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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“It is about understanding the messaging, our history and what we are doing to challenge a global pandemic. Mr Chambers talked about the war that we are currently fighting against the virus. We can win the war and beat the virus, but we have to do it together. That goes back to what Carál said about there being:”
“<BR /> <BR />Ms Ní Chuilín said something similar to what Mr McGrath said about the abuse that our constituency staff have taken. The language that has been used towards not just constituency staff but departmental staff is despicable. People now seem to think that they have free rein to say whatever they think or believe. Again, that abuse is unacceptable. Mr McGrath mentioned the language used about John Hume when people rang the SDLP offices. Ms Ní Chuilín mentioned the language used about Martin McGuinness when people rang the Sinn Féin offices. I have been told, because of the sacrifices that people made, never to show my face again at a Remembrance event. The people who said that are probably the same individuals who were waving swastikas on Saturday.”
“<BR /> <BR />In response to Ms Bradshaw's comments about the six-month gap between the second vaccination and the booster, again, that advice came from Joint Committee on Vaccination and Immunisation (JCVI) guidance and is based on its assessment of when maximum effect can be gained from a booster. I have never deviated from the JCVI guidance that we have received. In order to do so, I would need to get more guidance or someone would need to change that decision. The time between people getting their second dose and receiving their booster is therefore still six months. I am conscious that, in England, people have been allowed to book their booster appointment from five months after, but that does not mean to say that they are receiving it before the six-month window is up. We always keep the JCVI guidance and advice under review.”
“This is a global pandemic, yet some seem to think that it is happening solely in Northern Ireland. They think that somehow it is of our creation and our doing, or that it is because of our approach, but we are not in this alone. It is about looking at what has happened, at what been done elsewhere and at what additional supports or learning can be drawn on. I go back to Ms Ní Chuilín's point: it is not about where our health service currently is but about from where we started pre-pandemic. We were not in a good place. I have said that many times in here. The challenges that we are seeing are not because of COVID. They were there long before COVID. It also goes back to Mr Allister's point about the funding of our health service, on which he knows that I will not argue with him.”
“It is not easy in the format of government that we have, but the Executive and this place have a duty to tell the people of Northern Ireland not only what we expect of them but what we have to do.”
“The simple ask, and I have made it numerous times, is that Executive colleagues come together on a shared platform and send the clear message that although the things that we do may be challenging, they are to progress Northern Ireland and keep us moving in a direction that means that we do not have to go back to the lockdown scenarios that we had in the past. It is about going back to the basics — I think that that phrase was used earlier — of good hand hygiene, good respiratory hygiene, face coverings, keeping your distance when you can and getting your vaccine. <BR /> <BR />Mr Chambers talked about the importance of the same message coming from a collective leadership. It is challenging.”
“It goes back to the Chair's query about the test, trace and protect system and being able to contact many of those families to make sure that they had the advice and guidance that they needed. <BR /> <BR />Mr McGrath referred to this as being a public health issue. It was never more so, but the challenges that we face and the importance of public messaging are a worldwide public health issue. There is a certain déjà vu in the public messaging that we have seen in the past week and a half from the Executive and where we were this time last year in the approach to a very challenging winter.”
“I remember well the Chief Medical Officer's words at the start of the pandemic. When addressing a GP federation, he said that this would be the first pandemic that we would fight alongside social media. Many of the challenges lie in seeing through misinformation, misrepresentation and the undermining of public messaging. <BR /> <BR />The Deputy Chair commented on the superspreader event in The Elk, and Mr Carroll referred to it as well. It was a teenage event, so many of those attending were either unvaccinated or not eligible for a vaccine or a passport. The event had a considerable effect. It reached into 20 schools and many homes across Northern Ireland.”
“It was a mix. As the Member is aware, there is now a dual platform that allows people who receive a positive result to provide their contacts through a telephone message or a text service. That has been developed, and it ensures that people still get the advice that they need. As I said, from those 9,732 positive cases, over 27,000 contacts were identified. That is about the same ratio as we were getting before — between 2·5 and three contacts per positive case — and 99·4% of those people received the update that a contact had tested positive. <BR /> <BR />I return to where the Chair was going with where we are on compliance with face coverings and the work of the Executive COVID-19 task force. There is no single measure, silver bullet or single lever to be pulled.”
“I thank the Member. I will get on to that point as well. She may be aware that I have had my fiftieth birthday, so I fall into the age range that she is reaching. I am not as far advanced in the booster programme as Mr Allister, but I welcome his active support in getting it. <BR /> <BR />I go back to where the Chair was on the test, trace and protect system and to the increase in numbers. Some 9,732 people were referred to our test, trace and protect system the week before last, 89% of whom were contacted successfully. Over 27,000 contacts of the original positive cases were updated, and 99·4% of them were contacted and given the advice that they needed. Our test, trace and protect system still serves us well and still completes the job that it was intended to do.”
“It remains at the core of our public health response to the COVID virus, along with our vaccination programme. In the last number of weeks, testing and contact tracing continue to experience a significantly high demand, which is in line with increasing case numbers in the community, but still to a level that up until —”
“I also point him to the Executive's autumn and winter plan and response and the four steps that they thought would possibly be needed should situations arise. <BR /> <BR />Members, we do not find ourselves in a unique scenario or place with the virus. Unfortunately, we are trying to challenge a pandemic. That is why there have been discussions about responsibility and who should have the lead responsibility on enforcement. That discussion was had by the Executive this morning and will continue at another meeting, I believe, this afternoon. <BR /> <BR />The Chair also made comments as Sinn Féin's spokesman on health and asked about our test, trace and protect system. I have, I suppose, a continuing update about how that works. Our test, trace and protect programme incorporates our contact-tracing and testing service.”
“The Executive COVID task force was set up at the start of this year. That was meant to take all the different strands and pieces of work that cut across Departments or arm's-length bodies and bring them together in one place. I share the Chair's frustration. We do not see an openness about the three Es — education and encouragement before we have to finish up with enforcement — on the regulations that are in place and how they can be developed. <BR /> <BR />The Chair also made the point about my Department's response to managing the pandemic. I point him to the surge plans that each of our trusts developed at the end of last month. Those detail how they see themselves managing the pressures that they will be under over the next three months.”
“Mr Allister is correct: the premise on which the regulations have been delivered and how they have operated since we entered the pandemic has been a mechanism of the Executive. Unfortunately, it has been left to me over the past number of months to appear here and debate the changes that have been brought in. I assure the Member that I asked for that debate and vote in the House to be put in place as part of the process of taking forward that specific ask from my Department, as was done in other jurisdictions where the same mechanism was brought in. That will involve the Executive Office engaging with the Speaker's Office and the Health Committee to see whether that can be done. <BR /> <BR />The Chair of the Health Committee asked how I can provide the necessary level of enforcement and adherence and whether I can provide the evidence.”
“It is usually left to others to do that quite actively or openly, often before Ministers see or hear them. I will say this: following the paper that I presented on COVID certification and the updated paper this morning, I recommended that Executive colleagues support me in writing to the Speaker, as an Executive, and to apologise to the Health Committee about the enforcement date for COVID certification of 12 December. I believe that there is time and an opportunity for the regulations to be discussed at the Health Committee and debated in the Chamber before they are enacted.”
“There are those who, rather than have a democratic, legitimate debate, resort to what we have seen over the past few days, which are the threats and intimidation that, they think, can divert me from carrying out this role or change my mind about the direction of travel simply by raising the level of threat against me. The unfortunate thing is that some in society now think that my family members are also legitimate targets. I ask anybody involved in that, supporting it or supporting the dog whistle behind it to cease and desist because it does none of us in the House any service. <BR /> <BR />With regard to comments from the Chair about how we treat these debates — this starts from where Mr Allister left off — I do not widely discuss or disclose discussions that have been had in the Executive or papers produced for the Executive.”
“I welcome the debate on the Health Protection (Coronavirus, Restrictions) Regulations (Northern Ireland) 2021 (Amendment No. 18) Regulations (Northern Ireland) 2021 and the Health Protection (Coronavirus, Wearing of Face Coverings) (Amendment No. 7) Regulations (Northern Ireland) 2021. As always, I thank Members for their contributions. I will turn to some of the points that have been made. <BR /> <BR />I thank Members for their messages of support and solidarity, but it is a damning indictment of where we are that they are necessary.”
“As I have stated previously, under the ministerial code, I am required to bring any matter that is significant or controversial and clearly outside the scope of the Programme for Government to the Executive for consideration and agreement.”
“I thank the Member for the question. The Abortion Services Directions 2021 came into force on 23 July and required my Department to have commissioned abortion services in place by 31 March. They include requirements for the provision of information, contraception and a regional telephone-based, non-biased advice and referral service, all of which are elements of the ongoing planning work and will form part of an overall draft service specification. The draft service specification will be subject to Executive approval in due course and is expected to be completed and issued to the Executive in early 2022 for approval.”
“<BR /> <BR />Verifying international second doses, such as the one that he mentioned in Canada, is not as seamless a process as when the second dose has been given in a United Kingdom jurisdiction, where we can verify certification. It is not in place yet, but it is being worked on.”
“I thank the Member. The issue of having received one vaccination in one jurisdiction and the second in another should largely be resolved. If people applying go on to the nidirect website where they apply for the COVID certificate, and go to, I think, the second screen and scroll down a bit, they will see that there is an application through which they can ask for a letter of proof that they have been vaccinated in a different jurisdiction. It is a more manual process, not an automated one, to match the two things together to produce the certificate, but there is a process. I am happy to talk the Member through it and give him an explanation. That process is still there.”
“<BR /> <BR />For the domestic pass, which we launched at the start of the year, it was deemed, through interaction with the Information Commissioner's Office and other bodies, that that level of information should not be accessible to anyone requiring it in a domestic setting. That is why the domestic certification carries the simple 2D barcode, a photograph and the holographic HSC logo so that screen grabs cannot be taken and certificates cannot be passed from one individual to another. A lot of information technology was used to make sure that the passes are not easily abused in relation to their primary purpose.”
“I thank the Member for his question. The first international COVID certification that we developed had to meet data requirements not just for the United Kingdom but for the EU and the World Health Organization. We had to make sure that, if it were being used as an international travel pass, it embedded all the security measures that were needed to meet all the international requirements that had been agreed, which included data on the second vaccination, security and that the certificate could not easily be counterfeited. If the Member has downloaded the international pass, he will have seen that it has a 2D barcode and a reflective hologram that carries the data necessary for the international travel pass.”
“I encourage as many Members as possible to support the health service so that we can get the seamless transfer of people from hospitals to the care home sector and back into their own homes. <BR /> <BR />This is a challenging time in what we are seeing. Unfortunately, it is not new to the health service in Northern Ireland, but we are working to address how we support that sector, which was largely forgotten about, with people being kept in the dark about its workforce and who was in it.”
“I thank the Member. He makes a valid point. As late as last week, my Department and the Health and Social Care Board wrote to all the trusts again to reinforce that exact position. The phrase that used to be used was "bed-blockers". We are now seeing families and even elected politicians getting involved and telling or advising patients not to leave their hospital beds until enhanced or suitable care packages are in place. On many occasions, facilities such as the one that the Member talked about may provide the step-down facility that the health and social care sector needs and patients could go there first while entire care packages are sourced and put in place.”
“We are seeing that workforce decrease since decisions were taken in regards to Brexit. That concern was shared with your Minister in DAERA. Previously, when the husband, son or father worked in the food processing sector, the mother, wife or daughter worked in the domiciliary care sector. There has been a double hit on our available workforce. As I said to another Member earlier, we have established a number of support mechanisms and are looking at ways of enhancing our workforce so that we can keep it in place.”
“I do not have the exact, up-to-date number, but I know that, often, in the region of 300 people are waiting each day for assessments so that they can leave hospital. <BR /> <BR />It goes back to an earlier question about the availability of domiciliary care packages. In lieu of those packages, we have supported care homes as step-down facilities for patients. In the past, care homes would have charged for that after six weeks. We have now waived those charges, so if people seek to use care homes as step-down facilities, families will not be charged. That will allow us to make sure there is throughput of patients from hospital beds back into the community. <BR /> <BR />There are many challenges with the low number of workers in the community domiciliary care sector.”
“I agree with the Member. The scheme must work, and communication is essential. That is why it is particularly frustrating that many of the conversations among the public and the media are about partial papers and conversations that have been leaked. That continued up to this morning, prior to the Executive meeting at 9.30 am. Putting partial information out in order to establish a position that individuals have already taken is not a conducive way to do business.”
“Many seem to be focused on that since last week, deliberately, mischievously or to prove an ideological point that they have taken a stance on.”
“I do not think that I can go into such detail in the time that the Speaker would allow me to answer that question. I can update the Member that the Executive COVID task force, which is leading that engagement, met the hospitality sector last week. This morning, I was told that they will meet again today. As the regulations draw out and come to a firm position, there has been engagement not just with Hospitality Ulster but with the Hotels Federation. The task force is listening to their concerns and seeing how the scheme can be practically utilised. <BR /> <BR />A point was made in the earlier debate that this is not solely about COVID certification. There are the options of lateral flow devices and providing proof of having had a positive PCR within the past 30 to 180 days. It is not solely about the focused utilisation of vaccination.”
“The Member raises a valid point. We saw that, during the pandemic, with in-reach hospitalisations, where we had GPs and hospital consultants reaching into the care home sector, giving medical advice and support. We want to build on that. We saw it as useful and supportive. <BR /> <BR />One of the biggest challenges is that in care homes with many residents, many GPs are involved in supporting their individual patients. We are looking at how to streamline that interaction. Rather than a number of GPs supporting the home, we could take a more focused approach that allows a consistency of care and enables primary care to work with secondary care. Making a connection with the care home and the people working in it gives a more integrated approach, support package and mechanism for people in the care home sector.”
“I thank the Member for her question that relates to the support, recruitment and retention of domiciliary care workers. That workforce is under pressure because of its work and its numbers. That is why, as the Member is aware, I established a fair work forum for the independent care sector. That has now met. It was chaired by the Chief Social Worker from my Department, but we have identified the need to appoint an independent chair, who will look at that overarching piece of work. As I announced last week, we are looking at a number of options whereby we can provide additional financial supports to the domiciliary care sector. My intention is that those additional financial supports should go directly to the workforce.”
“The Member knows that that has been an issue for the past decade. My Department is working with the British Dental Association. I am hopeful that we can move to a swift resolution, but I doubt that that level of negotiation and contractual engagement is possible this side of the election. However, we have commenced that work, and we are working in partnership with the British Dental Association and dentists on how we prioritise the Department's work in supporting National Health Service patients and, as I said to the Member who asked the previous question, to make sure that we have a dental service in future. We are aware of the pressures that dentists are under.”
“Is the Member asking about the dental contract?”
“I thank the Member. She will know, from her previous role, that the amount of additional capacity is not the same as we have in the independent sector in other health provisions as well. It is about working with the British Dental Association and dentists on how we can support them to increase the amount of work that they do internally. In early February, we gave £1·5 million in support payments to help practices reduce fallow time through improved ventilation and through the purchase of high-volume suction devices. The ongoing conversation between our newly appointed Chief Dental Officer, the BDA and me is about how we maximise capacity in our current dental provision.”
“It is, therefore, possible that a dental practice with high demand for health service appointments but low demand for private appointments has longer waiting times for those health service slots and much shorter waiting times for private slots. <BR /> <BR />I can assure the Member that the Department of Health and the Health and Social Care Board advise dentists to prioritise patients based on clinical need, with patients in pain being high-priority cases. That is the conversation — it is a supportive position — between my Department and the British Dental Association. The Member can write to me about the specific case that she raised.”
“I thank the Member for her point. I do not know whether she has written to me about that specific constituency case, but, if she wants to raise it with me, I am happy for her to do so. <BR /> <BR />Most dentists in Northern Ireland spend part of their week doing health service work and part of their week doing private work. One of the conditions of our financial support scheme for health service dentistry is that dentists maintain their pre-pandemic health service/private split during the pandemic. Dependent on the current relative demand for care from health service patients and private patients, it may be that, in a given practice, waiting times are longer for health service care than for private care.”
“That group includes representation from the British Dental Association (BDA) and continues to explore ways to increase capacity in the sector so that practices can see more patients. <BR /> <BR />It is also important that we continue to review our treatment priorities to ensure that we are using the available capacity in the best way possible. I met the BDA on 21 October to discuss these issues and the ongoing challenges facing patients. My resolve and commitment to rebuild dental services and improve access to patients remains.”
“<BR /> <BR />In addition, in February this year, I provided a further £1·5 million to help improve patient throughput at dental surgeries throughout Northern Ireland. That funding helped practices to reduce the fallow time between patients by investing in improved ventilation or through the purchase of high-volume suction devices. <BR /> <BR />Revisions of the UK infection prevention and control guidance are the subject of a review. The proposals may increase the capacity in a practice by small amount, but my expectation is that, unfortunately, activity will remain unavoidably impacted for many months to come. <BR /> <BR />In June this year, I established the general dental services rebuilding stakeholder group, which provides a focus and momentum in addressing the challenges facing the sector in the coming months and years.”
“<BR /> <BR />The financial support scheme for general dental services has helped to ensure the sustainability of general dental practices during this uncertain period. At the same time, a network of urgent dental care centres was established across Northern Ireland to cater for patients who, for various reasons, could not receive care in general dental practice. As a result of both initiatives, patients with pressing oral health issues continue to receive vital healthcare. <BR /> <BR />Whilst the picture varies across Northern Ireland, practices dealt largely with those patients who experienced symptoms, and they are now in a position to offer appointments for check-ups and routine treatment.”
“I thank the Member for her question. The need for enhanced infection prevention and control measures in dental practices includes the need for fallow time between appointments. That has resulted in practices operating at around half of the activity levels seen prior to the pandemic. <BR /> <BR />Dentists are prioritising patients requiring emergency or urgent care to ensure that that more time-limited capacity is targeted appropriately. If a patient is not categorised as high-risk, has a diet low in sugar, no history of dental disease and has good oral hygiene, they will be judged as low-risk and able to safely wait longer for a routine appointment. Patient registration time frames have been extended to ensure that nobody becomes unregistered because they cannot access their dentist due to the pandemic.”
“I thank the Member for his question. The utilisation of COVID certification is a conversation that is ongoing in the Executive. That will be part of a wider debate at another time with regard to where that comes in and where it can be of benefit.”
“What the Member is referring to is what we have seen over the last 18 months, and that is about looking at our operational ability across the region. We are looking at the regional prioritisation oversight group coming together weekly to look at the long-waiters — those most in need of time-critical and time-pressured surgery — to make sure they are seen and operated on as quickly as possible. <BR /> <BR />We have looked at a number of initiatives across Northern Ireland. At one point, Belfast surgeons were operating in the South West Acute Hospital to make sure that we were getting the maximum utilisation of those theatres. We are looking at the additional capacity that we may use in Omagh Hospital as well, to make sure we are using and making available every square foot of health estate across Northern Ireland.”
“<BR /> <BR />What the Member is, I am sure, realising, and it was part of the debate earlier, is that COVID is not happening solely in Northern Ireland. When we look to the additional capacities that we could buy outside Northern Ireland, a lot are being taken up by those regions themselves.”
“I thank the Member for her question. I do not have those specific numbers with me. I can update the Member on waiting list initiative programmes that we have taken forward, which, as she will be aware, have been based on different monitoring round bids. <BR /> <BR />Just shy of 81,500 people have received additional elective activity outside our normal services that we were able to provide by additional payments to trusts, through GP federations or in the independent sector. We are using every available resource that we can. Our health and social care consultants continue to utilise local independent sector theatres at the Ulster Independent Clinic (UIC) and Kingsbridge to ensure that priority patients can be treated. We are looking to utilise resources in the Republic of Ireland and elsewhere.”
“<BR /> <BR />That elective care framework outlines the different scenarios and procedures in different locations that we are doing to keep the COVID-light sites as open and effective as possible. It also highlights our waiting list initiatives with regard to the funding that we have in place to support additional services, either in the independent sector or in other places.”
“I thank the Member. Since coming into this post, I have repeatedly said that the pressures we are currently seeing are not solely caused by COVID but are being highlighted by it. The pressures that we are seeing across our health and social care system are due to 10 years of underinvestment in the structures and in our workforce. In order to make sure that patients are seen as effectively and efficiently as possible, I announced and produced the elective care strategy back in June, which contains a number of additional steps that can be and are being taken by our reprioritisation organisational group, which is looking at waiting lists across the entirety of the region, rather than being simply based through trusts.”
“Whilst we continue to try to protect elective care as much as possible, the stark increase in hospitalisations has, undoubtedly, seen an impact on delivery. It is expected that surgical capacity will continue to be constrained for as long as that level of pressure persists.”
“I thank the Member. According to the latest statistics, in June 2021, 93·4 % of patients received their first definitive treatment within 31 days of a decision to treat. In that context, treatment can mean surgery, drug therapy, radiotherapy, specialist palliative care or active monitoring. There is, however, no doubt that, despite the incredible efforts of our front-line workers, the current extreme pressures on our hospitals are already having an impact on the system's ability to deliver planned surgery. Clinicians and health and social care trusts will continue to prioritise time-critical patients, and available capacity will be allocated on a regional basis in order to ensure that patients from across Northern Ireland have equity of access to surgery.”
“I thank the Member for her question. I know that the subject is dear to her heart, as it is to mine. I asked the chief social worker, along with the Public Health Agency, the Regulation and Quality Improvement Authority and a number of other agencies, to review how we can open up those places and processes more safely. I expect an announcement in that regard in the coming weeks. I will keep the Member up to date, because I know that she has continued to press on the matter and has a particular interest in it.”