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 and comment. Again, that issue was not covered at the British-Irish Council meeting, but I know that it is being talked and asked about. <BR /> <BR />Where cross-border travel is concerned, the Republic of Ireland's travel regulations are very clear: there should not be outside-county travel, and that includes coming into Northern Ireland. There is an onus not just on the guards and the PSNI but on those in the hospitality industry not to actively promote or seek cross-border business and trade while there is such a disparity in vaccination rates on either side of the border.”
“I thank the Member for her comments. Our new substance use strategy will, quite clearly, deal with those issues. It is a commitment under New Decade, New Approach that the Northern Ireland Executive publish a successor to the current alcohol and drugs strategy. Our new substance use strategy, 'Making Life Better — Preventing Harm and Empowering Recovery: A Strategic Framework to Tackle the Harm from Substance Use' has been co-produced by the Department of Health, working in partnership with key stakeholders inside and outside government, including service users and their families.”
“I thank the Member for her comments. Again, this was not specifically raised at the British-Irish Council meeting. However, my Department is actively engaged on those issues and, as the Member will know, they are part of the mental health strategy that is out for consultation at the moment to see how that service can be developed and progressed across Northern Ireland so that nobody falls between the cracks. My Department intends to make sure that everybody gets the support that they need.”
“My Department is analysing the responses that have been received, and a new strategy will be finalised before seeking ministerial and Executive approval.”
“I thank the Chair for his question. Although the topic was not discussed at the British-Irish Council meeting, I know that it has been raised at the Health Committee and that the Chair has asked for a specific presentation about the health inequalities that we are seeing. <BR /> <BR />My Department continues to focus on a number of strategies and work streams that are already out there. The Chair will be aware of the new strategic direction for alcohol and drugs (NSD) phase 2, which has had £8 million of investment in health and social care provision for tackling and evaluating the work that needs to be done. The strategic framework to tackle the harm from substance use has been out for a public consultation, which closed on 12 February.”
“The overarching aim of the review is to ensure that vulnerable people with substance use needs get the support to recover and turn their lives around in the community and in prison. <BR /> <BR />I take this opportunity to thank Minister Hargey and British-Irish Council ministerial colleagues across the Administrations who participated so productively in the meeting last month. I welcome the council’s work sector activity and the way in which it provided us with a great opportunity to discuss the issues, look at emerging issues of concern, share information and good practice, and bring forward agreed actions and areas for collaboration. <BR /> <BR />I commend the statement to the House.”
“The Northern Ireland Executive agreed to take the lead on moving forward with theme 4, which considers joined-up approaches to meeting the health and social needs of people who are homeless and use drugs and alcohol. We will do that in conjunction with the British-Irish Council housing work sector. <BR /> <BR />Ministers also had the opportunity to listen to a presentation by Professor Dame Carol Black on prevention, treatment and recovery, which was informative and timely. Professor Dame Carol has been undertaking an independent review of drugs in England for the United Kingdom Government Department of Health and Social Care. Her presentation focused on part 2 of her review and provided insight into lessons learned from the review study.”
“<BR /> <BR />Ministers noted and agreed the content of the forward work programme for the misuse of substances work sector. To address the challenges for the sector, they agreed that focus in the coming years should be on the following five themes: considering the lessons of COVID-19 and the delivery of drug and alcohol services; reducing the risk of drug-related deaths; reducing alcohol-related harms through the use of financial mechanisms; considering joined-up approaches to meeting the health and social needs of people who are homeless and use drugs and alcohol; and engaging with the voluntary and community sectors to consider their role in the provision of drug and alcohol services, and in the development and monitoring of policy. <BR /> <BR />Each of the five theme areas is being led by one of the member Administrations.”
“Those included discussions on 'Financial Mechanisms to Reduce the Consumption of Alcohol' and 'Measuring the Effectiveness of Addiction Services and Harm Reduction Interventions'. <BR /> <BR />Ministers noted the efforts across all member Administrations to decrease alcohol consumption and agreed that there was value in comparing approaches and sharing learnings from the emerging evidence base. They also recognised the importance of effective monitoring and evaluation to ensure that policy and practice are developed on the basis of sound evidence and that sharing this diversity of knowledge, understanding, experiences and learning across member Administrations affords a unique resource for enhancing monitoring and evaluation.”
“The Welsh Government were represented by Eluned Morgan MS, Minister for Mental Health, Wellbeing and Welsh Language. <BR /> <BR />This most recent ministerial meeting of the misuse of substances work sector was an excellent opportunity to engage with Ministers from the other BIC member Administrations on an area that is as relevant and important as it has ever been, the harms caused to individuals, families and communities by alcohol and drug use. <BR /> <BR />The meeting focused on ways to reduce alcohol consumption and opportunities to measure the effectiveness of addiction services, and considered how the future work of the sector can progress. <BR /> <BR />Ministers considered and reflected on the papers that were formally presented to the meeting.”
“The Northern Ireland Executive were represented by Deirdre Hargey MLA, Minister for Communities, and me, as Minister of Health. The Government of Guernsey were represented by Deputy Al Brouard, President of the Committee for Health and Social Care. The Isle of Man Government were represented by the Honourable Ray Harmer MHK, Minister for Policy and Reform. The Government of Jersey were represented by Deputy Trevor Pointon, Assistant Minister for Health and Social Services. The Scottish Government were represented by Mairi Gougeon MSP, Minister for Public Health and Sport, and Angela Constance MSP, Minister for Drugs Policy. The UK Government were represented by Jo Churchill MP, Parliamentary Under-Secretary of State for Prevention, Public Health Care and Primary Care.”
“I thank them, as Minister with responsibility for NIFRS, for the work that they did over the weekend. <BR /> <BR />With your permission, Mr Speaker, I wish to make the following statement on the British-Irish Council (BIC) misuse of substances work sector ministerial meeting, which took place in virtual format on Thursday 11 March 2021. Minister Hargey and I attended the meeting, and Minister Hargey has agreed that I make this statement to the Assembly on behalf of both of us. <BR /> <BR />The Irish Government lead the misuse of substances work sector, and hosted the ministerial meeting. As Chair of the meeting, Frank Feighan TD, Minister of State for Public Health, Well Being and the National Drugs Strategy, welcomed the delegations.”
“Before making the statement, I take the opportunity to place on record my thanks and to pay tribute to the firefighters and the leadership of the Northern Ireland Fire and Rescue Service (NIFRS), the partner organisations and the wider community, who worked tirelessly over the weekend to bring the fire in the Mournes under control.”
“<BR /> <BR />The Executive and the Assembly need to come together and make sure that we can deliver these plans and create a world-class cancer service that the people of Northern Ireland deserve.”
“<BR /> <BR />Members should be under no illusion. For far too long, Northern Ireland has been presiding over a decline in performance for cancer and other key health services. That is unacceptable. People from across the system have been working to develop a recovery plan and map out our ambition for cancer services over the next 10 years through the upcoming cancer strategy. However, Members must also understand that there is no quick fix to these issues. They will require significant and recurring funding to implement. There are substantial costs associated with the delivery of the recovery plan and the strategy. However, that is the price that we must be prepared to pay if we truly want to provide a high-quality service to people with cancer.”
“That includes clinical trials, information technology, epidemiology, cancer registries, prevention, nursing, health economics, scholar exchange and training. <BR /> <BR />The focus of this motion is on cancer services, and rightly so. Lengthy waiting lists are not good enough. Patients have a right to have services there when they need them. Health and social care services have already put in place innovative solutions to work together to address the situation whilst maintaining safety for patients. We have made a great deal of progress but must acknowledge that our services are not where we need them to be. We are all aware that we have limited resources and that it will take time to build capacity. Therefore, we have no choice but to make sure we keep doing the best that we can with the resources we have.”
“This funding will be managed through an intermediary funding body and, as such, will not impose any additional administrative requirements on trusts or the Department. <BR /> <BR />We are also building for the future. In March, I re-signed the All-Ireland Cancer Consortium. This is a multilateral partnership between the American National Cancer Institute and the health services of the Republic of Ireland and Northern Ireland. The agreement forges strategic alliances among the three jurisdictions to improve clinical cancer services and patient care on the island of Ireland and foster joint collaborations in cancer research and development. The consortium contributes to cancer control by focusing researchers on specific areas of care and research.”
“In the last financial year, my Department administered a discretionary, non-recurrent grant to help cancer charities continue to enhance the delivery of key services and provide support and advice to patients following the pandemic. That grant, using transformation funding of £600,000, covered the period from December 2020 to 31 March 2021 and enabled charities to deliver a range of key services to support people living with cancer during the pandemic. <BR /> <BR />I have followed this with a larger grant scheme, using COVID-19 funding of £10 million. This will be available over the three-year time frame of the cancer recovery plan. The funding will not only support charities in the delivery of cancer services but allow them to deliver on the recommendations outlined in the cancer recovery plan.”
“The development brought together healthcare professionals, cancer charities and service users and will set the direction of travel for the next 10 years. Currently, strategy recommendations are being reviewed with internal stakeholder groups. Several events have already taken place, including a charity forum, two lived-experience events and two children-and-young-people events. It is anticipated that a full external consultation will take place over the summer. <BR /> <BR />Additionally, cancer charities are struggling to deliver current services and develop new services for those suffering from cancer while managing the impact of failing income streams. To support cancer services, I have used both transformation and COVID-19 funding to set up two grant schemes.”
“The development of the new strategy is entering the consultation stage under the direction of a steering group led by Northern Ireland's Chief Nursing Officer, Professor Charlotte McArdle.”
“COVID-19 has led to a worsening of waiting times, but the problems have been building for some time. I am committed to dealing with the problem. To that end, I am finalising a cancer recovery plan, 'Building Back: Rebuilding Better', to make recommendations to redress the disruption to cancer services caused by the pandemic. The cancer recovery plan is also fully aligned with the short-term recommendations in the cancer strategy and will focus on a three-year period until March 2024. The recommendations cover 11 key areas from screening through to palliative care and have been developed with clinical and professional colleagues from across the health and social care trusts. <BR /> <BR />I assure you that the issues outlined by the coalition will be fully addressed in the new cancer strategy for Northern Ireland.”
“With that approach, any available theatre capacity across Northern Ireland is allocated to the patients in greatest need. That includes maximising all available in-house Health and Social Care and independent sector capacity. That regional approach will ensure the allocation of capacity on clinical priority and avoid any postcode lottery. We have utilised every resource that we can access from 1 April 2020, and approximately 5,000 patients have benefited from additional diagnostic and treatment capacity secured through the independent sector. <BR /> <BR />It must also be recognised that cancer services were challenging before the pandemic, with unacceptable waiting times and significant capacity and workforce challenges across a range of areas.”
“<BR /> <BR />As we continue to rebuild services, it will be critical that we move forward on the basis of two key principles. The first is care being delivered on the basis of clinical priority rather than the order of waiting. For cancer surgery, clinical prioritisation is based on Federation of Surgical Specialty Associations (FSSA) guidance. Additional surgical capacity has been provided through the independent sector and other UK and Republic of Ireland providers. <BR /> <BR />The second principle is equality of waiting across Northern Ireland. We must ensure that each cancer patient has the same opportunity to receive the same high level of diagnostic treatment and care available no matter where they live. The Health and Social Care Board (HSCB) has established a new regional approach to the prioritisation of surgery.”
“Whilst I am well aware of the accusation, it would simply be untrue for anyone to accuse my Department, our trusts or our front-line staff of prioritising one condition over another. Our clinicians were faced with impossible choices almost daily. I, for one, sincerely hope that they never find themselves in such a position again. Thankfully, the COVID-related pressures on the system have since greatly reduced, and that has allowed us once again to focus on time-critical patients. I can also confirm to the House that, for patients scheduled to be admitted in the period from 1 January to 11 April 2021, there were 1,177 suspected or confirmed cancer procedures cancelled by HSC trusts and, of those, over 93% have since had their treatment completed or been given a confirmed treatment date.”
“The pandemic has had a major impact on already unacceptable waiting times. Unfortunately, that includes some cancer services. Elective activity had to be reduced, as we had no choice but to redirect resources to respond to the increasing unscheduled pressures. That has also impacted significantly on access to surgery. Unfortunately, that included particular specialist cancer surgery, which is often reliant on access to those all-too-precious intensive care unit beds. Let me be absolutely clear: patients have been and always will be treated according to clinical priority as determined by specialist clinicians. At the height of the recent surge, our hospitals did their absolute best to care for everyone, and that included treating the sickest quickest.”
“There is a clear need to take immediate and sustained action to recover our referral rates and to do what we can to smooth referral pathways so that we can support more timely care. Of course, it goes without saying that early diagnosis is vital if we are to improve cancer outcomes.”
“In the first COVID-19 surge, many screening services were temporarily suspended. In addition, we know that many people with potential symptoms were reluctant to attend their GP practice and that access to dental care was very limited. Consequently, the number of red-flag referrals dropped. Although they have recovered somewhat for some cancers, and in some trusts, by the end of December 2020, they were still lower than in the equivalent period for 2019. <BR /> <BR />The impact was most severe for patients with cancers that have poor survival rates, such as lung cancer, where the timing of diagnosis and treatment is critical.”
“I commend all the cancer charities for joining together in the One Cancer Voice coalition, as outlined in the motion. That truly demonstrates the solidarity that is needed in order to continue to improve clinical cancer services and patient care nationally and to foster joint collaborations in cancer research and development. It is only by working together that we will succeed in providing the support that patients have the right to receive. <BR /> <BR />More than 26 people in Northern Ireland are diagnosed with cancer every day. Almost 10,000 people are diagnosed with cancer annually. The number of cancer cases diagnosed has increased by 54% over the past 25 years, and, as was said earlier, that figure is projected to double by 2040, primarily as a result of our ageing population.”
“I thank the signatories to the motion, because it gives me the opportunity to discuss the impact of the COVID-19 pandemic on cancer services and treatments, the measures that we have taken to manage the impact of COVID-19 and the plans for moving forward. <BR /> <BR />Let me start by saying that I am incredibly proud of the dedication and hard work of the highly trained doctors, nurses and other medical professionals who have provided care to our people in unprecedented circumstances. I am determined to work with colleagues and stakeholders across the services to deliver the improvements that we need to rebuild cancer services following the devastation of the pandemic. <BR /> <BR />Like others, I am all too aware of the challenges that cancer presents us with in Northern Ireland, especially in the aftermath of COVID-19.”
“I will need to check the terms of reference of the public inquiry and get back to the Member. We will provide whatever support we can to patients, where and when we can, as quickly as possible. If that involves some people being offered medical procedures or medical supports in other parts of the UK, we will do that. We will support them while they do that, because it is important that we get as many people as possible seen as quickly as possible to make right what was done wrong.”
“I do not have that detail to hand to answer the Member, but I will answer him in writing.”
“The trust has engaged with and is reviewing the independent quality assurance process by the Royal College of Physicians, which is concluding its work. The college has provided its interim update, and the findings are generally consistent with what was found initially by the Belfast Trust. It is necessary for the Belfast Trust to apologise to those patients, but I will also apologise. I apologise as Minister of Health on behalf of the Belfast Trust and on behalf of the service for the disservice that those patients received at the behest or at the hands of Mr Watt.”
“I reiterate my thanks to the chair and the Independent Neurology Inquiry team for all their work to date. That work has been ongoing, albeit on a full independent public inquiry footing only after I converted it towards the end of last year.”
“I thank the Member for that question. Part of the work being done, even in the consultation that has been launched on the duty of candour, is looking at something that starts to change the psychology and the mental aspect of how our health service works. <BR /> <BR />As I said, I converted Brett Lockhart's work into a full-scale public inquiry. The basis for needing that conversion to statutory public inquiry was primarily to ensure that the Independent Neurology Inquiry team had access to all relevant information so that it could draw its conclusions, make recommendations to my Department and support a timely outcome for the report. The inquiry team is at an advanced stage of fulfilling its terms of reference, and the decision to convert to a full public inquiry has not adversely impacted on the work or timescales of the inquiry.”
“There are long waiting lists, and the pandemic has made that much more challenging. That support is there through the Belfast Trust and the helpline.”
“Again, that is critical. When I met families and previous patients of Mr Watt, one of the main issues raised was the need for that support. <BR /> <BR />I appreciate the requirement for psychological support for neurology recall patients, given the distress that can be caused by the process. Access to psychological support has been put in place by the Belfast Trust to support patients who were affected by the neurology recall. That additional service, which has been provided to support patients affected by the recall, is not available to others. The Belfast Trust continues to support patients who attend the neurology service and those who were included in the neurology recall process. Members will be aware of the significant demand for psychological support across all areas of our healthcare system.”
“I do not have a firm date. If I had, I would have put it in the statement so that Members knew. <BR /> <BR />I reaffirm our support for the current neurology team and the neurology services that we provide. They are working in a highly stressful situation at this minute in time because of the public focus on this work, especially today, when the recall of cohort 3 and the review of cohort 2 have been announced. They are a group of professionals who are picking up many pieces, putting people's lives back together and still seeing their patients as effectively as they can. This has had a knock-on effect on our neurology services in Northern Ireland, and it will take work, input and strong leadership to bring the review about and to bring in people to fill the vacant posts in that service.”
“That is to make sure that nobody hears about this in a way that they should not and that the information, which is highly sensitive, highly emotional and highly stressful, is managed as sensitively as it can be.”
“I thank the Member for her comment. We wanted to ensure that this was managed, as much as possible, so that people who are waiting to see if they will be part of cohort 3 did not hear me announce the review of cohort 2 without us having done the preparatory work. Those letters have been issued and will arrive with people over the next few days. If people are still concerned and think that maybe they should be part of that cohort, they can use that contact number through the Belfast Trust to seek reassurance. They can also contact the Patient and Client Council, which is leading on the engagement and support work for us. It is meeting the family groups and charity groups, while the statement is being made, to re-engender trust in the work that has been done and that will be done under cohort 3.”
“It is in its interest to get to the bottom of this to make sure that it does not happen again.”
“It has advised that the matter has not identified a concern in the specific area of work that the consultant was asked to undertake as part of the recall or the ongoing follow-up of patients in his care. The consultant's recall-related work was done as part of a wider multidisciplinary team with the review of clinical findings being part of a key process. I understand that this may concern the patients involved in the recall, but I assure them that ongoing safety remains our focus. Patients and families impacted by the neurology recall will continue to be supported by the Belfast Trust. Any patient affected by the recall who has concerns can avail themselves of the neurology advice line. I have been given that reassurance by the Belfast Trust, which knows that this has to be got right and wants to ensure that it is done right.”
“The people working in it, as the Member knows, are genuine and good people who, at their core, do their best for everyone. Have there been failings and mistakes in the past? Yes. Have they been on my watch or before my watch? That is not relevant. It is about how we correct them, get them right and re-engender trust in our health service. <BR /> <BR />The Member has raised the matter of the consultant with me before in the House. I am aware of a hearing by the General Medical Council (GMC) regarding the consultant who assisted the neurology patient recall review in 2018. The hearing relates to a case in a previous post in England. My Department has received assurance from the Belfast Trust in the context of the consultant's work as part of the neurology recall.”
“I thank the Member. She knows me well enough to know that this is not work that I want to hide or brush under the carpet. I make the statement today to try to engender the trust in our health service that we all need to be part of. Those medical professions need our support to give reassurance to the public that, yes, things have gone wrong but the House is doing what it can to correct that and to support the people who have been failed. Our trusts are also doing what they can to correct that and to support the people who have been failed. There are a number of reviews and inquiries. The Member will be well aware that I have launched three public inquiries since coming into office in regard to what, I feel, needs to be brought out into the open, because that is how we engender trust in our health service again.”
“I thank the Member for that question. Those deemed to be uncertain will go through a further assessment process to see whether they fall into the other two categories. There are conditions that need to be taken into consideration other than the clinical diagnosis, the assessment of the patient for medication prescribed or not prescribed or the alternative treatments that could have been or were offered at that time. There is a further piece of work that goes on around those factors to make sure that all the prevailing circumstances to any diagnosis or reassessment of a diagnosis are taken into consideration.”
“The initial internal review by the Belfast Trust has been subject to an independent quality assurance process by the Royal College of Physicians, and that work is concluding. However, the college has been able to provide an interim update that there are findings are generally consistent with those of the Belfast Trust. The trust has contacted all its relevant patients and offered ongoing support.”
“I thank the Member. As I said in my answer to the Deputy Chair, the project board for the redress scheme has restarted again. I do not intend to subcontract that work at this stage as that would involve restarting all that work, and that would further delay any completion of what needs to come forward. <BR /> <BR />The epidural blood-patch review focused on 66 patients who were not part of cohort 1 or 2 and had a procedure under the care of Dr Watt. The findings of the internal review indicate that 46 of the 66 patients reviewed indicated that their care was unsatisfactory and fell below standards. For 45 patients, there was no clinical evidence that a blood-patch procedure was required.”
“However, if that is unsuccessful, all HSC trusts provide a blood-patch service, which is normally performed by an obstetrician and an anaesthesiologist. Other types of leaks, where the cause is not apparent, are looked at on an individual basis, and, where clinically appropriate and the expertise exists, a small number of cases are treated in Northern Ireland. However, more complex cases need to be managed by a multidisciplinary team for CSF pressure disorders.”
“I thank the Member: It is something that he has raised with me. I want to reassure him that I am aware of issues that have been reported about the local provision of treatment for cerebrospinal fluid (CSF) leakage. I want to be very clear about that matter. It can be a very serious and painful experience, and it is always a matter of clinical judgement as to the treatment provided, whether locally or through a referral to GB. Whilst issues around that treatment have been considered as part of the neurology inquiry, it is not accurate to say that that has halted the provision of the treatment in the health and social care system. <BR /> <BR />Where a CSF leak is clearly linked to a procedure such as epidural spinal anaesthesia during childbirth, it will be managed conservatively in the first instance.”
“I thank the Member for that question. The issue that she raises was made very clear to me when I met the families and the patients involved towards the end of last year. That is why I encourage anyone who still feels that they need to reach out for help to contact the patient helpline: that is what it is there for. I remind the Member that the helpline number, which is being supported and facilitated by the trust, is 0800 980 1100. Furthermore, the Patient and Client Council is an independent body whose services can be used by any patient or family that needs additional support.”
“We need to make sure that anybody who was misdiagnosed during that period can receive a review from another consultant, so that they get not just the financial but the medical and psychological support that they require.”