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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“In quick response, I am not in a position to name a chair, but I give the Member a guarantee and assurance that patient voices will be heard as we establish and finalise the terms of reference of the public inquiry.”
“As regards private patients, the Department is working closely with the Southern Trust to ensure that there is a process in place for follow-up to ensure that they can be confident of any healthcare services with which they were provided. Any private patients who are concerned should contact their GP or the trust's information line in the first instance.”
“The work of the trust in safeguarding patients and identifying further concerns continues, with oversight being provided by the Department's permanent secretary, who is leading the urology assurance group.”
“I thank the Member for his question. As he said, I provided an oral statement to the Assembly on this matter on 24 November and announced my intention to establish a statutory public inquiry. In July, the Southern Health and Social Care Trust notified my Department of clinical concerns in relation to the work of a consultant, who, as the Member said, no longer works in the health service. <BR /> <BR />To date, 1,159 patient records have been reviewed, 271 patients or families have been contacted and the equivalent of nine serious adverse incidents (SAIs) have been identified.”
“I thank the Member. That is a valid point that has been recognised in discussions with your ministerial colleagues, the Minister of Finance and the Minister for Communities. It is about the inequalities that COVID has highlighted across our society. We have a duty to tackle those inequalities and, going forward, that should be looked at, across the Executive, in the development of a Programme for Government. <BR /> <BR />One of the strengths of our National Health Service is that it is free at the point of use and free at the point of delivery, and you do not have to pay, for example, €50 to see a GP. Where there are financial challenges in areas of high deprivation with regard to access to work and to other supports, one of the big benefits that we have here is our National Health Service.”
“I am working with the Member's colleague, the Minister of Finance, to try to challenge that at Westminster, because to put that additional cost on PPE, as we enter a second surge, would be unconscionable.”
“I thank the Member. That was one of the matters touched on during the debate on regulations. The provision of free face coverings is not something that my Department has looked at. There is guidance as to how the public can go about making their own cloth face coverings from the utilisation of T-shirts and other pieces of clothing. That advice and guidance was there from the early introduction of regulations on face coverings. What I would say to those in workplaces is that there should be provision of free face coverings. <BR /> <BR />I am not sure whether the Member is aware of this, but there is a proposal to put 20% VAT back on PPE, which would have a significant impact not just on individuals or businesses but on our care homes and our health sector.”
“<BR /> <BR />There was a significant financial commitment under 'New Decade, New Approach' to move to those three cycles, so if the Member can support me in that ask to the Finance Minister, when my budget asks come forward, it would be appreciated, because it is definitely an ask that we are prepared to make.”
“That was one of the things that the working group was specifically asked to look at because, as I said, it was a commitment under 'New Decade, New Approach' that we would move to the offer of three IVF cycles. One of the challenges as well was moving to the age profile of women coming forward so that they could access the service. It is something that we are looking at because of the delays and knock-on delays that have been caused due to the pandemic and the service being paused. We want to make sure that nobody misses out because of steps that were taken by us rather than through any fault of their own. That work is all ongoing.”
“I thank the Member for her question. Pre COVID and pre pandemic, it was one of the things that we had set up to meet the commitment under 'New Decade, New Approach' to increase to three cycles of IVF. Unfortunately, one of the victims of COVID-19 was our IVF service in Belfast. It was paused; it was stepped down for months. It has now recommenced working, on a reduced capacity. The IVF working strategic group on how we build up to those three cycles has not met as we are trying to get the IVF facility, procedure and service back up to scale as soon as possible to meet the already latent demand that we unfortunately missed over a couple of months.”
“If we take all the steps and measures that we can in the House to reduce the rate of transmission and infection, we can get those services and provisions back on track as soon as is practical, possible and safe.”
“As I have said to the Member, I am not denying that there is an issue; I am saying that the challenge is that we have an already overstretched health service. It was stretched before the pandemic and COVID. Patients and members of the community were already approaching elected representatives about access to surgeries and to the health service. What the Member indicates is not new. It is something that I have experienced and that, I am sure, every Member of the House has experienced. The way to get those members of the public seen quicker is to reduce the number of COVID patients that we are supporting within our health and hospital services. Again today, we are still sitting at over 400 inpatients, with 39 in ICU.”
“A surgical oversight group has been established in the Northern Ireland Cancer Network with the aim of optimising capacity, now and through any potential surge, and to provide ongoing clinical advice to the cancer reset cells. <BR /> <BR />I reassure the Member and the House that all possible steps are being taken to maintain services during the second surge. However, it is likely that the redeployment of staff, staff absences, reduced access to theatres and patient reluctance to attend hospital will all contribute to delays in pathways. Experience from the first surge suggests that the greatest impact is likely to be on invasive diagnostics and surgical treatment. Depending on the scale and continuing duration of this surge, there may be a requirement to increase independent sector capacity beyond the current contracted level.”
“I do not think the Member is implying it, but I take exception to that. I have said it before in the House, in response to a question for urgent oral answer. There is ongoing work and challenges with the delivery of our cancer services. I will be clear — it was made clear when we were discussing our regulations — that those decisions are being made by clinicians on the clinical need of patients. Casting any aspersion on the professionalism or the work of our health professionals is unfortunate. I know the Member well enough to know that that is not his intention. <BR /> <BR />There are ongoing capacity challenges across the cancer pathway that the service is actively managing.”
“Their dedication and the detail that they have put into preparing for the vaccine mass delivery is impressive, and I look forward to sharing that with the Health Committee and in the debate tomorrow in the House, where, Mr Speaker, I am back again.”
“The detail that it has taken to get to this stage has involved overcoming a large number of logistical challenges. <BR /> <BR />One of the biggest challenges is that the AstraZeneca vaccine comes in batches of 975 vials per pack, and it will be highly challenging, if not impossible, to break those down into smaller packs. It is a vaccine designed for mass vaccination and mass vaccination centres, and that will pose an initial challenge to the delivery of our vaccine programme in Northern Ireland. That is why we are also looking to the development and the coming on schedule of other vaccines so that we can utilise them fully as well in the different models that we are working up. <BR /> <BR />Since taking on the post of Minister of Health, I have been greatly impressed by the people across the Health and Social Care service.”
“I thank the Member for a topical and apt question about the vaccine. As I have said, while the vaccine is part of the solution, we still have to follow the guidance that we have. That is why our regulations are still needed, and it is why all the good health advice regarding social distancing, face coverings, hand hygiene and respiratory hygiene is crucial. <BR /> <BR />I give the Member the reassurance that, until the MHRA says that the vaccine is safe to use, we will not use it. Developing the roll-out of the vaccination programme is a large logistical operational challenge. My Department gave a presentation to the Executive last week highlighting the preparations that we have already made. I can tell the Member that those preparations are impressive. We have offered that same presentation to the Health Committee.”
“I thank the Member for the question. I am assured by colleagues that it will not have any effect on or cause any setbacks to our vaccine programme, because our assessment will be done by the Medicines and Healthcare products Regulatory Agency (MHRA). Once that assessment comes forward, we will, hopefully, utilise that vaccine in a safe and appropriate manner. Only when that guarantee and assurance come forward will we utilise it in Northern Ireland.”
“Very much so, and the Western Health and Social Care Trust is working on that. We have seen that come about in other areas and in other facilities. However, the biggest deterrent in attracting staff to some of our excellent hospital and healthcare facilities is often that Members and other elected representatives start to talk about a service being downgraded or a location closing. That deters and disenfranchises people who may be interested in going to one of those sites to seek further employment. The implementation of what will be elective surgery lists in the SWAH is a further enhancement and something that makes it attractive for people to work there as well as giving them the opportunity, of course, to live in the Member's constituency.”
“A key initiative that is being developed is on the delivery of elective surgery services, with surgeons from across Northern Ireland travelling to Enniskillen to provide surgery that cannot be provided at other sites due to the number of COVID-positive inpatients. In the initial phase, that work has understandably been focused on high-priority patients who require surgery. The initial sessions have been offered to the Belfast Trust for surgical lists and time-critical treatments that have been displaced by the activation of the Belfast City Hospital Nightingale. Throughout the coming months, the position will be kept under review, and further work is under way to explore options for maximising the availability of capacity at the SWAH in the longer term.”
“I thank the Member for her question. As Members will be aware, over the last number of months, the COVID-19 pandemic has had a significant impact on the delivery of some services in our Health and Social Care system. As a result, it is critical that we make the best use of all available capacity in the system. <BR /> <BR />The Member will recall that she kindly invited me to the SWAH earlier in the year. During that visit, I saw at first hand the opportunities presented by the hospital. I am pleased now to be able to confirm that a number of new initiatives have been taken forward to support service delivery as we work to maximise the use of all available capacity in the system.”
“I am afraid to say to the Member that, because of the utilisation of the lateral flow devices in tests and the way that the test works, it is not possible to move that second test closer to home.”
“I thank the Member, but the testing that is being completed to allow our students to travel home is done with the lateral flow devices that are being set up in the mass testing centres in our universities. It is not practicable to move that testing centre closer to home for the second test because such diverse geographical regions are involved. I say to the students who are returning home that, when using public transport, they should follow all public health guidance, such as wearing face coverings and as much social distancing as is practicable. If there are alternatives to using public transport, they should explore those. They should avoid car sharing, because we have seen from previous studies in other places that car sharing has become a source of infection.”
“Certainly. The Member well knows my commitment to mental health since coming into office. In fact, when the pandemic first hit Northern Ireland, I gave assurances to the Committee, its members and the House that mental health would not go off my Department's agenda, and that is why we continued with the development of the mental health strategy, which will lead to the mental health action plan. Within that, we worked on the support mechanisms that will be needed for mental health specifically due to the fallout from COVID. I have no hesitancy in giving the Member that reassurance, and, equally, I am keen to work with and to support the Economy Minister on the issue in support of our students.”
“As the Member will be aware, I work with all my Executive colleagues to bring forward the necessary guidance, but in those regions and areas where other Ministers have policy lead, it is helpful to us if they bring forward that policy for discussion. We can then provide information and guidance rather than my Department leading on areas that are outwith our policy area.”
“Accordingly, my officials continue to work very closely with Queen's University and other key stakeholders on the practical and financial implications of delivering education in clinical environments and complying with social-distancing protocols. I have also confirmed to the universities that all such healthcare students will be entitled to avail themselves of the free healthcare car parking at HSC trust premises that has been made available to HSC employees up until 31 March. In addition, the universities have been advised that their healthcare students are key workers and are entitled to free public transport when travelling to placements.”
“<BR /> <BR />A joint statement from the four UK Chief Nursing Officers (CNOs) and the Nursing and Midwifery Council (NMC) was issued on 23 November to clarify the principles for nursing and midwifery students during the next phase of the pandemic. The overriding objective set out in the statement, which I consider to be paramount, is to continue to support students to complete their programmes on time, so that they can enter the workforce as registrants as quickly as possible. My officials have shared that statement with the local universities and have asked them to ensure that it is communicated to all students. <BR /> <BR />I am also fully committed to supporting the continuation of medical and dental education.”
“I thank the Member for his question. I will answer the question in respect of students at the local universities on healthcare courses commissioned by my Department. It is very important that reassurance and support is provided to healthcare students, so that they can pursue their studies despite the challenges created by the ongoing COVID-19 pandemic to learning on placements. Placements are a fundamental dimension of much preregistration learning across the health professions. Officials in my Department are working closely with key stakeholders, including the higher and further education providers, to ensure that students are made aware of the key messages, and that includes guidance specific to each subject area issued by their university or education provider and the overall health guidance issued by the Public Health Agency.”
“I thank the Member for his question. We continue to be in discussion with DHSC. Ministers from all four nations of the United Kingdom have a very close working relationship. Matt Hancock has congratulated us on what will be an ambitious programme. He is willing to discuss how that programme will work out in Northern Ireland as we take it forward. We have yet to see the outworkings of the pilots that have been taking place in Liverpool and in Merthyr Tydfil in Wales. In our system, it will be piloted at Queen's University and rolled out across our Health and Social Care system to make sure that, if we receive that number of lateral flow devices, we can utilise them in the best and most effective way.”
“For example, in Wales, during a seven-day period in mid-November, according to the most recently published Welsh Government data, 92% of positive cases and 82% of contacts were reached. In Northern Ireland, if we look at a seven-day period around the same time, we can see that 94% of positive cases and 98% of contacts were reached. There are, undoubtedly, aspects of both models that work particularly well and other areas that will require further refinement, and we have been open about that. I am satisfied that, in Northern Ireland, the measures that I recently discussed with the Health Committee and the Executive, with an increased focus on a hybrid model, involving manual contact tracing services supported by digital solutions, will ensure that we are positioned to deal with any further increases in numbers in the months to come.”
“I thank the Member for that. A TV programme compared our service with the Welsh model, and you will appreciate that the service models for contact tracing in Wales and Northern Ireland have their differences. As you are aware, the service provided by the Public Health Agency in Northern Ireland is staffed by health professionals focusing very much on a person-led approach. That manual element is augmented by a number of digitally-enabled solutions, including the recently introduced self-trace platform and the StopCOVID NI app. In Wales, contact tracing is provided through local authorities and health boards, which are supported by Public Health Wales. <BR /> <BR />Despite the differences in the models, it is still possible to draw some high-level comparison on performance.”
“<BR /> <BR />In Northern Ireland, we have always been clear that our contact-tracing system will be health based. It will remain embedded within our healthcare system. It is not part of any private, for-profit industry. We value what it brings to our health service as part of how we combat the spread of COVID-19 in Northern Ireland.”
“I challenge the Member's use of the word "inadequacy". I have challenged it in the past, as the Member knows. I see Mr Sheehan, who has developed expertise in that area, looking at me. From the onset of the pandemic to where we are now, we have seen significant changes in the contact-tracing system. Originally, the system was used to identify sexually transmitted infections and food poisoning, and a small team was based in the Public Health Agency. Now, we are always learning, and we are developing the system on the basis of what we see across best practice. We have increased the scale of the system, and we continue to increase the number of contact tracers who follow up on that service. We are developing digital and online platforms to allow that information to be gathered at a rapid pace, because we know the value of contact tracing.”
“<BR /> <BR />Data sharing and contact tracing are health based, like the information that is transmitted about patients who use the cancer services in Altnagelvin and the parents and patients who use the children's cardiology service in Dublin. That is an agreement between the Irish Government and the Northern Ireland Assembly's Executive, and it will not be affected by the General Data Protection Regulation (GDPR). The current challenge in the sharing of information is a difficulty that I have experienced with the Irish Government's sharing of data, specifically in relation to travel locator forms. It has been the basis of many conversations and much correspondence, but it is a difficulty that I have still not found a satisfactory resolution to.”
“I thank the Member for his two supplementary questions. On the first, information will be provided to students who are coming home from England, Scotland and Wales by the university at which they are studying. The advice, the testing method, the approach and the guidance that they must follow will be provided by the location at which that testing is being provided. Therefore, information on their travel corridor will also be established. <BR /> <BR />For students who are currently domiciled in our universities and are returning to England, Scotland or Wales, advice will be given through our testing system and the NTI that started in Queen's University at the beginning of last week. That will be expanded to students studying at Ulster University so that we can let them travel home safely.”
“That will involve the development of a hybrid model, with a focus on further digital solutions to deliver early messages to contacts and cases, while allowing the health professional staff in the contact-tracing service to risk-assess and deal with more complex cases and with clusters and outbreaks.”
“Learning arising from those NTIs will help us to better understand how the new asymptomatic testing technologies can be implemented and extended more widely. <BR /> <BR />With regard to the contact-tracing service, in addition to a number of digital enhancements, including a new self-trace platform, the Public Health Agency commenced enhanced contact tracing on 16 November. That is a significant development in our approach to combating the virus and will ensure a strong focus on identifying the likely source of a case of infection and potential common exposures, which can lead to clusters. My staff and colleagues in the PHA are continuing to work on a range of options to ensure that our contact-tracing service is well positioned to deal with the pandemic in the coming months.”
“I thank the Member for his question. Our testing and track and trace programmes continue to evolve at pace. As part of the UK-wide programme, we are continuing with the implementation of a number of new testing interventions (NTIs) in Northern Ireland — for example, the testing of asymptomatic healthcare workers will begin this week. That NTI will enable the early identification of the SARS-CoV-2 virus in healthcare staff who do not have symptoms, which will ensure that front-line staff self-isolate early, thereby reducing the risk of the onward transmission of infection. Testing of asymptomatic students also commenced this week at Queen's University with the use of lateral flow devices, and plans are progressing to offer testing, where needed, to the wider population of students.”
“I am not aware of that having happened. If the Member knows of any examples, I would appreciate it if she highlighted them to my office, because the Health and Social Care system — the equivalent of the National Health Service in Northern Ireland — is available for those who need it, free at point of use and point of delivery. That is something that I stand over.”
“We are working hard to correct that, but the availability of paediatric pathologists is the biggest challenge to us all.”
“I thank the Member for the point. She has raised the issue with me previously, and I know that she works on that area continually. We have been exploring a number of options, but the biggest challenge not only across these islands but across parts of the world is the availability of paediatric pathologists. It is an acquired skills set. There is an opening call for recruitment for our Health and Social Care service in Northern Ireland, and we have explored models with the Republic of Ireland, but the model that we operate at the minute involves being able to work with colleagues in the United Kingdom. It is not satisfactory; it does not provide the emotional support that parents often need when they lose a child. We are acutely aware of that in the Department and across the health and social care sector.”
“Statutory health and social care providers such as trusts, which run our hospitals as well as some primary care services such as GP surgeries and community pharmacies, are not regulated by the RQIA. However, the professional staff who work in those services are regulated, so that carries across with regard to my initial answer.”
“I thank the Member; she has made a valid point, and her question gets to the heart of it. There is a risk that those private baby scan studios do not tell women about an abnormality or a serious condition. Pregnant women are offered at least two ultrasounds during pregnancy by health and social care staff through our systems, and that includes an anomaly scan at 18 to 20 weeks. All private scans are in addition to that. <BR /> <BR />When it comes to the specific regulatory framework, RQIA's regulatory activity is determined by the 2003 legislation, which reflects departmental policy at that time. Since then, the health and social care system has changed dramatically in how we access care and in the type of care that is available. That includes the rise of services that are available on the high street and online.”
“I thank the Member for her question. Private baby-scan studios are not included in the list of regulated establishments and agencies as set out in the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. However, if ultrasounds are carried out in those studios by radiographers, the radiographers are regulated by the Health and Care Professions Council (HCPC). Independent hospitals and clinics may carry out private baby scans, and those establishments are regulated by the Regulation and Quality Improvement Authority (RQIA) under the 2003 Order and the Independent Health Care Regulations (Northern Ireland) 2005.”
“I thank the Member for his question. The answer was in the final sentence of my answer to Mr McAleer. Once a capital budget is available, the Health and Social Care Board will work with the Western Health and Social Care Trust to take forward the preparation of the business case in order to identify their preferred option. As I said, because the Chancellor of the Exchequer's spending review will now only cover 2021-22, my ability to take that project forward is subject to the confirmation of future capital budget allocations.”
“Between 6 April and 22 November this year, there were 109,697 COVID-related queries to GP practices. Of those patients, 23,022 were triaged and referred to primary COVID centres, with 15% of patients assessed at those centres and, then, referred to secondary care. The week from Monday 19 to Sunday 25 October saw 1,045 referrals — the highest weekly number of referrals since the centres opened.”
“I thank the Member for his question. The establishment of primary-care COVID centres was an urgent and immediate response to the challenges that were posed by the COVID-19 pandemic. They ensured that primary care services could be maintained by enabling patients who have COVID-19 symptoms to be treated separately from patients who have other conditions that require assessment or treatment in primary care. The staffing and operation of those centres is managed locally by GP federations in response to local demand. <BR /> <BR />Primary-care COVID centres have been crucial in ensuring that GP practices have been able to continue to deliver vital services and face-to-face appointments for patients and have greatly reduced the flow to emergency departments.”
“In addition, GP practices in GP-owned or leased premises can also apply to the Health and Social Care Board for grants to support the development of their premises.”
“As I said in my initial answer to the Member, I do. But, as I also said, the recent funding allocation only being for one year puts pressure on that. <BR /> <BR />A number of hubs for the Tyrone and Fermanagh area are envisaged in the strategic implementation plan, including Omagh, Enniskillen, Lisnaskea, Dungannon, Strabane and Cookstown. The hubs in Omagh and Enniskillen are operational. The business case for the hub in Lisnaskea is under review and will be followed by a business case for the Dungannon hub. The Health and Social Care Board is also investing in the development of spokes, which will take the form of smaller health centres, and is working with the Western Health and Social Care Trust to explore the need to invest in trust-owned health centres.”
“However, once a capital budget is available, the Health and Social Care Board will work with the Western Health and Social Care Trust to take forward the preparation of the business case to identify the preferred option.”