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 those two points. There is a specific section in the strategy on supporting young people from early years onwards. The Member will also be aware that, recently, the Minister of Education and I co-funded a support package for schools. The Department of Education put in £5 million, and we supplied £1·5 million for that support. It is about early intervention, which leads to prevention. In light of that, action 5 in the strategy seeks to expand that early intervention process. The strategy also highlights the use and delivery of alternative methods of therapy, including art therapy, music therapy and the incorporation of different methods of delivery in our day-to-day models.”
“I thank the Member for raising that last point. I heard the tail end of her petition yesterday, when she referred to the £400,000 for the mental health facility in Omagh as a "sticking plaster". Bringing that facility up to an acceptable standard is necessary work. The Member will see in the funding plan that the £285 million will go to the commitment to wider capital investment that we need to put in place. The majority of it is earmarked for the three mental health hospitals that have been identified across Northern Ireland. Part of that input is for the Omagh facility that the Member has called for and submitted the petition for yesterday. I have not yet received the petition, but I will respond formally to her on it.”
“and that the person will receive the support that they need when they go to the first door.”
“The strategy also states that the guidelines on dual diagnosis are clear in that services should work collectively to address the person's needs. I will go back to an earlier comment and say that, in this strategy, we want to focus on how:”
“I thank the Member. She asks what will happen in a year's time. I ask her for her support, along with that of her party colleagues, especially the Finance Minister, to ensure that, in a year's time, I have the funding commitment that is set out in the funding plan, not just for a year but for the 10 years as set out in the entire strategy, to do what is needed. <BR /> <BR />The Member raised dual diagnosis with me, and she and a number of her colleagues have often raised that. There is a specific section in the mental health strategy, from point 183 onwards, where we look at the outcomes for those with co-current mental health and substance use issues. The strategy targets these outcomes:”
“We keep hospital visitation under constant review. The next review is due on 9 July. We will look at the where the pandemic is then and will make a risk assessment. I want to correct the Member: I did not say that the 32% increase in referrals was due to restrictions; I said that it was due to the effects of the pandemic. There is a complete and justifiable distinction between the mental health effects of the pandemic and the effects of the restrictions that were put in place, which the Member was referring to.”
“The Member will be aware that I announced a £10 million mental health support fund, which will open on Monday. The fund is open to all charitable organisations that offer support services to people with mental ill health throughout Northern Ireland. Groups will be invited to submit proposals on themes that are key supports to mental ill health as a result of the COVID-19 pandemic and strengthen the person-centred approach in the new 10-year mental health strategy, so that funding ties in with the work that we have announced today.”
“I thank the Member for her question. The funding for the mental health hubs is laid out in the document that goes along with this showing what the recurrent financial commitment will be over the 10 years. As I said, publication of the strategy does not indicate that I have the funding to deliver it. The strategy is about the direction of travel, which is what I was asked to undertake and produce and what we have done. It is now about seeking the further, long-term, recurrent investment in all the aspects that need to be stepped out over the next 10 years to provide the support and the change of service that we need. <BR /> <BR />I have ongoing conversations with the Minister for Communities on how we can further support the voluntary and community sector.”
“My team worked closely with organisations such as the Northern Ireland Commissioner for Children and Young People (NICCY), the Prince's Trust and Action Mental Health during the consultation and development of the strategy to ensure that children and young people were involved. A children and young people's version of the strategy was produced to encourage and facilitate the engagement and involvement of children and young people in the consultation process.”
“The strategy also includes a commitment to increased funding for CAMHS to:”
“I thank the Member for his point. As I mentioned earlier when I was answering questions from the Deputy Chair of the Committee in relation to CAMHS, a number of actions in the strategy are designed to improve support for children and young people with mental health needs.”
“Those hubs will be supported to make sure that people can access that support when and where they need it rather than having to go elsewhere so that there is a "no wrong door" approach to mental health and that people can get support when they need it.”
“I thank the Member for her point about accessibility to mental health support, which she has often raised. Point 50 of the strategy highlights certain sectors and individuals and explicitly refers to the rural and farming community, in which mental health is a particular concern. As the Member knows, that is due to physical isolation from communities, worries about livelihood and anxiety around personal and family safety. Research conducted by the Farm Safety Foundation revealed that 84% of farmers under the age of 40 believe that mental health is the biggest hidden problem facing farmers. It is therefore important to reach out to harder-to-reach groups and intervene early in order to prevent the onset of mental health problems. That is why we have put forward action point 15 about the creation of mental health hubs.”
“As a former Minister, the Member knows that that discussion on mental health, as well as commentary and input from the Chief Medical Officer about how to take those recommendations forward, have always been taken into consideration. The funding gap is historic. In the House, we know that that issue has been there for some time, but it is about how the strategy and the associated funding plan sits alongside that to address the gap. The strategy also sets out to address some of the inequalities and internal funding issues in mental health. That is why there is a specific commitment to support CAMHS financially. The additional moneys that come in for mental health will also be invested in CAMHS so that it gets the 10% uplift and support that it needs.”
“I will take them in order but at a high level so that other Members have a chance to ask questions. <BR /> <BR />With regard to the capital programme, there is a sustained item in the mental health strategy relating to the required capital investment: we need £285 million. That is also covered in the funding plan, which addresses the three mental health facilities that have already been earmarked to be updated and upgraded from their current state. The Member is right about the investment that is needed in physical build and capital structure. The strategy sits alongside the funding plan because of the need for that collaborative approach. <BR /> <BR />The impact of COVID on mental health has always been at the front and centre of the Department of Health's decisions and its recommendations to the Executive.”
“I thank the Deputy Chair for his questions. You counted three questions, Mr Principal Deputy Speaker, but I counted five.”
“<BR /> <BR />On the issue of local engagement, there is a desire and an indication in the mental health strategy to produce mental health hubs to ensure that provision and support is closer to the people who need it and in the communities where they need it. We engage in both primary and secondary care delivery to do that. It is about that engagement and that multidisciplinary-team-approach that we have seen work elsewhere, and that will also be delivered through those local mental health hubs.”
“Over 20% of mental health nursing posts in HSC trusts are currently vacant, and while the number of psychiatry posts is not higher than in the rest of the UK, the use of locums to fill those vacant posts is very high. We have a combined locum and vacant post rate of 22%. Whilst locums can fill those duties, it is not the same as having a permanent post. The work is in there on how we fill those posts on a long-term basis and in a sustainable system. The funding plan mentions the investment that is needed to sustain those posts over the next 10 years, which is the duration of this strategy.”
“I thank the Chair, including for his acknowledgement of the engagement that my officials have had with the Committee and the engagement that the Committee has had with the voluntary and community sector in bringing forward the publication of this strategy, which was done while we were dealing with the pandemic as well. <BR /> <BR />There is a specific section in the mental health strategy on the workforce review. The outcomes are to present a well-supported workforce that is fit for the future and meets the needs of all those who are mentally ill. It is also about increasing the number of training places for mental health professionals and increasing the number of staff employed.”
“From the moment that I entered the Department of Health, I have been hugely impressed by the commitment, professionalism and unwavering dedication of the staff in the mental health team. In particular, I want to commend Tomas Adell, head of the adult mental health unit, who has been the real driving force behind the strategy, along with Peter Toogood, the new mental health director in my Department. Without their efforts, along with the support of everyone else, the work to develop the strategy would not have been possible. I want to extend a huge thank-you to everyone who has been involved in that work. <BR /> <BR />Together, we can continue to reduce stigma around mental ill health. Together, we can improve services and the mental health system. Together, we can improve mental health outcomes in Northern Ireland.”
“It is also accepted that our mental health services are in need of reform. The new mental health strategy that I am publishing today is the blueprint for that reform. Before concluding, it is worth noting all the people who have supported the development of this strategy. The strategy is the result of genuine co-production. Over the past year, hundreds of people have been involved in meetings, workshops, online events and direct communication with my officials on how we can ensure that we have mental health services that are fit for the future. That includes service users, carers, professionals, community and voluntary sector groups, and many others. In addition, I want to pay particular tribute to officials in my Department.”
“It will require a collective effort across the entire Executive to bring about the much-needed reform of mental health services. I am therefore working closely with my Executive colleagues to ensure that provision of the necessary funding is prioritised in the next Budget process. <BR /> <BR />Four actions in the strategy have been identified as key enablers. That includes staffing resources in the mental health system for implementation, the regional mental health service, the workforce review and the outcomes framework. My Department has identified funds in 2021-22 to initiate those four key areas of work, which will set the foundation for the strategy going forward. <BR /> <BR />In conclusion, it is accepted that the pandemic is having a significant impact on the mental health of the population.”
“<BR /> <BR />To outline the investment that is needed for the reform, I have published a funding plan together with the strategy. The funding plan identifies significant investment need, with an estimated need of £112 million to £158 million revenue funding per annum and a £285 million one-off capital investment. The funding plan outlines an investment need of £1·2 billion over the next 10 years to fully implement the strategy. At that level, it is therefore clear that my Department does not currently have sufficient funds available to implement the strategy unless significant levels of existing activity are ceased. Additional investment from outside the Department will therefore be required to make the strategy a reality.”
“Action 31 will create a single mental health service. That will be done not by removing HSC trusts, but rather by supporting them in their work through regional cooperation and consistency. <BR /> <BR />Unfortunately, mental health services in Northern Ireland have historically been underfunded when compared with those of other jurisdictions. For example, it is estimated that funding in Northern Ireland is 27% less than in England and 20% less than in the Republic of Ireland. That is despite mental health need being assessed as up to 25% higher here than in England. The strategy is therefore ambitious and provides the much-needed reform of our mental health services. However, delivery will be dependent on the provision of additional and sustained funding.”
“Action 10 seeks to increase the funding for CAMHS to 10% of the funding for adult mental health services. That will allow for real service improvement, and will continue to ensure that there is increased funding for CAMHS every time adult mental health services receive additional funding. Action 15 will change how mental health services are structured, with a greater focus on the community. That will bring mental health services closer to the person who needs them, where they have support from family, carers, friends and others. Action 17 seeks to fully integrate the community and voluntary sector in the development and delivery of mental health services. That will recognise the good work that is carried out outside the statutory sector and will bring those valuable partners into the work to improve mental health outcomes.”
“Action 2 is to create an action plan for promoting mental health through early intervention and prevention, with year-on-year actions covering a whole-life approach, from infancy to older age. The action plan will consider groups disproportionately affected by mental ill health, who often struggle to access early intervention services, and seek to reduce the stigma associated with mental ill health.”
“The second theme — providing the right support at the right time — provides service improvements, including improvements across the whole lifespan. It also outlines actions to integrate primary care and secondary care and the community and voluntary sector into service delivery. The theme puts the vision of truly person-centred care at the core of the reform work. The third theme — new ways of working — provides actions to create system change to allow effective and efficient delivery of mental health services and to promote innovation and research in order to improve mental health outcomes across our population. <BR /> <BR />While all the actions in the strategy are important, I would like to highlight a number of them today.”
“The strategy is built on a vision of a society that promotes emotional well-being and positive mental health for everyone, supports recovery and seeks to reduce stigma and mental health inequalities. Our vision sets out the aim for a regionally consistent system that provides equality and equity of service for everyone. We also want to break down barriers so that people are put in the centre. <BR /> <BR />The strategy is divided into three themes. The first theme — promoting mental well-being, resilience and good mental health across society — is key to removing and reducing the stigma associated with mental ill health. It provides actions for early interventions and prevention across the lifespan and considers those who care for people with mental ill health.”
“Going forward, we must equip those working in mental health services with the right tools and systems to ensure that they can help those who need help. We also need to work closely with our partners in the community and voluntary sector to reform our mental health services. <BR /> <BR />I am therefore pleased to announce the publication of the new 10-year mental health strategy 2021-2031. The strategy sets out 35 actions to initiate reform of our mental health services. It sets a clear direction of travel to support and promote good mental health, to provide the right early intervention to prevent serious mental illness, to provide the right care and treatment when people need specialist help and to provide new ways of working across mental health services.”
“In the last 18 months, I have published the mental health action plan, including a COVID-19 mental health response plan, and I have appointed Northern Ireland's first ever mental health champion. I have approved the creation of a specialist perinatal mental health service and managed care networks for both child and adolescent mental health services (CAMHS) and forensic mental health. I have also established a £10 million mental health charities support fund and initiated change across mental health services. <BR /> <BR />Across mental health services in Northern Ireland, we have a dedicated workforce who give their all to help and support those in need. I am extremely thankful for their hard work, in particular during the difficult circumstances of the last year.”
“<BR /> <BR />Equally, our community mental health services are experiencing increased referral rates and heightened levels of acuity. I have heard stories of patients desperately seeking help without being able to receive the help that they need. There are patients as young as eight needing specialist help for eating disorders and older people starved of human contact without the ability to get help for the mental illness caused by loneliness. <BR /> <BR />Since becoming Health Minister, I have made mental health one of my top priorities. I want to make sure that those who need help with their mental health can receive the help and support that they need when they need it. I have shown that it is not just about words and platitudes but about action.”
“It is currently estimated that the long-term effects of the pandemic may create up to 32% more referrals over the next three years. That means more than 19,000 referrals in adult mental health, over 5,000 more referrals to psychological services and over 24,000 more unscheduled care contacts. <BR /> <BR />That is at a time when our mental health services are already under significant pressure. Inpatient mental health services are under extreme demand, with health and social care trusts consistently operating above 100% bed occupancy levels in acute adult mental health services. We hear stories of patients who have to wait for very long periods in emergency departments under PSNI supervision, as there are no beds available in mental health, and of patients on mattresses on floors.”
“Thank you, Mr Principal Deputy Speaker, for the opportunity to speak today on the important topic of the new 10-year mental health strategy. <BR /> <BR />As we are all aware, mental ill health is one of the greatest challenges facing us today. The COVID-19 pandemic and the restrictions on everyday life have had and will continue to have a significant impact on our population’s mental health.”
“By making safer choices, following public health advice and complying with the regulations, we can all do our part to help lower the spread of COVID-19. I commend the regulations to the Assembly.”
“We have not had anyone in ICU with COVID-19 over the past number of weeks. We are therefore starting to see a trend. When the number of cases increases, there is a two- to three-week lag before we see hospital numbers increasing. At the minute, we are not seeing that, but we are seeing a number of people entering ICU and requiring ventilation. <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 again. COVID restrictions are being eased. We can meet more people and go to more places. We can cautiously start to return to a more normal way of life.”
“At this time, we are seeing an increase in the delta variant. As we have said in the past about any variants, or about COVID itself, it is always a matter of when and not if. If, however, the Member looks at where the variant is and its intensity in other parts of the United Kingdom, he will see that the number of cases here is some way behind. The delta variant is therefore spreading in Northern Ireland but not to the same extent as it is spreading elsewhere in the United Kingdom. It is still a concern for us, however. As the Member will be aware, we have had over 200 positive cases in each of the past three days, so that is a significant increase. <BR /> <BR />The number of people in hospital is still in the mid-teens, but, as of today, it is a concern that we have two people in intensive care on ventilation.”
“I have never discussed internal conversations or divisions in the Executive in the Chamber or in the media, and I do not intend to start now, but, in the past, other Ministers have said that if their party were able to direct solely the decisions made in the Executive, different decisions would have been made. As Health Minister, I stand here today and use that exact same language.”
“I thank the Member for that point. If she looks at the data, she will see that there are now a number of outbreaks and clusters in bars that there were not previously, because bars had been closed. There is therefore a trend that we can see of outbreaks and clusters shifting and changing as the regulations are relaxed. <BR /> <BR />The PHA's ongoing work is to ensure that the number of outbreaks in any location does not accelerate at any particular time, so it is about taking a cautious approach. We take a stepped approach to the relaxation of regulations so that there is time to reflect on the number of outbreaks or clusters in any specific location. <BR /> <BR />Mr Carroll referred to a number of media reports about travel across and within the CTA.”
“Paula Bradshaw asked for the publication of data. The Public Health Agency has been publishing weekly updates for a number of months now on where outbreaks and clusters have been identified and on changing trends, such as where numbers are increasing as relaxations are made to restrictions. <BR /> <BR />Mr Carroll —.”
“That is encouraging. Those sorts of steps and that level of uptake help us to make more relaxations, such as those that we are announcing here today. He also reinforced the basic good principles that we know work: good hand hygiene, social distancing and good respiratory hygiene.”
“He touched on the uptake of the vaccine by younger age groups and cohorts. As of 12.00 pm today, 142,712 people in the 18-to-29 age group had come forward and received their first vaccine. That is 50% of those in that eligible cohort, and I encourage the other 50% to come forward. <BR /> <BR />Cara Hunter's contribution was on mental health, on which she speaks passionately and often. She also submits questions for written answer on the issue. Before we go into summer recess, I intend to make a statement tomorrow to update Members on where we are with the mental health strategy. <BR /> <BR />Mr Chambers encouraged the population of Northern Ireland and thanked them for coming forward and taking up the opportunity to get the vaccine. Some 80% of our eligible population have received the first dose, and 60% have received the second dose.”
“In the region of 400 individuals came forward and took the opportunity of being able to walk in and get their vaccine. I join the Chair in sending the message that we must continue to follow the guidance that has seen us through the past 15 months: good hand hygiene, wearing face coverings and social distancing <BR /> <BR />The Deputy Chair, Mr Gordon Lyons, acknowledged the importance of vaccines and the decisions that vaccination enables the Executive to make on the relaxation of restrictions. He will be aware that the issues that he raised are due to be discussed at this week's Executive meeting. As he well knows, I do not comment on those before the Executive have had the opportunity to discuss them, but I am sure that an announcement will be made by the First Minister and deputy First Minister following that meeting.”
“I welcome today's debate on the amendment, SR 2021/151, and I thank Members for their contributions. Mr Deputy Speaker, with your indulgence, I will turn to some of the points that Members made during the debate. <BR /> <BR />The Chair of the Health Committee, in his opening comments, gave an acknowledgement, shared by other Members, of our vaccine programme and the advances that it is making. A number of walk-in locations will be announced over the coming days. Mobile vaccination units will also be announced over the coming days, and I encourage Members to keep an eye to the media, including social media, for their announcement by the trusts. It was a welcome sight when we saw the first walk-in deployment in the SSE Arena yesterday.”
“It is my firm belief that, overall, the restrictions and requirements imposed by the regulations continue to be proportionate to what they seek to achieve, which is a public health response to the COVID-19 infectious disease threat. I commend the regulations to the Assembly.”
“<BR /> <BR />I assure Members that, at all times, the Executive's reviews of the regulations were guided by the four principles that they agreed in May 2020, which focus on purpose, necessity, proportionality and reliance on evidence. In addition, we recognise the importance of balancing public health needs with those of the economy. The COVID-19 cross-departmental working group led by TEO continues to meet weekly and manages the process for bringing forward relaxation proposals to the Executive. Further, I thank the Health Committee for its continuous helpful contributions and scrutiny, which enabled the amendment to be finalised. <BR /> <BR />As Health Minister, I have ultimate responsibility for protecting the health of our most vulnerable and our vital health services.”
“including at premises that sell or provide alcohol. The Executive collectively ratified those decisions, and the changes were made the following day, Friday 4 June, to assist with that weekend's trade for the affected hospitality venues. <BR /> <BR />I understand that, in communicating the changes to the businesses that were impacted, their trade bodies and enforcement authorities, the Department for the Economy emphasised the importance of the mitigations that were still required. Those included collection of customer details for contract-tracing purposes, as required by regulation; effective management of queuing with social distancing; wearing of face coverings when not seated, as required already in the regulations; observation of hand hygiene; and undertaking of staff safety measures and enhanced hygiene and cleaning.”
“That was deemed a necessary precaution to prevent the transmission of COVID-19. Following significant sectoral engagement with Departments on the issue, operational and compliance challenges were reported, as well as significant challenges for the business models of buffet and carvery services. In addition, it was noted that, during the period of relaxations in summer 2020, only venues that served alcohol were required to operate on a table service-only basis. <BR /> <BR />Following Executive discussions on 27 May, the then Minister for the Economy brought a paper to the Executive with a proposal to amend the regulations to assist such hospitality venues by relaxing the requirement to provide table service. On 3 June, the Executive agreed to amend the regulations. The amendment permitted:”
“I was disappointed to receive the Minister's reply a week later, in which he said that he felt that it was not appropriate for him to lead on the scrutiny of the regulation as it was technically a matter for me. Such a response was disappointing. I hope that we will see less of it over the coming months. As I said this morning to the new Deputy Chair of the Health Committee when I welcomed him to his place, I am missing him already in his former role. Nevertheless, the debate needs to happen or else the changes to hospitality would have fallen. That is why I stand here today. <BR /> <BR />SR 2021/151 was made and came into effect at 12.30 pm on 4 June. Following the reopening of the hospitality sector outdoors on 30 April and indoors on 24 May, businesses providing food and drink were required to operate on a table service-only basis.”
“Today I bring forward a statutory rule (SR) on a very specific, narrow issue: SR 2021/151, the Health Protection (Coronavirus, Restrictions) Regulations (Northern Ireland) 2021 (Amendment No. 6) Regulations (Northern Ireland) 2021. Mr Deputy Speaker, with your permission, I will focus my remarks on the key changes made by the amendment. Before I do, however, I want to express my disappointment and, I am sure, that of others that it is me standing here today and not the Economy Minister. This is a single amendment that delivers a single policy that was facilitated and secured by a single Department: the Department for the Economy. That is why, on 15 June, I made what, I thought, was an entirely reasonable request to the newly appointed Economy Minister to lead the debate on the amendment.”
“As long as the establishment of the advisory committee complies with the relevant legislation, the two Health Departments do not get involved in selecting the members.”