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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“As the Member is aware, as a constituency MLA and the Minister of Health, I am supportive of those bids at all times. The Member will see that through the monitoring round bids that I continue to make to improve long-term investment in our health service. It cannot be done with short-term, non-recurrent budgets, which is why I look forward to having a longer and sustained budget that allows capital and revenue. That will mean that we can do the planning and recoup some of the underinvestment of the past 10 years.”
“I thank the Member for his question. He makes a valid point, and I have often said here that it is not just about investment in infrastructure — bricks and mortar or physical beds — but about investment in the staff that it takes to support those beds. That does not just mean the doctors and the nurses; it means the porters and the administrative workers who are there to support them. When this place came back in January 2020, the promise of an additional 300 nursing training places over a three-year period was welcome. That increase saw the number of nursing training places rise to 1,325 a year, but, like everything else, it takes time for those nurses to come through to support the beds. <BR /> <BR />There are a capital bids in from the Northern Trust on how it can expand.”
“I thank the Member for raising the issue. In regard to the elective care strategy that was published in June, once again I needed money from monitoring round bids to fund it. That is why I was thankful to the Finance Minister for funding my bids for Health and not diluting them in any shape or form. That allows me to continue with the work in the elective care strategy. <BR /> <BR />Over 65,000 people have been seen through waiting list initiatives; 1,800 people have been seen through mega-clinics; and another 4,000 have had preoperative (PO) assessments through GP federations. The hope that I can give is supported by the funding of monitoring round bids that I have made for my elective care strategy.”
“My Department continues to work closely with the Health and Social Care Board, the out-of-hours providers and key stakeholders to address the challenges in the out-of-hours service across Northern Ireland and to redesign it in line with the recommendations in No More Silos. The aim of that is to have a more stable, sustainable and integrated service that will better meet the needs of the whole population. That will include consideration of a regional model for delivery of the service.”
“I thank the Member. I am aware of the continuing pressures faced by GP out-of-hours services across Northern Ireland, with increasing demand and difficulties in filling GP shifts. An effective out-of-hours service is a priority for me. My Department continues to work closely with the Health and Social Care Board and the out-of-hours providers to address the current challenges. Service improvements continue to be introduced. Those include adjusting the skills mix of clinicians; increasing levels of nurse triage provision; employing more nurse practitioners, paramedics and pharmacists; and increasing flexibility in shift times.”
“We do not have any direct evidence of that. I know that your party conducted a GP survey, and I thank it for sharing the findings with me. Of those 233,000 people, 50% were seen face to face. The rest were triaged by telephone or the online service, and the GP directed them to where was most appropriate. That work continues to be progressed. Again, we are putting additional moneys into telephone and online consultation so that people do not have to wait to get an initial consultation with their GP.”
“However, I plan to publish the report and consult on its findings shortly, because it ties in with the recommendations from No More Silos.”
“In response to your last point, very much so. We want to make sure that people go to the right place to be seen. That is part of the benefit of Phone First: before somebody presents to an ED, they have the opportunity to engage in that way. One of the directions of travel in No More Silos is that we have a single number for the entirety of Northern Ireland, akin to the 111 service in England and Wales. That amalgamation across the entirety of the service would take some of the pressure off out-of-hours. <BR /> <BR />The Member will be aware, if she has been talking to the Royal College of Emergency Medicine, of the review of urgent and emergency care. Unfortunately, the publication of the report that sets out the findings and recommendations of that review was delayed by the pandemic.”
“The Member and his Minister are aware that the timeline for drafting that has been laid out. As I indicated in the earlier debate on the regulations, a small team in my Department has been left to draft those regulations on behalf of the entire Executive.”
“I thank the Member for that point, which his party continually raises. We are here to talk about emergency departments, but the SDLP wants to go in a different direction. On certification — I am sure that his Minister has briefed him on this, given that she seems to have briefed others on it — he will be aware that the head of the Northern Ireland Civil Service has said that that policy development work is being taken under its direction. That is where it lies. I have always been clear on that. Health is supporting them in that. <BR /> <BR />The Executive's autumn and winter strategic plan, which was supported by all Ministers, clearly stipulates that the initial work in developing the app should be done. We delivered that yesterday. Legislation on what it will look like is being drafted and prepared.”
“If that is a specific case, I encourage the Member to either contact the Patient and Client Council or refer it directly to the trust on an individual basis so that that case can be looked into. In relation to the narrative about GPs not being open, I reiterate to the Member that £5·5 million will be invested in our GP primary care structures over the winter. I also refer the Member to a comment that I made earlier about the number of people who are being seen by GPs. In the week commencing 15 October, 233,000 people came forward for a GP consultation with regard to how they could be best directed.”
“I have said that many times from this place, but monitoring round money does not solve anything when it comes at this time of the year to be spent in March to address a systemic problem that has been getting worse over the past 10 years, rather than doing the structural reform that we all know needs to be done now. We need that recurrent budget, should it be for three years or five years, to give us the surety to make the transformations that we need to make.”
“It is for early discharge, first and urgent care centres, ambulance handover bays and Hospital at Home. It will support the entirety of the system as it works through. However, that is only part of the monitoring round moneys that I got on Friday. That bit specifically addresses the problem that was raised in the initial question for urgent oral answer. I got £70 million that will go to giving our health service workers the 3% pay rise that was indicated by the independent monitoring body that looks at that matter. It allows me to take that to the next step as well. <BR /> <BR />Additional investment is needed.”
“It is for all those services that are actually there.”
“I thank the Member for her question. To be clear, the £21·2 million is for investment in No More Silos, which was the Department's strategy before I became Minister to address pressures in our emergency departments. I will make it clear to the Member: that investment is going towards those steps —”
“It is to support the work that needs to be done, as indicated by No More Silos, with regard to how patients are transferred through the entirety of our system. It is all about investing in the Northern Ireland health service. That includes Phone First, urgent care centres, the timely discharge initiatives, ambulance handover bays and Hospital at Home.”
“The £21·2 million that was announced to support No More Silos is solely for the health service.”
“Doing that smoothes out the pressures that our EDs are witnessing and releases the ambulances quicker than they would have been released had they simply gone to the closest ED. The Northern Ireland Ambulance Service covers the entirety of Northern Ireland and, as a result, is not constricted by the make-up of the five geographical trusts.”
“I thank the Member for his question. It is a valid point, and one that I have seen in operation where we have the hospital ambulance liaison officer (HALO) system in place, through which a member of the NIAS is in the emergency department in order to coordinate the handover. Although patients may be transferred to what the Member calls a hospital trolley, they remain patients of the Ambulance Service until they are fully integrated into the trust and all the necessary checks are able to be undertaken. That handover is therefore being done. <BR /> <BR />I referred to this in my original answer, but one of the changes that we have seen recently in the Ambulance Service is "smoothing", which is a clunky term. A patient is taken to an ED that has a shorter waiting time rather than to the closest ED.”
“I thank the Member for her question, although it is slightly off the subject of the original question. I will refer back to the autumn and winter contingency plan, which all Ministers supported. It refers to the fact that the development of appropriate enabling infrastructure to underpin a system of COVID status certificates is under way. As the Member will be aware, and as I said earlier, we launched that yesterday. The Department of Health has committed to bringing forward the domestic COVID certificate. Where and when it will be deployed is a policy directive for the entire Executive to make.”
“That has culminated in an intake of 111 students for the 2021 programme. That represents a 71% increase on the 2015 intake, when there were only 65 trainees. Although that investment in the workforce has seen the overall number of GPs working in Northern Ireland increase, more GPs are choosing to work less than full-time hours, with the result being that the overall GP workforce, as measured in whole-time equivalence, has decreased by 8% since 2014. That having been recognised, I have asked for a review of GP trainee places to make sure that there are enough GPs to meet our primary care needs into the future. I reiterate, however, that it will take time to get those medical professionals in place.”
“I thank the Member for his question. On the GP workforce pipeline, I reiterate that, a few weeks ago, I announced £5·5 million of additional funding to support primary care through the winter. <BR /> <BR />It has often been said in the House, and this is supported by all parties, that the crisis in the workforce that we are currently experiencing is not solely because of COVID. It is due to the underinvestment that there has been in our health service in the past 10 years, not just in bricks and mortar but in the people working in it. <BR /> <BR />My Department has continued to invest in our GP workforce, and, in recognition of the increase in demand for primary care services, there has been a steady expansion in the number of GP training programme places over recent years.”
“<BR /> <BR />Yesterday, the Member stated in the House that I had no plan to tackle elective care. I refer him to the elective care strategy that was published at the start of June. It might inform him of the work that is being undertaken, but it needs funded, and that requires cross-community, cross-Executive support.”
“We consider all systems as they are developed elsewhere. However, our challenge is always that of workforce and who is able to deliver the service in a timely fashion. There is no point in displacing a patient from one section to another. That is why we introduced the Phone First system. In my original answer, I told the Member how many people utilise that system, which allows them to be directed to the correct place at the correct time. <BR /> <BR />In the week ending 15 October, our total practice teams — multidisciplinary teams (MDTs) and GPs — had consultations with 233,412 people, which is 116 per thousand of our population, and over 50% of those were face to face. I have often said in the Chamber that the narrative of our GPs not being open is incorrect.”
“As I have said many times in the Chamber, that is no way to resolve the structural challenges that our health service faces after over 10 years of underinvestment.”
“I thank the Member. The royal colleges and trade unions have requested a summit. Since that request was made, I have met most of them, individually as royal colleges or through the trade union workforce structure. I indicated to them, and to some Executive colleagues, that I am minded to do that once I see an ongoing Budget settlement for Health. It would be premature to bring everybody into the room at this stage when, in two to three weeks' time, we will find out what our long-term funding will be. That is the wider discussion that needs to be had at that health summit. <BR /> <BR />I expect to see the updated report of the urgent and emergency care review shortly. It blends into the No More Silos work that was instigated a number of years ago but has been reliant on piecemeal, hand-to-mouth funding.”
“Those are the steps that we have taken directly. <BR /> <BR />We have not made an additional request for Military Aid to the Civil Authorities (MACA) support, because, as the Member knows, that serving unit returned only a week ago and is not currently available for redeployment. We monitor continuously whether and when MACA is available and how we can use it. I spoke with some of the serving medics before they returned home. Hearing phrases like, "I was glad to be here to be able to support my own in their time of need" was testament to the additional service and support that they provided to our health service.”
“<BR /> <BR />That money will bring forward specific functions, but I stress that the money became available to me only on Friday when the monitoring round was agreed. The money will be spent on increasing Phone First in urgent care centres, the timely discharge initiative, ambulance handover bays and Hospital at Home.”
“I thank the Member for her comments. The two consultants to whom you referred, from Altnagelvin and the Northern Trust, were reiterating and reinforcing the statement that I made on 22 September. We have seen this coming; we knew where this winter was going to take us. That is why I made a bid in the October monitoring round for over £20 million to support the No More Silos structure, which predates the COVID-19 pandemic. It is about the work that needs to be done to direct and rectify the challenges that we have already seen in our EDs. Unfortunately, the pressures that we are seeing now are not new. They are a direct result of underinvestment in the health service, both financially and in the workforce over the past 10 years.”
“What is needed is recurrent investment over a number of years to improve capacity and bring forward meaningful change.”
“That includes £3·8 million to support additional patient care, covering general practice and out-of-hours services, and up to £1·7 million to improve telephone infrastructure. Again, those measures will help to alleviate pressures on our emergency departments. However, I must stress that we all have a role to play to support our emergency departments and our wider health system. I encourage everyone to take up the COVID-19 vaccine, the booster and the flu vaccine when offered. There is a real tangible step that we can all take to support our emergency departments now and into the winter. <BR /> <BR />Finally, it is important to recognise that the issues that we are seeing in our emergency departments cannot be resolved with one-off non-recurrent funding.”
“<BR /> <BR />Phone First is currently available in the Northern, Southern and Western Trusts, with an interim service in the Downe Hospital in the South Eastern Trust. The service was also recently introduced in Lagan Valley Hospital. From 1 December 2020, more than 134,000 patients have utilised the service. Of those, 29,500 — 22% — were discharged with advice to refer to their GP. Around 60,400 — roughly 45% — were scheduled for an appointment at an emergency department or the urgent care centre alternative pathway. Some 40,300 patients — 30% — were referred directly to an emergency department. <BR /> <BR />I recently announced a package of £5·5 million to support service delivery in primary care throughout the winter.”
“<BR /> <BR />The Health and Social Care Board (HSCB) continually works with the Public Health Agency (PHA), the Northern Ireland Ambulance Service and the five trusts to address waiting times at our emergency departments with enhanced flow through the system and the facilitation of timely discharge. The Health and Social Care Board is also coordinating smoothing to manage our Ambulance Service flows better. <BR /> <BR />Following a further allocation in the recent October monitoring round, which was confirmed and announced on Friday past, I am investing a total of £21·2 million in the No More Silos action plan this year. The key initiatives that will be supported will manage the unscheduled pressures. That includes Phone First in urgent care centres, the timely discharge initiative, ambulance handover bays and Hospital at Home.”
“Obviously, I do not want that to happen, and nor does anyone working in the trusts. However, we must realise that we are facing levels of pressure as never before. <BR /> <BR />For several years before the pandemic, too many people were being forced to wait for over four hours and 12 hours in emergency departments. The current pressures have been exacerbated by the pandemic, but they were not caused by the pandemic alone. On 22 October, I made a statement to the Assembly that set out my approach to winter preparedness. I have also published individual trust winter and surge delivery plans. All that has provided information on what actions have been taken to support our emergency departments through this autumn and winter.”
“I thank the Member for tabling the question. Our emergency departments are operating significantly above capacity. The pressures on our trusts during the summer and into the autumn were unprecedented, often having been akin to the most difficult winter pressures previously witnessed. That is what makes the situation so serious. <BR /> <BR />As Members will recall, I stated on 22 September that a hospital emergency department could be forced to close as a result of the pressures.”
“As we continue to remove the remaining restrictions, our society moves closer to a return to normal life. By making safer choices, following the public health advice and complying with the regulations, we can all do our part to help slow the spread of COVID-19. I commend the regulations to the Assembly.”
“<BR /> <BR />I did not hear the comment that Mr Allister referred to, but I see that Tom Black said something similar in 'The Irish News' . That has not been discussed in the Department, nor had it been raised with me before I saw it on the front page of 'The Irish News' this morning. I would not be comfortable with, nor do I intend, following that direction of travel, whereby we challenge our health professionals to prove that they have been vaccinated before they treat patients. It is not something that I was aware of, have had conversations about or have definitely made a decision on. <BR /> <BR />I hope that I have answered as many Members' queries and questions as possible. In closing the debate, I remind Members that the choices that we make now will be crucial to ensuring that the virus does not begin to spread once more.”
“When we met yesterday, everything was on the table. We looked at where we could go. I want to see Community Pharmacy and GPs start to deliver what they have said they will deliver. Let us not take away from the programme that Community Pharmacy and GPs delivered at the very start, before we moved to the mass vaccination programme. <BR /> <BR />One of the things that we need to be conscious of is the fact that people cannot get a booster until six months after their second vaccine. There is a time delay involved in determining who is now eligible. It is therefore not just a matter of opening mass vaccination centres for everybody to come forward for their booster. We are providing further communication to make sure that people are clear about who is eligible and where they can go.”
“I think that it was Dr Alan Stout who said yesterday that he hopes to see an increase over the next couple of weeks, and so do I. We are making every effort to ensure that we can get our vaccine programme back on track and fully performing in order to deliver the booster programme as well. It is about working with all partners across the programme.”
“<BR /> <BR />The third vaccine that the Chair talks about is for people who are immunosuppressed. It is strange terminology, as it is a third vaccine, not a booster. Technically, it is a third vaccine. Just shy of 10,000 people who have come forward for the third vaccine are not included in our booster vaccine statistics. That starts to complicate the messaging. <BR /> <BR />For anybody who wants a vaccine, be it their first, second, third or a booster, the availability is there. When it comes to those people over 50 who are eligible for the booster, we are back to that twin-track approach, where it is got either from their GP or from Community Pharmacy. <BR /> <BR />Come forward and get your vaccine. Over 190,000 vaccine doses have been deployed to our GP practices. Those have to be used within three weeks.”
“I get that. Most of the people who came forward to the PHA as volunteer vaccinators or through the payment system were deployed to the SSE Arena. There were a large number of administrators as well. It is now about how we utilise them, through the PHA, to support our GPs. They are coming forward, and they are being used. <BR /> <BR />The Member is right about what is now available. We are still calling people forward for their first and second vaccines. In the region of 400 to 500 people a day are coming forward for their first vaccine. That is available through Community Pharmacy. From where people get their second vaccine will depend on from where they got their first vaccine. If people got their first vaccine from a GP practice, Community Pharmacy or a trust facility, they will get their second one from the same place.”
“The House will be aware that Community Pharmacy stepped in yesterday to provide booster programmes as well. It is now acting in that regard. There is currently a dual-track approach between GPs, who will call people forward, and Community Pharmacy, with which people can make a booking if they are eligible. Those over 50 who had their second vaccine at least six months ago are eligible.”
“We have now asked the Public Health Agency (PHA) to look at how we can enhance the administration side of things so that, when people get the vaccine or the booster, that information is put on to the system. That drives the dashboard, which, in turn, drives public knowledge about how many vaccines have been supplied.”
“The Member is right to highlight strongly the start that we got off to with that. I engaged with our Chief Medical Officer (CMO) and our vaccination team last week. Yesterday, I engaged with a number of actors who are key to the roll-out of our booster programme to see exactly where we are. While we have been able to support our GPs with additional vaccinators in some scenarios where they have been doing large vaccination campaigns, inputting the data into our vaccine management system did not keep up with that.”
“I want to see more enforcement and compliance, but, from the Department of Health's point of view, we have always had the struggle that the enforcement power and ability do not lie with us. We rely on other Departments, local government and the PSNI to make educated enforcement guidance and to have conversations with people, no matter where they may be, about face coverings still being a critical tool to be utilised by those who can use them. I acknowledge that there are people to whom face coverings are not applicable or by whom they are not easily used. <BR /> <BR />Mr Speaker, you indulged Mr Allister slightly, and, if you grant me the same indulgence, I will answer some of his points. I am slightly disappointed about where we are with the booster programme.”
“It is to get the vaccine when it is offered; wear a face covering in crowded or indoor settings; wash your hands regularly; cover your nose and mouth; self-isolate and take a PCR test if you have symptoms; if you do not have symptoms but are mixing closely with other people, take regular tests to reduce the risk of spreading the virus; meet outside, if you can; open windows when indoors; keep your distance from people who are not in your group; and work from home where practicable or do a mix of home- and office-based working. <BR /> <BR />There are still challenges. Ms Bradshaw highlighted part of the challenge, which is the communication when we start to ease regulations and move some parts from regulation to guidance. In many places and settings, face coverings, as I said in my opening statement, are still in the regulations.”
“It would reduce the workload, and the app will be able to be used in the other jurisdictions across the common travel area where proof of vaccination is needed. <BR /> <BR />Mr Chambers talked about the responsibilities that we still ask the general public to take on in order to support us. The messaging has not changed greatly.”
“<BR /> <BR />Mr McNulty is no longer in the Chamber. He spoke about "cautious optimism", but, in that messaging, I encourage people not to lose the benefits and the optimism by falling into a level of complacency, dropping their guard and beginning to act as though the virus has gone away. Mr McNulty started to talk about domestic certification. Yesterday, we launched the domestic COVID certificate app. Having that facility is part of the Executive's autumn and winter planning, should it be needed. I encourage anyone who has been vaccinated and is eligible to download the app, because, if the Executive make a decision at some point to utilise it in Northern Ireland, people already having it would be a big advantage.”
“A small team of drafters in my Department, which has been supplemented now and again with staff from other Departments, works on how regulations are drafted, changed and challenged. I will put that into perspective: other jurisdictions have large teams that work in multiple shifts, 24 hours a day, seven days a week, to do the same thing as we expect a small, dedicated team in the Department of Health to do. I reiterate what Mrs Cameron said and acknowledge the work that the team has done not only in turning the regulations out in time but in dealing with the challenge of converting into legislation the conversations or the will of a five-party Executive. As we heard in the debate, it is not always easy to change those conversations into legislation that can be easily understood and communicated. That was Ms Bradshaw's point.”
“I still feel the frustration and annoyance from the Health Committee about how it has to review, look at and mitigate the direction of travel of the regulations without the full evidence that goes to the Executive. We can give our input from a health point of view from our papers, our modelling, our TTP projection and our outbreak reports, and that is published on the Department's website, so I understand where the Chair and his members are coming from. The most recent amendment that we are talking about today was made on 9 October. We have not caught up on the debate over the regulations, but there is a shorter gap between when changes are made and when they are enacted. <BR /> <BR />I thank the Deputy Chairperson of the Committee, Mrs Cameron, for thanking and acknowledging the drafters.”