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 raising the point; as Minister for the Economy, she raised it numerous times. We always review and revise the travel restrictions under the guidance of the Chief Medical Officer and the Chief Scientific Adviser. The Member will know that the graded and individual exemptions from quarantine or providing proof of vaccination are continually reviewed at UK level. <BR /> <BR />I think that the Member will acknowledge that, as we see vaccines being widely delivered across the world, the proof of vaccination and the certification that can be provided not only at Northern Ireland or UK level but at EU level will allow those individuals who come in to the country to prove vaccination certification to a standard that will allow them to access the country under the traffic light system for guidance on international travel.”
“I thank the Member for that. There is now revised guidance and the periods between vaccines has been shortened. It depends on what vaccine she got for her first dose. It has been reduced to six weeks and eight weeks depending on the vaccine. I have it in my notes somewhere. If I remember it during the rest of Question Time, I will respond to the Member. I will reply to her in writing about shortening the period between the vaccine doses. It is possible, but I do not encourage it because it upsets some of the systems that we have in place.”
“All participants in trials who received a vaccine that will not be licensed, or received a placebo, have been advised that they will remain certified during a grace period to allow them to receive the standard vaccines, if the doctors in charge of the trials recommend that.”
“I thank the Member for her point, which is a significant one for the people in Northern Ireland who came forward for vaccine trials, some of whom received a placebo dose. <BR /> <BR />The four UK Chief Medical Officers and the Chief Scientific Adviser in Northern Ireland have advised that participants in well-regulated clinical trials should not be disadvantaged as global travel resumes. Participants will not be disadvantaged in any domestic vaccine certifications compared to anyone else who received their vaccines under the standard health and social care programme. The vaccine management system used by the CCS will record trial participants as being vaccinated.”
“<BR /> <BR />We are doing everything that we can to encourage as much uptake of the vaccine as possible in Northern Ireland. We have seen a great response to date. We have seen a great response from our health and social care system in delivering the vaccine. If the Member recalls, the programme started only a number of months ago rather than a long time ago.”
“I thank the Member. Other people have used the terminology that this is now a race between the vaccine and the variant. I concur with that. The more people we can vaccinate with first and second doses, the more protection we can give to the population of Northern Ireland. <BR /> <BR />The Member quoted examples of walk-in vaccine centres at the weekend. He will see those being replicated across all trust areas. All the trusts are moving forward with those centres for first doses and, in some cases, they will be located in towns and villages across Northern Ireland where we have identified a low uptake of vaccines. Our trust centres are still operating and will move to a walk-in service for first and second doses, as long as people have left the appropriate time between doses.”
“It will not. In fact, it allows members of the public to bring forward their second vaccine dose from what had been scheduled. We encourage people not to do that as it would affect the sequencing of our booking systems. However, that can be done if people prefer to do it and they follow the guidance. We do not encourage it, but it would allow people to be provided with the vaccine certification and verification documentation once they have received their second vaccine.”
“The interim documentation will have a short-term expiry date and will be of no use to anyone travelling at a later date. <BR /> <BR />I am sure that Members will join me in thanking the Health and Social Care Board staff, health and social care trust staff, the system developers and departmental officials for developing the interim solution in a matter of days and working over the weekend to enable our citizens to meet the changing requirements for international travel.”
“The system was available on the nidirect website on Friday evening, with requests prioritised by intended date of travel. Health and Social Care Board staff are verifying the requester's identity, locating their vaccine record and preparing a vaccine certificate for collection from one of three vaccine centres, and staff are on hand to assist with any difficulties that may arise. <BR /> <BR />There has been an incredible public response to the interim solution. As of 1.00 pm today, there have been 4,500 applications. For 125 of those travelling today, certificates were made available for collection from one of three collection points yesterday afternoon. The short-term interim arrangements are only for people travelling to foreign countries who require proof of double-dose vaccination up to 20 July.”
“The comprehensive solution is expected to be available for 19 July. For those unable to access the automated digital solution, a helpline will be available. Members will appreciate that IT-based solutions that require access to personal healthcare records must meet the strictest data protection and cybersecurity standards and that such work cannot be rushed. <BR /> <BR />A second interim solution was developed in an incredibly short time and was made available to the public on Friday evening last week. The service was developed after some countries unilaterally decided to require vaccination proof, ahead of the EU vaccine passport scheme becoming fully functional. The interim solution enables people from Northern Ireland travelling to international destinations to show that they have received both vaccine doses.”
“If I may, I request an extra minute to answer that question, as I know that it is of great interest to Members and their constituents. <BR /> <BR />My Department has undertaken two significant pieces of work to assist those wishing to undertake international travel. First, officials have been working on a comprehensive COVID-status certificate system (CCS) since April, when international standards for information exchange began to emerge. The final CCS will take the form of a printed certificate supplemented by a mobile phone app. That system will provide internationally accepted proof that the holder has either received both vaccine doses at least two weeks prior to travel, or has demonstrated immunity to the virus, or has received a negative PCR test result in the preceding 72 hours.”
“I do not have that detail, but I can get back to the Member on that. The specific timeline of concern is while they were working in the Northern Trust between July 2019 and February 2020. The review period will be between 21 June and 29 October 2021.”
“Again, I stress that a helpline and a dedicated email address have been established and are available for anyone who receives a letter or is particularly concerned.”
“I thank the Member for that, and I want to assure Members and all patients and their families that the investigation into these matters will be comprehensive and that anyone whose case needs to be reviewed will be contacted as quickly as possible. The Northern Trust has written to over 9,000 patients or parents and guardians and, as I said in an earlier answer, patients who receive the letter do not need to take any action. The Northern Trust plans to run a process of review and recall in tandem, which means that every patient will be contacted again as soon as the trust knows the outcome in relation to their images. The trust will make the necessary arrangements very quickly for those patients who may require further imaging or a follow-up appointment.”
“I thank the Member for making that vital point. I do not see it having a knock-on effect. This will be additional work for our radiologists to undertake, but it should not stop or hinder the work that we need to do while we build back the service that is in place in the Northern Trust. As I said, we are working with radiologists across different trusts to make sure that the review does not have any direct impact on the timeline of work that we need to do in order to rebuild our services, especially in diagnostics.”
“The Member has highlighted a problem that not only affects this incident and the look back but, as I have said before, has to do with long-term underinvestment in staff. That is why there is an unfortunate reliance on locums, which puts additional financial pressures on the health service and the trusts. <BR /> <BR />With regard to the recruitment of radiologists, we are looking to our allied health professionals to increase the number of training places so that we can reduce the number of locums. As the Member will know, the transformation of health and social care in Northern Ireland is a priority. The Department has undertaken significant work to alleviate the workforce pressures across the health and social care system and is examining all the potential options and implications to address rising expenditure on locum services.”
“That additional support is there for them as well.”
“<BR /> <BR />It will put additional stresses and strains on our psychology services, but, in regards to what we have seen in the past and through engagement with the Patient and Client Council about other recalls, this is the right thing to do to provide support and reassurance for people who are concerned about the recall and may be concerned about what is included or intimated in the letters.”
“I thank the Member. That indication has already been put out in the media notices from the Northern Trust and the letters. It is something that we have seen during the past number of recalls in regards to putting in psychological support. A helpline and dedicated email address have been established for anyone who receives a letter and is particularly concerned. A Freephone number — 0800 0234377 — has been set up and can be called from 8.00 am to 8.00 pm, Monday to Friday, and 10.00 am to 4.00 pm, Saturday, Sunday and public holidays. There is also a dedicated email address that has been established in the Northern Trust, which is radiologyreview@northerntrust.hscni.net. Any patient who has concerns about their treatment and would like information should contact the Northern Trust via the helpline or the website.”
“I thank the Member for his point. I understand why he raised it, but the Northern Trust has been clear: if anybody who has been scanned or seen by a radiologist in the Northern Trust over the same period has not received a letter or been identified, they have nothing to be worried about because that piece of work was not conducted by that radiologist. If they are concerned, the number is there and they can get in contact, but I ask patients who have not received a letter to be reassured because, if they needed to be contacted by the Northern Trust, they already would have been.”
“I thank the Member for her point. It is about how we support an already overstretched workforce in radiology. We have a number of vacancies not just in the Northern Trust but across Northern Ireland, and it takes time to train the radiologists to the degree to which they need to work in Northern Ireland. The Northern Trust is working with other trusts to identify any additional resource that may be available to support the radiologists in the Northern Trust while it conducts the look-back review.”
“I thank the Member for his point. The serious adverse incident investigation will be conducted through the trust. The trust advised that the SAI has been declared to review the individual circumstances of two patients with a grade 1 error, finding an example and the outcome of the radiology look back on radiology activity that was undertaken by the locum radiologist who was in practice and worked across a number of hospitals in the Northern Trust. The chief executive of the Northern Trust will commence that work as soon as possible.”
“I thank the Member for making that point. The radiologist is no longer working for the Northern Trust or in Northern Ireland. The incident and concern about it were highlighted to my Department via the Northern Trust. The General Medical Council had sought information about the consultant's work, so there was concern raised through the appropriate regulatory body, which brought it to the attention of the Northern Trust in the first instance.”
“<BR /> <BR />As I said, it is too early to say how many of the patients may need to be physically recalled, but that work is ongoing in the trust, having already started. If any patient who received one of those letters requires additional supports or inputs, the telephone number and email contact are there.”
“I thank the Member for his comments. It is unfortunate that such incidents happen. I thank the Member for indicating that, when an incident like this does come to light, there are the appropriate measures in place, be they look-back reviews or callbacks, to determine how it is graded. <BR /> <BR />I said in my statement how the 9,000 patients who received letters are being prioritised. The trust is working through the review on the basis of clinical priority. It is looking at the highest-risk categories first in order to identify any potential misdiagnoses so that those patients are called back first. As part of that review, it may therefore be necessary to recall some patients for further clinical assessments and upgrades.”
“Those details were supplied in the letter that was sent to those patients of concern.”
“I assure members of the public that correct and appropriate steps are being taken by the trust to identify, quickly and thoroughly, any potential for harm to those patients and to take any follow-up action that may be necessary. It is not possible to provide further detail without speculating. I am, however, happy to provide updates to the House as we learn more. <BR /> <BR />In the meantime, I am assured that the exercise will be conducted with the utmost care and with the utmost attention paid to the patients' needs, including the provision of advice and psychological support as required. As the Member will be aware, the Northern Trust issued a communication this morning to all elected representatives in the area containing an email address and telephone number directly linked to the recall.”
“I apologised earlier and addressed the issue of where I was today. It goes without saying that incidents of this nature are of the gravest concern to me as Health Minister.”
“The outcome of that review was such that a wider review of the consultant's work was deemed necessary in the interests of patient safety. Some 22 of the 30 reports were deemed to be satisfactory, and eight were deemed to be unsatisfactory, with two of those eight graded as grade 1, a serious error, and those will now be subject to a serious adverse incident (SAI) review.”
“<BR /> <BR />The trust is working through the review on the basis of clinical priority: looking at the highest-risk categories first to identify any potential for misdiagnosis. Therefore, as part of the review, it may be necessary to recall some patients for clinical assessment. However, at this stage, it is too early to say how many patients may need to be recalled. <BR /> <BR />The background to the review is that my Department was notified by the Northern Trust on 29 April 2021 that the General Medical Council had sought information about the consultant's work, prompting the trust to review a random sample of 30 CT reports generated by the locum consultant radiologist during her tenure with the trust.”
“Mr Principal Deputy Speaker, first, thank you for your indulgence in recalling the House. I apologise for the situation that I found myself in today. As you indicated, I make myself available to the House quite regularly. <BR /> <BR />As Members will be aware, the Northern Trust has written to over 9,000 patients to inform them that a review is under way of the work of a locum consultant radiologist who was involved in their care whilst working for the trust between July 2019 and February 2020. The review period is from 21 June to 29 October 2020. Letters were issued by first-class post yesterday, 28 June, and a patient advice line and website portal went live on the same day.”
“That is one of the leading actions, and is at action 2 of the strategy and how we identify those individuals and also promote mental health through early intervention and prevention with year-on-year actions covering a whole-life approach.”
“I thank the Member for her point. With regard to the specific inequalities, a number of specific groups that we have to tackle have been identified. In an earlier answer, I mentioned our rural population and how that needs to be addressed. At point 54 in the strategy, we need that renewed focus to ensure that mental health promotion meets the needs of early interventions. That includes targeted approaches to groups more likely to be adversely affected by mental ill health, such as BAME groups, refugees and asylum seekers, people with a specific trauma exposure, LGBT+ people, people with a physical or sensory disability and persons with an intellectual disability.”
“We need to see Northern Ireland travel in a direction where we can support education and our economy, but we have to do that with a healthy, physically and mentally able population. We need to start that now by investing in the strategy and delivering the 35 outcomes that have been indicated through the co-production and co-design.”
“If we had kept level, or at least kept with a realistic service provision and support mechanisms over the past 10 years, that need and that capital expense now would not be so big. <BR /> <BR />This is about taking tough decisions and having tough conversations at Executive level. If our block grant from Westminster does not increase, there is a need to find the money and invest it in the people of Northern Ireland. You cannot have a sustainable workforce if their physical or mental health will not allow them to go to work. You cannot have a sustainable education service if the children who attend it or the teachers or people supporting them are not physically or mentally able to carry out the work that they need to do. We need to invest in our health service for the future.”
“I thank the Member for his point. I have been clear that this is not about having to shift funding within the Department of Health. There is no point in my robbing Peter to pay Paul to deliver a mental health service while, at the same time, underfunding or reducing funding and support to another part of the health service. The last number of statements that I have made to the House in regard to elective care, no more silos and the work that needs to be done now in the mental health strategy indicate 10 years of underinvestment in the entire health service. The £1·2 billion that we have indicated that we need over the next 10 years to correct that underfunding is the cost that we paid for those 10 years of underinvestment.”
“The decisions that we made were replicated in many other jurisdictions, and, as I said in response to the Deputy Chair of the Committee, when we were coming forward with the recommendations and the decisions were being taken, the Chief Medical Officer always had his input on the societal matters and mental health and well-being of the population. <BR /> <BR />There was also a considerable piece of work in regard to the cohort that we asked to shield during the first wave of the pandemic. We asked the Patient and Client Council to engage with those people to indicate what additional mental health strains they were experiencing due to shielding. That was part of the feedback that we took into consideration when we came to the second wave and did not take as aggressive a stance on shielding that community as we had done in the first wave.”
“<BR /> <BR />When the Member talks about the Executive's decision, I do have to point out that the mental health impacts are being experienced not just in Northern Ireland but across the United Kingdom, in the Republic of Ireland and in every other country where the virus has had serious impacts not just on the physical health of people but on their mental health. We have never faced, in our lifetimes, a pandemic like this, and I hope that we never have to face it again. We had to take the decisions that we have taken as an Executive. We have not taken them in isolation, yet many Members seem to indicate that we were doing something that was unique to Northern Ireland.”
“I thank the Member for his question. I will clarify the point: the 32% more referrals is from the effects of the pandemic. That will include some of those who have suffered from the effects of restrictions and regulations that have been put in place, because we are aware of the impact that it has. The Member will be able to read back in Hansard what I said in my opening statement, and, if there was a misperception from my response to Mr Buckley earlier, I will correct that quite happily in the record. That 32% includes all the long-term mental health effects of the pandemic.”
“I will do my utmost to ensure that this strategy is funded, as, I hope, will all the Executive parties and all the other Members in the House in support of the vital work that the strategy sets about doing to deliver for all the people of Northern Ireland.”
“I thank the Member for her question. She will see that the substance use strategy is mentioned in the strategy in the context of the specific sector. Dual diagnosis is also mentioned. The strategies and pieces of work all came from my Department, and we have made sure that there is crossover with dual diagnosis in the strategy. As the Member is fully aware, in regard to dual diagnosis, service users often report difficulties in accessing services, with unclear lines of referrals. The response that we want to envisage from this must therefore ensure that mental health services and substance-use services consider the patient first and that the justice system fits the patient rather than expecting the patient to adjust to fit the system. That is laid out in the strategy. <BR /> <BR />I thank the Member for her comments regarding the funding.”
“I think that the Member is referring to having a regional approach to the delivery of child and adolescent mental health services that, because there is a different level of delivery across our trusts, we are not currently seeing. That is why one of the key aims of the strategy, and one that we are able to commence with the funding that my Department has committed, is to look at how to develop a regional service to deliver a consistent approach across Northern Ireland.”
“I thank the Member for his point about respite. He will be aware that the issue was debated in the House recently. The strategy covers where we want to go and what we intend to do with child and adolescent mental health. The outcomes envisaged by the strategy are supports for infants in child and adolescent mental health services, where children and young people should receive the care and treatment that they need when they need it, without barriers or limitations. That should be evident from a shorter waiting list. <BR /> <BR />The strategy includes an outcome for a reduction in difficult transitions for children and young people by having improved outcomes from 10,000 More Voices and similar user surveys.”
“I thank the Member for his question. As I said earlier, my officials have engaged widely with stakeholders and groups on the consultation and in other engagements that we have had on producing not only the strategy but the action plan. <BR /> <BR />I was introduced to the Elephant in the Room group by the Member's party colleague Chris Lyttle, in his role as Chair of the Education Committee. At that point, we were able to bring the group to present to the Executive subcommittee on mental health, resilience, well-being and suicide prevention. The organisation has therefore had direct input not only into how we developed and worked on the strategy but into the Executive subcommittee. I think that there were follow-up meetings with the then Minister for Communities, Carál Ní Chuilín, on how she could support the work that it was doing.”
“They know now that mental ill health is not a stigma that needs to be hidden. They should be talking about it, should they feel that they are under strain and pressure from social media and all the other changes in society that the Member and I did not have to face at that age.”
“The Member asked about the investment that the Department of Health and the Department of Education could make together. As I said in response to an earlier question, a number of months ago, the two Departments announced a joint funding package for mental health supports in schools. Some £5 million came from the Department of Education, which was supported by £1·5 million from my Department. That is the first step. That is an investment in the mental health and well-being of our young people to build in early-age resilience.”
“I thank the Member for his point. Having transferred from the Health Committee to the Committee for Education, he brings knowledge about what work can be done across the system. <BR /> <BR />The mental health strategy's specific section on young people includes, as I said earlier, the "'no wrong door" approach, especially for CAMHS. Should we get to that stage, action 7 of the strategy is:”
“I thank the Member for his point. In my opening comments, I said that the time for warm words and platitudes was over. That is what the action plan and the funding plan are about, so that I can present the financial ask to ministerial colleagues. What is needed to deliver the strategy has been costed by my departmental officials. I will continue to engage with ministerial colleagues on the necessity of investing now. It is really about investing to save. We have to invest now in the mental health and well-being of the people of Northern Ireland so that we do not see increasing pressures and expanding waiting lists as we try to address the mental health needs of our population.”
“<BR /> <BR />I acknowledge that the Minister from the Member's party, the Minister for Infrastructure, has already made a commitment that, if it is necessary for surrenders to be made from departmental budgets, she is up for that, so that we can get health back to where it should be in Northern Ireland.”
“<BR /> <BR />On the financial commitment, I listened to the Minister of Finance making his statement yesterday, when he said that health was an Executive priority. Mental health is a Department of Health priority. We have to rebalance the imbalance that has been there over the past number of years in investment in our facilities and our workforce, and we need to fund the work that needs to be done. There is a challenge and a job to do. That is why we deliberately set about publishing not just the strategy but the funding plan needed to deliver it. It is not just an abstract document that will sit there. We can see what the money is needed for, where it can be invested and the outcomes from that investment.”