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 start by thanking the Chair of the Health Committee for tabling the motion and the Members who have spoken so passionately in their support. In this debate, we have seen the best of the House: working together on a subject with a unity of purpose. Many times, when Committees bring motions to the House, it ends up with Committee members talking to themselves. However, this subject has brought in many other Members, with a diverse range of aspects and personal contributions that have shown the dedication of the House to truly tackling the challenge that is mental health. It has also highlighted the many aspects that make up the mental health challenge across Northern Ireland. When we talk about mental health in the generality, we can forget about some of the specifics that have been mentioned by Members today.”
“Those three generators have arrived in India: two of them have already been connected to hospital supplies, and the third one is undergoing commissioning work. We expect to receive an update in the next few days on the full operation of those three generators and the vital part that they are playing in helping India to combat COVID-19 by supporting patients with a supply of oxygen that has been engineered, developed, designed and built here in Northern Ireland.”
“I thank the Member for his question. That is a fantastic example of what we in the health service of Northern Ireland can do. It has not been acknowledged greatly that the three generators that we were able to ship were manufactured in Northern Ireland with support with engineering from the Belfast Trust.”
“I thank the Member for his question. The Mater has played a vital and crucial role in our fight against COVID. It also plays a vital and crucial role in our recovery process. I raised that issue in discussion with the chair of the Belfast Health and Social Care Trust when we last met. I stressed to him the value that we place on the Mater Hospital as part of our footprint and as part of our entire health estate. We need every square foot of it. Service provision may not be the same as it was pre COVID, but I assure the Member that it is a vital part of and link in our health service in Northern Ireland.”
“I thank the Member and acknowledge the work that the Northern Ireland Hospice provides as a regional service. The Member will be aware that not just my Department but the Department of Finance made a number of financial interventions during the past year in support of the hospice. He will also be aware, because I have said it numerous times, that I am constrained by a one-year budget with non-recurrent funding proposals. As we go forward, I must look at what commitments are in place in New Decade, New Approach to support palliative care. It is a whole-Executive approach, and we need a commitment to a recurrent Budget that can allow us to make long-term commitments.”
“The Executive have yet to come to an agreement on the provision of early medical abortion in Northern Ireland. Women who require access to services not available in their own trust area can contact the British Pregnancy Advisory Service for access to services. They may also contact their GP.”
“The Member's question has been covered in the Chamber a number of times. My Department is not required under the law to commission abortion services. In recognition and anticipation of regulations being introduced by the UK Government from March last year, however, my Department had commenced work to develop a commissioning model and service specification for those services to be delivered in Northern Ireland. That work was paused from February 2020, owing to the need to divert departmental and Health and Social Care (HSC) staff resources to manage the response to the pandemic. The Western Health and Social Care Trust has been delivering a service, and, as far as I am aware, it is looking to recruit to fill the post that is vacant at the minute.”
“I thank the Member for his supplementary question. As was debated yesterday afternoon about how we now have to look to the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA) regarding where medicines are licensed and their uses, it puts an additional strain on the small team that works with my Chief Pharmaceutical Officer on how we assess what medicines are available and on the additional bureaucracy and management that is now needed because we are in two jurisdictions. While the grace period is useful, it is coming to an end, which puts an additional workload on how we seek to ensure that those medicine supplies and medical devices are there for the long term and not just through the grace period.”
“I thank the Member. As we debated yesterday, medicines and medical devices supplied through the NHS bring cost advantages to the Northern Ireland health service, and their distribution through our controlled free NHS and GP prescriptions cannot threaten the EU single market. Given that everyone in Northern Ireland will be adversely affected by increased pharmacy costs, there has to be a realisation about the implication of what that means for additional bureaucracy, the time frames and the supply chains that have to be put in place for the delivery of those medicines.”
“As I said, I will check with my Department on how far that work has been progressed. Again, I will respond to the Member in writing with an update as soon as I have it.”
“I thank the Member for her question. I can answer with regard to what has happened since January 2020. As the Member knows, within a number of weeks of coming into office, we were faced with a pandemic, so many pieces of work that were already in train in the Department were put on hold. I think that this was one of them, and I will check that and get back to the Member in detail in writing. I do not have the specific list in front of me, but I will respond to her.”
“We have been looking at that regional approach so that we take people from the top of the waiting list or with key priorities and offer them the operation or the service no matter where that theatre capacity may be so that we can get a standardisation, I suppose, across Northern Ireland so that those who are waiting longest do not have to wait on their local trust's waiting list but we can see how we can respond as a service to get those waiting lists down.”
“I thank the Member. He asked for my opinion about that waiting list: of course it is not acceptable. Since I have come into post, I have been clear that those waiting lists are not acceptable. We must do everything that we can to get in front of them, not just get back to where we were. When we look at where we were pre COVID, we see that those waiting lists were increasing, even without the challenges that COVID has presented. It is about how we look at our rebuilding board, and I know that the Member specifically mentioned the Western Trust.”
“I thank the Member for his question. He will know that we have established a board for rebuilding services to look at how we get back to completing the number of surgeries that we were completing in the past. <BR /> <BR />On orthopaedic surgeries, while we look at a specific hub-and-spoke model that we had developed and build up local capacity, we are using the private sector. Recently, we utilised orthopaedic operations in the Republic of Ireland. We were able to buy some provision of operations there while we get our health service back to full capacity.”
“The guidance is there for a reason: it is not only to support the people of Northern Ireland but to maintain and provide advice to those who wish to travel from other areas to Northern Ireland on how they can best look after themselves and the loved ones whom they are coming to visit or stay with, or the work colleagues with whom they will be socialising now that some easements have been made.”
“I thank the Member for his question. In the past 14 months, the Executive have supported travel within the common travel area under guidance rather than regulation, because, if we put it into law, it will need enforcement. If we were to put in place regulations on travel east-west, we would have to take into consideration travel North/South and how that would be policed and enforced. The Executive have taken the decision that the rules on travel within the common travel area should be based in guidance.”
“I confirm to the Member that the information is in guidance at this time, because that is how we as an Executive have managed travel within the common travel area.”
“That programme allows for a proportion of the fleet to be replaced annually, which spreads the need for capital funding evenly over the period of replacement and allows it to be planned and managed effectively, thus minimising the risk to service operations.”
“I thank the Member. To give the Member and the House an update, I will say that our Ambulance Service has a fleet of 330 emergency and non-emergency vehicles, including A&E ambulances, patient-care service vehicles, the Northern Ireland Specialist Transport and Retrieval (NISTAR) vehicles, rapid response vehicles (RRVs) and support vehicles. <BR /> <BR />There are currently 116 A&E ambulances, 112 patient care service vehicles and 43 rapid-response vehicles. The vehicles are replaced under a five-year rolling programme. In January 2021, the Department approved a business case for £22·7 million for the replacement of vehicles until the end of 2025-26.”
“I thank the Member. The pandemic has caused manufacturers in the automotive industry to close factories for short periods. That has created supply chain delays and has, ultimately, reduced the availability of new vehicles, which has caused the Northern Ireland Ambulance Service (NIAS) to experience delays in replacing ambulances. However, my Department continues to provide capital funding for the Northern Ireland Ambulance Service fleet replacement programme, and, in January 2021, following a short delay due to the pandemic, the Department approved the fleet replacement business case for the period 2021 to 2025-26.”
“I thank the Member. Some of the challenge has come from the perception of what the Department has been doing. In October, NHS England announced that it was supplying £10 million to be invested in the establishment of a number of multidisciplinary clinics, which would improve multidisciplinary teams in the same way that we are looking at a multidisciplinary approach. I understand that neither Scotland nor Wales are planning to follow England's approach on the establishment of the specialist assessment clinics. In Scotland, the focus to date has been on developing community-based services and on mental health needs. Wales has identified a need for a multidisciplinary rehabilitation service, with a care pathway being developed for post-COVID-19 syndrome, as well as a recovery map.”
“I thank the Member. I do not have an update on ME services with me. However, she has long called for the establishment of the long COVID support model, and I thank her for her consistency in and persistence on that. Once again, when it comes to supporting the bid for additional funding through the Executive, I hope that she can apply the same pressure on her ministerial colleague as well. I will get back to the Member in writing with an update on recruitment for the ME service.”
“I assure the Member that the full services and where we base long COVID supports will be part of the commissioning model in order to make sure that we get the best supply and locations across Northern Ireland. I will not make any commitments at this time, but it is vital that those services are established and funded.”
“I thank the Member for the local question. Who knows? Maybe when the bid comes to the Executive, he may be able to support or approve it, depending on what role he finds himself in, if any.”
“I thank the Member for his question. With regard to who will make up those teams, we are looking at that multidisciplinary approach as well, so there will be physiotherapists, primary care and secondary care. <BR /> <BR />The costing proposals that have come forward to me to establish that service are not insignificant. This year and next year, we are looking at something in the region of £2 million to supply that service. It is not simply a question of how much money I will allocate; it is how much his party colleague in the Ministry of Finance will see this as a worthy cause to support in additional item bids or monitoring rounds from COVID moneys. It has been debated in the House that this is a service that is needed.”
“I thank the Member for his question. The Health and Social Care Board recently submitted proposals to my Department, and I have asked that they be considered urgently. I hope to announce a decision shortly. <BR /> <BR />In developing the proposals, the Health and Social Care Board has been engaging extensively with the primary and secondary care sectors as well as other stakeholder groups to ensure that we have the right service offering to meet the needs of people in Northern Ireland. Once a final service model has been approved, work will be undertaken to rapidly deliver the appropriate services.”
“Unfortunately, it is not as far advanced as we would like, but that is due to go out to consultation towards the end of this year, so that preparatory work will have been started for whoever takes up this post after the next election.”
“I congratulate the Member and his wife on the birth of their child. I know that in a conversation earlier, there was an allegation made by the Chair of the Health Committee that the Member was interested in going to discos. Speaking from experience from a number of years ago, as a new father, that will be the last thing on the Member's mind. <BR /> <BR />With regard to his question, the substance use strategy that is being worked through by my Department acknowledges that alcohol is still the drug of choice in Northern Ireland. The question is how we meet that strong challenge. The Member may or may not be aware that we are looking at a minimum unit pricing strategy for Northern Ireland.”
“I thank the Member for that. He is right, and that is the challenge that continually faces not just my Department but the PHA and GPs that we work with in collaboration as well. It is about making screening accessible to people in their own environments. <BR /> <BR />The Member will be aware of the Big Bus that goes round for the cancer screening services. It is about bringing that service as close to people as possible but also making them aware of the preventative benefits of screening. That is what this is about, and what the discussion in regard to health inequalities should be about. It is about prevention being better than cure or treatment, so the more people we can screen, the better. It is about education and awareness but also accessibility.”
“The young people's oral health options group has, unfortunately, been delayed until later this year, although some preparatory work has commenced. The intention is for the groups to establish the oral health needs of children and older adults in Northern Ireland and review the evidence base to determine which preventative interventions are likely to be the most effective and cost-effective.”
“The current Northern Ireland oral health strategy was published back in 2007. Despite its age, the main oral health problems that are described in the document and the approaches to prevention that are advocated by it remain largely valid today. Although it is still valid, it is accepted that, in some instances, the settings or opportunities for prevention have changed. As such, prior to COVID-19, my Department decided that the two sections of the Northern Ireland population that would benefit most from updated oral disease prevention programmes were young people and older adults. <BR /> <BR />An 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 later this year.”
“I fully agree with the Member. He knows that I addressed the issue at the Health Committee on Thursday. When we talk about health inequalities, that is the measure at the end. We, as an Executive, a community and an Assembly, need to invest at the start so that we support the community and the individual throughout their life. As I said, those inequalities are subject to the conditions in which people are born, grow, live, work and age. If we, as an Executive, can improve people's lived experience through their housing conditions, education, opportunity to work and opportunity to have a better life balance, we can really challenge those health inequalities. That is something that is, and should be, at the core of our Programme for Government.”
“The Public Health Agency has also developed a short-, medium- and long-term plan for the recovery of health improvement services, the majority of which are focused on the most deprived communities.”
“Those conditions influence the ability of individuals, families and communities to take control of their own lives and choices and whether they are enabled and supported to lead long, healthy, active lives. <BR /> <BR />My Department leads on Making Life Better, which is the overarching strategic framework for public health through which the Executive committed to creating the conditions for individuals, families and communities to take greater control over their lives and be enabled and supported to lead healthy lives. The pandemic has, no doubt, exacerbated existing inequalities. Therefore, my Department and the Public Health Agency (PHA) continue to deliver a range of actions to address the impact of COVID-19 and other health conditions and behaviours on the most deprived communities and reduce health inequalities.”
“I thank the Member for his question. The latest health inequalities annual report, which was published by my Department on 14 April, highlighted that inequalities in health outcomes continue to be a key challenge. The report showed that alcohol- and drug-related indicators continue to show some of the largest health inequalities that are monitored in Northern Ireland, with rates in the most deprived areas being five times those in the least deprived areas for drug-related mortality and four times for alcohol-specific mortality. Other large inequalities exist for teenage birth rates, smoking in pregnancy and healthy life expectancy. <BR /> <BR />Inequalities in health outcomes primarily arise because of the inequalities in the conditions in which people are born, grow, live, work and age.”
“My officials are working to develop policy proposals in respect of providing a pay uplift, which will be part of a package of measures to improve opportunities for the social care workforce in line with the wider aims of the Department of Health's work to reform adult social care and its future sustainability for Northern Ireland. <BR /> <BR />As I said earlier, in addition to addressing low pay, further measures have been delivered to improve the training, education and career development opportunities available to the workforce, and I have invested funding to develop a social care workforce strategy for Northern Ireland. That strategy will signal the commitment of my Department to the strategic value of the social care workforce in the health and social care service in Northern Ireland.”
“I thank the Member for that. If the Principal Deputy Speaker wants medical help, I am sure that we can point him in the right direction. <BR /> <BR />The expert panel report, 'Power to People', which was published by my Department in 2017, proposed that the care and support sector should be at least a living-wage sector as a first step to recognising it as a professional workforce. <BR /> <BR />On 13 May 2020, I announced that I intended to make much-needed improvements in standardisation with regard to pay, training and career pathways for the social care workforce.”
“I do not have an answer with me today, but I will get back to the Member in writing.”
“That also has to be tackled and addressed through that piece of work. It is about a whole-system approach because no part of the health service works independently of any other part.”
“I thank the Member for her point. She will know from my original answer that I welcomed the fact that, between May last year and April this year, we have an additional 2,000 people working in that highly valued profession. It is about giving them the support and recognition to do their jobs. It is also about it being a career for those who want a career in the service. <BR /> <BR />I recently established the social care fair work forum, which will bring about representations from the health trade unions, the workers, the service providers and the trusts, so that we can identify how to progress those who want to work in social care and make it a job of choice for many. However, the Member rightly indicated that, in some areas across Northern Ireland, there is a geographical challenge in regard to recruitment.”
“I urge that it is not that they are viewed as bed-blockers; it is basically just until we get appropriate care and support mechanisms in place to ensure that they are going home to a safe environment. It is vital that we get that flow right, throughout our entire health service, so that we can get as many people as possible seen in a hospital setting.”
“Every evening, that outstanding list is shared with the commissioning teams and key workers for review and validation. That is an ongoing process of review of people who are still in hospital but need a support package.”
“I thank the Member for that point. It is about patient flow and flow management. As constituency MLAs, we all know of the challenges. When the appropriate care package is not available, some family members want their loved one to remain in the hospital setting until it is provided. I understand that there are several hundred fully or partially outstanding domiciliary care packages across Northern Ireland. While that is not the situation that I want to see, trusts have mitigation measures in place to ensure that care is still provided to those individuals. To ensure the continuation of care, the trust sends a list of outstanding cases to its in-house domiciliary care service and all the independent-sector providers each day, requesting their assistance with accepting those care packages either in full or in part.”
“— to support people to remain in their home.”
“There are also occasions on which individuals are returned home into their family's care until a package can be implemented. While delays in implementation can be frustrating for all concerned, it is vital that patient safety and well-being remains at the forefront of decision-making in hospitals. <BR /> <BR />Some £275 million was invested in domiciliary care in the financial year 2018-19. The Department remains committed to providing a high-quality domiciliary care service —”
“<BR /> <BR />Now and throughout the pandemic, health and social care trusts and providers have endeavoured to ensure that any fully or partially outstanding domiciliary care packages are still provided. As of 26 April this year, there were 23,188 domiciliary care packages being provided in the community. I am pleased to note that, over the past 12 months, the social care workforce has expended significantly, with an increase of 2,086 registered workers between May 2020 and April 2021. While that is welcome, more staff are clearly still needed to ensure that services continue to be delivered as and when they are required. <BR /> <BR />Trusts aim to achieve timely discharge in every case. Sometimes, however, there are delays in getting people home. In some cases, that can be a result of delays in getting the right care package in place.”
“I thank the Member for his question. Domiciliary care is an essential front-line community care service that has been sustained throughout the COVID-19 pandemic. Statutory and independent-sector domiciliary care providers have liaised closely during the pandemic to maintain service provision. The pandemic has presented challenges for the sector, such as the suspension of some domiciliary care packages at various stages. That was done at the request of service users or families to reduce the risk of contact and transmission of the virus. Some domiciliary care providers have experienced COVID-19-related staff shortages that led to changes in service provision. Trusts have worked to address those shortages by, for example, reconfiguring service provision across geographical areas.”
“I thank the Member for that important question on the support that carers need. They have had a particularly hard time over the past 14 months. The social care recommendations are being worked through by the Department. We have looked at them, especially for care homes, to see how we can support people with a dementia through the care partner programme so that we can ensure that a family member or another familiar face can go into their care home and give them that support while they are there. That work is ongoing. As I say, the vital piece for us is that it is co-produced, because one thing that we must take out of the past 14 months is to learn from the lived experience of people who suffer from dementia and their carers.”
“Additional work is ongoing to support the roll-out of products and findings from phase 2 of the Delivering Social Change programme, which includes and takes account of input from users and dementia sufferers through a co-production approach.”
“I thank the Member. I refer him to some of the content in my previous answer about the regional dementia leads and the commissioning specification that has been drawn up by the Health and Social Care Board. The implementation groups have been asked to submit investment proposal templates to support the implementation of a prototype. That bidding and implementation process is due to end by 30 June this year. <BR /> <BR />In relation to the reform of dementia services, my Department has previously provided funding to support the roll-out of actions from the Delivering Social Change dementia signature programme. That included the appointment of 10 dementia service improvement leads, 10 dementia navigators and 44 dementia champions.”