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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“The expectation is that a pathway will be rolled out across all areas in a three-year time frame, subject to the availability of any funding necessary. As Members know, we face and are likely to continue to face an extremely challenging fiscal environment.”
“The regional dementia lead and commissioning staff at the Health and Social Care Board (HSCB) have drawn up a detailed commissioning specification and invited the local implementation groups to submit investment proposal templates to support the implementation of a prototype in each area. That is to be completed and returned to the Health and Social Care Board by 30 June this year. It has been agreed that the implementation structures will include a regional steering group that will have oversight of implementation across all five trust areas in order to ensure consistency and shared learning, a regional stakeholder reference group and local multi-agency and disciplinary implementation groups that will include people with dementia and carers.”
“I thank the Member. To date, work has been carried out that has already made significant improvements to the lives and well-being of people with dementia and their carers. It is vital that we continue to push forward with that work. In 2019, regional dementia leads, integrated care partnerships and the trusts established multi-agency working groups to consider what arrangements, structures and resources were required to support the roll-out of the regional dementia care pathway. <BR /> <BR />Legacy funding from the Delivering Social Change dementia signature programme supported the recruitment of two dementia service improvement leads in each trust, with specific responsibility for coordinating the pathway implementation programme in their respective trusts.”
“I thank the Member for sharing that story. I would like him to have the extra minute for taking the intervention.”
“New layers of complexity and bureaucracy are being created. I appeal to Members to choose their words carefully, however. There are uncertainties and challenges, but every effort is being made by my Department to ensure that the needs of all our patients and people in Northern Ireland are met.”
“The scope of the decisions on this is outwith the competence of the House and my Department. We have a major responsibility to provide input and advice when the Department of Health and Social Care asks for it. We are getting great support from DHSC and the MHRA in recognition of the challenges that are now faced to the supply of medicines and medical devices to Northern Ireland. My deepest regret is that, as Minister of Health in Northern Ireland, I do not have a seat at that table. That is where we could truly identify all the issues that we know of and all the knock-on implications that any change will have. I would value that dedicated and detailed input. <BR /> <BR />As I was saying, I have sympathy with the concerns expressed by all Members, because this situation is very far from ideal.”
“I thank the Member for his intervention. I hope that, by demonstrating our interactions with the DHSC and the MHRA and the work by the Chief Pharmaceutical Officer and her team, he will see that we are working on the issue on a case-by-case basis. Many of the theoretical and policy problems that are presented to us need a case-by-case answer. At the end of this, it will be a political solution and agreement. No matter how much policy that departmental officials, the EU or Westminster come up with, the answer will be political.”
“I have sympathy with the concerns expressed by Members.”
“My Department will continue that work in the coming months to ensure that future access to medicinal products and medical devices is maintained for the citizens of Northern Ireland. My Department has the support of the Department of Health and Social Care in Westminster and the Medicines and Healthcare products Regulatory Agency. I believe that I have clearly demonstrated that all the issues are being given serious attention by my Department and that intensive work is ongoing. I thank Members of the Health Committee for their acknowledgement of the work of the Chief Pharmaceutical Officer, Cathy Harrison, and her team in their dedication to the task. <BR /> <BR />Neither my Department nor I have created or sought this situation, and we cannot fix it by ourselves. The EU and the UK Government have central roles in finding the way forward.”
“I assure Members that, throughout this process, I have spoken with the Executive and provided my colleagues with a comprehensive briefing setting out my up-to-date assessment of the situation. I will, of course, continue to do so. My officials also continue to liaise with officials from the Executive Office on related matters. <BR /> <BR />I conclude by saying that the actions taken by the pharmaceutical industry and the interventions, when needed, by my officials have ensured that there has been no significant reduction in the quality or quantity of medicines and medical devices on the market in Northern Ireland. They have risen to that challenge, and the Assembly will no doubt join me in acknowledging their hard work to date and in thanking them.”
“In addition to that, officials engage with wider stakeholder groups in the health and social care sector in Northern Ireland, with community pharmacy and with groups representing patients across a range of interests and medical conditions. <BR /> <BR />I note that the motion:”
“The underpinning principles of this work are to ensure that the clinical needs of patients in Northern Ireland are met and that equity of access to medical products is maintained across the United Kingdom. The DHSC has committed to communicating to industry specifically on supplying to Northern Ireland. My officials have requested further clarification from the DHSC regarding the time frame for that guidance. <BR /> <BR />Thirdly, the DHSC is involved in formal discussions with industry about its plans for the end of the grace period, and my Department also maintains close contact with stakeholders in industry, and officials have frequent meetings with individual companies.”
“So far, there is no evidence to suggest an increase in the price of medicines, but that does not mean that that could not change. <BR /> <BR />The grace period for medicines is a short-term mitigation that has benefited the medicinal supply chain in Northern Ireland. However, to reduce the potential for risks manifesting themselves at the end of the grace period, I assure the Assembly that a number of other mitigations are ongoing. <BR /> <BR />First, medicines are the subject of ongoing discussions between the UK Government and the EU Commission to reach a negotiated position on implementation of the protocol. Secondly, my Department is working with the DHSC in London at official and ministerial level through direct and regular engagement between the Minister of State for Health and me.”
“That is acknowledged in the motion that we are debating today. <BR /> <BR />A number of issues were raised. We are aware that price increases are a potential risk, and, if issues emerge, we have systems in place to deal with them.”
“I note what the Member says, and I note that the motion states:”
“There is no evidence yet to suggest that patients in Northern Ireland are unable to access medicines that they need or, indeed, any issues with the safety and efficacy of the medicines that are available. However, when the grace period ends, all suppliers will have to comply fully with the requirements of the Northern Ireland protocol, and my Department is aware that companies are planning for potential major changes to their supply arrangements from January 2022. The Chancellor of the Duchy of Lancaster asked for an extension of that grace period, but the EU has yet to agree to that. Members should note that pharmaceutical companies are subject to an obligation to ensure continuous supplies of medicinal products so that the needs of patients in Northern Ireland are met.”
“<BR /> <BR />I note Members' concerns about the Northern Ireland protocol, and I agree that the challenges for the pharmaceutical industry and my Department must be addressed and worked through. The Assembly will agree that it is important that those challenges are properly defined. At this time, the true extent of how the protocol will impose barriers to trade is still to be seen, but it should be the policy of all in the House to avoid any barriers. <BR /> <BR />Since the start of the year, trade has, thankfully, been maintained, and the pharmaceutical industry has adapted to the additional regulatory and import checks required by the protocol when moving goods from GB to Northern Ireland.”
“<BR /> <BR />I advise the Assembly that the grace period has been successful in mitigating potential risks to Northern Ireland medical supplies. At this time, the Department is, fortunately, not aware of significant risks to patient care because of an actual or proposed diminution in the quality of medicinal products or devices placed on the Northern Ireland market. Certainly, there has been a range of issues involving delays to deliveries of medicines and medical devices as suppliers adapt to new import arrangements. However, the majority of those relate to trader readiness and have been satisfactorily resolved at this stage. My officials continue to offer support and interventions when needed to ensure supplies for patients.”
“Tagrisso has proven to be an example of the complex issues that we currently face and the additional steps and procedures that now need to be managed when there are differences between the decisions of the MHRA and the EMA on medicine authorisation. <BR /> <BR />On supply, Members will be aware that we currently benefit from a grace period to allow the pharmaceutical industry more time to adapt its systems to comply with the new requirements under the protocol that will come into effect after 31 December 2021. The new requirements will mean that medicines moving from Great Britain to Northern Ireland will be subject to additional batch testing and verification. In addition, all medicines in Northern Ireland will have to have packaging that complies with the EU falsified medicines directive.”
“However, in order to avoid a delay for Northern Ireland patients, the MHRA, the Department of Health and Social Care in Westminster and my Department worked together with the drug company in order to enable Tagrisso to be available in Northern Ireland for patient use in line with the rest of the United Kingdom while allowing it to be used outside its licence. While the EMA authorisation is being finalised, Tagrisso will be available under compassionate use and judged on a case-by-case basis.”
“I said that differences between the two regulators creates a risk of divergence, so it covers both — North/South and east-west. I do not want to politicise the drug supply. <BR /> <BR />I want to talk about the example that has been used here today. Tagrisso was already licensed by the MHRA and the EMA under the Northern Ireland protocol, and Northern Ireland follows the conditions of the EMA licence. When a change of licence held by MHRA was approved under Project Orbis, it applied only to Great Britain, leaving Northern Ireland subject to an EMA update, which has not yet happened.”
“<BR /> <BR />We have seen an example of that in recent days with the change to the medicines licence for Tagrisso, which is a lung cancer drug.”
“Members should be aware that the Northern Ireland protocol has major implications for the regulation and supply of medicines and medical devices. Under the Northern Ireland protocol, Northern Ireland is obliged to continue to follow EU laws and regulatory processes for medicines and medical devices, but Great Britain is not. Consequently, whereas Great Britain is now subject solely to the regulatory authority of the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), Northern Ireland must follow the European Medicines Agency's (EMA) centralised procedure for medicines authorisation. If there are any differences in medicine licensing decisions or timelines between the two regulators, that creates a risk of divergence between Great Britain and Northern Ireland that must be managed.”
“Thank you, Mr Deputy Speaker, for the opportunity to respond to the motion and to Members' remarks. <BR /> <BR />I reassure Members that I and my Department are committed to maintaining the supply of medicines and medical devices in order to meet the needs of people in Northern Ireland. Furthermore, I am committed to ensuring that Northern Ireland citizens continue to have the same access to new medicines and innovative treatments as citizens in the rest of the United Kingdom. As a constituent part of the United Kingdom, we should expect no less. <BR /> <BR />The Assembly can be satisfied that, as Minister of Health, I am prioritising those issues. Undoubtedly, however, where this issue is concerned, under the flawed protocol, there are challenges.”
“While that is a personal decision for some families, it is a prohibitive one for many. I do not want systems and services where families feel that they must take that route: I want equity in our systems. I want equity in services that are free, based on need and accessible to all. I want children to have the best start in life and to get the support that they need and the education that they deserve, not one that is dependent on or defined by a diagnosis. I want individuals — children and adults — and their families to feel supported, included and understood in the communities in which they live. It is not just about waiting lists and services but about building a longer-term vision in which we respect others and work together to bring about change in the outcomes for good.”
“I understand, in publishing the strategy, that Members and the public that we serve will expect a road map to improvement: that is what we all want to see. However, in the current climate, we must also manage our expectations of what can be achieved. Whilst we are optimistic that we are heading into a more positive climate that we hope to be able to refer to as "post-COVID", our services must recover and rebuild. The interim strategy sets the plans for our actions in motion and provides a direction of travel as we emerge into a post-pandemic world. My officials will continue to keep the work under review. <BR /> <BR />In recent weeks, media attention has highlighted the lengths to which many families have gone in seeking private assessment in light of our current waiting lists for autism assessment.”
“My officials will present the options that emerge from the forum to me, and I assure Members that, when plans are in place, I will keep the House apprised.”
“That would ensure that the implementation of actions would not be delayed at a time when need has never been greater, and I can assure you that I am committed to that and that those plans are commencing. <BR /> <BR />You will be aware that the vision of the interim strategy is to respect, to listen and to involve. In underpinning my commitment to the inclusion of autistic people, their families and carers and our community and voluntary representatives in shaping and developing the strategy, my Department has established an autism forum. That forum met for the first time on 28 April to determine its role, and further engagement is planned to determine our focus for a longer-term strategy, how we will work in partnership to develop and co-produce that and how we will monitor and evaluate the actions emerging from it.”
“Therefore, I took a decision to publish an interim autism strategy to set out priorities for outcome-based actions for 2021 and 2022 that will align with the Programme for Government. Again, I thank Kellie Armstrong and Clare Bailey for their offers of support and encouragement — and that was received from all Members across the House — on how we do this, not just as Health alone but with all of us working together to support those who need it most. To do that, I wrote to my Executive colleagues and our Health Committee in October 2020 to advise them of my intention to bring together the outcomes of the preparatory work and engagement undertaken in the publication of an interim strategy, which would ultimately inform the development of a fully co-produced autism strategy to commence later in 2021.”
“<BR /> <BR />Whilst I am aware of the pressures on our health and social care systems as we address the emerging priorities of the pandemic, I am also aware that, as a result, the development of a new long-term autism strategy for implementation has been severely constrained. In considering options, I was mindful of the challenges that had been experienced by children, adults and their families throughout the pandemic. I was conscious of the efforts placed upon identifying the priorities and actions that had been identified in preparation for the development of an autism strategy. I wanted to enable a direction of travel to be set as we rebuild our services. <BR /> <BR />I also wanted to acknowledge the voices of the people who had contributed so much to influencing and shaping the outcomes that the strategy will set out to achieve.”
“The stark reality of how this impacts on people who may have been diagnosed with autism or who are waiting on assessment has been drawn to my attention in this House by many Members on many occasions. The routines and structures that provide coping mechanisms for many — schools, familiar locations and people and, of course, respite care and short breaks — were all withdrawn or limited at a time when families experienced great need. Whilst these were difficult and, for many, unpopular decisions, we all know that they were vital to control the spread of the virus and protect everyone in society, especially our most vulnerable.”
“I thank the Member for his question. It does present challenges. Kellie Armstrong clearly demonstrated in her contribution how the challenges that Health has, or that members of our society have, with what has happened over the past year have been additionally compounded by that one-year Budget. It is no fault of this House. It is no derogation of the responsibility of this House. I have heard, from every party in this Chamber, their commitment to a recurrent Budget, if not for everywhere then especially for Health, to allow us to address that. <BR /> <BR />Throughout the past year, we have all had to change our routines and the way in which we live our lives.”
“As I have previously said, all waiting lists must be addressed, and that includes those for autism, whether it is for an assessment or for the delivery of services and support to individuals and their families.”
“<BR /> <BR />Aware of the need to continue delivery of these services and that support, autism services in our trusts investigated alternative solutions, both nationally and internationally, to implement methods of assessment that would be compliant with the requirements of NICE guidance. I commend them for their efforts and commitment in implementing alternative methods of support and interventions through digital platforms, clinical helplines and provision of resources to all those in need, regardless of diagnosis or not. <BR /> <BR />However, the reality of the impact on waiting lists in some areas has been realised, and I have no doubt that the situation has influenced the tabling of the motion today, and understandably so.”
“There was no doubt in anyone's mind that that would have a significant impact on waiting lists, which were already growing. <BR /> <BR />A crucial element of the autism assessment is built on observation. It is known as the autism diagnostic observation schedule (ADOS) and provides a structured, standardised method of assessment of communication, social interaction and behaviours. Throughout the pandemic, that assessment could not be delivered due to the social-distancing and public health guidance measures. As the assessment is undertaken in close proximity, the impact of PPE on the individual could render the assessment invalid.”
“Through participation in multi-agency autism forums in trust areas, they spoke to members of our local councils to hear more about the work being undertaken as they strive to become autism-friendly areas and about how public services are implementing actions to provide appropriate support. <BR /> <BR />That work, and much more, has demonstrated where my priorities for an autism strategy should lie. However, as we have said in so many debates and Question Times throughout the past year, no one could have prepared us for the impact that COVID-19 would have on our lives and on how services would have to be delivered. As the impact of the pandemic heightened and public guidelines and restrictions were put in place, autism services in our trusts had to take the difficult decision to cease delivery of elements of the autism assessment.”
“To determine how priorities can be addressed, my officials participated in forums with health and social care clinicians, who are dedicated to providing support and interventions specific to individual needs. They heard first-hand about the challenges experienced with managing waiting lists and about how those clinicians are already working to improve that. My officials also worked across Departments, including Education, to determine how autistic people are being supported by and considered in the delivery of our services, as well as to identify actions that could make a real difference to their lives and to the lives of their families.”
“Those priorities included Health and Education working more closely together, which was mentioned many times today, and we will do that; greater provision for early intervention and standardised regional services, with equity of access across the region, and we will strive to achieve that; accessibility to mental health services through a mental health strategy, and we will improve that; greater awareness and understanding of the needs of autistic people in our workforce, services, communities and families, and we will work in partnership with the relevant bodies to increase that understanding. <BR /> <BR />We were also told that actions, not words, were needed.”
“<BR /> <BR />In preparation for the development of a revised strategy, the focus of my officials has been to listen to the voices of those who matter most: autistic people, their families and carers, and the community and voluntary sector that represents them and works tirelessly to provide advice and support. From that engagement, a clear sense emerged of the priorities that families and individuals wanted to see addressed through a strategy.”
“I want to take this opportunity to share my rationale for publishing an interim strategy, setting out my immediate plans. I also want to advise how I intend to proceed with the development of a longer-term strategy that can provide actions that will make a difference to lives. Many of you are aware, and many have mentioned, that the Autism Act places a legislative requirement on my Department to prepare a cross-departmental autism strategy. That was mentioned by many Members today. Also mentioned was the pivotal and important role that education plays. The previous autism strategy came to an end in December 2020. Although it achieved much and significantly raised the profile of autism as a condition, there is a lot of work still to be done.”
“That has been highlighted so many times by the personal and constituency examples and stories recounted by nearly all MLAs in today's debate. <BR /> <BR />I said in my statement on 13 April that we must put waiting lists right, and that includes for autism. In supporting individuals, children and families, we all have a responsibility to work together, which Ms Bailey's contribution highlighted. Given the prevalence of autism today, we should no longer expect autistic people, their families, and those awaiting assessment to adapt to society. We also have a collective responsibility to increase understanding and to prepare society to adapt to and understand the needs of children and adults with autism and their families. <BR /> <BR />Today's debate raises the question of bringing forward a longer-term autism strategy.”
“<BR /> <BR />I realise that, if a child is waiting for an autism assessment for a significant length of time, that may impact on its emotional health and well-being, personal development and education. That is not acceptable. For the family of that child, it can impact on how they live, how they support their child and, indeed, any other children in the home, and all that without having the necessary information and, in a lot of cases, no additional support. That is not acceptable. For those adults who may have experienced lifelong challenges in their social interaction and in their ability to communicate and interact with their environment and who have taken the decision to seek assessment and obtain support that could make a positive difference to their life, that is not acceptable.”
“I welcome the proposal in the motion, that in the amendment and Members' contributions today. The debate provides me with an opportunity to acknowledge publicly that I am acutely aware of the considerable challenges being experienced by individuals and families on waiting lists for autism assessments. I remind Members that the situation is unfortunately not unique to autism. As recently as Tuesday 13 April, I made a statement in the House in which I mentioned our "absolutely dire waiting lists". I said that the pandemic had highlighted fragilities in our health and social care system and acknowledged that one of the casualties is autism, which is being highlighted here today.”
“When those in elected office resort to point-scoring or repeating conspiracy theories, it has consequences. It creates misinformation and resistance to change but, most of all, it lets patients down. <BR /> <BR />I trust that my comments this evening will provide further assurance about what I value and how I see the Downe Hospital having a hugely important place in the COVID-19 recovery effort and in the vital journey towards health service transformation across Northern Ireland.”
“For all the reasons that I explained, I sincerely hope that the Downe Hospital does not become a political football. I sincerely hope that no hospital in Northern Ireland becomes a political football. I sincerely hope that our health service does not become a political football. After the next election, one of the other parties could, perhaps, pick up the Department of Health and nominate the Minister of Health, as they could have chosen to do last January. At that point, they actively chose not to do it. Next time, there may be a reversal of roles and arguments. Then others will have an understanding, as Mr Wells has, of the challenges of this job and that making sure that the health service delivers for everyone is not as easy as some may think.”
“I thank the Member. <BR /> <BR />I was going to come back to the vaccination programme because I know that it was raised. We shifted vaccination programmes to GPs and community pharmacies so that people could get the vaccine. We still see over-80-year-olds coming forward now because they have lost their vaccine hesitancy. In respect of the over-16s, we have a licensing problem with the AstraZeneca vaccine, which is only licensed for over-18s. The Pfizer vaccine is licensed for over-16s for a number of specific medical cases, so it is not just the general over-16 population. If the Member has written to me on that, I will be able respond. <BR /> <BR />As we are having this debate, I note the change in health debates over the last few weeks. Let us be realists. We are a year away from an election.”
“It does not mean that all services will be delivered in exactly the same way until the end of time. <BR /> <BR />Change can be positive. It can improve the quality of healthcare for local populations. Surely we should, collectively, try to do that.”
“Medicine and treatments change, and we should not remain wedded to a 20th-century way of doing things. It is easy for parties across the House to endorse the general principle that change is needed. It is a different matter when specific changes at a local level are proposed. That is why, for some, the temptation proves too strong to grab those headlines or proclaim grand conspiracy theories about what is being done about the future of individual hospital sites at regional management board sittings or in presentations or minutes that nobody has seen. <BR /> <BR />Let me be clear — I will give you this commitment — there is no plan, hidden or otherwise, to close, downgrade or run down any hospital in Northern Ireland. That includes the Downe. That does not mean that every hospital will remain frozen in time.”
“The causes being championed are, like the Downe, invariably worthy. Rarely, if ever, do I hear suggestions about where I can get that extra funding. The impression is given that funding and staffing are unlimited and that I merely need to be persuaded to spend more or move more staff to a particular area. In reality, funding is very limited. At present, indeed, it is an increasing struggle to maintain our existing services. <BR /> <BR />Again — the Member will take this whichever way he wants — I am worried about petty, point-scoring politics when it comes to the vital task of reforming and transforming our struggling health service. Changes in clinical practice, standards, demographics, technology, and workforce challenges mean that we simply cannot have a conversation, in isolation, about the role of any one hospital.”
“However, I have been struck recently by how often political debate about our health service ignores basic financial realities. Barely a day goes by without an MLA, a councillor or an MP calling on me to significantly increase spending in a key area. The former Minister of Health will know that that is part of the job.”