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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“That is what I want for the Downe Hospital. <BR /> <BR />As I said, I want the Downe Hospital to be a vibrant, integral part of the regional approach in the South Eastern Trust. I believe that it is. Ms Bradley indicated what an excellent facility it is. It is one of our newer hospitals, opening in 2009. Why not use that facility? That is what we want to do. Look at the three-month rescheduled building plans that are all based on available footprint and staff. <BR /> <BR />Everybody in the House knows — at least, they should know — the acute budgetary pressures on my Department, across government, and on the public sector. Single-year Budgets have only made a bad situation worse. I believe that I have cross-party support in calling for sustained investment and multi-year Budget settlements.”
“If they click on the news and see a threat, or even the insinuation of a threat, that a hospital or service may be reduced, downplayed or taken away, they will become discouraged. That is when such language becomes very difficult and makes it harder for us, the hospital and those who want to work in it. <BR /> <BR />I know where the Member is trying to take the conversation. I have challenged. As I said, he quoted me in the work that he has done in promoting the Downe Hospital in this place. <BR /> <BR />We have to be realistic about the position of our health service, and his party has been part of all the reforms that have been brought forward over many years and supported them. It is about where we take political stances and looking at the health service as a whole, rather than as hospitals or units in isolation.”
“The Member may not be grandstanding, but some of his party colleagues, some councillors, and MPs for the area have been. He knows the devastating effect that that has on the morale of the people working in that hospital. <BR /> <BR />I raised it at the start of my contribution. When I had this conversation with the Member a number of weeks ago, I raised the similarity that we had in North Antrim with the Causeway Hospital. One of the things that the chief executive asked us to do, as responsible local politicians, was to stop talking the hospital down because it was distracting and making it harder to recruit people to that hospital. As I said in my opening comments, we have so many vacancies across our health and social care system. Someone looking for a job may google the hospitals where jobs are available.”
“Since coming into post, I have done my best to keep politics out of the health service, especially during a pandemic. Politics, and especially political grandstanding, must not become a threat to our health service. By that, I mean easy-option politics, short-termism and politics that is only interested in point-scoring or landing a headline in the media. <BR />Reforming our health service across Northern Ireland is challenging. The Member may shake his head, but every MLA wants the best for their region. I get that, but, as Minister, I have to deliver a health service.”
“I will disappoint the Member now: I do not have a date for that. Everyone in the House has to be realistic about the situation that we are in. Elected Members have met the trust officials on numerous occasions. I do not have a date for the reinstatement. Looking across the entirety of the system, you will know well, as a former Health Minister, the pressures that we are under.”
“I could go on, but suffice it to say that that clearly illustrates my earlier point about the Downe being a vibrant hospital that provides a rich mixture of important services to the local and regional population.”
“<BR /> <BR />The other new services that the trust has introduced are ophthalmology outpatient services; trust-wide bowel cancer screening; trust-wide sexual health services; maxillofacial surgery; frail elderly rapid assessment services; a midwife-led unit; two general practice services on-site; Marie Curie services on-site; orthopaedic integrated clinical assessment and treatment services (ICATS); multidisciplinary teams; and community respiratory services on-site. There is a range of other services, including outpatient physiotherapy; musculoskeletal and women's health services; podiatry; orthoptics; occupational therapy; rheumatology hand services; ENT services; speech and language services; and children's and social work services.”
“During that time, the trust introduced new services to the Downe, including a regional centre for cataract services. I know that the Member opposite challenged that, because only a few people were coming to it from outside the region, but it is a regional service that we are constantly building on. I get the same complaints from people in North Antrim who have to travel for their cataract surgery, but I can tell you now that there are people in North Antrim who would quite happily travel to the Downe to get a cataract operation. That is where we have to be at as we move forward with our health service regionally.”
“As society reopens in the weeks ahead, the implementation of rapid-testing technology at the Downe urgent care centre will further enhance patient and staff safety and help maintain a high degree of confidence that the unit can be kept COVID-free. <BR /> <BR />I will turn, more generally, to the evolution of the Downe since the South Eastern Trust took over responsibility for the hospital in 2007. Most people would see that as a positive story. A new hospital was opened in 2009, with investment in excess of £60 million. In 2010, the trust began to transform its acute services across all three sites — Downe Hospital, Lagan Valley Hospital and the Ulster Hospital — in recognition of sustainability challenges faced by healthcare delivery across the UK and globally.”
“For patient needs and health outcomes, that is clearly preferable to large numbers waiting in a crowded ED, where they have a high risk of contracting infection. <BR /> <BR />Most importantly, however, 14 patients a week, on average, are now being advised, on first contact, to attend an ED. That must be compared with the pre-COVID context, in which 14 patients a week experienced delays while waiting for transfer to definite care. Patients are now being directed to the right care in the right place at the right time, so it is not surprising that feedback from patients and users of the Phone First urgent care service has been extremely positive, with 100% positive reviews from patients in March 2021.”
“As we have seen right across trusts, that spirit has accelerated new ways of working, enabled staff redeployment to care for the sickest patients across the region and maintained vital services. In response to the Member, I acknowledge that there is concern locally that the pre-COVID-19 service level has not yet been reinstated at the Downe emergency department. In the meantime, the consultant-led Phone First urgent care centre provides safer and more timely access to unscheduled care services in the local area. In the first three months of this year, attendance steadily increased from 528 to 597 to 765 a month. Of those patients, 70% had their medical needs attended to in a scheduled slot at the urgent care centre. The remaining 30% were redirected to an appropriate care setting, such as a GP, an advice service or emergency care.”
“I will come to that issue shortly. First, I pay tribute to the health and social care staff and support staff who work at the Downe Hospital and across the South Eastern Trust, in hospitals and in the community, for their agility and the enthusiasm with which they have met the unprecedented challenges of the pandemic.”
“As Members of the House, the Department of Health, the Minister of Health and former Ministers of Health, we know our desire to deliver the service that we want: a National Health Service that is free at the point of use and delivery.”
“We have a responsibility to move the discussion about the Downe Hospital or any hospital in Northern Ireland out of that negative space and begin to discuss how the entire health and social care system can work together as a true, united and joined-up system to serve the needs of the entire population and so that no Member or constituent, no matter which constituency they live in, feels that they are a second-class citizen. Unfortunately, at this time, many people who are in need of health services, no matter where they live, do feel second class, because we cannot provide the services that we want to provide.”
“Yes, the challenge that now faces the health service is huge and unprecedented. The Member asked what was the difference between England, where it is estimated that it will take five years to recover, and Northern Ireland, where it will take 10 years. That is because, due to continued underinvestment in the health service and workforce, Northern Ireland was already five years behind before COVID hit. <BR /> <BR />The challenge that now faces the health service is huge and unprecedented. Yes, I would say that we can be sure that further change is inevitable but that it will be right across Health and Social Care in Northern Ireland. I want to encourage representatives from South Down and the South Eastern Trust area to play a constructive role in that discussion.”
“<BR /> <BR />I committed wholeheartedly to that when I published revised trust rebuilding plans on 13 April. Those plans are available on the Department's website. I encourage Members to read them, because they give the detail of where we are and where the ambition lies. They are three-month rebuilding plans, because that is how I see our being able to take steps. They are three-month steps, because of the resources, facilities and staff that we have. The Downe Hospital is an important part of the recovery plan for the local population whom it serves, the role that it plays in the South Eastern Trust's hospital network and the regional services that it provides to the population of Northern Ireland. Yes, COVID-19 necessitated some temporary downturns and changes in how services are provided.”
“We are already having that discussion right across Health and Social Care. As I told the Member when he raised the issue previously, that is about using every available resource as effectively as we possibly can, including the vital Downe Hospital, to recover from the devastating impact of COVID-19 on services across Northern Ireland. The Member who secured the Adjournment debate talked several times about where we were last year. What he forgets is where we were even a number of weeks ago with the COVID pandemic. In January, due to COVID, there were nearly 1,000 inpatients across the entirety of the system. Therefore, the issue is not where we were a year ago; it is where we were weeks ago. The Member seems to think that there is some magic switch that turns on the health service overnight.”
“It is a beacon of transformation — an exemplar of integrated working between primary, community and secondary care.”
“I put it to the Member that, as the chairman, I think, of a party that has endorsed many reviews of health and the work that needs to be done, he should acknowledge, as Ms Bradley did, that we are no longer in a position in which we can provide every specialty in every hospital across Northern Ireland. That is why, since becoming Minister, I have been clear when talking about regionalisation. The reality is that Downe Hospital is a vibrant healthcare facility.”
“That is especially the case in our general hospitals. Any newly qualified health worker researching which hospital to work from could be forgiven for thinking that there is some lingering threat of closure hanging over Downe Hospital. There is not, but that is what is being perpetuated by the constant scaremongering by some, including elected representatives — councillors, MLAs and MPs — who really should know better.”
“Thank you, Mr Deputy Speaker. I will start by being clear: as I have said before in the House, the biggest threat to Downe Hospital is not from any imagined or perceived desire to diminish or close it; it is the constant talking down of the breadth of services already available there. As all Members will be aware, we face serious challenges in recruiting and retaining sufficient numbers of healthcare staff across the system. That is what a decade of underinvestment in the health service does. <BR /> <BR />In the past 15 months, I have approved 600 new nursing and midwifery training places and have increased the number of university medical places, but those take some time to come online. In the meantime, my Department, the trust and the hospital are working hard to recruit and, importantly, retain enough staff.”
“We have asked for those minutes, and, as yet, neither the paper nor your party has been able to provide them to substantiate that. The Member may be aware that Dr John Maxwell is now in Australia, where he has been working for some time. We have been in contact with him, and he has no recollection of that minute, meeting or presentation. I just want to put that on record. That was raised by the local MP in the local paper, but we sent in lines to correct that narrative because it is dangerous.”
“A survey in July 2020 that was commissioned by the All Ireland Institute of Hospice and Palliative Care found that, due to the COVID-19 pandemic, 64% of respondents reported that they had been thinking more about death and dying than before. The same percentage stated that the pandemic had increased the importance of discussing palliative care if they or someone important to them had a life-limiting illness. <BR /> <BR />I hope that, as we set out our vision for our future society through the Programme for Government, we collectively recognise the responsibility that we have to ensure that good palliative care, end-of-life care and bereavement support are intrinsic to that. I support the motion.”
“From that, a number of recommendations have been made on how bereavement care and support might be improved. I am pleased that a new, broader Northern Ireland bereavement network is being set up with representation from a wide range of organisations, including Health and Social Care and cross-departmental and community organisations and agencies. The new network will take forward the recommendations in order to improve bereavement care and support in Northern Ireland. <BR /> <BR />COVID-19 has changed the way that we go about our daily lives. It has also changed how we think about and see the world. Many people now have a keener recognition of the things that are most important to them. There is evidence to suggest that that is also the case in how people are thinking about palliative care.”
“That work will develop a rapid discharge pathway to facilitate choice in the child's place of death and to raise awareness of the role of the medical needs of children's palliative care in each trust. <BR /> <BR />Unfortunately, over the past year, many people in our community have had to deal with the loss of a loved one. I know how profound the impact of bereavement can be, particularly during the pandemic, when the loss has been coupled with the pain of separation and when the support and comfort that would normally come from being with others has been curtailed by the restrictions. In April 2020, the COVID-19 Northern Ireland bereavement care work stream was tasked with producing a report on the needs of the bereavement service that arose during the pandemic.”
“<BR /> <BR />I also want to acknowledge the work that has been progressed to support palliative care for children, which was raised by Mr Catney and Mr Butler. It is underpinned by my Department's 10-year strategy for children's palliative and end-of-life care and is led by the paediatric palliative care network, and good progress has been made to implement that strategy. That includes the commissioning of a needs assessment for children's palliative and end-of-life care, including those with life-limiting conditions. Work is at an advanced stage on the development of a regional antenatal and perinatal palliative care pathway.”
“However, that is not something that many of us do. A recent research report by the University of Ulster, 'Where Are We Now?', found that whilst 28% of respondents had heard of the term "advance care planning", only 7% had engaged in that conversation. Despite that, four fifths of respondents felt it would be comforting to know that their family knew about their wishes. I encourage everyone to think about advance care planning. Speak to those who are important to us and those involved in our care about our wishes, feelings, beliefs and values. If we take the opportunity to make choices for our future care, then, if the time comes, those choices can help inform and support good palliative and end-of-life care.”
“Advance care planning focuses on what is important to a person in their life and, if they become unwell, what will be important and what they will prioritise in the future. Although traditionally driven by the palliative care community, it is relevant at any stage of life and provides the opportunity for people who wish to do so to think about their present and plan for their future. <BR /> <BR />We know it is important to people. In 2016, 68% of respondents to the Let's Talk About research by the All Ireland Institute of Hospice and Palliative Care (AIIHPC) said that:”
“<BR /> <BR />There are many misconceptions about palliative care, and Mr Clarke and Ms Ní Chuilín mentioned some of those, such as the belief that it is only for people with cancer, that it means that nothing else can be done or that it is only for the final weeks or days of life. We need to be clear in our message that palliative care is for anyone living with a life-limiting illness. We also need to emphasise the holistic nature of palliative care in addressing people's social, emotional and spiritual needs. It is about helping people not simply to live with their illness, but to live well, whether that be for years, months or weeks. <BR /> <BR />As part of the public health approach, work is progressing to develop an advance care planning policy for adults in Northern Ireland.”
“<BR /> <BR />There are three key strands to this approach: first, increasing public awareness, understanding and discussion of palliative and end-of-life care; second, creating and building on the role of communities in supporting people living with life-limiting conditions and those important to them; thirdly, encouraging people to think and plan for their future physical, emotional, social, financial and spiritual needs as part of that holistic approach to advance care planning. That is appropriate at any stage of life. As part of that approach, we must all be part of a society-wide conversation that helps to destigmatise not only dying, death and bereavement but also palliative care, so that we can be clear about how palliative care can support a good life as well as a good end-of-life experience.”
“My Department is leading a programme of work to develop and implement a public health approach to palliative care that recognises the role of society and community in enabling and supporting people with life-limiting conditions, and those important to them, to live well with flexible, holistic and person-centred care based on positive and collaborative partnership.”
“Through the ambition and actions of the palliative care in partnership programme and its member organisations, collectively and individually, there has been real progress in how we design and deliver palliative and end-of-life care in Northern Ireland. <BR /> <BR />However, there is a growing recognition that dying, death and bereavement are not just matters for Health and Social Care. They are societal issues that require a societal response: in effect, a public health approach to palliative care that draws on the expertise and experience of the wider community, working in partnership with Departments and other organisations.”
“It has worked with general practice so that people with palliative care needs are identified earlier, supporting timely intervention and the better coordination of treatment and care. <BR /> <BR />Together with Marie Curie, the partnership has supported the development and roll-out of a rapid response service to provide out-of-hours support for people with palliative and end-of-life care needs in their own homes. It has also developed a role description and competencies for a palliative care key worker, typically the district nurse, for those who would benefit from a palliative care approach.”
“There has been significant progress over the past decade since the strategy's publication. The palliative care in partnership programme, which has been co-led by the Health and Social Care Board and the Public Health Agency, brings together a range of stakeholders from the statutory, independent and community and voluntary sectors to support the development and improvement of palliative care services for adults in Northern Ireland. That partnership has been a driving force in supporting high-quality palliative and end-of-life care, irrespective of a person's condition and across all care settings. It has extended education and training in palliative care across health and social care, including in care homes.”
“However, the importance of care and support towards and at the end of life must also be recognised. The effects of illness, disability, age or frailty, loss and bereavement are shared experiences that make up our common humanity, and the way in which we respond must also reflect that. <BR /> <BR />We need to recognise the universality of those life experiences as we develop a vision for the future of our society and for our citizens. Access to quality palliative and end-of-life care and bereavement support when it is needed is what we would wish for ourselves and for those who are important to us. As has been stated, in 2010, my Department published 'Living Matters Dying Matters: A Palliative and End of Life Care Strategy for Adults in Northern Ireland'.”
“I encourage them to raise the issues and the anomaly with their Executive colleagues so that it can be addressed. <BR /> <BR />While the statistics underline the evidential need to include dying, death and bereavement in the Programme for Government, importantly, how we care for people who are towards the end of life and how we support people in bereavement is a measure of our compassion as a society and of how we value our fellow citizens. The mover of the motion outlined how the draft outcome framework, rightly, highlights the importance of giving every child and young person the best start in life, encouraging and supporting people to enjoy long, healthy and active lives, and of fostering a caring society that supports people throughout their lives.”
“The rationale for that is very clear. As has already been said, our population is ageing: in 2019, the number of people aged 65 and over increased by 2·1%. Projections indicate a continued ageing population. The number of people aged 65 and over is projected to grow by 25·1% by mid-2028. The proportion of the population aged 85 and over is projected to double by the middle of 2043. The population need for palliative care in Northern Ireland is predicted to increase by 31% by the year 2040. There are approximately 16,000 deaths each year in Northern Ireland, with an average of five people assumed to be significantly impacted by each person's death. I welcome the input of the 10 contributors to the debate today, all of whom are members of the Executive parties, which were the authors of the Programme for Government.”
“I want to assure Members that I, my Department and my party support the correction of that omission so that palliative and end-of-life care and bereavement support are an intrinsic part of our Executive's collective vision to support all our citizens from the start to the end of their lives.”
“They have also been there to support and care for those who have experienced the loss of a loved one and whose grief has been compounded by being separated from family and friends. <BR /> <BR />The motion includes a call for the inclusion of dying, death and bereavement in the Programme for Government and emphasises the importance of a good end-of-life experience. Many in the palliative care community have highlighted their concern at the exclusion of palliative and end-of-life care and bereavement from the draft outcomes framework. I agree that the exclusion is an anomaly that needs to be addressed. I do not believe that anyone in the Chamber thinks otherwise, and I commend those who have highlighted the need for dying, death and bereavement to be an integral part of our Programme for Government.”
“I welcome the debate, brought by Joanne Bunting and sponsored by an all-party group, because it gives the opportunity to highlight the importance and value of palliative and end-of-life care and bereavement support. I respond to what is a call to the entire Executive. <BR /> <BR />I thank the palliative care community and bereavement support providers for the flexibility, resilience and dedication that they have shown during the COVID-19 pandemic. They have worked tirelessly to plan and provide holistic and person-centred treatment, care and support for those living with palliative and end-of-life care needs and those who are important to them. They have ensured that, despite the many challenges of the past year, essential palliative care services, advice and medicines have continued to be available.”
“I thank the Member for his question. As I said, he may be aware that I recently announced and published an interim autism strategy. The action in that strategy is to implement a new framework of care to deliver a proactive, integrated and streamlined pathway for children and young people across the region and to provide a range of early intervention approaches and support to meet their needs and the needs of families and carers. I will make sure that that includes service users and those who depend on those services to make sure that there is co-production and co-design.”
“I thank the Member for his question about the long-overdue update on an autism strategy. I am aware of the increase in waiting lists for autism assessments and the distress that that has caused to children and to families who are managing challenging circumstances. The pandemic has exacerbated some of that. We are progressing the specifics of the autism strategy. I announced the consultation on that a few weeks ago. I will write to the Member with specifics on the dates and on how to access it.”
“Again, I thank the Member for her very specific question, on what is a very sensitive but important piece of work. Those support mechanisms should be there. I know that we have engaged with voluntary and community organisations to ensure that they are there as a backup and as support in many cases. Again, I will follow up on the specifics and get back to the Member.”
“The Member will note that the report was co-sponsored by the Executive Office and my Department. Work has been done on that, and a management board has now been established. I would appreciate it if the Member could write to me on the specifics about social workers and access so that we can follow up on those individual cases. That is not something that I want to reflect. When we, from our side, launched the report, which was a necessary and long-overdue piece of work, I think that I gave Members an assurance at the time that we would put as much effort as possible into supporting the birth mothers. I am therefore disappointed to hear of those failings and gaps. I will certainly follow up on the detail that the Member asks for.”
“It is the one of the natural steps that we take, because affiliated organisations have the ability to manage and control the necessary requirements for sporting activities in order to allow the restrictions to be relaxed. Given our vaccination uptake and the low number of hospital and ICU admissions, it is my hope that we get to a point very soon at which we can move quickly and steadily along the pathway of allowing us to return to as much normality in Northern Ireland as is possible.”
“I thank the Member. With regard to his initial point about differentials in where responsibility lies, one thing that I have found in the past 14 months is that, if any Minister is queried about regulations, it usually ends up being my fault or turned round so that it is on the basis of guidance from my Department, the Chief Medical Officer or the Chief Scientific Adviser. I am not surprised that the Member has had that response. We will certainly follow up on it. <BR /> <BR />The process of easing restrictions and regulations is now being handled by the Executive's COVID task force, and the steps that we will utilise are set out in the Executive's COVID task force pathway. If I remember correctly, there is a step under sport.”
“I thank the Member for his question. The introduction of face coverings in post-primary school settings was done at the request of the Education Minister as a step to allowing their reopening. I am sure that, if he puts forward a request for that to be considered with regard to updated medical advice and guidance, the Chief Medical Officer and the Chief Scientific Adviser will do that.”
“I thank the Member. Although the costs are still to be determined, on a pro rata basis, my Department could be facing a cut of many tens of millions of pounds each and every year. Needless to say, a budget reduction of that magnitude would seriously undermine our ability to fund all our most fundamental health and social care services. After a decade of underinvestment and a desperate need to rebuild after COVID, the last thing that our health service needs is such a deep cut to its annual budget. I sincerely hope that the Finance Minister will find an alternative way forward for what was, as I said, a welcome announcement about the payment of the victims' pension, or the Troubles permanent disablement payment scheme, as it is properly known.”
“I thank the Member for his question. I very much welcome the announcement of the Troubles permanent disablement payment scheme, or the victims' pension, as it was previously known. TEO and the Department of Justice are leading on the design and administrative functions of the scheme, and there will be a cost associated with it. I am deeply concerned that it has been suggested, even by the Finance Minister in the House, that the associated costs could come from reductions to Departments' resource budgets simply on a pro rata basis and that that may be required to fund the payments. There is no doubt that the payments need to be made, but I hope that all Members agree that top-slicing a health service that has never been as stretched as it currently is would be deeply damaging and a detrimental step.”
“I note the Member's point. Due to the decision taken during the period when this place did not sit, there is now a duty on trusts across Northern Ireland to deliver abortion services. There is also a duty on us to support mothers and potential mothers with every physical and psychological support that we, as a health and social care service, can provide, no matter what their decision on abortion. That duty is there. I, for one, think that the women of Northern Ireland deserve that we deliver that for them.”