Robin Swann
North Antrim · Ulster Unionist Party · Northern Ireland
“I thank the Minister for his detailed statement. I know how passionate he is about the subject and how many times he has brought it to the Executive.”
“It has been reported that today will potentially be the warmest day of the year. As we move into the summer and our summer holidays, I want to raise public awareness of wildfires across Northern Ireland, which have been detrimental to farmland and our environment over the past number of years.”
“Wildfires are still having a detrimental impact on our environment and, occasionally, on livestock, but that reduction shows the impact of the Northern Ireland Fire and Rescue Service's proactive approach to educating the general public and engaging with rural communities and schools on its fire safety message, which is to stay alert, not…”
“There has been a lot of talk of sport in this place over the past few days, with everybody concentrating on UEFA. One sport that is going on across Northern Ireland at the minute is cross-community and goes across all age groups without fear, favour or distinction: pigeon racing.”
“I want to put on record that, since this place passed the amendment that recognised pigeon racing as a sport under the 2016 Act, over the past five years, pigeon racing clubs across Northern Ireland have been able to obtain £113,000 of rates rebates through the sports and recreation rate relief, allowing many of those clubs to continue ra…”
“There was much coverage on social media over the weekend of an incident in Staines in England, in which a police car rammed a young calf to bring it under control. It has restarted the conversation about animal cruelty. <BR /> <BR />I am dealing with a specific case in my constituency.”
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“I thank the Member for his question. That scoping work is being carried out, as it was work that was commissioned by my permanent secretary during the period when there was no Minister in place. That has recommenced following an easing of COVID pressures, and it is being reported to the Northern Ireland Office, which is engaging with that.”
“The trusts deliver the service, and it is up to them to deliver the administration of that service. However, my Department has advised the trusts that abortion is now legal and that the regulations require such terminations to be carried out on health and social care premises by registered medical professionals. The EMA pathways were put in place by the trusts, starting from April 2020, in line with their statutory duties and functions to provide medical care and treatment in accordance with the needs of the patients and subject to the law.”
“I think that they will apply to anyone who wishes to take up that option. My Department was informed on Friday of a temporary pause to the Western Trust's early medical abortion service, and my Department will continue to monitor ongoing efforts by the trust to restore delivery of those services with minimum disruption. At this stage, it is not known how long services will be paused in the Western Trust. It is my understanding that efforts are ongoing to put additional staff in place as soon as possible and to resume provision of an EMA service with the minimum of disruption.”
“I thank the Member. That was raised in the British-Irish Council statement earlier, because it was discussed at the British-Irish Council. I believe that the introduction of legislation for minimum unit pricing for alcohol could be a key population-level health measure in addressing the issue. Therefore, I have made a commitment to have a full consultation on minimum unit pricing once our new substance use strategy is finalised. That consultation will examine a range of possible options for alcohol pricing, including consideration of the emerging evidence of the effectiveness of minimum unit pricing following its implementation in Scotland and elsewhere.”
“Many of the commitments in 'New Decade, New Approach' are necessary not just for the advancement of the health service in Northern Ireland but for much of the sorely needed transformation.”
“I thank the Member for his commitment to offering support. He is aware that there are many health-specific proposals in 'New Decade, New Approach'. I do not have the reassurance of funding in this year's Budget or the coming year's Budget. At present, no funding allocation is aligned directly with those proposals. Priorities and promises have been made by the Finance Minister with regard to funding those. It will be up to the project board, which includes the First Minister and deputy First Minister and the Secretary of State, to prioritise those proposals and the funds that are made available to them. <BR /> <BR />The Member will be aware that, as Minister of Health, I will push for as much of that money as possible to come in our direction.”
“That investment must be in line with the identified need and the priorities for service development within the strategic commissioning and planning processes. <BR /> <BR />The Member is aware that the challenge is that there are a number of funding shortfalls in my departmental budget due to New Decade, New Approach agreements that were made without the necessary funding being attached. I therefore encourage her to lobby her party member, who is part of that assessment board, about the funding process.”
“I thank the Member for her point. As I said earlier, there are a number of funding shortfalls in the "Addressing Northern Ireland's unique circumstances" section of 'New Decade, New Approach'. It is anticipated that the level of funding that is made available will not be sufficient to cover all the areas set out in 'New Decade, New Approach'. As I said, however, it is my understanding that the specific projects that the funding aims to support are determined by a joint board that includes the Secretary of State and the First Minister and deputy First Minister. To date, my Department, the Health and Social Care Board and the Public Health Agency have not been involved directly in that process, but we would welcome any further investment in substance use services.”
“That unit currently has a waiting list of 25 individuals for inpatient treatment. <BR /> <BR />As an independent provider of tier 4 rehabilitation services, the Northlands centre is part of the regional network of tier 4 addiction services for Northern Ireland, providing counselling, inpatient treatment and aftercare counselling services, along with support counselling for families, to achieve recovery for those with alcohol and drug addictions. Northlands offers a range of addiction treatment services, both residential and within the community, for individuals, couples and families with drug and alcohol problems. Most of its services are provided in its purpose-built facilities in Londonderry, with outpatient counselling services also operating in Coleraine and Magherafelt.”
“The Western Trust is the only trust that provides a home detox service in Northern Ireland. <BR /> <BR />For the most complex cases, the Asha Centre addiction treatment unit in Omagh is one of the three regional inpatient complex detoxification and stabilisation units, the other two being Shimna House in the South Eastern Trust and Carrick 1 in the Northern Trust. Together, those three units provide 30 inpatient beds for complex detoxification and stabilisation across the region. Residents from any trust area can avail themselves of treatment in any of the units of their choice. The Asha Centre is an eight-bed unit that provides a six-week inpatient programme. It currently has seven beds in operation, with the eighth bed being utilised for isolation, if required, due to COVID.”
“Future funding for addiction services will be reviewed in line with the forthcoming substance use strategy, which addresses the needs of the Northern Ireland population as a whole, including that in the north-west. <BR /> <BR />The Western Health and Social Care Trust community addiction service consists of a core multidisciplinary team that is supplemented by a number of more specific services, including link and liaison nurses, opiate substitution therapy services, home detoxification services and an eight-bed complex detoxification and stabilisation inpatient unit. The service offers the full range of treatment options and receives approximately 2,500 referrals per year. For the majority of patients, where detox is required, withdrawal can be managed in the community as part of the shared care detox programme.”
“With your permission, Mr Deputy Speaker, I will take questions 4 and 12 together, and I ask for additional time to give my answer. <BR /> <BR />Alcohol and drugs services across the north-west are provided through a combination of primary and secondary care services that are commissioned by the Health and Social Care Board, along with the prevention, treatment and support services that are commissioned by the Public Health Agency. All those are in line with the regional alcohol and drugs commissioning framework, Northern Ireland's overarching public health strategy, 'Making Life Better' and the Executive's current substance use strategy, the 'New Strategic Direction for Alcohol and Drugs Phase 2'. Resources for alcohol and drugs services will continue to be managed on a regional basis.”
“Continuing the roll-out of primary care MDTs will support the transformation of service provision in the context of a rapidly changing landscape of treatment options, workforce gaps and opportunities for change. Given the innovative nature of that approach, learning and evaluation are key elements of the MDT programme. The effectiveness of MDTs is being reviewed on an ongoing basis through an independent evaluation. Although year 1 of that evaluation has been heavily impacted by COVID, work is ongoing to address those challenges.”
“I thank the Member for her point. As I indicated in my original answer, the impact of the MDT programme has been to provide more care closer to people's homes and to improve access to early support and diagnoses by proactively managing patient need in the local GP practice setting through a multidisciplinary early intervention team. In my answer to the original question, I talked about the professionals that patients can actually access. <BR /> <BR />During 2019-2020, across the five sites, a total of 41,459 first-contact physio appointments were made, 86% of which were managed in primary care and only 12% of which received onward referrals.”
“Like me, they will want to get back to as normal a health service as we have seen in the past. That will be replicated in the Royal College of GPs and British Medical Association. The Member has heard those representations at the Committee. She knows the input that health professionals and organisations are putting into returning our health services as much as possible to face-to-face consultations while realising that those services are still under pressure.”
“As I have said before and referenced in the answer to the previous question, we have seen an increase in face-to-face consultations and how we are now, compared to where we were in November 2019. The situation in regard to face-to-face GP consultations is improving. However, we need to be clear that many patients' experience of trying to access GP appointments is comparable to what it was pre-COVID. It was not a good level of service then either, because we saw a decrease in the number of GP practices and GPs across Northern Ireland. <BR /> <BR />I pay tribute to and support my GP colleagues in the healthcare family, who have stepped up and gone above and beyond to work in COVID and vaccination centres and who have supported their patients throughout this time.”
“Despite the need for social distancing and infection control, GPs have been able to maintain face-to-face consultations at a level. Of those recent consultations, 37% were face to face, compared with 50% in November 2019. <BR /> <BR />As has been clear from the outset of the pandemic, our GPs are working tirelessly for the good of everyone in the community. They have not only delivered a range of additional services, including COVID centres and vaccinations, but have remained focused on continuing to deliver core, vital services. We owe all of them a huge debt of gratitude for the work that they have done. I acknowledge that that level of service is not consistent across all GP practices. A small number have not stepped up to the mark and the expectation of even their own colleagues.”
“I thank the Deputy Chair of the Committee for her points. I do not agree with the use of the term "switching off". We had to take drastic steps during serious waves of the COVID pandemic that put serious pressure on the entirety of our health workforce. <BR /> <BR />I want to be clear that our general practices are open. They have been open throughout the pandemic. I pay tribute to GPs' hard work, commitment and innovation as they continue to provide a critical service for us all. GPs have continued to see patients. Indeed, the number of consultations is now close to pre-pandemic levels. The most recent figures, for the week ending 16 April, show 83 consultations per thousand, compared with 87 consultations per thousand in November 2019.”
“The Member made the analogy of the health service being an oil tanker that needs turned around. We need to start turning it around very fast. The health service has been able to reposition itself pretty quickly over the past 14 months, but we need to make sure that the support is there to turn it around, get it parked and get it to a place where it supports the entirety of Northern Ireland, including through investment in primary care, in secondary care and across the workforce of the health and social care family.”
“Our GP colleagues see the benefits as well. Experience to date has shown that many of those working in MDTs were recruited from existing roles within health and social care trusts. Recruitment to our MDT roles must be progressed through a measured approach so that we are not robbing Peter to pay Paul and shifting the same staff around the service.”
“I fully agree with the Member about the benefit that MDTs will bring because it is about that multidisciplinary team aspect. When they were initiated, or even first talked about here, there was much reluctance about somebody going to a GP thinking that they had to see the GP, but they saw the benefits when they could see a physiotherapist, a nurse practitioner or even a pharmacist face to face rather than having to wait to engage with a GP.”
“My Department and the Health and Social Care Board are engaged in a process to develop the road map, as I indicated. That involves engaging with all those in general practice and the trusts to agree realistic and achievable proposals, which will then be aligned with the overall strategic priorities or current and emerging pressures. <BR /> <BR />That road map, as I said, is due to be completed before the summer, and will enable robust planning on the cost and timescale for the roll-out. However, further roll-out of the model is dependent on the availability of a suitably qualified and experienced workforce, readiness of accommodation and appropriate funding.”
“I thank the Member for his question. The primary care multidisciplinary team (MDT) model introduces new physiotherapy, social work and mental health roles into GP practices to work alongside an enhanced level of nursing staff and the existing practice team. It aims to move from a system of treating illness to holistically supporting good physical and mental health and social well-being. <BR /> <BR />Like many transformation projects, the expansion of the programme has been affected by the COVID-19 pandemic. However, the MDT model is in development in five areas across Northern Ireland: Londonderry, west Belfast, Causeway, Newry and district, and north Down and Ards. It is fully implemented in the Down GP federation. <BR /> <BR />Across all the areas, the programme supports 300 members of staff.”
“Departmental officials are considering whether the project should now move to full business case stage. I will update the Member when that is received.”
“I thank the Member for her support. I am sure that her former colleagues, too, will be pleased that we are making positive progress in that area. <BR /> <BR />The Newry Community Treatment and Care Centre project involves the provision of a new 12,600 square metre primary care facility to provide fit-for-purpose accommodation for general medical services (GMS), selected acute outpatient and diagnostic services and a large number of multidisciplinary teams, many of which will be relocated from outlying sites and leased premises. <BR /> <BR />The Newry project was initiated under ministerial direction in March 2013. It experienced delay, primarily as a result of protracted negotiations over planning permission between the contractor and Newry, Mourne and Down District Council. Planning permission was approved on 1 July 2020.”
“However, MDTs are not the only initiative in place to support those working in primary care.”
“<BR /> <BR />My Department and the Health and Social Care Board are engaged in a process to develop a road map for the implementation of MDTs across all the remaining GP federations, including Lisburn. That involves engaging with those in general practice and the health and social care trusts to agree realistic and achievable proposals, which will then be aligned with overall strategic priorities and the current or emerging pressures. <BR /> <BR />Development of the road map is expected to be completed before the summer. It will enable robust planning on the cost and timescale of the roll-out of the model for the remainder of Northern Ireland. Further roll-out of the model is, however, dependent on the availability of a suitably qualified and experienced workforce, readiness of accommodation, and the appropriate funding.”
“I know that the Member has an interest in this issue, especially in regard to mental health support and provision. The primary care multidisciplinary team model introduces new physiotherapy, social work and mental health roles into GP practices to work alongside enhanced levels of nursing staff and the existing practice team. It aims to move from a system of treating illness to holistically supporting good physical and mental health and social well-being. <BR /> <BR />In the South Eastern Trust, MDTs have been fully implemented in the Down GP federation, accompanied by a small introduction jointly in Ards and north Down. While a formal evaluation of the MDT programme is under way, it is clear that the model is already impacting positively on some of the core services in the South Eastern Trust, such as physiotherapy and mental health.”
“Following a period of commissioning, it is anticipated that the building will open to patients in late autumn or winter this year.”
“I thank the Member for his question. Lisburn Primary and Community Care Centre at Lagan Valley Hospital will provide fit-for-purpose accommodation for seven GP practices, selected acute outpatient services and a large number of trust services, many of which will be relocated from Lisburn Health Centre, Warren Children's Centre and other leased premises, namely TSL House. The new development will help to enable greater management of chronic conditions in the community and will be closer to patients' homes through the collocation and integration of GP practices alongside multidisciplinary teams (MDTs) in a functionally suitable building. <BR /> <BR />Construction of a new primary and community care centre is progressing well and is scheduled for completion in June 2021.”
“That is why we engaged with those companies to give the reassurance that our Department and the Department of Health and Social Care are doing all that we can within our remit and our power to ensure that those supply lines are as seamless as possible. <BR /> <BR />In addition, the Northern Ireland Office holds a not insignificant financial pot to facilitate and support that, and we have engaged with it on how we can utilise that best to make sure that there is no disruption to the supply of medicines or medical devices in Northern Ireland due to the protocol and its outworkings.”
“I thank the Member for that point. It is topical, and it was raised at the Health Committee last week. We currently receive 98% of our medicines and medical devices directly through GB, so the protocol will have an implication. It is not currently having an implication because we have a derogation until the end of this year. However, the triggering of article 16 towards the end of last year, around vaccines, has unnerved suppliers. There is work in progress between my Department, the Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA) who are also involved. That incident had an unsettling effect. Consistent suppliers are now asking more questions and are concerned about the implications of the protocol.”
“The Member will be aware that the trusts have published their rebuilding plans for the next three months, and we are looking at the rescheduling and utilisation of our theatre capacity at a regional level rather than solely at trust level. It is about how we rebuild core services across the entire spectrum, including some of the invaluable preventative operations that can take place. However, first of all, we are tackling red-flag cases and making immediate urgent responses while we rebuild our service back to where it should be and where it can be.”
“As I said in my response to the Member, our Chief Allied Health Professions Officer will undertake a review. It is due to be completed by October 2021. I will ask her to include the Member's query in her review.”
“I thank the Member for her question. I know that she has written to me on that point. She asked about the quality of the orthosis provided. The device can be custom-made for the child from an impression that is taken of the child's leg and foot, or, if suitable, an off-the-shelf, prefabricated AFO can be utilised. The regulations provide more stringent requirements on the manufacture of any medical device, including orthotic devices that are manufactured by orthotic services. The guidance and standards for best practice are those from the British Association of Prosthetists and Orthotists guidelines for the provision of orthotic services. The guidance sets out the quality of the fabrication of devices, and those standards will apply to all patients.”
“The typical waiting time between paediatric appointments is between six and 12 weeks. <BR /> <BR />I fully recognise that there is a constant need to review service delivery models, including paediatric orthotics, as children's needs for replacement devices are often more demanding, because of children's growth and general wear and tear. As part of the AHP workforce review programme, an orthotics workforce review was taken forward. It identified a number of issues, including variations in service delivery and access to services. As a result, the Chief Allied Health Professions Officer has asked for one of her trust paediatric heads of service to take forward a review of orthotic services across Northern Ireland. The intention is to have that review completed by October 2021.”
“Some of the paediatric caseload is seen in a special school clinic by orthotists. School clinics are weekly, fortnightly or monthly, depending on the school. Most children who attend those schools should be cast and supplied with their AFO within a month. Only pupils who attend those schools are able to be seen in those clinics. All other paediatric cases are seen in general clinics across a variety of hospitals. <BR /> <BR />Typically, waiting times can vary from trust to trust and depend on how the services are delivered. At clinics, the availability of appointments determines delivery of, speed of and access to services. Paediatric patients are usually prioritised over routine patients who are seen at the clinics, but, in the main, they will be seen in a general clinic, where adults are also seen.”
“I thank the Member for her question. The clinical service that provides paediatric ankle foot orthoses (AFOs) is provided mainly by orthotists through contracted services to the health and social care trusts. There are two service providers in Northern Ireland, one of which manufacturers AFOs in Northern Ireland. The production lead times for AFOs are about three weeks from assessment to delivery to the trusts, with urgent orders being able to be completed within a week for inpatients or patients who are post-operative. <BR /> <BR />Service levels for orthotic services vary across trusts. In some trusts, children with SEN are able to access the service via a consultant, GP or allied health professional (AHP) referral, while, in others, the referral sources are more limited.”
“I thank the Member. It is about destigmatising those who seek help and want to end their dependence on drugs or even alcohol. That is why that work is done through the Public Health Agency, the Department and very many in the voluntary and community sector. Given that those services are supported through Community Pharmacy, it is unfortunate that they are seen as a threat, rather than the solution that they bring, because of a misunderstanding by certain sections of the community. I agree with the Member that we will help people by destigmatising their problems. We also need to make sure that the real focus and ire are directed at those in the community who are exploiting the needs of those people and are involved in criminal activity.”
“The Member will be aware of the campaigns by the Public Health Agency and all the other organisations. One of the strongest messages has come from community activists on social media: "One pill can kill". It does not matter what or who is your source of information, it is about the recognition that one pill has the ability — the terrible ability — to end a life. Somebody may be seeking a release or think that it will bring about a good feeling, but it can cause the end of a life, and families and communities have to bear that pain and loss afterwards. I ask people to please step away from utilising illegal drugs, the misuse of prescription drugs and supporting what are criminal activities.”
“Again, it was not something that was specifically covered in the meeting, but, under the heading "Addressing Northern Ireland’s unique circumstances" in 'New Decade, New Approach', the UK Government committed to making funding available for a number of areas, which could include additional funding to support the Londonderry addiction centre. It is anticipated that the funding made available currently will not be sufficient to cover all areas set out in 'New Decade, New Approach'. However, I understand that the specific projects that the funding is aimed at supporting are to be determined by a joint board that includes the Secretary of State and the First Minister and deputy First Minister.”
“I thank the Member for his question. We have seen concern not just about the misuse of prescription drugs but about prescription drugs becoming a commodity and now being sold rather than being used by the people who need them. Operation Pangea brings in the cross-sectoral approach in trying to tackle that and to identify those who are not only misusing but selling drugs, whether illicit or prescription drugs. That is why we need to take the fuller approach in how we tackle that. Our new substance use strategy, which I spoke about earlier, will also look into those specifics.”
“It also extends as far as Interpol, which addresses the illicit supply of drugs and prescription drugs.”
“I thank the Member. Again, it was not raised in the meeting because it is wider than just North/South cooperation. With regard to working closely with the PSNI and the justice system, there is a sharing of information to take the appropriate joint action to reduce the supply of and demand for drugs. A subgroup of the organised crime task force meets specifically to share information on drugs and to take joint enforcement action, such as Operation Pangea. The medicines regulatory group and the Department also work in day-to-day cooperation with a wide range of local, national and international enforcement partner organisations. That includes the gardaí, the Police Service of Northern Ireland, Border Force, HM Revenue and Customs and the National Crime Agency.”
“I thank the Member, and I know her genuine interest in this area. It is something that she continually raises. Part of the mental health strategy and consultation is the recognition of the need for support for dual diagnosis and how we look after that. Northern Ireland is leading on the work stream around the joined-up approaches of meeting the health and social needs of people who are homeless and use drugs and alcohol, so there is an opportunity to further explore dual diagnosis under that work schedule. Again, I lead on that with the Member's party colleague Deirdre Hargey, the Minister for Communities. I will raise it with Deirdre, and we will see whether we can get it on the agenda for the next British-Irish Council meeting.”
“Thankfully, as we come out of the pandemic, we can release officials back to their key areas of policy focus, which look at those pieces of work. When we no longer have to put such an intense focus on COVID and COVID-prevention measures, the Department of Health and the officials who work in it can get back to their core service.”
“I thank the Member for his point. The strength of the British-Irish Council is shown because we can raise and discuss those issues, as they do not happen in isolation in Northern Ireland, the Republic of Ireland, Jersey or the Isle of Man. There is a lot of challenging work that can be done on asking, "Have I enough staff in the Department?" We recently looked at recruiting and bringing across a number of officials to the Department. I am not sure whether the Member is aware that the Department of Health is one of the smaller Departments in the Executive, although a lot of our other work is done by arm's-length bodies. The focus that we have on our substance use strategy and all the other strategies involves a wide range of interventions and support.”
“I have, therefore, made a commitment to have a full consultation on minimum unit pricing once our new substance use strategy is finalised. <BR /> <BR />The consultation on minimum unit pricing will examine a range of possible options for alcohol pricing, including the consideration of the emerging evidence on the effectiveness of minimum unit pricing following its implementation in Scotland and elsewhere. The policy considerations arising from the consultation will be brought to the Executive in due course.”
“While drug misuse is a key issue in Northern Ireland, alcohol misuse still causes more harm at a population level in Northern Ireland. In fact, alcohol misuse kills up to three times as many people in Northern Ireland each year as drug use. It is fair to say that alcohol remains our drug of choice, and we have the combined alcohol and drug strategy in order to increase the emphasis that is put on the harm that is related to alcohol misuse and to raise the issue on the public, media and political agendas. The harms caused by the misuse of alcohol are a major public health issue in Northern Ireland, and I believe that the introduction of legislation for minimum unit pricing for alcohol has the potential to be a key population-level health measure to address the issue.”
“I thank the Member for raising something that was discussed at the meeting.”