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. As I demonstrated in my answer, I first need to get it through the Executive Committee, so I ask for the support of all Members and Ministers in the House to enable me to do that as soon as the Executive are able to meet and move forward with it.”
“I therefore wrote last week to the First Minister and the deputy First Minister, under the urgent decisions procedure of the ministerial code, in order to ensure that the Bill is able to proceed to First Stage and Second Stage in the remaining weeks of the current term. <BR /> <BR />My answer provides options for answering the question in four scenarios: option 1, in which no decision has been taken by the First Minister and the deputy First Minister; option 2, in which the paper has been declined by the First Minister and the deputy First Minister; and option 3, in which it has been agreed by the First Minister and the deputy First Minister. Unfortunately, I do not have an answer for the fourth option: for what happens to the Bill in the absence of a First Minister and a deputy First Minister.”
“I thank the Member for his question. As he will be aware, my Department has undertaken substantial work to complete a draft organ and tissue donation (deemed consent) Bill. The timing for its introduction to the Assembly is at a critical stage. I wrote to ministerial colleagues on 12 April and again on 1 June to seek formal Executive agreement to introduce the Bill at the earliest opportunity. <BR /> <BR />Individual Ministers have responded to me, mostly reflecting the strong support from the Northern Ireland public for my Department’s recent public consultation. My revised paper has not yet been discussed and voted on in the Executive Committee, however, so it has not yet progressed to the Assembly.”
“The intention is that the groups establish the oral health needs of children and older adults in Northern Ireland and review the evidence base in order to determine which preventative interventions are likely to be most effective and also provide value for money.”
“I thank the Member for her comments. She will be aware that our current Northern Ireland oral health strategy was published in 2007. Despite its age, the main oral health problems described in the document and acknowledged by the Member remain the same and are largely still valid today. The young people's oral health options group has been delayed until later this year, although some preparatory work has commenced. The older adults' health options group has been established and is chaired by the acting Chief Dental Officer. The oral health strategy for older adults is expected to be published this year.”
“I support and applaud the work that they have done through the pandemic. It has been a challenge, not only with an increase in referrals and attendances but as they get back to having as many face-to-face appointments as they can. I am aware that some GP practices across the country are not providing as full a service as they might do. I share the frustration at that, as do members of the Royal College of GPs and the British Medical Association committee of GPs, which are fully committed to re-servicing and to seeing as many of their patients as they safely can.”
“I thank the Member for his question. I am aware that the Royal College of General Practitioners and the British Medical Association's general practitioners committee commented on that matter recently.”
“I thank the Member for his question. The guidance that we use was agreed with the chief dental officers across the United Kingdom, so there is a UK-wide approach to those recommendations; it is not one that has been taken solely by my Department. Further to that, as I said in my initial answer, that is why I established a £1·5 million revenue grant fund to help practices to invest in measures such as improved ventilation systems so that we can rebuild capacity throughout the sector.”
“<BR /> <BR />Looking forward, the Department, as part of its wider approach of rebuilding services, is engaging with the British Dental Association on the continuation of the financial support scheme and support for PPE for the remainder of this financial year. Whilst we need to deal with those immediate issues, we also need to consider how dental services can be provided in a sustainable way going forward. To that end, I have asked officials to establish a general dental services rebuilding stakeholder group, which will formalise engagement between the Department, the HSCB and the British Dental Association so that momentum around those issues continues.”
“To date, the Department has been able to invest £57 million in relation to those issues since the pandemic started. Furthermore, in February 2021, I established a £1·5 million revenue grant fund to help practices to invest in measures such as improved ventilation systems. That fund is helping to build capacity throughout the sector and is addressing some of the patient throughput issues that have been unavoidable in recent times. Our short-term objective is to support the increase in activity levels through continued financial support that incentivises the treatment of priority health service patients in a manner that is safe for patients and staff.”
“I thank the Member for his question. Enhanced infection prevention and control measures have reduced patient throughput by approximately 60%. As soon as those measures can be safely eased, they will be, and the Chief Dental Officer continues to liaise with colleagues across the United Kingdom on that critical issue. To ensure that the limited treatment capacity is targeted appropriately, the guidance issued to all dentists recommends that patients are prioritised on the basis of need and that any patient who requires emergency or urgent care is given the highest priority. <BR /> <BR />A financial support scheme was established in April 2020 to support dental practices. The scheme provides an additional payment to eligible practitioners each month based on their average earnings in 2019-20.”
“It remains imperative that the trusts initiate applications that the regulators have undertaken to expedite for relevant employees within those time frames. In doing so, there is no reason for any disruption to cross-border care.”
“I thank the Member for his point. In recognising that, currently, there is no legislative alternative to dual registration, my Department initiated discussions with the Irish Health Department and the Republic of Ireland's medical and nursing regulators to identify a pragmatic approach to registration requirements. To date, all parties have agreed on the need to avoid any disruption to the delivery of care, and, through discussions with the Irish Health Department, the Irish Medical Council and the Nursing and Midwifery Board of Ireland, an understanding has been reached that an effective grace period for individuals who require dual registration applies while the necessary applications are being processed.”
“I thank the Member for his supplementary, although it was some way off the original topic. I once again submitted proposals to Executive Ministers about that issue on 19 May. My paper has, as of last week, not yet been discussed by the Executive Committee. I am seeking consensus, as I am required to do under the ministerial code, while my Department resumes the necessary planning work for commissioned abortion services under the 2020 regulations.”
“The Republic of Ireland reimbursement scheme will set out a framework based on the cross-border healthcare directive and will allow patients to seek and pay for any treatment in the private sector in Ireland and have the costs, up to the cost of the treatment in Health and Social Care (HSC) in Northern Ireland, reimbursed. The Republic of Ireland reimbursement scheme will be open to ordinary residents of Northern Ireland and managed by the Health and Social Care Board. All treatments are subject to prior authorisation. <BR /> <BR />I am aware that Ireland has extended an administrative process to Irish patients to use CBHD-like processes to access care in the private sector in Northern Ireland. That is completely a matter for the Department of Health in the Republic of Ireland.”
“I thank the Member. The cross-border healthcare directive (CBHD) enabled UK citizens to access healthcare in any EU country in either the private or public sector and to be reimbursed for that care abroad by their home country. As of the end of the EU exit transition, the directive no longer applies to the UK. Transitional provisions have been made to ensure that if someone has applied to or used the CBHD before the end of the transition, reimbursement for treatments will be honoured for up to one year, based on certain conditions. <BR /> <BR />I have also asked my officials to look at the possibility of re-establishing a version of the cross-border healthcare directive to the Republic of Ireland.”
“A primary focus for both is to ensure that the comprehensive cross-border healthcare arrangements that benefit citizens from both jurisdictions are not only maintained, but further developed.”
“Those range from the radiotherapy unit at Altnagelvin hospital, which is advantageous because it makes the provision of specialist services financially viable by sharing facilities to enable people from both jurisdictions to access care locally, thereby avoiding lengthy journeys to specialist centres elsewhere; to very local services, such as out-of-hours services, and working together to allow patients to attend the closest centre when they are in need. <BR /> <BR />The services that are already in place will continue, and new services will be explored. To support that, engagement between my officials and the Department of Health in the Republic of Ireland is frequent and positive.”
“I thank the Member for her question. Cross-border services, and those provided on an all-island basis, are, in and of themselves, not directly affected by the UK's exit from the EU. A number of service level agreements and memorandums of understanding are in place between the Health Service Executive, the health and social care trusts, and specific providers to deliver a wide range of services that are important to the people who use them.”
“I thank the Member for his point. I am on record, as is every party in the House, as saying that a one-year budget for health is unsustainable. That is why we need specific recurrent funding for Health, which allows us to make long-term investments, not only in capital and buildings but in our professionals and our workforce, for training, recruitment and retention. The specific point of the question highlights the need for recurrent funding to address and tackle the challenges faced by our health service and the workload faced by our health professionals.”
“That work includes the development of costed proposals for an assessment service, which will include a range of professions, including occupational therapy specialists, in line with National Institute for Health and Care Excellence (NICE) guidelines and the specification for the multidisciplinary assessment clinics that were recently established in England. <BR /> <BR />My Department has already carried out a series of AHP workforce reviews, including occupational therapy, to ensure the provision of an AHP workforce that is capable of meeting current and future service demands. Those are living documents that are continually reviewed to take account of those additional requirements as needs arise, which includes the impact that we will see from COVID-19.”
“The Member highlights the point that recruitment, retention and training are crucial. While we may ask for places, it takes a number of years before those professionals come out at the other end. In order to address the additional pressures that have been placed on the service as we emerge from the pandemic, my Department asked the Health and Social Care Board (HSCB) to initiate work in respect of the assessment of people who continue to experience long-term ill health, such as COVID-19 infection.”
“The need to expand this programme will be considered in future budget build exercises.”
“I thank the Member for her point. As she is aware, my Department annually commissions undergraduate training places from Ulster University for six categories of the allied health professions (AHPs). The numbers commissioned in 2021 included 55 occupational therapists. That represents an increase of 56 commissioned places from 245 in 2019-2020 to 301 in 2020-21. An additional 10 undergraduate places for occupational therapy were considered for 2021-22. Funding for any proposed expansion of AHP undergraduate training programmes commissioned by my Department will be required on a recurrent multi-year basis, and, unfortunately, the current budgetary pressures facing my Department mean that there is no funding for any such expansion. That includes occupational therapy.”
“Increased investment is necessary in order to deliver a service that is fit for purpose and can meet the ongoing challenges. Again, as is the case with many of our health and social care services, budgetary pressures are a severely limiting factor. I placed on record my view that the budget for my Department for the year ahead is extremely disappointing. We need sustained investment and multi-year Budget settlements to support long-term investment in providing and skilling up our workforce.”
“I can advise the Member that the total number of people waiting for an occupational therapy appointment across all five health and social care trusts, as of 30 April, was 14,200. Of these, 7,948 people have, very regrettably, been waiting longer than the target of 13 weeks. I am acutely aware of the increasing frustration and challenges that are being experienced by individuals and their families on an ongoing basis while they wait for an appointment to see an occupational therapist. <BR /> <BR />Unfortunately, as Members will be only too well aware, this position is by no means unique to the occupational therapy service.”
“As there are approximately 2,000 hernia mesh operations in Northern Ireland each year, that constitutes a substantial number of patients who may present with symptoms. I say to the Member, as I said to other Members, that if people are presenting with problems, please advise them to contact the Patient Client Council or their GP in regard to getting the best direction of travel and the best solution. If the Member has cases of any individual constituents, I ask him to write to me with those details.”
“I do not have a summary of the number of people who are making complaints. It is impossible. I do not have the ability to say how many people have been adversely affected by hernia mesh surgery in Northern Ireland. As with other surgery, complications can occur, and, in the case of hernia mesh surgery, these complications may include chronic pain or debilitating pain. We know, according to the 2018 guidelines compiled by the international HerniaSurge Group, that, worldwide, more than 20 million patients a year undergo groin hernia repair. According to the HerniaSurge Group, overall, the incidence of clinical significant chronic pain is in the region of 10% to 12%, and debilitating chronic pain affecting normal daily activities or work ranges from 0·5% to 6%.”
“I thank the Member for her question. I am disappointed that she says that my departmental officials have been described as dismissive. That was noted in the Chief Medical Officer's circular of July 2019, which I mentioned at the beginning. On the support mechanisms, I ask the Member to encourage patients to engage with the Patient Client Council and with their GPs. If she has any specific concerns or positions, I would be happy to meet the Member to discuss those.”
“That work is moving forward, and I plan to provide a formal response to that report shortly.”
“I thank the Member for her question. I do not yet have a date for when that treatment will start, but the Belfast Trust is working on that. The Member raised the Baroness Cumberlege report. Baroness Cumberlege published her findings on 8 July, and, as the Member knows, that report investigated what had happened specifically in respect of two medications, hormone pregnancy tests and one device, the pelvic mesh implants that were used in surgical repair of pelvic organ prolapse and to manage stress urinary incontinence, the use of which has been linked to crippling life-changing complications. Following that publication, I issued a statement apologising to those who were affected, and a departmental working group was established to consider the nine recommendations in the report and my Department's response to that.”
“Patient pathways are designed in order to ensure that patients have access to the most appropriate treatment for their condition. Patients should be supported through the process with informed discussions with their clinicians in order to ensure that their preferences and any inherent risks are explored and understood.”
“I thank the Member for his comments; they are appreciated. <BR /> <BR />Patients who experience problems following that type of surgery are advised to consult with their GP and, if necessary, seek referral to the health and social care trust where their surgery was performed in order to get appropriate care and treatment. For counselling and any support aside from surgery, patients may be offered assistance by their GP, the appropriate multidisciplinary team or services in the relevant trust. The Health and Social Care Board (HSCB), the Public Health Agency (PHA), the Patient Client Council (PCC) and the health and social care trusts assist patients through the provision of information on the treatment options and services that are available.”
“I completely endorse the need for patients to be fully informed about the risks of treatment and non-treatment before any surgery takes place.”
“Indeed, the National Institute for Health and Care Excellence (NICE) views the use of mesh for hernia repair as standard clinical practice. It has been performed for a number of decades, and its safety and efficacy are understood. <BR /> <BR />Very regrettably, the July 2019 circular notes that there are reports of patients who have suffered disabling complications from the use of mesh for hernia repair and that a number of them feel that they were not fully informed about their condition, treatment options and the complications that may arise. That harm was further compounded by the fact that the professional response was described as "dismissive". The circular noted the importance of working in partnership with patients:”
“The Department of Health does not have guidance on hernia mesh procedures. There is, however, a Chief Medical Officer's (CMO) circular entitled 'Use of Hernia Mesh', which was issued to health trusts and general practitioners on 30 July 2019. That circular notes that the use of mesh for hernia repair is a long-standing surgical procedure that is carried out worldwide and has led to a significant reduction in the number of patients suffering from hernia recurrence and, therefore, to a reduction in the number of those needing surgery. As such, it remains an option for patients in Northern Ireland and their clinicians to consider in consultation when deciding on a course of treatment, and I consider that to be appropriate.”
“We need to take every opportunity to encourage people to talk about mental health, whether that is in the Assembly, on television, in the workplace or in private. I assure Members and the public that I remain committed to improving mental health services and mental health outcomes for all the people of Northern Ireland. The challenges ahead might seem insurmountable, but, if we all continue to work together, we can overcome them to make a significant, lasting and positive difference for all the people of Northern Ireland.”
“That will provide grants to charitable organisations that provide interventions to improve the population's mental health. In recognition of the fantastic work of the community and voluntary sector, the new fund will equip and enable those charitable organisations to provide a wide range of support services for people with mental ill health and help to ensure continued access to mental health support services in the community for those who need them. Many of those services have been named today. The fund is expected to open formally before the summer and will be accessible through the Community Foundation website. <BR /> <BR />In closing, I thank colleagues on the Health Committee for tabling the motion, which I fully support, and I thank all Members who spoke for the tone, tenor and content of their contributions.”
“The particularly difficult funding position that my Department currently faces does not make redressing that imbalance any easier, and the capital budget position remains severely constrained. Full implementation of the strategy, which all stakeholders fully support, will require significant investment. Securing that investment to achieve what we want and what society deserves will require full support from the Executive and the Assembly. We must now walk the talk. If we are truly serious about making mental health a priority, which many in the Government and the House genuinely want to do, we have to do our utmost to get the resources in place. <BR /> <BR />One of my most significant actions in recent weeks was the establishment of the £10 million mental health support fund.”
“<BR /> <BR />Unfortunately, despite the great strides forward that we as a society have made in talking about mental health and despite the progress over the past year, I must also reflect the reality of the funding position. As Members know, historically, mental health services in Northern Ireland have, compared with other UK jurisdictions, been underfunded. Mental health in Northern Ireland receives between 25% and 30% less funding per capita than England, despite many indications that mental health needs in this country are greater, not least because of the legacy of the Troubles. That equates to a funding gap of approximately £100 million to £150 million a year, which is a dire reflection of the low priority that we as a society and a Government have afforded to mental health until now.”
“The consultation concluded at the end of March this year. In total, 428 responses were received, with over 82% assessed as positive. That strategy is my Department's long-term strategic plan to address the pressure on mental health inpatient beds, to meet the increased needs created by the pandemic and to put mental health on an even footing with physical health in this country. I hope to publish the final strategy in the summer of this year, together with a funding plan setting out the resource requirements to implement it. The final strategy will seek to draw clear linkages with the new substance use strategy, which, along with the Protect Life 2 strategy, I hope to publish in the next few months. Those three strategies are hugely important as we seek to make significant positive changes to the lives of people in Northern Ireland.”
“While that is likely to have a positive impact on patient outcomes and pressures on the system, it will require additional investment. <BR /> <BR />The mental health action plan also committed to developing a new 10-year strategy for mental health in Northern Ireland. That, I believe, is the best way to address the historical issues facing mental health services; to face up to and meet the increased demand caused by the pandemic; and to put in place real and lasting change that will significantly improve mental health outcomes for all the people of Northern Ireland. <BR /> <BR />Members will be aware that, in December last year, I published for public consultation a draft mental health strategy for 2021-2031. That followed an intensive period of co-production, even during the pandemic.”
“They are hugely dedicated and caring, and they do a difficult job in increasingly difficult circumstances. I assure them and the House that their efforts do not go unnoticed or unappreciated, and I commend that workforce for its commitment to helping others in their time of need. <BR /> <BR />Unfortunately, it is highly likely that those pressures will continue as the mental health surge that we have all been anticipating hits home over the coming months. My Department is taking actions to help and support those who deliver services. In the short term, a regional bed flow network has been established, but, for the longer term, I have recently approved the policy direction for psychiatric low-secure inpatient and mental health rehabilitation services.”
“It is, unfortunately, highly likely that we will see a surge in mental health needs over the coming months and years; indeed, we are already witnessing the beginnings of that in our mental health services. Our trusts are reporting an increase in referrals, as well as a heightened acuity of patients. Members will no doubt have heard the comments that I made to the Health Committee last week about bed pressures. Those include patients sleeping in chairs and the reality of being a patient in mental health crisis. It is a sad reflection of the priority that we have given to mental health over the last number of years that patients cannot count on having a bed to sleep in when they are admitted to hospital. <BR /> <BR />I publicly thank the staff who work with our mental health patients.”
“That was done in partnership with the Health and Social Care Board, the PHA and Community Pharmacy Northern Ireland. The campaign runs to the end of this month and encourages people to simply ask the question, "How are you feeling?". <BR /> <BR />Well-being campaigns are a hugely important tool in promoting positive messaging on mental health, reducing stigma and supporting people to look after their emotional well-being and mental health, as well as signposting people to further help and support if they need it. However, even as we start to move out of the restrictions that have been in place, the impact of the last year will affect for some time to come our communities, their mental health and the services that support them.”
“<BR /> <BR />My Department has worked collaboratively with the health and social care sector, the community and voluntary sectors and other Departments to provide as much help and support to our population as possible. That includes free online stress control classes; a COVID-19 well-being hub; new use of technology; funding for children and young people for the Department of Education; and much more. Along with the health and social care sector, my Department has developed public messaging during the pandemic, and, as the Chair acknowledged, the Take 5 programme has been widely adopted by many agencies and communities. I am pleased to see that continue. For example, last month my Department launched the "How are you Feeling?" mental health campaign in over 500 community pharmacies in Northern Ireland.”
“As raised by quite a number of Members, children and young people have been disproportionately impacted. For many, the loss of the daily structure that school attendance normally provides, alongside reduced social contact and support in school, has had an impact on well-being and could lead to a deterioration in mental health. Early in the pandemic, I recognised that impact, and, as a result, in May 2020, my Department produced the mental health action plan, which included a COVID-19 mental health response plan. That set out a range of key actions that my Department and its agencies were taking forward to support our communities during the initial period of lockdown and beyond.”
“My Department leads on Making Life Better, which is the overarching strategic framework for public health. It outlines the Executive's commitment to creating the conditions for individuals, families and communities to take greater control over their lives and to be enabled and supported to improve their well-being and lead healthy lives. Departments are working together on a range of issues, including mitigating the impacts of poverty and tackling the conditions that create health inequalities. It is important that we continue to work collaboratively on that, as no Department has the resources or the power to combat the issues alone. <BR /> <BR />There is no doubt that the pandemic has exacerbated health inequalities, and it has certainly impacted our community's mental health.”
“It is shocking but, unfortunately, unsurprising that those living in our most deprived areas experience poor mental health. While I am encouraged that there were some positive changes noted in the report, there is much more work to be done to improve that. It is not something that my Department alone can address. Inequalities in health outcomes arise primarily, as I said in Question Time, because of the inequality in the conditions in which people are born, grow, live, work and age. Those conditions, known as social determinants of health, influence the ability of our communities and the individuals in those communities to lead long, healthy and active lives.”
“<BR /> <BR />I am grateful to have the opportunity again to speak publicly about one of my top priorities and one of the most important aspects of my Department's remit: mental health. Last week, during Mental Health Awareness Week, mental health rightly featured heavily in the media. I am hopeful that we can continue to build on that platform to ensure that it continues to receive public and governmental focus. We have to keep the momentum going if we truly want to see lasting and meaningful change, but that focus and commitment need to be maintained for 52 weeks of the year, not simply for Mental Health Awareness Week. <BR /> <BR />As we have heard, the 'Health Inequalities Annual Report' that was published last month highlighted the continuing challenges in mental health.”