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.”
The complete record
Every one of 5,640 lines we hold for Robin Swann, in date order, each linked to its source. Free to read, in full, without an account. Page 58 of 113.
“I have had conversations with the Commissioner for Older People in regards to that and he did not use that language with me. In fact, he understands the support that we have been giving to care homes and to the families who want to make visits, especially when we are seeing challenges in specific care homes. I have asked the Commissioner for Older People and he has put out a call that he shares any concerns that he has with specific care homes or care home providers as a whole, so that we can engage fully. The Health and Social Care Board can provide support and guidance, the Public Health Agency can supply additional support and guidance, and the RQIA can also be involved, so that we can get as many care partnership arrangements set up and in place as possible.”
“For the period up to 4 March, 373 nursing and residential care homes have been paid £6·52 million in funding for staff support in respect of care partners and visiting.”
“<BR /> <BR />Trusts are working with individual care homes to provide the support that they might require to move forward with the facilitation of safely managed and meaningful visiting arrangements and the implementation of the care partner concept. As well as trusts, the Health and Social Care Board (HSCB) and PHA are working with those homes that are finding implementation more challenging and are identifying and sharing good practice. The Regulation and Quality Improvement Authority (RQIA) will assess the approach being used, including when undertaking inspections of care homes, and compliance with the visiting policy and practice will be a material consideration in the inspection and regulation of each care home. Funding has been made available to help homes to implement the approach set out in the regional guidance.”
“I thank the Member for his question. I acknowledge the dedication of all independent care home providers and staff who continue to work tirelessly to provide care to residents under the challenging circumstances that have been presented by the pandemic. Unfortunately, there remain a number of families who have not as yet been able to successfully set up care partner arrangements for their loved ones. The Department and Public Health Agency (PHA) are supporting care homes to implement the full visiting and care partner arrangements. The most recent figures indicate that almost 80% of care homes are facilitating indoor visiting when they can and when it can be done safely. Just over half of all care homes report that they have care partner arrangements in place where it is appropriate for a resident.”
“The debate yesterday that she mentioned refers to the potential commissioning of a service that is cross-cutting and controversial, and it has been legally advised to me, as Health Minister, that it is. That is why it is a decision for the entire Executive, not just me, to take, no matter what some Members said in the House yesterday. <BR /> <BR />I appreciate that I have not had the time or the detail to address a number of Members' questions, but I undertake to review Hansard and write to Members on those issues. The debate has been an invaluable opportunity for me to hear at first hand the views of Members on the Bill and on other issues. I wish the Committee well as it begins its crucial scrutiny of the Bill.”
“Our recruitment processes have improved, and the number of vacant positions has decreased significantly over the last number of years. That work continues to be progressed through, as I said, the recruitment of new nurses and other staff. There are now regular advertisements for positions available through BSO, other trusts and our Health and Social Care Board. As, I think, I said, the PHA is not included or touched on in any part of the Bill, and I thank Ms Bradshaw for acknowledging the work of the PHA. <BR /> <BR />Ms Bradshaw raised the issue of whether this work was cross-cutting or controversial: it is not. None of the services mentioned in the Bill that are currently covered by the Health and Social Care Board are controversial or cross-cutting.”
“That does not, however, detract from the need to ensure local input into the planning process and the need to set strategic priorities and, indeed, the outcomes that the system will be required to deliver. That will continue, but it does not provide the opportunity to improve on the current process. This is now being taken forward as part of the programme of work on how we can plan our services differently, because it is imperative that we allow time for that new way of planning services to be developed and tested before placing anything in statute. The need for legislation will be explored, as work on those developments will continue to form part of the future consultation. <BR /> <BR />Paula Bradshaw mentioned the vacancies that still exist in BSO. We continually face a challenge to fill those positions.”
“The Department will continue anything that is being done by or for the board, including legal proceedings, following the board's being closed. All that responsibility will transfer from the Health and Social Care Board to my Department, which is, I believe, the place where it should sit. <BR /> <BR />Carál raised the legislative provision for local input and setting priorities. While there is no legislative provision for setting priorities or local input, the closure of the Health and Social Care Board results, as we have said, in the end of the requirement for local commissioning groups. That requires my Department to produce a commissioning plan direction and the development of a subsequent commissioning plan. All that then becomes public.”
“I identified that when she talked about the transfer of powers and all the functions that are covered, particularly in schedule 2, where it shows the small impacts that the Bill would have and the wider implications of those transfers of power. It is about achieving better outcomes for our citizens and patients. She also asked about the public assurances that I could give. She is right: I was shocked when I saw the headlines in yesterday's papers. It is not something that I expected or that I expect. She will know that, since I have come into office, I have instigated three public inquiries where I see the challenge and where accountability is needed. I will highlight the fact that, in my opening statement, I made assurances about work that has started or been done that the Bill also covers.”
“However, as I said earlier, through the regionalisation of services, we have really seen the benefit of all the trusts' specialities coming together and working collaboratively, especially during the past year. That has benefits not just for the delivery of services but especially for the input and output for our patients, who are at the centre of everything that we do. <BR /> <BR />Although Carál Ní Chuilín noted that the Bill was technical in nature and felt that, sometimes, she could put down her screen, I noted from her contribution that, at no time, did she do that. She has read the details of the Bill, as I would expect her to do.”
“Equality screening, a human-rights impact assessment and a regulatory impact assessment were all completed without any impacts being noted. <BR /> <BR />Mr Chambers mentioned that the Bill was small but extremely significant. He is right: it sets in train a direction that many other Ministers have talked about and brought forward proposals on. The Bill will see the first significant step in making a major structural change to health and social care in Northern Ireland. Many reports and studies have been produced, but this is the legislation that will start to enact some of those recommendations. Mr Chambers referred to our party policy on regionalisation and the need for one trust. That conversation has been had many times and is not part of the Bill.”
“In effect, the closing of the Health and Social Care Board will remove the statutory requirement for local commissioning groups. However, let me be clear: whilst the Bill will remove the construct that is local commissioning groups, it in no way detracts from the need for local input and intelligence in our planning processes. As I have mentioned, work has begun to develop a new way of planning services that is based on an integrated care approach. A key part of that process will be to take on the learning from the local commissioning groups and bring forward a mechanism to ensure the continuation of local input. <BR /> <BR />Ms Hunter also talked about the impact on rural communities. I want to make it clear that the statutory obligations of equality screening and impact assessments have been observed in the development of the Bill.”
“That has commenced. Those training places are in place and are funded, and we are working through the process of training. <BR /> <BR />Ms Hunter and Carál Ní Chuilín raised a number of issues on regionalisation versus centralisation. One of the clear approaches that I have taken since coming into office and throughout the pandemic is to look at the regionalisation of services, rather than simply centralising everything towards Belfast. We have seen the need to use all our structures, whereas, in the past, there was always a perception that we would end up closing something or looking at downscaling something. We realise now that the regionalisation approach will benefit us as we come out of the pandemic. <BR /> <BR />A number of Members — I think that Cara Hunter was the first — raised the local commissioning groups.”
“A programme of work is under way to build capacity and capability in the board structures. <BR /> <BR />Members asked about consultation and engagement with staff. A staff-side forum has been in place since June 2018 to facilitate trade union engagement and consultation on the change programme. The forum currently meets bimonthly. Additionally, I will say that trade union representation is an integral element of the project work strands set up to co-design new ways of working. <BR /> <BR />Cara Hunter raised a number of queries, including one about the lack of nurses. Although not connected in any way to the Bill or to the changes, I point out that part of the agreement that led to our return to this place over a year ago was the commissioning of 300 additional training places for nurses over three years.”
“<BR /> <BR />The new operating model will see the former board staff continue to undertake their functions, albeit under the direction of the Department. That approach, although it will streamline structures and reduce bureaucracy, will provide for continuity of service, thus minimising risks to the overall system. The staff will be employed by the Business Services Organisation, but, as I said, they will be led by a senior civil servant at grade 3. I want to make it clear to Members, as well as to staff who may be listening to this, that staff will retain their Health and Social Care terms and conditions throughout their employment with the Business Services Organisation. In addition, no Health and Social Care Board staff will be made redundant as a result of the changes.”
“There is a recognition that this is the first step in bringing about significant change across the health service in Northern Ireland. That has been proposed and promised in the many reviews and documents to which a number of Members referred. I thank all staff in the health and social care system for the work that they do, and continue to do, as we look to streamline structures. <BR /> <BR />The Deputy Chair also talked about workforce changes and workforce shortages. The Health and Social Care Bill makes provision for the closure of the arm's-length body known as the board. The Bill relates solely to the board and will not have any material impact on any other health and social care body. That also answers Ms Bradshaw's enquiry about the Public Health Agency, which will not be affected by the legislation.”
“Following the board's closure, the Department will be accountable to me for all the functions delivered by the former board staff under the direction of my Department. The deputy secretary who will be directing former board staff will be a member of our top management group and the departmental management board. The delivery of those functions will be subject to the appropriate level of scrutiny. As Members will be aware, the composition of the departmental management board includes non-executive directors as well. <BR /> <BR />Pam Cameron, the Deputy Chair of the Committee, and other Members raised the issue of multi-year budgeting and funding for health, never mind for the generalities of the health service, and called for clearer accountability.”
“As part of the hosting arrangements, the Business Services Organisation will be accountable to my Department for the delivery of HR services and support to former board staff who will be in its employment but who will be directed by my Department in the operational discharge of their day-to-day responsibilities. <BR /> <BR />A number of Members asked how the loss of scrutiny by members of the board will change the accountability of those with expertise. I recognise the expertise brought to the table by all board members appointed through public appointments and place on record my thanks to them for the valuable work that they do, which they will continue to do right up until the dissolution of the board.”
“A number of Members touched on the issue of accountability, and I was asked to provide granular detail. The Department will be accountable to me for all the functions delivered by former board staff who come under the direction of my Department. The staff will be led by a civil servant at deputy secretary level, who will be directly accountable to the permanent secretary in the Department for the performance of the former board staff. The permanent secretary is, in turn, accountable to me for the overall performance of the Department. <BR /> <BR />Queries were raised about the Business Services Organisation's hosting arrangements. Ms Bradshaw raised a number of them.”
“His first was about how the Department could ensure a standardised approach to tendering for services across the health and social care trusts. The trusts will continue to work within the agreed current procurement guidelines, as the Bill will not impact on their procurement or tendering processes.”
“It is clear from the debate that the construct of the Bill is accepted and agreed but, understandably, there are some concerns about its impact, particularly in relation to accountability, staffing and local involvement in the development and identification of future services. I therefore welcome and thank Members for all the points that they have made, and I thank the Health Committee for its engagement so far and in the future. <BR /> <BR />I turn to some of the specific issues raised and points made in Members' contributions. In the opening contribution, the Chair of the Committee asked a number of questions and made a number of points.”
“It is not often that I say that in this place, I assure you.”
“Thank you, Mr Speaker. Bear with me a moment. I was expecting more contributions, as you can tell, Mr Speaker”
“The closure of the board is a step forward as we seek to reduce the bureaucracy and complexity so keenly associated with our system. As part of a wider transformation, it is a step that will enable us to better focus our resource and enable the system to operate more effectively and efficiently, and I think that we can all agree that that need has never been greater. I look forward to hearing what Members have to say about the Bill.”
“<BR /> <BR />Schedule 3 places a duty on the Department to make arrangements for a statement of final accounts of the board, and, together with a report from the Comptroller and Auditor General, this must be laid with the Assembly. It also sets out provisions to ensure continuity with previous directions issued to and by the board. In addition, the Department may continue anything being done by or to the board, and that includes legal proceedings, following the closure of the board. Clauses 5, 6 and 7 are standard interpretation, commencement and short title clauses respectively. <BR /> <BR />In conclusion, at this point, it will be clear to Members that the Bill is relatively straightforward and that it is subjective, though technical, in nature.”
“<BR /> <BR />Clause 4, the transitional provision, includes schedule 3, which ensures an ordered winding up of the board and the continued proper operation of the health and social care system. A power is included to provide for regulations to be made, if required, to address any non-alignment of existing legislation not already identified as a consequence of the closure of the board and commencement of the new arrangements. Again, this is not novel or contentious and was evident in the Health and Social Care (Reform) Act (Northern Ireland) 2009, which provided for the dissolution of a number of health bodies and the transfer of their legislative functions.”
“However, in the operating model, they will be directed by my Department and will be led by a senior civil servant. Again, this comes back to the need to maintain service delivery. This approach, while streamlining structures and reducing bureaucracy, will also provide flexibility for the work on new planning approaches to evolve, and, importantly, through employment with BSO, the former board staff will retain their HSC terms and conditions, and no staff will be made redundant. Staff engagement has been and continues to be a fundamental part of the process. Consultation with staff and their representatives will be a key part of the development and operation of the transfer scheme for those staff.”
“That oversight will be facilitated by regular ongoing performance reporting by the trusts to my Department. The Bill provides that the trusts must, at the very least annually, submit for the Department's approval a scheme detailing how they are exercising the social care and children functions of the Department. <BR /> <BR />Clause 3 provides for the schemes for the transfer of assets and liabilities. To help to effect a dissolution in practical terms, the clause places a duty on the Department to make one or more schemes for the transfer of the board's assets, which include its staff and its liabilities. Whilst a transfer scheme for staff is not new or novel and has been used on many occasions in the past, this is a novel arrangement and one that has been fully considered. In this case, the staff of the board will transfer to the BSO.”
“Following on from that, the Bill provides my Department with regulation-making powers to ensure that practitioners have access to an independent appeals process after the closure of the Health and Social Care Board. <BR /> <BR />In other areas specifically related to social care and children, amendments will result in these functions being directly placed on health and social care trusts. It is important to note that, currently, trusts already exercise these functions as a consequence of their delegation from the board. In this respect, the Bill merely ensures the continuation of the trusts' ability to fulfil their role in this area. The Bill provides for my Department to be directly responsible for the oversight of the trusts' exercise of these functions.”
“As I said, work has begun on looking at how we plan and manage services based on collaboration and integration and in a way that is built on local need and local input. <BR /> <BR />Clause 2 refers to the transfer of the regional board's functions. It introduces schedule 1, which is the core of the Bill. It details the amendments that are required to existing legislation in order to achieve the transfer of powers, duties and responsibilities as a consequence of the board's closure. The amendments to health-specific Acts and orders will result in the duties and responsibilities that were held previously by the board being placed, in the main, directly upon the Department. That includes contracts for primary care providers, which will now become the responsibility of the Department.”
“<BR /> <BR />The first clause provides for the dissolution of the Regional Health and Social Care Board, and, as a consequence, local commissioning groups (LCGs) will cease to exist. The board currently has a statutory duty to appoint local commissioning groups, but that statutory duty will end on the dissolution of the board. However, a statutory duty will remain on my Department to secure the commissioning of health and social care services, and, in doing so, to set the priorities and, indeed, the outcomes that the system is expected to deliver. Whilst the dissolution of the board will remove the requirement for local commissioning groups, let me be clear about this: the clause is about the removal of a construct and does not in any way detract from the need for local intelligence and input into the planning decisions.”
“However, as I pointed out, the first step is about streamlining structures, providing clarity on decision-making and enabling effectiveness and greater efficiency. This is not about changing process. The approach enables us to move forward in a way that minimises any risk to service delivery. However, I assure those who contributed and the Assembly that those views will be considered in the work that has commenced to look at how we may plan and manage our services differently. <BR /> <BR />I will move now to the Bill. The Health and Social Care Bill seeks to provide the legislative framework for the closure of the Health and Social Care Board and the transfer of its functions. It is a relatively short Bill that is technical, with seven clauses and three schedules. I will cover the essential elements of the proposed legislation.”
“On that basis, the decision to close the board was taken — a decision, I assure the Assembly, that has been subject to engagement and consultation. <BR /> <BR />A public consultation exercise ran from December 2015 to February 2016 and received over 180 responses from a wide range of stakeholders. The consultation report, which was published in March 2016, reaffirmed the need for change. While acknowledging that the closure of the board would not cure all the issues facing Health and Social Care, it recommended that having more effective structures would allow for better focus on resources and support the system to operate more effectively and innovatively. <BR /> <BR />I put on record my thanks to those groups for their contributions. I also acknowledge the concerns that were raised about how services will be commissioned.”
“Key to that is that it not only seeks to harness the strengths of our health and social care sector but looks beyond to what can be achieved when we work in partnership with the voluntary and community sector, government and our service users. That has been a key learning from our response to COVID and one that, I am sure, we can agree that we must work on now to ensure that we do not lose as we turn our attention to the future. However, I reiterate my point that the Bill deals with the first step, which is the closure of the board, and the origins of that can be found in the review of commissioning arrangements, which was published in November 2015. The review identified a number of weaknesses in the system, which I referred to, such as the complex and bureaucratic structures and the lack of clarity in accountability and decision-making.”
“That will ensure the continuity of service delivery and mitigate any risk. From the time that the initial decision was taken, the process has been not about the people who are involved but the need to streamline our structures and reduce bureaucracy. In designing this operating model, engagement and analysis have taken place across the health and social care system. Work has continued in that vein as multi-organisational project strands have been established to not only take forward the necessary steps in order to ensure a seamless implementation but to identify and take forward improved ways of working. <BR /> <BR />Building on that first step, I recently approved the commencement of a programme of work that will look at how we plan and manage our services in a way that promotes integration, collaboration and service improvement.”
“As we seek to transform how we plan and manage our services, we must do so in a staged manner that ensures that we manage any risk to our service delivery. <BR /> <BR />In this first step, we will see the closure of the Health and Social Care Board and its staff supported as they move to a new operating model where they will continue to undertake the same roles and functions as before, but as an integral part of my Department and not as an arm's-length body.”
“The closure of the board is an important step on that journey. <BR /> <BR />Before I move to the Bill itself, it will be helpful to set the scene for what the legislation will mean in practice. The Bill, in closing the Health and Social Care Board, will transfer responsibility for its functions, in the main, to my Department. The staff of the board will transfer to the Business Services Organisation (BSO) under a hosting arrangement. Crucially, those staff will retain their Health and Social Care (HSC) terms and conditions and will continue to undertake their current roles and functions, albeit they will be directed by the Department and led by a senior civil servant at deputy secretary level. That is an important point.”
“The objective of the Health and Social Care Bill is simple. It is to facilitate the closure of the Health and Social Care Board (HSCB) and transfer responsibility for its functions, in the main, to my Department. I am pleased to be able to open the debate on the Bill today, not least due to the fact that the closure of the board was first announced some five years ago. It is important that we now take the steps required to bring certainty to staff in the organisation, but also that we respond to the clear evidence that our current system is complex, bureaucratic and no longer meets the needs of today's society. We know from the various reviews and reports that have been commissioned, from Donaldson to Bengoa, that we must transform how we plan and manage our services to meet the needs of our growing and changing population.”
“<BR /> <BR />Most of the ongoing conversation that we are having is productive and positive. However, the latest announcement showed a weakness, and I have asked the Chief Medical Officer to make sure that neither jurisdiction is blindsided by such announcements in future.”
“I thank the Member for her question. The Chief Medical Officers of both jurisdictions sign the MOU on the sharing of information, best practice and communication on our test, trace and protect systems. There is a mutual sharing of information. As I said before in the House, unfortunately, I was disappointed that we did not have at least some heads-up about the announcement that was made. There is still a challenge in sharing the passenger locator form data. That is now a serious issue. We have been continually raising that, and it is becoming an issue with those travelling from England, Scotland and Wales. People are travelling through Dublin Airport using the common travel area, and some are avoiding the process of quarantining in hotels that they are asked to adhere to.”
“I thank the Member for her question. We are seeing a number of peculiarities such as that case. If she wants to forward the specific details to my private office, we will get a response to her. However, the nature of our booking nature system is that we insist on anybody who wants to receive the vaccine having a medical insurance number. If there is anything that we can do between us and the rest of the UK, I would consider looking at that. However, no clear pathway is yet established to allow mutual support for individuals living in another jurisdiction.”
“I hope that this will coincide with the greater availability of vaccine and our moving on to a different age cohort being eligible to be part of our vaccination programme, which, as the Member rightly indicates, is a great testament to the people working in the National Health Service and the volunteers who are coming forward. <BR /> <BR />Receiving 30,000 bookings in the first three hours after opening up to the over-50s shows confidence not just in the vaccines but in the programme that we are delivering.”
“I thank the Member for his question. As I said in the initial update that I gave the House on the vaccination programme, in being part of the UK, we were part of the forward buying of seven different vaccines. At the minute, the MHRA has approved two: Oxford-AstraZeneca and Pfizer, so those are the two that we are using. We received a significant delivery last week, which has been dispatched around our GP centres and regional vaccination centres. <BR /> <BR />I am sure that the Member is aware that we hope to open, on the 29th of this month, another regional centre, at the SSE Arena.”
“When the travel opportunity opens up, if she wants to go to Fermanagh for the vaccine, I am sure that they would be willing to support her. <BR /> <BR />With regard to her question, as of 14 March, the MHRA had received fewer than five reports of blood clots. As the Member will know, being a member of the Health Committee, fewer than five indicates a number that we cannot report.”
“According to one of your colleagues, Fermanagh is a good day out for unionists”
“I would not have believed that you are in that age group, Carál.”
“My Department and I have always been guided by the expert advice that comes from the MHRA, and that comes from the initial guidance that we got that the vaccines were right to use for the purposes that they were designed for and from the guidance on the intervals between the first and second doses. So far, the MHRA advice and guidance has stood us and the United Kingdom in good stead.”
“I thank the Member for his comments. I will refer back to comments that I made from supporting commentary that has been received not just from the MHRA but from the World Health Organization advising countries not to pause vaccination campaigns because of the difficulty that that would bring and of the importance of vaccination campaigns continuing so that they can save lives and stem severe disease impacts from the virus. <BR /> <BR />The Member will be aware that, as I said in my opening comments, the European Medicines Agency has also given its consent to the use of the Oxford-AstraZeneca vaccine, but we have seen many political challenges from a number of nations regarding the utilisation of the Oxford-AstraZeneca vaccine.”
“I thank the Member for his point. While not wanting to make a political issue out of the matter, the first that I became aware of it yesterday was through the media. I have asked my Chief Medical Officer to review the terms of the memorandum of understanding because it is disappointing that that is how we found out. When we took the decision to announce that we would continue, I communicated that to my counterpart in the Republic of Ireland, Stephen Donnelly, so that he knew of the steps that we were taking.”
“There is no opportunity to pick and choose vaccines in our current programme. Due to the supplies of the Oxford-AstraZeneca vaccine, we are migrating some of our regional vaccination centres across to that vaccine, so there will be a dual process whereby some centres will run a second dose of the Pfizer vaccine while still running first doses of the Oxford-AstraZeneca vaccine. <BR /> <BR />I welcome the Member's commitment to and thankfulness for our vaccination programme. We should also acknowledge the large numbers of our health workers and volunteers who are coming forward to deliver this extensive programme across Northern Ireland.”