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 that point. The importance of mental health has been well iterated through the mental health strategy and work programme that we published for 2021 through to 2031. As the Member is fully aware, the strategy is a vision for the future and states that we aspire to have mental health services that are compassionate and able to recognise and address the effects of trauma. A specific strategic outcome is the facilitation of a trauma-informed practice through targeted approaches to people with a specific trauma exposure. That has been endemic and embedded in my Department's work since I have taken up this role.”
“To date, funding has been used for research into best practice on appropriate therapies, including a scoping review with recommendations from Queen's University Belfast; training of trust staff in the provision of consultation services; promotion of the Health and Social Care Board's compassionate leadership initiative; and provision of innovative, web-based information management software.”
“I thank the Member for her follow-up question. Mr Lunn asked about funding, a question that Ms Flynn had also intended to ask. Figures from the Health and Social Care Board indicate that the regional trauma network now receives recurrent annual funding of circa £3·3 million, with the full amount of funding received having been allocated. The funding has been used to establish the regional staff team, with a clinical director and operational support functions, and clinical and administrative roles have been funded across the five trusts.”
“I will make a fuller announcement in the next few days, as I said in my substantive answer. An important part of establishing the regional trauma network was the co-design of services with stakeholders. It included victims and survivors, the community and voluntary sector and the Health and Social Care Board. I wanted to ensure that the views of stakeholders influenced the nature and direction of the network, because they are integral to the development of an effective and world-leading psychological trauma service. A number of legal questions also needed to be answered before we could make progress.”
“To date, that has involved the commissioning of research into best practice on appropriate therapies, conducting training and establishing key clinical and administrative posts in the Health and Social Care Board (HSCB) and trusts. Whilst there were a small number of outstanding issues to resolve, not least varying legal arguments to consider, I am pleased to advise that my officials have been working diligently and I expect to be presented with a final proposal within days. I hope to have the service operational as quickly as possible thereafter.”
“I thank the Member for his question. As Members will be aware, a regional trauma network was included as part of the Stormont House Agreement in recognition of the need for a comprehensive trauma service to better support victims and survivors. Whilst there may have been some debate previously as to what exactly was meant by that, since taking up office, I have been clear with my officials that I wanted to see a scheme developed as initially envisaged. It was a clear political commitment and something that victims and survivors undoubtedly deserve and require. <BR /> <BR />A range of preparatory work to enable the delivery of this important service has been undertaken.”
“I thank the Member for that. As she will be aware, currently, there is a consultation on social care provision for adult services. I encourage the Member to make sure that her views and opinions are fully recorded in that to make sure that the services that are being delivered in every setting meet the needs of those who use them.”
“Furthermore, as I said, trusts have now been instructed to get on with the job of implementing the pathway, and they will be required to set out updated rebuild plans to outline the time frame to fully restore day care, short breaks and transport.”
“I thank the Member for her point, because it is not just because of COVID that we are in this situation; the challenges were there before COVID. <BR /> <BR />Trusts are at a varying level of adult day-care provision, at between 50% and 60% of pre-pandemic capacity. Trusts have reported significantly reduced access to community short breaks and transport provision. That reflects restrictions on the availability of physical space and the use of independent sector contracts. Trusts are exploring options to further increase the level and range of services that they can provide. Whilst that has resulted in nominal increases to provision, a change in policy is required to restore services to pre-pandemic levels.”
“I thank the Committee Chair for that point. As I said, the pathway was agreed today. My officials will now write to all the trusts to direct the full implementation of the pathway. I expect trusts to act without delay. The operational delivery will be with trusts.”
“— that many carers and family members faced due to the reduction in services of adult day care, short breaks and transport, the Member has raised the issue numerous times in the Chamber. Any time she raised it, I gave her my commitment that we would look at the remobilisation of those services. The pathway has been published. It does not mean that we will go to full delivery straight away, but it sets a pathway to allow our trusts and service providers to get there.”
“I will take the opportunity to respond, Mr Speaker. With regard to the challenges —”
“The review and the pathway will be placed on my Department’s website.”
“The risk of COVID-19 transmission must, however, be balanced against the health and well-being of carers, who have received a partial service for nearly two years. That is why I have approved in full the pathway for the remobilisation of adult day care, short breaks and transport. <BR /> <BR />My officials have written to the health trusts to direct the full implementation of the pathway, and I expect trusts to act without delay. The trusts will be able to use the pathway as an enabler to scale up services in a holistic manner to manage risks. The trusts will be required to update rebuild plans and outline the time frame for the full restoration of respite services. I personally thank the families who have shaped the pathway through the engagement panel facilitated by the Patient and Client Council.”
“Dynamic risk assessments of each setting and the implementation of infection control measures ultimately determine the level at which services can be delivered safely. While services have reduced, just as they have in many neighbouring countries, I am, however, mindful of the support that they provide to service users and their families. <BR /> <BR />Members will be aware that the Public Health Agency (PHA) was tasked with undertaking an in-depth review to identify a safe pathway to the full restoration of services. It was formally submitted to the Department at the end of October 2021, and consideration of the pathway was required to take account of the evolving evidence on the transmission, virulence and vaccine escape of the omicron variant.”
“I request a further minute, so that I can provide a full update on this important topic. <BR /> <BR />Trusts proactively identify unpaid carers by working closely with GPs, pharmacists, the community and voluntary sector and other public agencies. As standard practice, when staff identify carers, they are offered carer assessments or reassessments, and, if that is accepted, arrangements are made for assessments to be carried out. While the impact of the pandemic has yet to be fully quantified and assessed, it is clear that the physical and mental health of our vulnerable adults and carers has been affected as a result of COVID-19 restrictions and the subsequent reduction in adult day care and short breaks. Adult day care and short breaks are subject to nationally agreed health protection guidance to keep service users safe.”
“As has already been indicated, that announcement is due to be made in the next few weeks. <BR /> <BR />In conclusion, I thank everyone who has worked tirelessly to ensure that the vital out-of-hours services have continued to be available, especially in the light of the many difficult and unforeseen challenges that have presented during the COVID-19 pandemic. I recognise the importance of ensuring that patients can receive the right care at the right time and in the right place, and I assure Members that my Department will continue to work in partnership with all relevant stakeholders to progress the plans for those vital services.”
“<BR /> <BR />It is important to note, however, that the increasing demand for primary care services cannot be met solely by increasing the number of GPs' rather, it is part of a wider programme of work to help improve patient access to services in primary care. Other elements include the wider roll-out of the primary care multidisciplinary teams, as has been mentioned, as well as the introduction of advanced nurse practitioners and additional general practice nurses, all of whom are making a difference to how services are delivered in primary care and contributing to improved patient outcomes. Plans for the further roll-out of the primary care MDT model are under development. It will provide much-needed hope for the areas that do not currently have the model and will allow providers in those areas to plan properly for the future.”
“My Department has continued to invest in our GP workforce. That is why we have increased the number of GP trainees by over 70% from the 2015 level. It is a pity that they were allowed to fall to that level and that more work was not done and investment made before now, but I welcome the additional training places that are available in Magee and through the graduate entry medicine (GEM) programme. There are 111 new training places available for GPs each year. Work has commenced on reviewing the number of training places for GPs, with a view to increasing the number of places available.”
“During my first summer as Health Minister, my colleague Rosemary Barton invited me to visit the site to see the out-of-date and inadequate facilities that the practices were having to use and to meet the many staff. That visit left me in no doubt of the necessity for the new build, and, as Minister, I was more than happy to give it my approval. That new £18·5 million facility will support the delivery of integrated primary and community care services for the population of Lisnaskea and the surrounding east Fermanagh area. It will provide a central hub in Lisnaskea, support a network of 16 GPs and provide services to a combined practice list of around 25,000 people. <BR /> <BR />I appreciate the need to further stabilise and bolster the capacity for services to be delivered in primary care.”
“Key features of that new model for the out-of-hours services will include a regional telephone-based urgent care clinical advice, assessment and treatment service and improved access to a broad range of clinical services, including doctors, advanced nurse practitioners and physiotherapists. <BR /> <BR />It is important to note that the pressures and challenges facing out-of-hours services also affect primary care services more widely. That is particularly evident in Fermanagh and South Tyrone. I know that it is important to the people of Fermanagh and South Tyrone and across Northern Ireland that they know that they will continue to be able to access high-quality primary care services in their area. It is for that reason that I was delighted to announce the approval of the business case for the new healthcare centre in Lisnaskea.”
“For that reason, my Department has established a working group, in line with the recommendation from the Regulation and Quality Improvement Authority (RQIA) review of out-of-hours services, to develop a new model for the out-of-hours service. The working group, which has membership from the Health and Social Care Board and health and social care trusts, GP representatives and representatives of the out-of-hours providers and the Department of Health, will ensure that that new model is embedded in the wider unscheduled care infrastructure as part of the work on the implementation of No More Silos, which Mrs Barton mentioned.”
“Sixteen have already confirmed that they will spend their full additional allocation — their £121,000 share — of the £1·7 million that was made available for telephone services. In addition, managing winter pressure funding totalling a further £100,000 has been identified for those practices. All 21 practices have confirmed that they will use all of their funding by the end of March 2022. Finally, for the current winter period, additional funding totalling £146,000 was provided to Western Urgent Care for the provision of additional out-of-hours services. <BR /> <BR />Whilst those additional supports are important, I am also conscious of the long-term issues affecting GP out-of-hours services that must be addressed.”
“Members will know that, in addition to the finances that were mentioned, I invested £5·5 million to support general practice in Northern Ireland over the past winter period and to make up the shortfalls from what has been long-term underinvestment. Of that £5·5 million, £1·7 million was made available to further improve telephone infrastructure and accessibility. The other £3·8 million is to support additional patient care, covering general practice and the GP out-of-hours service; incentivise uptake of out-of-hours shifts through the critical period; and promote and expand the provision of cover to a wider range of professionals from across primary care. <BR /> <BR />Members will know that there are 21 GP practices in the Fermanagh and South Tyrone area.”
“<BR /> <BR />Due to the COVID-19 pandemic situation, Western Urgent Care has, like many other providers, adapted how it operates and has implemented video consultations, which have enabled patients to be assessed in a suitable manner without the need to travel to a base. All calls to the service are prioritised on the basis of their clinical urgency, and patients who are assessed as urgent will be triaged and allocated appointments first. As, I am sure, Members will understand, when the service receives a high number of clinically urgent calls, that may mean that it takes longer to triage the routine calls. <BR /> <BR />I thank Mrs Erskine for acknowledging the money that we have provided, especially over the winter periods.”
“<BR /> <BR />Western Urgent Care has spent considerable time and effort over several years on skill mixing the clinical workforce so that it can effectively and efficiently use the resources that are provided to continue to meet the needs of patients as locally as possible. Despite the challenges, I believe that, in common with our other out-of-hours providers, Western Urgent Care and its staff work hard, and they work hard to ensure that clinical cover is available at all times across the out-of-hours period. That means proactively engaging with GPs to seek additional cover for shifts, as well as seeking cover from an expanded range of professionals.”
“Since that time, a number of initiatives and service improvements in GP out-of-hours have been introduced. They are not only in Fermanagh and South Tyrone but across Northern Ireland. They include adjusting the skills mix of clinicians; increasing levels of nurse triage provision; employing more nurse practitioners, paramedics and pharmacists; increasing flexibility in shift times; incentivising more new start GPs to do out-of-hours shifts; and facilitating out-of-hours providers to recruit non-GP clinical staff to their workforce. In addition, the GP retainer programme requires retainees to do one GP out-of-hours session per month.”
“Our GP out-of-hours service is delivered mainly by our GPs, supported by input from other healthcare professionals, including our nurses, nurse practitioners and pharmacists. Similar to the experience across the United Kingdom, all five out-of-hours providers in Northern Ireland, including Western Urgent Care, are experiencing increased difficulties in securing sufficient GP numbers to fill all available shifts. <BR /> <BR />Members may or may not be aware that, in 2004, the general medical services contract included a clause that enabled GPs to opt out of providing 24-hour cover for their patients. In Northern Ireland, the majority of GP practices opted out of providing out-of-hours care for their patients. That happened on 1 January 2005, meaning that there is no contractual obligation for GPs to work in out-of-hours services.”
“Let me be clear about this: whilst they have, no doubt, been exacerbated by the pandemic — I know that Mr Gildernew and others agree with this — they were not caused by it. <BR /> <BR />I understand well the particular challenges facing primary care services in rural areas; indeed, some Members may be aware that officials from my Department met Fermanagh and Omagh District Council recently to discuss issues in primary care in the region. Western Urgent Care is the out-of-hours provider for the Western Health and Social Care Trust, and the five clinic bases are located at Limavady Health Centre; Strabane Health Centre; Omagh Hospital and Primary Care Complex; the Lakeland Health Village in Enniskillen; and Altnagelvin Hospital in Londonderry.”
“Thank you very much, Mr Deputy Speaker, and thank you for the opportunity to respond to the points that have been raised this afternoon. I thank Mrs Erskine for securing the debate, as well as those who contributed to it. <BR /> <BR />Members will know that the GP out-of-hours service is a core element of Health and Social Care (HSC), and that provision in primary care, as Mr McGrath indicated, is all part of the same service. In common with other services across the health and social care sector, the out-of-hours service is under considerable strain, both in Fermanagh and South Tyrone and across Northern Ireland as a whole. The problems across our health service are, unfortunately, deep and long-running.”
“As we move through one of the most difficult times that we have faced throughout the pandemic, we again ask everyone to look after themselves and each other by following these simple precautions: get your first and second vaccine doses and your booster; limit your social contacts; meet outdoors where possible; if meeting indoors, make sure that the room is well ventilated; wear a face covering in crowded indoor spaces; take a lateral flow test before meeting others; and practise good hand and respiratory hygiene. By making safer choices, following public health advice and complying with the regulations, we can all do our part to help lower the spread of COVID-19. <BR /> <BR />I commend the regulations to the Assembly.”
“That is because the Executive were still having a discussion about the first part of the amendment (No. 8) regulations, which is to do with "severe distress" caused by face coverings. The conversation was still being had about what the final replacement for the amendment (No. 8) regulations would look like. The Member says that I am asking him to trust me: it is up to the Member where he stands on the amendment (No. 8) regulations. <BR /> <BR />I have answered as many of Members' questions and queries as possible. This is not ideal. I remind Members that the choices that we make now will be crucial in ensuring that the virus does not begin to spread once more. As we continue to remove the remaining restrictions that are in place — I want to emphasise that point — our society moves closer to a return to normal life.”
“Ms Bunting is looking at me, because she and the other Whips in this place know the challenges that we are often up against. <BR /> <BR />Having noted the opposition of some Members to the "severe distress" element on face coverings, which has already been removed, I ask them not to divide the House and vote the amendment (No.8) regulations down, while supporting the other amendment regulations that have already been taken forward.”
“I do not disagree. When I responded to the Member's contribution about how this place does its work, I said that the amendment to remove the element about causing "severe distress" has already been laid and will be moved and debated. We have already removed that part. In the process of the House, I have no way of segregating the amendment (No. 8) regulations into different parts that can or cannot be moved. When the regulations are laid, they go through the Committee process, they are considered by the Examiner of Statutory Rules, they are put in the Order Paper and they come here. It is nearly a two-week process just to get through that. Having served as a Chief Whip in this place for a number of years, I know the frustrations from the other side. I know the pain, I was going to say, of standing here trying to explain things.”
“8) regulations will start a redrafting process, so we will be left with a period when people travelling on a ferry will have to wear a face covering when they are outside and at a 2-metre distance from others, and the need for face coverings will be reintroduced at train and bus stations. There will be a time lag during which the provisions that the amendment (No. 8) regulations remove will come back and be enforceable. <BR /> <BR />I say to Members that opposition has been noted. I ask them not to vote against the regulations — they do not have to vote for them — if Members can thole that, so that we can retain the parts of amendment (No. 8) that are in place and are still necessary, while acknowledging that —”
“I thank the Member for her intervention. I was about to go there. I was getting a briefing from officials — I apologise: I do not want to land them in it — on that very issue this morning when the Chair came to seek clarification on the point that the Member has raised. It is important. It was described in a helpful way. Imagine that the amendment (No. 8) regulations are a train that has already left the station with all those different parts on it. The Executive have agreed to remove "cause severe distress", but including the other parts of the amendment (No.”
“Voting down the amendment (No. 8) regulations will remove all parts of them, not simply the bit that has already been replaced, so it has that correspondence. I was getting —”
“What we have done throughout the past two years has not been simply for the sake of it; it has been to protect the people of Northern Ireland and to support our health service.”
“I would not want to say that the Member is wrong, but the Business Committee has not met yet or considered any correspondence that it may have received from me about what may or may not be debated next week. I will not pre-empt a discussion of the Business Committee or a decision that it might make later this afternoon. <BR /> <BR />One thing that I will say to Mr Allister is this: he talked today about the Executive's need to be seen to be doing something, and I take exception to that. We could never have tackled COVID by doing nothing, and that would be a failure on the part of this place. I know — the Member is correct — that that is not what he is saying, but I want to be clear that that impression is not the case.”
“We rightly have Committees to scrutinise them, and our Examiner of Statutory Rules has a role in what is brought forward, but what happens in this place is often towards the end of that process. I am fully supportive of it, and the Member knows well that I do not shirk my responsibility in coming to the Chamber to stand in front of Executive decisions and take questions.”
“<BR /> <BR />Mr Allister rightly referred to how the process in this place sometimes challenges what we want to do, whether as an Executive, as Ministers or as legislators, and how we manage our business. That is not a challenge to you, Mr Principal Deputy Speaker, or to the Business Office; it is about how we schedule our business two weeks in advance. When we look to other legislatures, we see that they can move in a matter of hours to bring forward regulations, changes or amendments that need to be brought in quickly or expediently, and — I have said this from the Dispatch Box before — this place needs collectively to look at how we can be more agile in debating such issues and passing regulations.”
“8) regulations originated, especially the part regarding the enforcement of the wearing of face coverings. I will deviate from that for a moment. We had indications that the paediatric COVID vaccine should be with us by the end of this month. It is part of a UK order, and I was told this morning that that is still on track. The original Joint Committee on Vaccination and Immunisation (JCVI) advice stands: five-to-12-year-olds with underlying health conditions or who live with someone who is immunosuppressed will be able to access that vaccine. JCVI is looking at being able to expand the availability of the paediatric vaccine to a wider cohort, but we await that feedback from JCVI.”
“As we start to ease restrictions and move to a better place, complacency starts to become the greater challenge. There is a collective responsibility, and we still need to pull together as we go through these next days, weeks and months. <BR /> <BR />That leads into Mr Chambers's helpful commentary, which was a reminder to us all that we are dealing with a global pandemic. Northern Ireland is not dealing with it on its own, and we should not revert to the mindset that what we do here is done in isolation and does not affect others. Mr Chambers gave a message of thanks to the people of Northern Ireland and to the health service that has supported us so admirably through the past two years. <BR /> <BR />I have covered Ms Bradshaw's point about where the proposal in the amendment (No.”
“She said that what is being said by members of the public is important to how we enter the next stages of our fight against COVID. Sometimes, we now talk about "omicron" rather than "COVID". Delta is still present in society, and we keep a constant watch for another variant that may come round the corner. Thankfully, we also have scientists and UK health advisory services constantly keeping an eye on that for us. On the support for various sectors, any Minister who comes to the Executive looking to support a certain section of our community that has been financially or socially challenged by the pandemic will receive my support. That should not be in question. <BR /> <BR />Colin McGrath summed up well the fact that we are not out of the woods yet. The virus is still with us.”
“Again, I have had the conversation with the Chair of the Committee about the challenging position where, while officials are trying to explain to Committee members the conversations that are being had, those conversations have already been had among the public. I think that the Committee met on the morning of 20 January, and the Executive did not meet until the afternoon to discuss that point. <BR /> <BR />Mrs Cameron spoke about the amendment (No. 20) regulations and the amendment (No. 21) regulations, and she raised concerns about the amendment (No. 8) regulations. She acknowledged that the amendment (No. 8) regulations are multi-part regulations. I thank the Member for her contribution and for the tone and tenor in which it was made.”
“To align with other regulations in not requiring social distancing, however, the provision removes that requirement. While I fully appreciate and the Executive acknowledge the concern about the first part of the amendment (No. 8) regulations, which is being revoked and replaced, the other parts of the amendment (No. 8) regulations are still required and are still part of the conversation. <BR /> <BR />Those were the main concerns raised by a number of Members and parties in the Chamber. While we have on record their opposition to that part of the amendment (No. 8) regulations, I ask that they acknowledge that the other parts are still important to the technical amendments that needed to be drafted under the face covering regulations.”
“It was about moving from encouragement, which had got us so far, to implementation and enforcement. Options were discussed by the Executive, and, as has been pointed out, removing "severe distress" did not bring about a satisfactory result for what the Executive were trying to achieve. That is why that part of the amendment (No. 8) regulations has been removed and superseded by a unanimous Executive decision to remove it. <BR /> <BR />The amendment (No. 8) regulations still contain other requirements. They remove a requirement to wear a face covering when outdoors in public transport premises and make a minor amendment to the requirement to wear a face covering when outdoors on a ferry, where, previously, social distancing of 2 metres was required.”
“Unfortunately, as I have said in this place before, while we have those conversations in the Executive, they are already being transmitted, transposed and being had in the public sphere, so, before the Executive can take a final decision or process, the debate has started and, as Members indicated, caused further distress to those who think that they could or will be impacted, because they do not have the full information, as Ms Bradshaw often talks about, on what is being talked about. <BR /> <BR />I have to correct Ms Bradshaw and the Committee: it was not a Department of Health recommendation to bring in amendment No. 8; it was brought in following a recommendation on a paper from the Executive Office over engagement from the Executive's COVID task force on what more could be done to enhance the wearing of face coverings.”
“Thank you very much, Mr Principal Deputy Speaker. Again, I welcome today's debate on the amendments to the Health Protection (Coronavirus, Restrictions) Regulations and the amendment to the face coverings regulations. I thank Members for their contributions. I will address a number of points that Members raised. <BR /> <BR />In his opening comments, the Chair talked about whether some members of the Health Committee could support amendment No. 8, as did others, and referred to how officials from my Department, the Department of Finance and the Executive Office had engaged with the Committee. The conversation on the removal of "severe distress" as a reasonable excuse carried on through the Executive for some time.”
“While I understand the concern, and I have heard it about the first part of the amendment (No. 8) regulations, if the amendment (No. 8) regulations are not made today, those other parts of the amendment (No. 8) regulations will also fall, and that will require further amendments to be brought into legislation to reinstate those. It will create a grey area about what happens from the point at which they are moved until those amendments are remade. I just wanted to clarify that for the Member, although I accept fully her concerns about the first part and the undue stress.”