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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“Before I start my remarks on closing the debate, I pass on the condolences of the House to Mr Carroll on the loss of his grandmother. It is never easy to lose a loved one, but there is often a special relationship with a grandparent that, I am sure, many Members have had. Mr Carroll, will you pass on our condolences to your family? <BR /> <BR />I welcome today's debate on the two amendments to the Health Protection (Coronavirus, Restrictions) Regulations. I thank Members for their contributions. I will address some of the points that were made by Members. <BR /> <BR />I was deliberate in my opening comments on how the regulations are the culmination of Executive decisions.”
“A person may remove their face covering when seated at a table in hospitality venues such as a bar, cafe or restaurant, and no change was made in this regard. However, in larger venues such as concert halls, theatres, cinemas and conference facilities, face coverings must be worn at all times while seated and can be removed only when actively eating. I commend the regulations to the Assembly.”
“That removes the need to record time of arrival and removes the requirement for premises owners to collect this information. This was duplicating the requirement placed on the organisers. <BR /> <BR />Amendment No. 6 to the Health Protection (Coronavirus, Wearing of Face Coverings) Regulations commenced at 6.00 pm on 30 September. This technical amendment to the Health Protection (Coronavirus, Wearing of Face Coverings) Regulations arose as result of amendment No. 4 to the regulations. It clarifies that a person is exempt from the requirement to wear a face covering in a relevant place while actively consuming food and drink, including intoxicating liquor, and that, at all other times, face coverings should be worn in indoor venues such as theatres, concert halls or cinemas.”
“It removed the limit on the number of people who can attend an indoor gathering in a private dwelling, limiting, effectively, indoor gatherings at private dwellings to 30 people from any number of households. It removed the maximum number who can stay overnight at tourist accommodation, and it removed the requirement to be seated at an event in a concert hall, theatre, conference hall or other indoor venue being used for that purpose. Lastly, in response to feedback from the industry, it amended the requirement for visitor and attendee information in the context of large ticketed events. The previous wording was drafted with hospitality in mind, as large venues were not open. The amendment enabled operators of ticketed events with fixed start times to collect the details of a lead booker rather than every ticket holder.”
“Venues are asked to follow public health guidance to continue to utilise all other available mitigations, such as hand sanitising, good ventilation and using one-way systems where possible. The wearing of face coverings remains a legal requirement in these settings. The Executive also decided to remove the requirement to socially distance in indoor seated venues, such as theatres, concert halls and cinemas, during a performance, rehearsal or recording, and they advised that additional alternative mitigation measures should be utilised. <BR /> <BR />Amendment No. 17 to the Health Protection Regulations, which was made on 11 October, immediately extended the operation of the principal regulations to 24 March 2022. Further changes contained in this amendment came into operation on 14 October.”
“The Executive weigh up the totality of the effect that each restriction can have in combination with other restrictions in reducing the rate of COVID-19 in Northern Ireland. However, any relaxation to the restrictions will be associated with an increased risk of virus transmission, as has been the case through the epidemic. <BR /> <BR />I return to the amendments in question today, starting with amendment No. 16 to the Health Protection (Coronavirus, Restrictions) Regulations, which was made on 30 September. This amendment was made following the Executive's agreement at their meeting of 27 September to remove the legal requirements to socially distance in retail and indoor visitor attractions.”
“SR 2021/283, the Health Protection Regulations (Amendment No. 17), was made on 11 October, and the third amendment, SR 2021/274, the Health Protection (Coronavirus, Wearing of Face Coverings) (Amendment No. 6) Regulations, was made on 30 September. <BR /> <BR />I begin by reminding Members that it is the Executive Office that holds the lead responsibility, and it operationally manages the processes leading to Executive decisions on the ongoing need for restrictions and the requirement to amend the regulations. I am disappointed that, once again, it has been left to me to introduce these amendments. <BR /> <BR />The past 19 months have been unprecedented, and the Executive have sought to balance individual and societal liberty with public health requirements in the face of a protracted global pandemic.”
“Today, the House is considering three very specific statutory rules that were introduced following decisions taken by the Executive on 27 September 2021 and 7 October 2021. SR 2021/276, the Health Protection (Coronavirus, Restrictions) Regulations (Northern Ireland) 2021 (Amendment No. 16) Regulations (Northern Ireland) 2021, was made on 30 September 2021.”
“I thank the Member for that supplementary. There is a multitude of forms out there, as the Member is fully aware. Language is important, especially when we are dealing with applications from groups applying for challenging funding schemes. Equality questions should be appropriately phrased. I thank the Member for drawing my attention to that.”
“I will ask the PHA to review those forms and how accessible they are. I am sure that the Member will be aware that some of those equality questionnaires are crucial to the monitoring and other work that the Department does to make sure that it meets its obligations. The PHA will be under the same obligations in relation to its duty of care. I am unaware of the specific forms that the Member refers to, but I will ask the PHA to see whether there is any way in which they can be simplified. Given the information being collected, I will not give a commitment that they can be.”
“I encourage the Member, his party and all who are concerned about this to get involved in the consultation response to make sure that the strategy is fit for purpose and meets the needs of everyone in Northern Ireland. <BR /> <BR />One of the first events that I attended as Minister was a public consultation on the development of the strategy. That was before it went out for consultation. The voice of young people was clear that day, and they said loudly and clearly that they felt that their voice was not in the consultation. That is why it is there now. They are an important cohort, and we have to support them. We have to support not just the children who are going through treatment or have received a diagnosis but their parents and those who care for them.”
“I thank the Member. I have asked all trusts to review those waiting times to ensure that what has been reported is accurate and to compare the timeline of information that may have been supplied to the commissioner with where we are today. The current information coming from at least one trust — the Belfast Trust — is that no children are waiting. However, I want to seek that reassurance from all other trusts as well. <BR /> <BR />On children's cancer services specifically, the current cancer strategy, which is out for consultation, has a large section on how we look after children with cancer. It looks not only at the number of children who present with cancer in Northern Ireland but at teenagers and young adults who are transitioning from children's services to adult services and how they are supported.”
“<BR /> <BR />We will work with the Commissioner for Children and Young People on the recommendations that she has made, but a large amount of work is already being undertaken through different avenues to address some of the needs highlighted in her report.”
“I agree with the Member that we are failing most of society in Northern Ireland when it comes to waiting lists. Today's report by the Northern Ireland Commissioner for Children and Young People (NICCY) — my officials engaged in its publication and production — was about highlighting, which it does, the challenges across the entirety of our health and social care system and how we let down a large number of patients. I have said this before from this place and in other places: more needs to be done. We need more recurrent investment, and we need to support our existing staff. We are paying the price for 10 years of underfunding as well.”
“After receiving further advice from the Chief Nursing Officer, I have agreed to the implementation of the recommendation that we move to the next step in gradual easing, and that will take place from tomorrow, 20 October. The pathway will be reviewed again in mid-November. Our public health officials will further review the data and recommend further progress on the pathway, if that is merited. Furthermore, the potential for additional easements over the 2021 festive period for visiting will be considered.”
“Again, I thank the Member for her question. She will be aware that guidance went out from the Department to all trusts to make sure that a standardised approach was taken. I am aware that there has been some deviation from that. The Department's publication 'Visiting with Care — A Pathway' was effective from 7 May and is available on the Department's website. The pathway provides a staged approach to the restrictions that apply to visiting care homes and other facilities. <BR /> <BR />I will inform the Member and the House when I receive further advice on how residents with capacity may be facilitated and how people may be supported to visit other facilities.”
“I thank the Member for raising with me what is a sensitive issue. I do not have the answer with me, as it is a specific constituency matter. I will write to the Member or meet her to discuss what steps need to be taken to come to an equitable solution to ensure that her constituent is not discriminated against in accessing transport, be that transport through the education system or public transport. It is not an issue that has been raised with me before, but I thank the Member for bringing it to my attention.”
“I do not have the capital works budget plan with me, but I will write to the Member about that. It is worth repeating that, regarding the new set-up, the GP Federation Support Unit has come forward and taken on the Bannview practice to make sure there is continuity of support for patients there. I will write to the Member with the detail of capital builds.”
“This is the first time in Northern Ireland that general medical services have been provided by a GP federation. In August, the Health and Social Care Board and the GP Federation Support Unit wrote to patients of the former Bannview medical practice to make them aware of those new arrangements. The practice has a new medical team in place and a new practice manager in post. The Health and Social Care Board is arranging to meet the Beechwood family practice to ensure that it has the appropriate support to ensure the success and ongoing delivery of that practice.”
“I thank the Member, and I know that she has taken a keen interest in that issue in her constituency. I recognise that it has been an unsettling time for patients of Bannview, and it has been particularly difficult during the wider uncertainty created by the pandemic. I thank them for their patience and ongoing support for the practice and its staff as the Health and Social Care Board worked to secure a new contractor for the practice. <BR /> <BR />I am delighted that the GP Federation Support Unit, acting on behalf of GP federations across Northern Ireland, took over the contract from 1 September 2020 and now provides general medical services to the patients of the former Bannview medical practice. The practice is now known as the Beechwood family practice.”
“Again, the recommendation from the working group has to come to the Executive. It is TEO and Department of Health cross-departmental work that has been taken forward. One of the recommendations from the working group was that TEO should lead on the implementation of the acknowledgement to the victims and the women who were so badly treated. TEO will also bring forward the payments, as it did for the survivors of historical institutional abuse, so that there is that continuity of understanding and a recognition that they will be treated equitably and fairly, as has happened in other cases.”
“I thank the Member for his point. Again, the Executive took forward a very emotive and important piece of work. I met the commissioning group that completed the report, with the First Minister and the deputy First Minister, on the evening of its publication. Their clear ask was for that work to be prioritised. A report from the cross-departmental working group will be brought to the Executive, as per the recommendations for next steps. I am aware that one of the working group's recommendations was for TEO to lead on the work to recognise that that is what the survivors of the homes deserve and because of the cross-cutting nature of the responsibilities across all Executive Departments. Also, the Executive of Northern Ireland will rightly play their part in acknowledging the hurt and pain that was caused to those women and their children.”
“My Department has set up a working group with the key stakeholders to develop guidance to underpin that new policy. That will ensure that there is clear information available on how the new single eligibility question will operate. The group is made up of representatives from the trusts, the Health and Social Care Board, the Department of Health and stakeholder representation from Age NI. Work is progressing on the development of that guidance, with two meetings having taken place to date. I expect that working group to report in the coming weeks.”
“<BR /> <BR />With regard to the provision of continuing healthcare assessments, circular care management provision of services and charging guidance was introduced on 11 March 2010. That outlined the responsibility of health and social care trusts to ensure that appropriate assessments of needs for individuals, including those with continuing healthcare needs, are carried out. In light of the new policy, it remains the responsibility of trusts, as outlined in the aforementioned circular, to ensure that assessments are carried out as appropriate.”
“I thank the Member for his question. I recognise that the subject of continuing healthcare continues to attract significant public interest in Northern Ireland and other jurisdictions. As Members will be aware, the policy of continuing healthcare was updated in February of this year, with the aim of creating a fairer system in which all individuals who need to avail themselves of residential or nursing home care services will be subject to the same charging policy. That followed a public consultation that was undertaken in 2017. The new policy of a single eligibility criteria question is the same criteria as has been adopted in Scotland. It is a clear benchmark by which to assess whether someone's principal needs can be met outside of a hospital setting, be that for social care or healthcare.”
“There is a continuing watching brief on what can be done with the resource that will be provided to make sure that we are delivering for patients, but we need a longer-term investment in not just our workforce but our capital structures.”
“The Member will be well aware of my Department's financial pressures, not just in single-year resource budgeting but in the capital improvement that we need. We have had underinvestment in not only the resource side but the capital side for more than the past 10 years. There is, therefore, a lot of work to be done across our footprint. I think that it was valued at £1·2 billion the last time that I looked, with £600 million of essential maintenance outstanding. That is before we get to some of the critical investment in our capital footprint that we need. The steps that we took in increasing the waiting area at Altnagelvin, more than a year ago, were necessary at that point.”
“<BR /> <BR />My Department also continues to work closely with the Health and Social Care Board, out-of-hours providers and key stakeholders to address the current challenges in out-of-hours services across Northern Ireland, and to redesign out-of-hours services. That is aligned with No More Silos, the project that was taken forward on how to improve and fix our emergency departments and how and where people present to them. The aim is to have a more stable, sustainable and integrated service that will better meet the needs of the population. It includes the consideration of a regional model for the delivery of the service.”
“I thank the Member for his point, which highlights that it is one health service trying to support all patients, no matter where or how they present. I am aware of the continuing pressures faced by the GP out-of-hours service across Northern Ireland, with the demand and increase in difficulties in filling GP shifts. An effective out-of-hours service is a priority for my Department and me, and we continue 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. They include an adjustment of the skill mix of clinicians; an increase in the levels of nurse triage provision; the employment of more nurse practitioners, paramedics and pharmacists; and an increase in flexibility in shift times.”
“Where a face-to-face appointment is appropriate, that will be arranged. <BR /> <BR />The Member will be aware that I recently announced the investment of £5·5 million to support our GPs over what will be a challenging number of months. As I mentioned earlier with regard to Community Pharmacy, we have seen greater collaboration working between primary and secondary care. That is something that we should build and work on in order to deliver a one-system health approach in Northern Ireland that serves all our patients.”
“I thank the Member for that point. It is important that people can access GP services when they need to do so. GP practices are open and will continue to provide face-to-face appointments and alternative consultation options for patients as appropriate. Even prior to the COVID pandemic, primary care services were coming under increasing pressure. For the week of 8 October, the average number of patients presenting to primary care was 99 out of 1,000 of the population. So, nearly one in every 100 of the population of Northern Ireland was presenting to a GP to be seen or triaged. Considerable work is being done in our GP practices, and there are general practice "Telephone first" consultations. That allows patients to seek timely medical advice from their GP, and it is the GP who decides how best to meet the need of a patient.”
“I thank the Member for that point. Our patients who are waiting should not have to sit on the floor. It is unacceptable for them to have to do that, but we have challenges in that our waiting rooms in our emergency departments are still maintaining social-distancing measures, and the footprint is the same across all our health and social care facilities. That puts additional strains on the footprint that they are using. I am aware that a number of the hospitals where we have our main emergency departments have increased the size of their waiting areas by the utilisation of additional facilities. I am thinking of Altnagelvin in particular, where additional working capacity has been put in place to make sure that patients do not have to sit on the floor.”
“What is needed is recurrent investment over a number of years to bring forward meaningful change.”
“<BR /> <BR />My Department has undertaken a review of urgent and emergency care. That will be published shortly and will be taken forward in an elective care framework, and my Department is investing in what is already being done in the No More Silos action plan. The expansion of evidence-based ambulatory emergency care and rapid access services will also help to mitigate some of the pressures on urgent and emergency care that have been created by long elective care waiting times. Each of those initiatives will help to reduce waiting times by improving hospital capacity and flow and by developing services that enable patients to be discharged once medically fit. However, I reiterate that the issues that we are seeing in our emergency departments cannot be resolved by one-off non-recurrent funding.”
“Many patients are also presenting with more advanced or complex needs, particularly those with chronic disease, and the impact of the pandemic, together with the wider systemic pressures that we are facing, has led to a situation where each of the major emergency departments across Northern Ireland is now operating significantly above capacity. <BR /> <BR />The Health and Social Care Board is working collaboratively with the Public Health Agency, the Northern Ireland Ambulance Service and the five provider trusts to improve waiting times at our emergency departments. That is done by enhancing flows through the system in order to facilitate timely discharge. An audit of our emergency departments' patient pathways will be conducted to better understand and address issues for patients.”
“I thank the Member for her question. There is clear evidence that our unscheduled care system has been under increasing pressure over the past number of years. Those pressures are most clearly seen at our emergency departments, which act as bottlenecks for all patients who are unable to access the care that they require. The significant challenges facing our elective care, cancer and mental health services are increasingly leading to patients presenting at emergency departments as their conditions worsen, and that leads to the need for urgent care.”
“That age cohort has already started to be vaccinated. <BR /> <BR />Our main school programme commences within the next week, using our school vaccination teams. I encourage parents who have eligible children in that age group to make sure that they bring their children forward, complete the appropriate documentation and get their children vaccinated, in accordance with the CMO and JCVI guidance.”
“I thank the Member for her question. The schools programme should commence within the next number of weeks. We have already commenced vaccination in special schools, in accordance with the criteria laid out by JCVI for those eligible and more vulnerable cohorts. That work is ongoing. <BR /> <BR />The 12- to 15-year-olds are able to receive vaccines because of the expanded advice given by JCVI, which was supplemented further by the advice that we received from all four Chief Medical Officers (CMO). As I previously advised, persons aged 12 to 15 with specific underlying health conditions that put them at risk were offered two doses of the Pfizer BNT162b2 vaccine. As the Member is aware, that original group included children with severe neuro-disabilities, Down's syndrome and underlying conditions.”
“I place on record my thanks to Community Pharmacy for the delivery of the next phase of our vaccination programme, namely the booster vaccine, and also for delivering the flu vaccination.”
“I thank the Member for that specific point. As I said in my initial answer, over 220 community pharmacies have come forward to supply and deliver the COVID booster programme, and that is about half the community pharmacies in Northern Ireland. That makes the programme very accessible for the majority of people in Northern Ireland, who can go to their local community pharmacy and receive the booster dose. <BR /> <BR />Over the past 18 months, we have seen a real partnership approach between the Department and Community Pharmacy, with Community Pharmacy linking in with primary and secondary care and supporting them in what has been a very challenging time across the entire health family.”
“Therefore, we went ahead and started the flu vaccine programme because we are aware of the benefit that comes from it. I encourage anyone who is eligible for the COVID-19 booster, or their first or second dose, to come forward and get it. Anyone who is eligible for the flu vaccine should also make sure that they get it, because the criteria for that have also been expanded.”
“I welcome the Member to the House, and thank her for raising a critical point. Last year, in the roll-out of the flu vaccine programme, we saw a massive uptake. That was because of how GPs delivered it. We saw that again over the weekend, where GPs took over multistorey car parks to deliver up to 1,200 flu vaccines in one day and one sitting. We have seen a change in how it is approached, and we see those vast vaccination programmes rolling out at GP level as well. <BR /> <BR />I would like to have been in a place where we could deliver the flu vaccine and COVID booster at the same time. We could have used that efficiency. However, as I said in my answer to Mr Robinson, we are not in that place. We do not see large numbers coming forward for the booster dose.”
“Many countries do not require that certification for under 18s, so it may be worth checking whether it is necessary.”
“I thank the Member for that question. As she is aware, 16- and 17-year-olds have been offered the first dose. I encourage all those who are eligible for that to come forward. Of those who are eligible, 50% have come forward and received their first dose. JCVI is monitoring the implementation of the second dose. Once we receive guidance from JCVI on whether it is necessary to proceed with that and when it is necessary to do so, we will do that. Once those young people have received one dose, there should be no delay or challenge to their accessing proof of vaccination, but I will clarify that for the Member.”
“I can assure the Member that there is no shortfall in the availability of booster doses of the vaccine. The criteria to which we are working may seem more stringent than the criteria that we first used, but that is because we are going back to the first nine priority groups rather than to the mass vaccination programmes that we have seen since. We are also working on a six-month timeline, so it is those small numbers of people who came forward in the initial vaccination programme who are now eligible for the third dose. I give the Member an assurance that we do not have concerns about the supply of vaccines for booster doses.”
“As of midday today, 29,836 booster doses have been delivered, as well as 4,123 third doses. GPs will shortly begin to call their patients who received their second dose six or more months ago, with 220 community pharmacies across Northern Ireland starting the booster programme for front-line healthcare staff who are not directly employed by a trust. It is hoped that the majority of eligible people will have received their booster by the end of the year.”
“I thank the Member for his question. The Joint Committee on Vaccination and Immunisation (JCVI) has advised that groups 1 to 9, which were prioritised in phase 1 of the COVID-19 vaccination programme, should be offered a booster dose of the COVID-19 vaccine. JCVI advice states that the COVID-19 booster vaccine dose should be offered no earlier than six months after completion of the primary vaccine course, which is the full two doses. The six-month interval between completing the primary course and getting the booster dose will drive the timeline for eligibility and delivery. <BR /> <BR />The health and social care trusts began booster vaccination programmes in care homes in the week commencing 20 September 2021. Trusts also began further vaccination of front-line health and social care staff in line with JCVI guidance.”
“Those included 10 dementia service improvement leads, 10 dementia navigators and 44 dementia companions. Work has already been done in the community, and the new strategy that we will bring forward is part of the reform of the adult social care strategy.”
“I thank the Member. She will know that the regional dementia strategy, which was developed as far back as 2011, addressed a wide range of issues, drawing on best practice here and elsewhere. That strategy made recommendations that were aimed at improving the services and support arrangements. To date, we have implemented a significant number of programmes to improve the services provided to, and the experience of, those living with dementia. Phase 1 of the Delivering Social Change dementia programme, Still Me, was launched in 2016. That programme included a package of dementia projects. At that point, there was funding of £6·25 million. My Department has previously provided funding to support the roll-out of actions from the Delivering Social Change dementia programme.”
“I thank the Member for that question. That is why I specifically mentioned the dementia care pathway, which is about making sure that there is continuity across all trust areas. That includes a regional steering group that will bring members from all trusts into one place so that they can learn from each other and ensure that consistency of approach. As I said, that work is also supported by our regional stakeholder reference group, which includes those with dementia, their carers and those with lived experience. We have been able to utilise that during the pandemic, but we have also seen how it can ensure a consistent approach across Northern Ireland, which, as the Member is well aware, is geographically a very small footprint when it comes to those levels of services.”