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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“<BR /> <BR />In 2019, the Western Health and Social Care Trust carried out work to convert two old dental rooms to provide additional GP practice space in the Carrickmore health centre to meet the urgent and immediate needs of the practice. A requirement for funding to commence new health centre provision in Carrickmore was identified by my Department as part of a recent Department of Finance-led four-year capital budget information-gathering exercise. However, since that exercise, the Chancellor of the Exchequer's November spending review now covers the 2021-22 year only. Therefore, my ability to take the project forward is subject to the confirmation of future budget allocations.”
“The Health and Social Care Board, through the primary care infrastructure development programme, is taking forward planned investment in primary care premises across Northern Ireland. That will be based on a hub-and-spoke model. Carrickmore health centre is a spoke of the Omagh hub, and it is recognised that, due to the growing size of the GP practice, it is now operating in a space that is well below its capacity requirements. It has, therefore, been identified as a priority for capital investment. However, due to many competing priorities across Northern Ireland, it is likely that new provision in Carrickmore will be a longer-term priority unless significant new capital funding can be provided.”
“The regulations were put in place before school resumed on 2 November 2020.”
“Their purpose is to mandate the use of face coverings by post-primary pupils on home-to-school transport and public transport. Previous amendments to face coverings legislation had extended the requirement to use a face covering on all buses, coaches and taxis but not school transport. An exemption existed for children under 13 years of age. The amendments to the regulations has been made so that only children who are not yet at secondary school are now exempt from wearing a face covering on school transport or public transport. The term "junior pupil not yet receiving secondary education" exempts children under 11 years and six months old who are not yet at secondary school from wearing a face covering. The exemptions from medical and other requirements remain unchanged.”
“<BR /> <BR />These may be small matters in themselves, but they are intended to ensure the integrity of the Executive's restrictions and reflect our understanding of the impact that they are having on people. Some of the amendments tighten the restrictions slightly, and others loosen them slightly. In anything that we have done, we have sought to assess the risk — the risk of increased infection associated with loosening restrictions and the risk of serious negative consequences for individuals and the community if legitimate and valuable aspects of life are restricted. <BR /> <BR />SR 233 amends the wearing of face coverings regulations. The amended regulations were made on 29 October and came into force immediately.”
“The amendment No 12 regulations ensure that there is no restriction on school physical education as a consequence of the restriction on sports events. That would, clearly, be an inappropriate restriction on children's education and a barrier to schools delivering the curriculum. They ensure that, where tables are set up outside a bar or café, they are treated as part of the premises and are subject to restrictions as much as where there is outside seating. We were made aware of instances of businesses seeking to subvert the intention of the original restrictions by having stand-up tables that would have allowed customers to loiter around the premises as much as if there had been seating and, thereby, undermining the effectiveness of the original restriction.”
“My Department was made aware of the impact that the restriction would have had on ongoing productions and responded by making the exception on the condition that extensive protective measures were in place. The industry standards are high, and I understand that this has allowed those productions to continue. Fourthly, they ensure that motorhomes are categorised with touring caravans in the regulations, so that, where sites for touring caravans are closed, the same restriction is placed on the sites for motorhomes.”
“Secondly, they ensure that people who rely on a carer are not prevented from taking individual exercise. We have made sure that, where a person needs assistance in entering a swimming pool, for instance, that is not inadvertently restricted. Thirdly, they ensure that the restrictions on the close-contact sector do not extend so far as to prevent make-up and hairdressing for film and television production that is under way during the period of the restrictions.”
“Although that was, regrettably, not the case today, I thank the Ministers who have shown or are shortly to show generosity with their time and support, namely the two junior Ministers, the Communities Minister and the Justice Minister. <BR /> <BR />I will move on to the issues at hand. SRs 232 and 239 amend the Health Protection (Coronavirus, Restrictions) (No. 2) Regulations in a specific and narrow way. The amendments achieve the following. The amendment No. 11 regulations ensure, first, that the categorisation of tourist accommodation within the restrictions regulations follows the existing formulations in the Tourism (Northern Ireland) Order 1992. That will simply ensure clarity around types of accommodation that were not explicitly set out in the original drafting, such as hostels.”
“<BR /> <BR />Were I not to move the regulations today, they would have fallen, yet, despite their not being my Department's amendments, I suspect that Members will agree that it was important that such an outcome should be avoided. Whilst, in their virtually identical responses to me, both felt that they were not accountable for the regulations, I have already expressed my belief that, during an unprecedented global public health crisis, there should be no space for Ministers or Departments to work in silos. That is why I especially welcomed the previous commitment from the First Minister and deputy First Minister that regulations would be tabled and led in the Assembly by the relevant Minister.”
“The three sets of regulations before the Assembly make specific amendments to the Health Protection (Coronavirus, Restrictions) Regulations and the Health Protection (Coronavirus, Wearing of Face Coverings) Regulations, but, before I move to the detail of each of the SRs, I must place on record my disappointment that neither the Minister for the Economy nor the Minister of Education agreed to my request for either or both of them to lead on the Assembly's scrutiny of the changes — changes, I might add, that were primarily made only following direct requests from those Ministers on specific and detailed amendments.”
“I give the Member the commitment that the terms of reference will be as full and complete as is necessary. I am sure that the trust's becoming aware that two out of those 10 patients who were listed for surgery under the care of the consultant were not on the hospital's patient administration system at that time will also be a major part of the inquiry.”
“Of those, 1,159 patient records were initially reviewed and 271 patients were contacted, and, out of that, there was an identification that nine serious adverse incidents would be initiated. That is why I have decided to establish the public inquiry, under the Inquiries Act 2005, to address those concerns.”
“The Member talks about numbers. As I said in my statement, it is important that, when we get into a situation and a process such as this, which is about the numbers of people who are being seen, the records being looked at and all the rest of it, we do not forget that, behind each of those numbers, there is an individual and a family, as well. It is important that we do not just try to look at this in those pure number terms. <BR /> <BR />With regard to the number that the Member referenced, the more than 2,000 patients were the patients who were in his care during the initial 18-month look-back exercise, which was conducted for the period between January 2019 and June 2020.”
“That side of the work concerns me as well, and that is why we have been in contact with Mr O'Brien's solicitor to make sure that we get full access and that we provide as much support to the patients he saw privately as we do for those known to the Health and Social Care sector. However, patients seen privately by Mr O'Brien can seek that reassurance and support from the Southern Trust. They will be treated equitably with Southern Trust patients.”
“Putting that trust and confidence back into the system is the challenge that I have and that we all have. We have good people working in the system. We have a good health system, and I ask Members to encourage people not to lose faith in all the good people working across our health and social care sector. The Southern Trust has led in providing support mechanisms, and I reiterate that there is a telephone number for people, should they be seeking support. The number is in the statement, and it has been made available. <BR /> <BR />The concern that we have is the number of people who were seen in private practice. Much of that work was carried out in private domestic services. Therefore, it sat outside the regulatory framework, which requires the registration of external assurances of facilities in the independent sector.”
“The Southern Trust will work to make sure that any of Mr O'Brien's patients who need follow-up assessments or interviews, even in regard to work completed by Mr O'Brien, will be seen by other consultants in the urology team. <BR /> <BR />The Member is right to raise a concern about the pressures that our urology service is already under. Like many of our health services, it already has vacancies in posts, so it will put additional strain on that service. Should patients be assigned or designated to go to a urology service, I encourage them to take up that offer because, as has been said, there are many good clinicians still working in our health service across Northern Ireland, and they are there to provide the best health and social care that they can.”
“As I said, that will be the outworkings and some of the work that the inquiry team will look into, as well as how far back it goes and how many look-backs we need to have. As I said in my statement, the initial look-back was at the work completed between 1 January 2019 and 30 June 2020. The trust became aware only when two out of 10 patients listed for surgery under the care of the consultant were not on the hospital's patient administration system at that time. That came to light early this summer. The inquiry will pick up on a lot of that work and answer a lot of the Member's questions.”
“I will give that assurance, because one of the things that the Southern Trust has done is make sure that Mr O'Brien's patients are now being supported by other consultants and receiving the treatment and the updates that they need. As I have said before, anyone who has concerns about whether they fall into the scope of the review or, indeed, whether they were under Mr O'Brien's care, can phone that number to seek help, medical or psychological, should they require it. One of the outworkings of the neurology inquiry was an understanding of the necessity to provide support and care. We possibly failed to do that in neurology, but we want to make sure that we get it right in the urology inquiry, given the concerns that have been raised today.”
“If there is legal action, I cannot comment on it, as the Member will be aware. The terms of reference for the inquiry have yet to be finalised and will not be finalised until the chair has been appointed. However, there will be full engagement on how the terms of reference are drawn up to make sure that we get to the root cause of why this was allowed to happen and, indeed, why it happened.”
“I thank the Member for her point. I do not have that information with me, but I can get it and update the House when we have it.”
“<BR /> <BR />The reason why, today, I am calling on anybody who has been under the attention of Mr O'Brien in a private capacity to come forward to the Southern Trust is so that, through the terms of the inquiry, we can support them as well and make sure that they get whatever medical and psychological support they need and deserve, even having been under Mr O'Brien's private care.”
“Again, that came to light when the trust became aware that two of the 10 patients who were listed for surgery with that consultant were not on the hospital's patient administration system at the time, so that will be included in the inquiry's scope. As the Member highlights, the concern then is the relationship between what was being done privately, often in domestic settings, and how that goes unregulated, unrecorded and unnoted. Unfortunately, that leaves us having to contact Mr O'Brien's solicitors to make sure that he brings forward any records or any patient details that he holds.”
“I am sure that that will be the outworking of all three inquiries that I have instigated and announced since taking over as Minister of Health 10 months ago.”
“I thank the Member for his comments. Unfortunately, I recognise what he says. I stress, however, the point that he made about there being many fine consultants working across our Health and Social Care system. I want to be clear to the Member, the House and the public who are listening that there are very many good people working in our Health and Social Care system. I ask people to put their trust in them. <BR /> <BR />The relationship between trusts and consultants is a piece of work that will be brought to bear in the inquiries that I have announced today. Health Ministers before me have had the same struggle with that relationship and the same level of concern. It gives me no pleasure to announce two public inquiries on the same day. That indicates the concern that I have as Health Minister that things need to change.”
“I give the Member that assurance. One thing that came to light when I met some of the neurology families and the charities was the frustration over communication. That is why I have asked the Patient and Client Council (PCC) to lead on the engagement. It was leading on the work that we did with the neurology families; it will now do similar work with urology patients and families to ensure that they are as fully embedded in the process as possible and kept up to date regularly with each step that is being taken. It is important that they know that the work that is being brought forward by the inquiries is there to support them as well as to identify what went wrong so that we can make sure that it does not happen again.”
“In the outworkings of all the inquiries, there will be a strong thread of recommendations that, I hope, will leave our Health and Social Care system in a far better place from a clinical governance point of view.”
“<BR /> <BR />This is not just a recent manifestation that we have to address, but I hope and am sure that the inquiries will bring things to light so that we can really get to grips with what are — I will not go as far as to say that there are systemic failings in our health service, because it is not widespread — distressing incidents. There are many, many good people working across our Health and Social Care system who need support and need the structures to support them, but, when we find cases like this, we need to ensure that we find and bring to light all that went wrong and all that is needed to correct what went wrong, so that it does not happen again.”
“It brings me no pleasure coming forward to make these statements; in fact, it distresses and upsets me that we find ourselves in the position that we have to make them. When I engaged with the neurology families, the most distressing piece that I heard was that they had lost trust in our health service. That is why I have moved, as the Member acknowledged, for a public inquiry in relation to Muckamore and urology and am now transferring neurology across to that as well to make sure that we get to the root cause of the problems so that we can correct them.”
“The basis and need for the neurology inquiry to be converted to a statutory public inquiry is primarily to ensure that the Independent Neurology Inquiry team has access to all relevant information to draw its conclusions and make recommendations to my Department and to support a timely outcome of the inquiry team's report. Even though the inquiry team is at a very advanced stage of its evidence-gathering process, I do not foresee the decision adversely impacting on its work or timescales. As the Member would expect, I consulted the Independent Neurology Inquiry chair in advance of my decision, and he was fully supportive. I know that the patients and families involved are eager to see the publication of the cohort to recall, and I can advise that I expect to make a statement addressing that publication in the near future.”
“We do not have specific numbers for that, which is why we have been in contact with Mr O'Brien's solicitor to make sure that whatever provisions are put in place also apply to the private group of patients that he was seeing, sometimes in a domestic setting. As I said in my statement, the Southern Trust does not hold those records, so anyone who has seen Mr O'Brien in a private practice or in a domestic setting should come forward to the Southern Trust and seek assistance from that information helpline, which is now available from Monday to Friday, 10.00 am to 3.00 pm. The telephone number is 0800 414 8520.”
“<BR /> <BR />The outworkings of the inquiry with regard to Mr O'Brien will depend on the outworkings of the royal college and the inquiry itself; it is not for me to predetermine them.”
“I thank the Member for his comments. The chair will be appointed under the Inquiries Act and will, of course, be independent. <BR /> <BR />As I said in my statement, the first look back was from 1 January 2019 until 30 June 2020, and further look backs will be decided depending on what they find in that, what the urology review group bring forward and the references from the Royal College of Surgeons. That time frame will be looked at, and they will go as far back as necessary. It is important to instil as much confidence in patients as possible to ensure that they come forward, make contact using the number provided by the Southern Trust and seek the help and assistance that they need.”
“<BR /> <BR />On the participation of patients, as we are in the early stages of the identification of a number of them, they have not been engaged yet, but they will be engaged in the terms of reference of the full inquiry, as my statement detailed.”
“Officials from my Department, the Health and Social Care Board (HSCB) and the Public Health Agency (PHA) have participated in weekly progress update calls with the trust since 10 October, summarising the current position and including the quantity of patient case notes that need to be reviewed and progress on the SAIs. <BR /> <BR />The object of the group is to review the progress of the initial scoping exercise; consider the emerging strategic issues; commission and direct further work as necessary; monitor the impact on urology and related services; ensure coordination with other associated reviews and investigations; and oversee communication across all stakeholder groups. As I said, detailed terms of reference and the membership of the group are attached to the statement and will be available to Members.”
“I thank the Chair for his comments. I apologise for not being able to give him a personal briefing on this; there was an Executive meeting this morning. <BR /> <BR />On the terms of reference of the urology assurance group, as I said, the Department received the early alert from the Southern Trust in July 2020. By that stage, the trust had taken initial actions relating to the concerns, including the restriction of the consultant's clinical practice and access to patient information, notifying the GMC and discussing the matters with the Royal College of Surgeons' invited review service to understand the scope.”
“While I remain convinced that the experience of patients who use our health service is overwhelmingly that of a safe and quality service, these incidents, regrettably, dent the confidence of service users. I fully acknowledge that, and I will do all that I can to ensure that lessons are learned to prevent situations such as these occurring again. I trust that Members will agree that what I have announced today constitutes robust and timely action in a deeply concerning situation. I commend my statement to the Assembly.”
“It is important to note that the inquiry team is at a very advanced stage of its evidence-gathering process, and I want to be clear that I do not intend this decision to add to or alter the work or timescales of the neurology inquiry team, nor do I expect to see changes in the way that evidence has been gathered or public access has been provided. That would not be in the interests of the patients and families affected. They have already waited too long for answers. My officials will be in contact with Mr Lockhart as soon as possible to ensure that the transition is as seamless as it can be. <BR /> <BR />The emerging situation in the Southern Trust causes me and my Department the gravest of concerns.”
“To date, the work of that independent inquiry has been largely unaffected by that non-statutory approach, and I take the opportunity to thank Brett Lockhart QC and his team for their immense efforts in recent months. However, to ensure that, in the closing stages of the neurology inquiry, Mr Lockhart and his team have timely and unfettered access to all relevant information, I also announce that I intend to convert the Independent Neurology Inquiry to a statutory public inquiry under the Inquiries Act 2005.”
“Members will be all too aware that these significant concerns come hard on the heels of the recall of neurology patients by the Belfast Trust, and I am sure that Members will be keen to see the outcomes of that inquiry in due course. I recently met patients and families affected by the neurology recall and reiterated my apology to them for how they had been let down by the Health and Social Care system. To address those cases, as Members will know, an independent inquiry was initiated by the Department. That inquiry was established in the absence of Ministers, when it was not possible to constitute the inquiry under the Inquiries Act.”
“A significant element in all this work, therefore, will be to communicate with and support patients and their families as much as possible in the coming weeks and months. To help with that, the Southern Trust is developing a patient support package to include any counselling and psychological support that is needed, alongside the provision of family liaison and related support services.”
“Members will know that, behind every statistic, there is a patient, a family and their story and experience. These types of exercise can cause upset, distress and anxiety.”
“I believe that that is the best way to ensure that the full extent of the concerns is identified and for the patients and families affected to see that those and all relevant issues are pursued in a transparent and independent way. My officials are preparing the way to get the inquiry up and running as soon as possible. That will take some time, and I would expect that the respective families and patients will have the opportunity to influence the inquiry's terms of reference. I must also be mindful of the statutory duties placed on me to discuss the issues with the appointed chair in advance of establishing the inquiry. Further details will be provided in that regard when they are available. <BR /> <BR />Inevitably, this type of work leads to a range of statistics relating to patient numbers, records reviewed, patient contacts and so on.”
“<BR /> <BR />The remaining issues to be addressed relate to the management of all past, present and future cases that would meet the threshold for an SAI review, as well as establishing why this happened and whether action could have been taken by the Southern Trust to identify and address the apparent deficiencies in the consultant’s clinical practice. Given the large number of cases already identified as meeting the threshold for an SAI review and my concerns that there may be more to come, a different and specific approach is required. The fourth action, therefore, that I intend to take is to establish a statutory public inquiry under the Inquiries Act 2005.”
“Thirdly, in relation to the consultant's private patients who are not known to the Southern Trust, I have requested that Mr O'Brien's solicitors outline how he intends to provide a similar independent process to ensure that those private patients are alerted to issues arising and that their immediate healthcare needs are being met. While the Department has no explicit duty to take this particular matter forward, as part of our wider healthcare responsibilities, I want to do all that I can to safeguard patients who may have received care or treatment in a private capacity from the consultant.”
“Specifically, that group will review the progress of the initial look-back exercise; consider emerging strategic issues; commission and direct further work as necessary; monitor the impact on urology and related services in the Southern Trust; ensure coordination with other associated reviews or investigations; and oversee communication across all stakeholder groups, with patient care being the central focus throughout. I have published the terms of reference for the group alongside the statement. Secondly, the Royal College of Surgeons has been commissioned to carry out an independent review of a sample of the clinical cases included in the initial look-back exercise to determine whether a further, more extensive look-back or patient recall by the trust is required.”
“I need to determine quickly whether a further look-back exercise is required that might necessitate a significant review and recall of a larger group of patients, other than those identified to date, who require a review of their clinical care and treatment. In addition to that, given the large number of cases that have been identified as meeting the threshold for an SAI review, particular action will be required to ensure that matters relating to those patients and their care and treatment are dealt with in an effective and timely way. <BR /> <BR />I have therefore taken the following actions. First, I have established a urology assurance group, chaired by the permanent secretary of my Department, to provide external oversight of the various work streams arising from the initial look-back exercise initiated by the Southern Trust.”
“The impact of the concerns will be felt most severely by the patients and families affected, and, unfortunately, we are only at the start of what is likely to become a long and detailed investigation of the matter. As Health Minister, I want first to unreservedly apologise to the patients and their families for any upset and distress that has been caused. I wish to reassure them that I will endeavour to ensure that they obtain appropriate treatment and support and the care that they need over the coming weeks and months. <BR /> <BR />I propose to take a number of actions to uncover how the situation developed over a number of years without any apparent action being taken by the trust to deal with the practice of the consultant before now.”
“That is also of significant concern to me, as many of those patients may be unknown to the Southern Trust or the wider Health and Social Care (HSC) system. <BR /> <BR />Following a recent media report about the developing situation, the trust has issued a statement and has advised patients that, if they are concerned about aspects of their urology care and require further advice, they should contact the Southern Trust by email or through its urology information phone line. That information line is available from Monday to Friday between 10.00 am and 3.00 pm, and the number is 0800 4148520. <BR /> <BR />I am sure that the House will agree that the issues identified by the trust's review group are of the gravest concern.”
“<BR /> <BR />So far, nine cases have been identified that meet the threshold for a serious adverse incident (SAI) review, and all nine patients and/or their families have been contacted by the trust to inform them of the position of their respective cases. A further six cases are being reviewed in more detail to establish whether those patients have come to harm. <BR /> <BR />The consultant also had a significant amount of private practice. Much of that was carried out in private domestic premises and, therefore, sat outside the regulatory framework that requires the registration and external assurance of facilities in the independent sector in which clinicians may undertake private practice.”