Robin Swann
North Antrim · Ulster Unionist Party · Northern Ireland
“I thank the Minister for his detailed statement. I know how passionate he is about the subject and how many times he has brought it to the Executive.”
“It has been reported that today will potentially be the warmest day of the year. As we move into the summer and our summer holidays, I want to raise public awareness of wildfires across Northern Ireland, which have been detrimental to farmland and our environment over the past number of years.”
“Wildfires are still having a detrimental impact on our environment and, occasionally, on livestock, but that reduction shows the impact of the Northern Ireland Fire and Rescue Service's proactive approach to educating the general public and engaging with rural communities and schools on its fire safety message, which is to stay alert, not…”
“There has been a lot of talk of sport in this place over the past few days, with everybody concentrating on UEFA. One sport that is going on across Northern Ireland at the minute is cross-community and goes across all age groups without fear, favour or distinction: pigeon racing.”
“I want to put on record that, since this place passed the amendment that recognised pigeon racing as a sport under the 2016 Act, over the past five years, pigeon racing clubs across Northern Ireland have been able to obtain £113,000 of rates rebates through the sports and recreation rate relief, allowing many of those clubs to continue ra…”
“There was much coverage on social media over the weekend of an incident in Staines in England, in which a police car rammed a young calf to bring it under control. It has restarted the conversation about animal cruelty. <BR /> <BR />I am dealing with a specific case in my constituency.”
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“I thank the Member for his point. However, taking the Speaker's direction at the start, as legal proceedings are ongoing today, I will not answer it at this point.”
“I thank the Member for the points that she raised. I will ask that the information on the trusts' websites be reviewed to reflect any changes from the transfer from Informing Choices to BPAS, so that the women who seek it have access to the necessary guidance and information, and there is easy pathway to where they should contact.”
“On the last point, I will cover that in comments tomorrow during the Second Stage of the Adoption and Children Bill. On the other point, there should be no differential in advice given by Informing Choices and BPAS.”
“I thank the Member for the point that she raises. BPAS is providing a telephone service, the same as Informing Choices NI was. It is the same provision of advice.”
“<BR /> <BR />In the interim, Informing Choices NI signalled its intention to withdraw the current service from 1 October due to funding issues. In response, trusts established an alternative advice and referral service, and, as of today, they have put in place an interim advice and referral service that is being delivered by the British Pregnancy Advisory Service (BPAS) in place of Informing Choices. My Department has been advised by the trusts that BPAS will provide the service for Northern Ireland seven days per week at no cost. That will ensure continuity of advice and referral into the trusts' EMA services pending wider decisions on the commissioning of abortion services in Northern Ireland. Until then, women here can continue to access abortion services by contacting BPAS.”
“Thank you very much, Mr Speaker. As you highlighted, the House will be aware that, further to the direction brought forward by the Secretary of State in July, my Department had asked Informing Choices NI to submit a funding request for the cost of providing an interim telephone-based information and advice service. A funding request for £83,000 was received in August, and my officials have been pursuing it in line with departmental approval processes, with the intention of bringing a paper on the matter to the Executive for agreement in line with the legal advice received. That funding would have been in addition to the £137,000 that my Department and the Public Health Agency (PHA) already provided in grant funding each year to Informing Choices NI.”
“The PHA contact tracing service continues to proactively identify schools with a high number of cases, and it is proactively contacting those schools to provide appropriate assistance and guidance. Those processes continue to bed in. <BR /> <BR />As of 27 September, the PHA education cell was actively following up on 10 schools, most of which are special schools where there is an arrangement to follow up on every case. In a small number of clusters, wider testing has been recommended. That has happened in a number of schools, and the PHA has worked directly with those schools to manage the situation. My officials and the PHA continue to work closely with the Minister of Education, the Department of Education and the Education Authority to embed those new processes.”
“I thank the Member for his question. He raised this at the Education Committee, and, apart from the sight of him eating a bun, I think that he had a good engagement with the Chief Medical Officer and the Education Minister. <BR /> <BR />Contact tracing of school-age children remains very good, with almost all school-age cases completed within 24 hours. The latest performance data is that, as of 26 September at 4.30 pm, with contact tracing continuing at 8.00 pm, of 429 positive cases received, 383 had been successfully completed. Fewer calls have been escalated to the PHA education cell, and none was escalated by the Education Authority over the weekend of Saturday 25 September and Sunday 26 September.”
“I am surprised to hear that, and I can assure the Member that the 3% increase was recommended by the independent review body. As I said, I am still waiting for support from my Executive colleagues to be able to make a formal pay offer that can be put in place for the trade unions to consider. I would rather go forward and pay the 3% that I have in hand at that point than wait on any potential additional funding coming from elsewhere.”
“Although my Department had included initial budgetary cover for HSC pay awards of 2% for implementation of the review bodies' recommendation of an increase, coupled with the higher baseline pay bill across the year following increased activity, I will require further additional funding. That is why, on 22 July, I wrote to the Finance Minister seeking funding. Recently, I again submitted a formal bid for an additional £70 million for pay pressures from the upcoming October monitoring round. I am currently waiting for a decision.”
“As the Member will be aware, the NHS Pay Review Body and the Review Body on Doctors' and Dentists' Remuneration both reported and recommended a 3% uplift in the salaries of relevant staff from April of this year. I am fully supportive of the recommended increase for our health and social care workforce and see an early announcement of an acceptance of the recommendations as a small measure of our collective gratitude. As, I am sure, all in the House will agree, in recent years, those staff have faced unacceptable delays in the implementation of pay awards. We cannot be seen to permit that to reoccur this year.”
“By way of an update, general dental services have received an additional £13·9 million in funding for PPE alone since April 2020. Fee-for-service and PPE support have also been introduced, and it has been projected that an estimated £4·3 million will be provided to dentists specifically for level 2 PPE for the remainder of this month. Additional financial supports have therefore been put into dental practices over the past 18 months to make sure that they can continue to see patients and perform their work.”
“Recently, I met our interim Chief Dental Officer to see what more the Department and the Health and Social Care Board can do to encourage more people to come into the profession, in order to allow our dentists to expand the provision of their service to NHS patients, should they be in the younger age cohorts or the older age cohorts. <BR /> <BR />Dentists provide a vital service as part of our healthcare family. The important point to make is that dentists are not just about teeth. They are about checking the mouth for things such as oral cancers. They do so much. Our dentists, because of the vital role that they play and the input that they can have, are included in our cancer strategy.”
“I thank the Member for his question. Earlier, he asked a question about GPs, and the pressures put on them have been repeated for dentists across the health and social care system. We have put in place a number of mechanisms to support NHS practices to maintain the levels of work and support that they need to provide, should that be financial support, PPE provision or the additional moneys that were supplied at the start of this year to put in additional ventilation systems. We have always had a struggle with NHS patients accessing dentists, and that is because of the number of dental practices that we have.”
“I will not proceed with expenditure of over £10 million to develop a scheme without Executive support to do so.”
“There has been a lot of commentary, from politicians and from the media, who seem to be informed of discussions and other things that took place, which does not reflect or correspond to any meeting that I was at. <BR /> <BR />The Member asked about the value that was placed on introducing a domestic vaccine certification system. That is correct. The policy lead for the introduction of that certificate is the Executive Office. Until I get a policy direction or the Executive agree a policy to develop that domestic certification scheme, should it be for use in Northern Ireland or to allow people in Northern Ireland who have been vaccinated to access facilities or sporting or recreational events in England, Scotland, Wales or the Republic of Ireland, I cannot proceed.”
“When I saw some of the commentary last night, it reminded me of a line in a poem:”
“Again, I thank the Member. I am not sure where his anger comes from.”
“<BR /> <BR />I welcome those parties that have joined me in the past week in seeking to develop a COVID certification scheme so that, should we need it in Northern Ireland, we have one ready to deploy and utilise, and also so that we do not detract from the opportunity of people in Northern Ireland who have been vaccinated and who want to avail themselves of systems, venues, or sporting or entertainment events in England, Scotland, Wales or the Republic of Ireland should such a scheme be necessary. It is vital for us to prepare such a scheme.”
“I thank the Member for his question. I need to be clear that the vote that was taken last night was on a scheme that we do not have, for a sector that is willing to introduce the system on a voluntary basis. That sector is actually more than willing to do it. What was done last night does not reflect my position on the development and implementation of a vaccine certification programme. I have been clear about that since 22 April, when I asked Executive colleagues to bring forward a proposal so that, if we ever needed to utilise a COVID domestic certification system, we would have one in place. We are still waiting for that conversation at the Executive.”
“I will. Since coming into my position, I have seen the work of advocates in the voluntary and community sector to support the work of healthcare. It should not be underestimated. I congratulate the gentleman and wish him well as he undertakes that fundraising exercise. I also wish his sister well in seeking and getting the help and support that she needs.”
“<BR /> <BR />A small business research initiative is being led by the PHA to develop a digital platform to support people who live with chronic pain in Northern Ireland. That will include women with endometriosis. As it is expected to take some time before that platform is available, I appreciate that it is not available to anyone in the immediate future. I hope that it nonetheless provides further reassurances that people who suffer from chronic pain from conditions such as endometriosis are not being ignored or forgotten, and that plans have been and are being put in place to help them.”
“The Health and Social Care Board is responsible for ensuring that the National Institute for Health and Care Excellence (NICE) guidelines on the diagnosis and treatment of endometriosis, which were endorsed by the Department in October 2017, are cascaded and embedded in the health and social care system. Therefore, a patient with endometriosis will receive support from their GP to manage the condition until they are seen by a gynaecologist. If their condition worsens, they are referred urgently to secondary care. There are no specific endometriosis services in the Northern Trust and Southern Trust areas. There is a limited service in the South Eastern Trust area. Patients in those areas are usually referred to services in the Belfast Trust and Western Trust.”
“I thank the Member for his question. He has corresponded with me on the matter. I have received a lot of correspondence on endometriosis treatment and diagnosis, and I am very aware of the considerable pain that the condition can cause to women who suffer from it. As patient demand for elective care services currently exceeds funded health service capacity for both new outpatient and inpatient day-case treatment across a range of specialties, including gynaecology, regrettably, it is inevitable that waiting times will increase, as has been seen over the past few years. <BR /> <BR />Endometriosis services are provided as a subspecialty in gynaecology.”
“It is important that anybody who needs to see a GP actually gets to see them. It is not easy, but one thing that we need to be clear about is that it is not just a COVID or post-COVID problem: pre COVID, we had the same challenges because of the reduced workforce in GP practices and high demand for the services that they provide. That is why we rolled out initiatives like the multidisciplinary teams, where individuals in a practice and healthcare professionals could see a wide range of patients in different settings, and not everybody had to go and see the GP in the first instance.”
“When the son, daughter or carer calls about someone who is suffering from dementia or has additional needs, many GPs will be able to triage the patient, as will the GP's receptionist, because they are known to the service. That is one of the strengths of the GP fraternity. We often underestimate how well they actually know their patients and clientele.”
“I thank the Member for her point. There are a number of avenues, but the crucial part of her question is the last line about the GPs who know the patient best.”
“If patients need to see their GP, there should be access to them. GPs should take the support mechanisms coming from my Department and the Health and Social Care Board in regard to updating telephone services and fully automating repeat prescriptions as much as possible in order to alleviate the additional pressures and time commitments in the work that GPs are trying to do.”
“I thank the Member for his comments. Initially, he pointed out the challenges that we have. We have GPs across the country providing an excellent service that is over and above manning out-of-hours services and COVID centres and looking after their own practice. As in many other situations, there are those who present challenges to the reputation of an excellent workforce. The additional strains and stresses coming from how they are perceived or portrayed as a whole, which is often unfair, are not just felt in GP practices but add to the strains and stresses on our EDs and other parts of our hospital service. <BR /> <BR />On the work of 'No More Silos', which is on making an out-of-hours telephone call first rather than going directly to the ED, there are steps that I encourage patients to take before simply turning up at the ED.”
“GPs want anyone with a health concern to feel reassured that they will be able to get an appointment and see a GP if necessary.”
“<BR /> <BR />Consideration is also being given to ways to better deal with routine requests such as repeat prescriptions to release capacity. At the same time, work is well advanced on a review of GP trainee places to make sure that we have enough GPs to meet our primary care needs in the future. It is anticipated that the review will be completed in the autumn. The work that is already under way is part of a wider programme to help improve patient access to services in primary care, and that includes the wider roll-out of primary care multidisciplinary teams (MDTs) and work to reform the out-of-hours service. <BR /> <BR />Finally, I reiterate that, if people have symptoms, an unexplained illness or any reason to be concerned, they should, in the first instance, contact their GP, who will be able to provide advice.”
“<BR /> <BR />Feedback from GPs indicates that many patients are presenting with more complex needs, particularly those with a chronic disease, making it more difficult for GPs to see all the patients whom they would wish to see. I am aware that some patients are experiencing difficulty in accessing their GP by telephone, and I understand their frustration where that is the case. I also share the concern that that causes. Work is under way on a number of fronts to help improve access to primary care services for patients. My Department has invested £1·7 million to upgrade GP telephony services and improve telephone access. Further urgent work is progressing with GPs and the Health and Social Care Board to explore how telephony can be better used to support the service.”
“The pandemic has accelerated a trend that was already under way of making greater use of technology to help manage the increase in demand in primary care. <BR /> <BR />General practice "Telephone first" consultations allow patients to seek timely medical advice from their GP. The GP decides how best to meet the need of the patient. Where a face-to-face appointment is appropriate, that will be arranged. That approach has enabled GPs to appropriately manage, treat and support a greater number of people than would otherwise have been the case. Recent figures indicate that approximately 147,000 GP and practice nurse consultations are taking place on a weekly basis.”
“I will join questions 6 and 10 together. Again, I ask for additional time. <BR /> <BR />I thank the Member for his question. I recognise how important it is that people can access GP services when they need to do so. I want to stress again that 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-19 pandemic, primary care services were coming under increased pressure. Figures from 2019 indicate that patient contacts were at almost 15 million per year, and that was up from an estimated 12·7 million in 2014. At the same time, the GP workforce as measured in whole-time equivalents has decreased by 8%.”
“<BR /> <BR />Part of the challenge — I have had conversations with trusts about the lack of parking facilities at some of our hospital sites — is that the provision of parking facilities for staff where we have been able to provide that support negates the number of parking spaces available for patients, those coming in for day procedures or visitors. That leads to long queues and missed appointments, because people wait for so long for a car parking space that they do not get in to get the procedure for which they are attending hospital.”
“I thank the Member for her point, although it is not connected to the question. She will be aware that we supplemented car parking charges for a considerable time. Not every trust across Northern Ireland applies the same criteria, charging facility or charging mechanism, but I am aware that the trusts that have reintroduced some level of charging for their staff are trying to put in place park-and-ride provision and other alternatives, rather than simply looking to fundraise in order to plug the gap.”
“I thank the Member for his point. I have answered many questions through the frequently asked questions on the departmental website. As our weekly meetings progress and as we get more movement, those frequently asked questions are updated. <BR /> <BR />I want to place it on record that the independent sector is valuable. The payment is in recognition of the workforce that we have there. To date, we have made payments totalling £55·463 million to over 83,000 workers in the HSC system. As I said, that was a complicated process, but it was simpler than what we have to do for the independent sector. However, the dedication and commitment are there, and the support is there to ensure that those workers are acknowledged as well.”
“I thank the Member. Under the eligibility criteria set out for the payment, staff must have worked in an organisation registered with the Regulation and Quality Improvement Authority (RQIA) and hold a contract with a health and social care trust or the Health and Social Care Board for the provision of adult social care or a children's residential care service. In addition, staff working in an organisation with a contract with a health and social care trust for providing day opportunities will be eligible. Staff must have worked at least one month's continuous service between 17 March 2020 and 31 July 2021. Staff employed on a part-time basis will receive a pro rata payment. If the Member wants to send me the exact details of the organisation and the individuals, I will get back to him with clarity on that.”
“I thank the Member because, when I first brought the issue to the Executive, she was one of the supporting Ministers who ensured that not only was the money there but additional money was there so that National Insurance was not taken out as well. <BR /> <BR />It does not and should not take away from the value that we place on those in the independent sector. As I said, it is proving more problematic than simply paying those who work in our health and social care trusts, where there is a small number of employers. The dedication and commitment is there, and, as the Member knows, the money is there to make those payments. It is just how we get the process right to make sure that it is auditable and accountable because, after all, it is still public money that we are accountable for.”
“I assure the Member that I receive those emails as well. I made the commitment, I have the money there and my dedication, and that of my officials, is there. I cannot provide a date or time — much as I would like to — but I assure the Member that, as I said, the trusts, the Health and Social Care Board and the Business Services Organisation are meeting weekly to ensure that those issues are resolved. We continue to engage with employers, trade unions and those who are represented by trade unions in the sector to make sure that we can get the payment rolled out effectively, efficiently and as soon as possible.”
“However, I cannot be definitive about a timescale for delivery of the payments, nor do I want to provide an artificial expectation by being pushed into providing an exact date for the payments. However, what I can assure Members and, more importantly, those working in the sector is that my officials are actively engaged in trying to resolve those outstanding issues without any further undue delay. <BR /> <BR />In recent days, officials have had further detailed discussions with trusts, the Health and Social Care Board and the Business Services Organisation about the next steps in progressing the payments. Weekly meetings will continue to ensure that those issues are resolved. I remain personally committed to ensuring that the recognition payment will be paid to independent sector staff as soon as is practicable.”
“Unlike the statutory sector payments, on which my officials were working with a small number of employers, the independent sector has a larger employer base. In addition, workers in the independent sector are much more transient than the statutory sector, and developing a set of standardised eligibility criteria has proven to be more challenging. Likewise, the development of a payment mechanism, particularly in circumstances where an employee has moved between providers or has moved out of the sector completely, has proven problematic. <BR /> <BR />My officials continue to engage with trade unions and representatives of employers to develop a workable payment process. Whilst that has taken longer than for staff working in the health and social care trusts, that does not reflect any difference in the value of the work done.”
“Mr Deputy Speaker, with your indulgence, I will answer questions 3 and 13 together and ask for additional time. <BR /> <BR />Members will be aware that, in January, I announced that a special recognition payment of £500 would be made to Northern Ireland's health and social care workers. Payment to the statutory sector employees commenced in July. An additional letter was issued to care home, domiciliary care and supported-living providers in May, advising that work on eligibility and the mechanisms for processing payment was ongoing and that further information would be provided. A further letter was issued in August, providing an update. <BR /> <BR />Work to deliver the payment to staff in the independent sector has proven to be complex and challenging.”
“<BR /> <BR />In addition to that, the Patient and Client Council conducted an online survey throughout August to provide families with the opportunity to shape the restoration of services. Carers responded positively to the draft framework, although they raised some concerns about the proposal to introduce service user testing, which will require further consideration. My officials have been assured that the framework will be submitted shortly for my consideration. We must make sure that the restored service meets the needs of the people who use it, rather than delivering something that departmental officials, trust officials or the PHA think meets the specification that they think it should meet.”
“I thank the Member. When he hears the word "review" from me many times it is because work is ongoing and delivery is being made. The Member knows that with regard to what has been delivered over the past 18 months by my Department and people working across the health and social care sector. <BR /> <BR />In the Chamber I am often asked what engagement there has been with stakeholders. With regard to the review of current provision, I made it clear that we engaged the Patient and Client Council, and it set up an engagement panel of 20 carers. That was established and has met five times since the beginning of August with regard to the review of the provision of what we can bring back and how we will do that.”
“I can confirm that no one will be denied the health and social care service as a result of that.”
“I thank the Member for her point, which a Member raised in the Chamber last week or the week before. The PHA has undertaken a review of vaccination uptake in adult centres, short breaks and transport. I am pleased to report that there has been a high level of vaccination across service users and staff, which provides a strong platform to increase service provision further. Options are in development to introduce routine testing for service users, and that will further mitigate the risk of COVID-19 and increase service provision. It will also complement the existing routine testing programme for health and social care staff. Families have expressed concerns over potential service user testing, which is being further explored. We recognise that some individuals may be unable to avail themselves of vaccination or participate in testing.”
“Her point is well made, and she has often heard me say in the Chamber that I want a regional service and not a postcode provision. The work to review the provision of day-care services is not just about rebuilding what we had but about seeing what more we can do and making sure that it is consistent across all the trusts. That is why my Chief Social Work Officer has ensured that other bodies are engaged, including the health trusts, the Health and Social Care Board, the Public Health Agency, the Department and the users, who include family members and stakeholders who use the service. They will have an input to the review and its outcomes. Rather than its being just an exercise in finishing off where we started, we are taking this opportunity to improve provision.”
“That includes the increased use of day opportunities to provide a meaningful outlet for people with disabilities.”
“I thank the Member for that point. I am acutely aware that the reduced provision of adult day care and short breaks has placed a significant burden on our carers over the past 18 months. I extend my gratitude to families for the role that they have played in keeping their loved ones safe and responding to the emerging needs during the pandemic. <BR /> <BR />Trusts are at varying levels of service provision, which is reflective of the availability of physical space and the use of independent sector contracts. My Chief Social Work Officer tasked trusts to review those rebuilding plans, with a view to replicating effective practice across all trust areas. Our health trusts are also exploring a range of options to increase further the level and range of services provided.”