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 value them all equally and appreciate the work that they do, often unrecognised, because they are in the background, making the entirety of the machine work.”
“I thank the Member for his point. One of the things that I have done since becoming Minister is to make sure that we value and recognise all our workforce in the health and social care system. Unfortunate language has been used, even a couple of weeks ago, about the differential between front line and back room, and I think that that was disappointing and derogatory to many. Without those back-room staff, as they were termed, the front line could not work. To me, as Minister, each is a vital cog in our overall health service in supporting patients on their clinical pathway to get the medical supports that they need. Without the individuals that the Member recognised, nothing in our health service could work.”
“The additional supports that we have put in have been more focused on recruitment during the pandemic, rather than specifically on retention. I will certainly raise the issue that the Member raised in the Department, and I thank her for that.”
“I thank the Member for her question. To be quite honest, that last point has not been brought to my attention or come across my desk. I assure the Member that, now that she has raised it, I will raise it with our workforce directorate and the Chief Nursing Officer. Contributions that are made in this House do help to shape the way that we go forward and the way that my Department takes its overall policy. <BR /> <BR />I want to highlight the fact that, at the end of September 2020, the overall vacancy rate for registered nursing and midwifery staff was 7·4%. That is unacceptably high and is equivalent to the level of March 2017, but it is a major improvement from the peak vacancy rate of 13·1% recorded in June of last year. Work on recruitment and retention is ongoing.”
“I thank the Member for his acknowledgement of the further support that has been given and is being offered. We are still working with our trade union colleagues and other stakeholders to get clarity and detail on the specifics of that cohort in order to show that they are a valued part of our workforce. That is a bit of the ongoing work in relation to that support and that acknowledgement, and it is only a small acknowledgement. The moneys for our permanent HSC workforce are there. I have that in my budget, and the Finance Minister gave credence to the ministerial direction that I issued. That should be working its way through our payments and processes very shortly.”
“<BR /> <BR />The record number of preregistration nursing and midwifery training places that were commissioned this year includes the additional 300 places that were indicated in 'New Decade, New Approach'. It will take three years of training before those students can be registered to practise, and the additional nurses will require an investment of some £38 million over six or seven years. Tackling our unacceptable waiting lists will not be possible without sustained and substantial investment and additional staffing. I have made it clear that that must be a major Executive priority in 2021 and beyond.”
“<BR /> <BR />The Chief Nursing Officer (CNO) has requested that the Northern Ireland Practice and Education Council for Nursing and Midwifery undertake a project on perioperative nursing careers in response to the recognised number of nursing vacancies in that particular area of practice. The purpose of the project is to promote perioperative nursing and to support and develop career pathways for registered and non-registered nursing staff. The Member will also be aware that we reopened the workforce appeal in an effort to build capacity, with a particular focus on certain roles and positions across hospitals and community care. That is a short-term fix that will deliver only a temporary solution. We need to fix the problem on a permanent basis, with newly trained and qualified people being appointed to permanent positions.”
“I thank the Member for his question. As he knows, the unfortunate reality is that Northern Ireland's health service was already struggling to meet demand for elective services well before the pandemic. We simply did not have the workforce, particularly the nursing workforce, to be able to provide sufficient elective and unscheduled care at times of pressure. As a result of the prevailing COVID situation, an even greater number of staff have been absent or have had to be redeployed in order to meet the urgent and immediate needs of extremely ill patients who require urgent treatment.”
“We will certainly put out the information and clarification that the Member asked for.”
“I thank the Member. To be clear, it is not that carers are not a priority; they are, and they are in the priority matrix that was established by JCVI. We are working our way through that in order of risk according to the criteria that were set out by the JCVI. We will get to carers, and I know that Patricia took on board your ask from the Health Committee and is working on it so that we can reassure carers that we will get to them. <BR /> <BR />We need to be clear that we are still in the early days of the vaccine programme. We are dependent on the supplies of the two currently approved vaccines that we have in stock. As more vaccines come on line and more get approval, we will be able to accelerate even further the vaccinations for those priority groups.”
“I thank the Member for that point. There has been much discussion of the issue since the EU triggered article 16 on Friday. That had potentially very real implications for us because we had vaccine in transit. Had article 16 been enforced, we may have seen difficulties with the arrival of a supply of vaccine in Northern Ireland. I pay tribute to those officials in my Department who were working vigorously behind the scenes while the noise was being made on Friday evening to make sure that that dispatch of vaccines arrived here on Friday night and was fit to be distributed through our practices and vaccination centres. Vaccines should not become political. We have been very clear over the last year that fighting COVID-19 is not about politics but about saving lives.”
“You don't have to wait until you have enough vaccine to do the entirety of the cohort". <BR /> <BR />If the Member wants to give me details of GP practices, I can get back to her with how much they have received and when they received it. We are keeping a tight eye on the amount of vaccine that each of them receives and the returns that they put in regarding the number of patients whom they vaccinate, to make sure that we get maximum use out of the vaccine that we are distributing.”
“To clarify, although people talk about our vaccination programme, we are running a twin-track programme because of the peculiarities of both vaccines. The Pfizer vaccine has to be stored at between -70° and -80°, which is why it is being used specifically in our regional centres. As Mr Bradley highlighted, we are using the younger cohort — those who are 65 to 69 — who are more mobile and more agile and can go to the regional centres. The GP practices are picking up the other cohorts. <BR /> <BR />With regard to the supply of the AstraZeneca vaccine, as soon as we get a delivery, it is put out to the GPs; it does not sit in our central stores for any period of time. There will be instances where GP practices receive a batch that is not enough to complete a full cohort of a specific age group, but to them I say, "Make a start.”
“I thank the Member for her question. We are working with somewhere in the region of 321 GP practices, which are rolling out the vaccination programme to the elderly cohorts and those who are clinically extremely vulnerable. They are calling forward patients to fill specific time slots, so it is not done on a first come, first served basis. Most of the slots are being taken up by people who are called forward, rather than there being any surplus at the end of the day.”
“I thank the Member for her question. As she knows, we have moved to using our regional centres for the 65-to-69 cohort, who are being brought forward on an appointment basis. I assure you that there are very few people missing out on those appointments, so it is not necessary to have that standby list. Should we have any vaccine that is coming to the end of its usability or shelf life, we are calling forward a small cohort of Health and Social Care workers to receive their second dose so that we can move on with that programme.”
“I thank the Member for his question. As I said, the housebound patients on the GP register who are over 80 will be vaccinated by GPs working in conjunction with their district nursing colleagues. The Member's constituent will be got to in a timely manner. If the Member wants to forward details of the practice or the constituent involved, I will happily follow that up.”
“<BR /> <BR />The Joint Committee on Vaccination and Immunisation (JCVI) has identified the best option for preventing mortality and morbidity as being, initially, to protect those most at risk, namely persons falling within groups 1 to 9. The vaccination plan has therefore been targeted at the specific age cohorts of the population most at risk and does not measure deployment against overall population numbers. However, vaccination deployment is an ongoing programme, and it is subject primarily to the availability of the vaccine, which means that the average weekly rate is likely to change and increase as larger cohorts of the population come forward to be vaccinated.”
“<BR /> <BR />Vaccination wastage has been incredibly small, which is due entirely to the professionalism and dedication of the pharmacy staff, vaccinators and GP staff who have managed to keep it so low. It is currently estimated at less than 0·5%. That is much lower than a normal vaccination programme and ensures that the vast majority of that precious resource is being given to those who need it most. <BR /> <BR />The roll-out of the vaccination programme is dependent on a steady supply of vaccine. We are part of the UK-wide procurement process, which should ensure that the UK has access to up to 367 million doses. Northern Ireland will receive 2·85% of all the available COVID vaccines in the UK. As Members will be aware, the UK was the first country in the world to authorise the deployment of a COVID-19 vaccine.”
“In addition, care home residents not vaccinated by mobile teams will receive the vaccine from a district nurse working with their GP practice. GPs will regularly check their records to ensure that none of their patients in the eligible cohorts has missed out on an offer of vaccination. <BR /> <BR />The vaccination of priority groups 1 and 2 has largely been completed, and the GP programme is working through the vaccination of priority groups 3 and 4: those aged 70 to 79, as well as those deemed clinically extremely vulnerable. GPs will be in touch to invite individuals in groups 3 and 4 to come to receive the vaccine, and, for the vast majority of individuals, no further action is required. However, I suggest that anyone in group 1 or 2 who has not been contacted by their GP contact their practice to check the position.”
“Mr Speaker, with your permission, I will group questions 2, 7, 10 and 14. With your indulgence, I would like some latitude to provide a more thorough answer. <BR /> <BR />The plan for deploying the vaccines is well under way and has been designed to be pragmatic, agile and flexible. The programme started on 8 December, and, by close of play yesterday, 246,421 vaccines had been administered: 221,809 first doses and 24,612 second doses. The deployment plan involves a mixture of delivery models. Most people aged 80 and over should now have been invited to receive their first dose or been advised that they can expect to receive the vaccine. Housebound patients on the GP register who are over 80 will be vaccinated by GPs working in conjunction with their district nursing colleagues.”
“That co-production approach will help to ensure that the changes that we make work in practice.”
“I thank the Member for her supplementary. As she knows, nine work streams and seven subgroups were established in an overarching project to lead the work required to implement the recommendations of the inquiry into the hyponatraemia-related deaths. The work streams and subgroups are a duty of candour; death certification; a duty of quality; paediatric-clinical collaboration; serious adverse incident training; user experience and advocacy; workforce and professional regulation and assurance. I want the recommendations implemented fully but without unintended consequences. To do that, I have gathered over 200 people from different backgrounds to work through how best to implement the recommendations. They include service users and carers; the voluntary and community sector; and people from Health and Social Care organisations.”
“Considering what the Speaker has said, the Member will be aware that my Department and I have accepted all 96 recommendations of the O'Hara report. In the introduction to the report, Mr Justice O'Hara recorded important caveats about individuals who were criticised by his report. He stated:”
“A Department has no power to prevent any citizen, including a civil servant, from bringing legal proceedings in his or her own name. As the Member will be especially aware, the outcome will then be a matter for the courts.”
“The Member makes a valid point. I have always said that the Executive and Assembly work strongest when they stand together with a single voice supporting the health service, because that is what our health service workers need to hear. They need that reassurance that this place has their back at all times and that, when it comes to regulations and their enforcement and compliance, not only do the Executive step up and set an example but every Member of the House steps up and sets an example. I believe that that is what the people of Northern Ireland expect from us. I also believe that that is what our health service workers actually deserve from us.”
“They have, through working with us, increased their theatre capacity. As I said, there are an extra 112 theatre allocations between now and the end of March, which allows us to put more patients through. <BR /> <BR />We need to be clear that, between 12 January and 18 January, 4,262 elective procedures were carried out by the NHS, so it is not as if we have come to a complete standstill in regard to inpatients and day-case admissions. That work goes on. I sincerely apologise for the number of cancellations, but I can assure anybody who was to have an operation and had their procedure cancelled that we are doing our utmost to get them back in and get them seen.”
“I thank the Member for his point; it is something that we have often said in here. While consultants may have capacity, the challenge lies with our ICU staff, the anaesthetists and the rest of the theatre staff who need to support not just the surgeon but the patient during their operation and during their aftercare. That is where those years of underfunding have left us, and the independent sector can pick it up because it has the workforce in place. <BR /> <BR />In regard to picking up that spare capacity, as I said in previous answers, during the first wave, a lot of patients who were utilising the private sector started to cancel operations whereas, this time, they have not, so there is a larger increase of the private sector still utilising private capacity for what is a fee-paying business.”
“However, one of the challenges, from an accounting point of view — this has often beat us in many of these steps — is the fact that the money had to be spent in year, so it is not as if we could carry any of that £90 million into next year to further utilise independent-sector provision, which is something that I would like to do. The Finance Minister said in his statement earlier that he is approaching Treasury so that he can roll that money into next year. I wish him every success, because I can assure the Member that, if the Finance Minister receives that sort of flexibility, my Department will be able to utilise the money and will bid for it.”
“I thank the Member for his question. One of the challenges that we faced was that we did not receive such significant allocations during this financial year. However, now that we have received them at the tail end of the year, they have to be spent by 31 March. That is where the challenges come. If I had year-end flexibility and could roll money into next year or further years or if I had a multi-year budget, I could utilise that money five times over, but the difficulties in our accounting system, and the fact that we are in a one-year Budget that is non-recurrent, creates an additional challenge in being able to spend. The Minister of Finance highlighted that. <BR /> <BR />We have been looking at different avenues — creative avenues — of retaining and spending money, and we looked at utilising the independent sector.”
“When we looked at the three service providers that we have in Northern Ireland, one of the things that we saw was that they bring different skill sets. The one in the north-west deals mainly with orthopaedics, so we are utilising its facilities and staff to get the best fit with what it can supply. It is mostly about the provision of theatre staff, theatres and intensive care units so that we can move forward on cancer and time-critical patients. That has been brought forward, and those patients will be dealt with using that regional approach so that those who are in most need of accessing that capacity can do so.”
“I thank the Member. One of the things that we did, especially when we entered this wave, was to re-establish and reopen our workforce appeal. As of 13 January, a total of 1,049 part-time or recurrent workforce appeal positions have been filled. That covers 646 appointments in the health and social care sector and 403 clerical and admin appointments. We have utilised that workforce appeal during the third wave. They were brought in during different waves to fill certain slots at certain times. Many of those people were not seeking full-time positions in the first wave, but we are utilising that tool again.”
“I am not sure that there are any political objections anywhere across any of the five parties in the Executive about the utilisation of the private sector to support our health service and work to reduce the current waiting lists. I am not sure of the premise of the Member's question or what he is inferring. I have the support of all the parties in the Executive for the utilisation of the private sector to help to reduce waiting lists. There are also commitments in next year's Budget and in New Decade, New Approach to use all available avenues to reduce our waiting lists.”
“I thank the Member. She has championed long COVID and our supports for it extensively, even since we entered our first wave. She will be aware that I have asked the Health and Social Care Board to bring forward a response on what that provision will look like. I am quite open in saying that, if we have to look to private suppliers and private providers for that additional support for long COVID patients so that we can start to work on our extended and increasing waiting lists, we will do that.”
“They will be a welcome addition to our workforce at a time when it needs critical support as we work through this third surge, with over 800 inpatients and over 70 people currently in ICU. All help is therefore welcome.”
“I thank the Member for raising that point. As I said in an earlier answer, and I have said it since taking up this post, I will take help whenever we need it, wherever our staff need it and wherever our health service needs it. <BR /> <BR />A lot of detailed planning has taken place to make sure that the military technicians who are being supplied have all the support that they need to hit the ground running. That will include welcome and induction to our hospital systems, including the testing requirements and vaccination, clinical and local induction, including infection prevention and control, donning and doffing, and testing everything that is needed.”
“When I met the providers just over a week ago, they reminded me that they were already part way through a financial year in which we were using the independent sector but that the Minister who was in place at the time cut all funding for the utilisation of the private sector, and that is when our waiting lists started to escalate again.”
“Unfortunately, we are now paying the price for that underinvestment in our health service, not just in staff but in facilities. When we look at our waiting lists for elective, inpatient, day-case procedures, we see that the only way in which we would be able to make a serious attack on the ever-increasing numbers is by utilising the independent sector as much as possible. As I said in response to Mr Buckley, however, until we get that long-term surety of recurrent funding to address and eat into the waiting lists, it makes that a difficult relationship.”
“One of the biggest challenges, however, that we face as a Department in utilising the independent sector is non-recurrent funding, because we can go to the private sector with only a one-year allocation and a one-year pot, and what it needs to increase its capacity to help reduce our waiting lists is that surety of funding for three to five years so that it can increase its facilities and staffing numbers to start to eat into our waiting lists. That approach was committed to in New Decade, New Approach. While we continue to work on one-year financial cycles, however, that makes it hard to engage in the long term with those independent providers.”
“I thank the Member for his point. One thing that has to be made clear is that, during this surge, unlike during the first and second surges, those independent providers continue to support their own patients as well. What we are seeing during this surge, which we had not seen previously, is that the demand from private patients has not dropped off but increased. Although we were able to get that additional capacity in surges one and two, we are not able to get it now, because there is a large uptake in demand in the private sector during this surge. We welcome any additional support that we are getting from the private sector, however. <BR /> <BR />The Member mentioned finances for utilising private-sector capacity. The private sector is one of our critical tools for reducing waiting lists in general, not just because of COVID.”
“<BR /> <BR />As regards the utilisation and uptake of the independent sector, I already said in my answer that, in the surges between April and December last year, we supported 3,900 patients. During the third surge, we have gained a further 112 additional theatre sessions from those independent providers. We have already engaged and continue to engage to see what additional capacity they can supply.”
“I thank the Member. He has raised this strategy time and time again. What I have said to the Member time and time again is that it is an Executive strategy. The First Minister and deputy First Minister announced a COVID Executive task force so that we could bring all the parts together. The Member can shake his head all that he wants, but he has to realise that every Minister has a responsibility. I know that, at times, Members on the other side of the House want to put the full responsibility on me and my Department. I will bring forward the Health response; I always have and I always will. However, I bring forward recommendations to the Executive, which bring forward an Executive strategy as a whole, as they did back in May.”
“I recently approved the establishment of a new regional approach to ensure that any available theatre capacity across Northern Ireland is allocated to those patients most in need of surgery, both during the surge and as we come out of it. That will include seeking to continue to maximise fully all available in-house HSC and independent sector capacity both within and outside Northern Ireland.”
“From April to December 2020, approximately 3,900 patients have been treated by local HSC consultants in the three local independent sector providers. Provision for continued access to the three independent hospitals had been made until 31 March 2021. However, given the impact of the third surge, I can confirm that we recently secured a further 112 theatre sessions for Health and Social Care cancer and time-critical patients. <BR /> <BR />In addition to that, some capacity has been secured from Republic of Ireland private clinics. Discussions are ongoing with NHS England for in-house and independent sector capacity for Northern Ireland patients.”
“The spread of coronavirus continues to cause serious disruption to our Health and Social Care (HSC) system. Unfortunately, elective care activity has had to be reduced in an attempt to free up capacity, including staff, beds and critical care services. The first and second waves of the pandemic placed unprecedented demands on acute services, with elective work reduced or postponed. The position has further deteriorated during the third surge. <BR /> <BR />Given the impact of COVID-19 on health service operating capacity, I made it clear that all possible sources of additional capacity should be utilised. That has included securing theatre capacity from local independent sector health providers. As has already been made clear, that has allowed many hundreds of the most urgent and time-critical patients to be treated.”
“The Member's raising it here today and my answer will hopefully reinforce the message that the support and funding are there for a reason: to support the workers and the owners of care homes but, most importantly, to support the residents of care homes. The message has been loud and clear, and it is one that my Department will continue to make to care home providers.”
“We put financial supports in place that will help care homes to support their workers through what will be a challenging period of isolation. We have regular engagement with care home providers, and that is ongoing in a number of other areas, so I encourage all care home providers, owners and shareholders to take up the financial supports provided by my Department to ensure that their workers are supported during any period of illness when they have to take time off due to being either a positive COVID-19 case or a contact case. That is what the finance, guidance and support is there for.”
“The Member rightly identifies one of the biggest frustrations for the Department and me. At the start of the outbreak and during the initial waves of the pandemic, care homes owners needed help to give their workers financial support so that they were not impeded by having to take statutory sick pay should they either contract COVID or become a contact case.”
“I could nearly just say, "I refer the Member to my previous answer". However, he will be aware that where we currently see the spread of COVID, the infection rates are stable but still increasing slightly. The number of inpatients in our hospitals has not decreased at all over the last number of weeks. The two-week restrictions have seen a stabilisation of the numbers, but those are still too high. I do not think that the Member will be surprised to know that I will bring a paper to the Executive on Thursday with a number of recommendations. As I said, he knows me well enough to know that I will make those recommendations to the Executive so that they can have the discussion.”
“I thank the Member for his question. He is right: the discussion with the three devolved nations, which will be chaired by Michael Gove, takes place this afternoon. As he will be aware, the announcement was made on a UK-wide basis by the UK Prime Minister, First Ministers and deputy First Ministers. That discussion is being supported by the decisions and recommendations of the four Chief Medical Officers from across the nations. As the Member well knows, I never comment before a discussion has taken place and a decision is made. We will wait to see the outcome of the meeting and what it recommends.”
“<BR /> <BR />I want to see more people being able to donate blood. However, I also want to make sure that it is safe, and my decision to reduce the deferral period from 12 months to three earlier this year was also based on SaBTO advice. I look forward to seeing more donors on the Northern Ireland Blood Transfusion Service's register. Being a regular donor myself, I know the vital importance of giving blood. Every donation can save or have an effect on up to three lives. The more people we have who are eligible to donate blood, the better it is for all of us.”