacity. The trust has provided a range of alternative services to mitigate the reduction in capacity. However, it is recognised that respite services must be fully restored. The Northern Trust has provided an indicative time frame to fully restore services to pre-pandemic capacity in adult day-care centres by 27 March and short-break capacity by 11 April. That time frame is subject to any further surges or localised outbreaks of COVID-19. A formal review of the implementation of the pathway and remobilisation will be undertaken in late spring 2022.”
“I thank the Member. Adult day care and short breaks are still subject to nationally agreed health protection guidance to keep service users safe. Dynamic risk assessments of each setting and the implementation of infection control measures ultimately determine the level at which services can be delivered safely. The Chief Social Worker wrote to trusts, on my behalf, to outline my expectations of the implementation of the pathway to remobilise adult day care, short breaks and transport, and to seek an updated position on current service provision. <BR /> <BR />As of 15 February, the Northern Health and Social Care Trust provides a day service to 81% of its pre-pandemic clients in adult day centres.”
“A number of people are already utilising that, and we look for such assistance where we can buy it. <BR /> <BR />The Member will be aware that COVID is not a problem that only the Northern Ireland health service has faced. All of the health services across the UK and the world have faced it. We would have utilised additional international capacity, but that has been taken up by the health services in different countries. The ability to purchase international procedures is not as readily available as it has been in the past.”
“I thank the Member for his point. He will be aware that we instigated the cross-border initiative, although, again, that was only for one year, because of the financial pressures. We have been utilising that, and we have been able to send people to the Republic of Ireland under a cross-border healthcare directive.”
“I thank the Member for her question. In my initial answer, I indicated what can be done in-year with substantial amounts of money, but it becomes all the more challenging when that money is not recurrent. As of the end of December 2021, an additional 157,687 outpatient and allied health professional (AHP) assessments and diagnostic tests and inpatient and day-case procedures had been delivered through those waiting list initiatives, both in Health and Social Care and through the independent sector. That shows that that £90 million has already brought forward over 150,000 people who have been seen somewhere in our health service. If that money were recurrent, it would really make a large difference to what we could not only strategically plan but strategically deliver.”
“I want to see that programme brought in as quickly as possible in phases so that we can truly look at those different ways of working together to address a challenging situation in Northern Ireland.”
“I thank the Member for his question. I note that he has a petition out on that issue: I am not sure whether the petition will also address the budgetary pressures that we are under, but I would welcome that being highlighted as well. <BR /> <BR />The Member will be aware of a number of initiatives that the Northern Ireland Ambulance Service is putting in place to meet the needs of all the population of Northern Ireland, whether that is the rural or urban population. He will note the response to Maggie's Call at the end of last week, through which we will see our Northern Ireland Ambulance Service and Northern Ireland Fire and Rescue Service (NIFRS) working in partnership on cardiac response.”
“The likes of our cancer strategy, our elective care strategy and our mental health strategy all become that bit more difficult when we do not have that recurrent Budget.”
“I thank the Member for his point. I welcomed the fact that health had been given priority by the Executive in the Budget. That commitment was made by all Ministers and parties. However, it is important to note that the lack of recurrent investment received by the health service over the last number of years, not just that that will not be received in future years, means that it is needed simply to ensure that our existing services are funded on a sustainable basis. It will not fully resolve the financial gap that faces the health system as we move forward, but the inability to plan and put those transformation projects on a sound, firm financial basis makes it all the more difficult for us.”
“I thank the Member for his question. He makes a valid point about the work that we need to do on cancer. That is why I have deliberately set out the cancer strategy and the work that we need to do to get on top of that. <BR /> <BR />The Member will be aware that a number of the red-flag cases that are cancelled are usually rescheduled within a pretty quick time to make sure that those patients can be seen as quickly as possible. It is important for us to be sure that we have as few COVID patients as possible in not only our hospital system but our intensive care system so that we can utilise that capacity for the people who need to come forward for more serious operations. If the Member has a specific constituent in mind and wants to communicate with me about that, I will be glad to get back to him.”
“The recent resignation of the First Minister has cruelly robbed patients and our staff of the prospect of a three-year budget. I cannot over-emphasise how frustrated I am that some in this place are so willingly repeating the mistakes of the past. The task at hand has been made immeasurably more difficult.”
“<BR /> <BR />As Members will know, last June, I published the elective care framework, which set out a detailed series of time-bound immediate, medium-term and long-term actions to address our unacceptable waiting lists. A number of initiatives are well under way, including the payment of enhanced elective care rates to staff in specific key areas of work; the introduction of mega clinics to maximise patient throughput; the introduction of a cross-border reimbursement scheme; and a move towards leasing Health and Social Care (HSC) theatres to independent providers, at times when they are not otherwise in use, to address backlogs. I made it clear, however, that certainty of investment through multi-year budgets would be absolutely critical for the delivery of the actions and targets that were set out in the framework.”
“I thank the Member for his question. Members will be aware that virtually all waiting times — not just first consultant-led outpatient appointments — were in crisis at the return of the Executive in January 2020. Whilst the pandemic has exacerbated the situation, we must never forget that it did not cause it. It is not the first time that Northern Ireland has faced issues with waiting times. Prior to 2005, our hospital waiting times were the longest in the United Kingdom, but, by 2009, the situation had broadly stabilised. It remained relatively stable until 2013-14. Then, through a combination of one-year budgets, poor performance management and a lack of serious strategic oversight, the situation shamefully deteriorated to the extent that it did.”
“I am reassured that the consent of the Department of Health in Northern Ireland is required before the making of regulations on matters within the Assembly's competence. The Department will aim to engage the Health Committee during the development and promulgation of any regulations to be made under these new enabling powers. The new provisions will allow for different provision for different parts of the UK, and the regulations will be subject to the affirmative procedure, which allows for close scrutiny of any provisions by Parliament. I commend the motion to the House.”
“Whilst I fully agree with that view, it is important to understand that it would not have been possible to progress separate primary legislation for Northern Ireland within a similar timescale. It is for that reason that I believe that, on this occasion, it is appropriate and makes good sense for Westminster to legislate on matters that are devolved to ourselves. I note that the Welsh Assembly and the Scottish Parliament have agreed legislative consent motions in respect of the provisions as they relate to Wales and Scotland. <BR /> <BR />It is crucial that the public retains confidence in the healthcare system, and an important part of that is increased transparency in relation to healthcare payments.”
“I thank Members who have contributed to the debate. I think that it was the Chair who, again, touched on the crux of this LCM: the recognition of transfers of value as well as monetary ones, and also moving from a voluntary to a mandatory scheme. I take the opportunity to offer my thanks to the Health Committee for taking the time to examine this LCM, especially given the tight time frames involved, and for its helpful and positive engagement with my officials. <BR /> <BR />Some Members hold the view that, as a matter of principle, that if something falls within the devolved competency of the Northern Ireland Assembly, where possible, legislation should be made by the Assembly.”
“<BR /> <BR />In conclusion, I am supportive of the provisions and that, in the interests of good government across the United Kingdom, insofar as the Bill's provisions deal with a devolved matter, they should be considered by the UK Parliament, particularly considering the policy basis for the proposals, which was a report that was commissioned mainly in respect of the NHS in England, albeit with input from Northern Ireland. There is an assurance in the new clauses that the consent of the Department of Health in Northern Ireland is required before the making of regulations on matters that are within the Assembly's competence. The new provisions will allow for different provisions for different parts of the UK, and the regulations will be subject to the affirmative procedure, which allows for close scrutiny of any provisions by Parliament.”
“<BR /> <BR />DHSC has advised that a collective of small to medium-sized enterprise device manufacturers seem very supportive of plans because they see an opportunity to level the playing field with larger manufacturers through increased transparency. DHSC plans further engagement with the industry. There has been no regulatory impact assessment of the new proposals. DHSC has confirmed that it will be conducting an assessment before making regulations, once the detail of the policy is clear, and will work with the Department of Health in Northern Ireland to complete that work. The proposed provisions will not place any burden on businesses as the requirement to report information will only come into force once regulations are made.”
“<BR /> <BR />These are enabling provisions. There are no known financial implications. There may be financial implications in the development and implementation of any secondary legislation. Those costs have not yet been assessed, but an assessment of impacts on businesses, including small and microbusinesses, and wider impacts, such as those on the environment, trade and competition, will be completed, where appropriate, alongside secondary legislation. <BR />DHSC has engaged extensively with the medicines industry and is advised that the industry is generally supportive of the principle but would want the chance to inform regulations and the detail of how reporting obligations will be fulfilled.”
“The DHSC acknowledges that there is more to do to inform the development of regulations and ensure that the needs of patients, the healthcare sector and the industry are heard. Therefore, the UK Government will be conducting a full public consultation in advance of making regulations, and the devolved Administrations will be strongly involved in that work. <BR /> <BR />The provisions of the Bill are compatible with the European Convention on Human Rights. The DHSC does not anticipate significant human rights or equality impacts but will complete a full equality impact assessment alongside secondary legislation. The primary legislation provisions have no detrimental impact on particular protected groups or on health inequalities, and there is no adverse impact on any groups listed under section 75.”
“However, it is felt that those are not comprehensive, partly because they do not cover all types of transfers of value and partly because they are voluntary, but also because they rely on consent for the name of the recipient to be disclosed. It is considered that a statutory requirement to report information would help to resolve those problems. <BR /> <BR />As part of preparing the UK Government response to the Cumberlege review, the DHSC consulted extensively with patient representatives to inform the development of the relevant clause. Following the publication of the review, the UK Government have spoken with medicines and medical devices associations to gather internal feedback on that duty.”
“The intention is that that information will then either be published by relevant companies on their websites or be submitted to the DHSC for publication in a searchable and publicly available database for greater transparency and to help address any perceived conflicts of interest. It is proposed that an exception to the reporting requirement would be available for those that already report to an industry-run scheme that is recognised as an appropriate alternative by the Secretary of State for Health and Social Care. <BR /> <BR />A number of voluntary reporting schemes for pharmaceutical companies and medical-device manufacturers are run by trade bodies.”
“<BR /> <BR />The proposed legislative provisions would provide the Secretary of State for Health and Social Care with the necessary power to make regulations that will require pharmaceutical companies, the manufacturers of borderline substances and the manufacturers, importers and distributors of medical devices to report payments and other transfers of value that they make to teaching hospitals, research institutions and healthcare professionals. <BR /> <BR />The intention is for the legislation to capture payments that relate to specific medicines, substances and devices and other payments that may not relate to a specific product.”
“The Department of Health and Social Care's intention is for that to include borderline substances, which it considers to be another area where professionals can prescribe products to patients and where transfers of value may influence those decisions. That will include products such as dermatological and nutritional products that are used to treat medical conditions and are prescribed to patients along with nutritional borderline substances such as enteral feeds, oral nutrition supplements, specialist infant formulas, gluten-free products and products for patients with metabolic conditions.”
“Finally, it provided for an extension to the whole of the United Kingdom of the powers related to the reporting and publication of information about payments and other benefits that are provided to persons in the healthcare sector. <BR /> <BR />In the clauses, "health care product" is defined as:”
“<BR /> <BR />It required the Secretary of State for Health and Social Care to obtain the consent of the Health Ministers in Scotland, Wales and Northern Ireland, as appropriate, before he could make provisions within devolved legislative competence in regulations relating to information about payments etc to persons in the healthcare sector. <BR /> <BR />It also provided regulations related to the reporting and publication of information about payments and other benefits that are provided to persons in the healthcare sector to enable different provisions to be made for different parts of the United Kingdom. It allowed for regulations related to the reporting and publication of information about payments and other benefits provided to persons in the healthcare sector to be subject to affirmative procedure.”
“On 24 January, the Minister for Technology, Innovation and Life Sciences from the Department of Health and Social Care tabled new clauses at the House of Lords' Committee Stage of the Health and Care Bill. Those clauses were to enable regulations to require the reporting and publication of information about payments and other benefits provided to persons in the healthcare sector by manufacturers and suppliers of healthcare products and to enable provision to be made for the enforcement of requirements relating to information about payments to persons in the healthcare sector, including through the imposition of civil penalties.”
“Recommendation 8 is being implemented in two parts. The legislative consent motion relates to the second part of the recommendation, which is on the mandatory reporting of payments. The purpose of the recommendation is to address the perceived and real conflicts of interest in the provision of healthcare and treatment where healthcare professionals and others have financial links with pharmaceutical and medical device companies. The responsibility for transparency should lie not only with the profession but with the pharmaceutical and medical device industries. <BR /> <BR />In December 2021, the Department of Health and Social Care proposed that it would legislate to implement that part of recommendation 8 on a UK-wide basis. It thus made amendments to the Health and Care Bill.”
“The panel's report, 'First Do No Harm', was published on 8 July 2020. In her report, Baroness Cumberlege set out nine recommendations that were relevant to all three of the interventions at which the review panel was asked to look. The recommendations are targeted at improving patient safety, at providing help to those who have been harmed and at improving practice and learning. Yesterday, I published a written ministerial statement on the progress that has been made to date on implementing the nine recommendations in Northern Ireland. <BR /> <BR />Recommendation 8 states:”
“In February 2018, the then Secretary of State for Health and Social Care established a medicines and medical device safety review. That review was set up to look at how to improve the way in which the NHS in England and the Medicines and Healthcare products Regulatory Agency (MHRA) responded to patient-reported concerns more effectively and in a way that ensured that those who raise concerns are properly heard. Although the primary focus of the review was on the NHS in England, the review team, which was led by Baroness Cumberlege, visited Northern Ireland in December 2018, and the panel heard evidence from patients here. <BR /> <BR />The review centred on matters relating to the use of pelvic mesh implants, sodium valproate and hormone pregnancy tests such as Primodos, and, as I said, it was chaired by Baroness Cumberlege.”
“As I said previously, the Assembly granted legislative consent to motions on 15 November for provisions in the Health and Care Bill relating to medicine information systems, international health agreements and the regulation of healthcare and associated professions. The need for a further legislative consent motion has arisen as a result of the Department of Health and Social Care's decision in December 2021 to use the Health and Care Bill to provide regulation-making powers to create a system for the mandatory reporting of healthcare payment data. <BR /> <BR />I wrote to the Health Committee on 26 January to advise it of my intention to table this legislative consent motion, and I am grateful to the Committee for its consideration of the motion at its meeting on 10 February. <BR /> <BR />I will briefly explain the policy background.”
“I also thank my Executive colleagues for enabling me to take forward this LCM. <BR /> <BR />Some Members, as a matter of principle, hold the view that any legislation that falls within the devolved competency of the Northern Ireland Assembly should, when possible, be made by the Assembly. I agree with that view. However, in the area of the transfer of functions of arm's-length bodies that extend across the United Kingdom, it is appropriate in the safeguarding of current service delivery in Northern Ireland for legislation to be taken forward at Westminster. I commend the motion to the House.”
“Thank you, Mr Speaker. I thank Members for their comments. The Chair's comments about timeliness and management of the memorandum of understanding have been noted and heard. He acknowledged that, in my opening comments, I noted that this LCM received urgent procedure only on 24 January; that should not be missed either. <BR /> <BR />On the further development of the memorandum of understanding, when that has been agreed between all DAs and the DHSC, I am content for its content to be shared fully with the members of the Committee. <BR /> <BR />I thank the Health Committee for taking the time to examine this legislative consent motion and for its helpful and positive engagement with my officials on the matter. The Committee had to work within a challenging timescale, and I thank it for its patience, understanding and cooperation.”
“<BR /> <BR />As a consequence of the secured devolved Administration consent clause and removal of any future potential liabilities, my Department recommended Northern Ireland's approval for the LCM to support and retain key services that are delivered to Northern Ireland by those UK-wide functions, while noting that any future transfer of functions touching on devolved Administrations' legislative competence will require our consent. I ask Members to support the motion.”
“In light of those amendments, Executive approval to move forward with the legislative consent process was sought and secured via an urgent procedure request on 24 January. Subject to further briefing from my officials, the Health Committee agreement was secured for the legislative consent process. <BR /> <BR />The Scottish and Welsh Governments have provided legislative consent approval for this UK-wide provision. Failure to obtain Northern Ireland's support would have consequences for all the devolved Administrations as the current function in the scope of this power to DAs will be carved out, with devolved Administrations potentially having to go it alone to deliver these services. The nature of the services, such as organ donation, is best served on a UK-wide rather than on a local devolved Administration basis.”