Robin Swann
North Antrim · Ulster Unionist Party · Northern Ireland
“I thank the Minister for his detailed statement. I know how passionate he is about the subject and how many times he has brought it to the Executive.”
“It has been reported that today will potentially be the warmest day of the year. As we move into the summer and our summer holidays, I want to raise public awareness of wildfires across Northern Ireland, which have been detrimental to farmland and our environment over the past number of years.”
“Wildfires are still having a detrimental impact on our environment and, occasionally, on livestock, but that reduction shows the impact of the Northern Ireland Fire and Rescue Service's proactive approach to educating the general public and engaging with rural communities and schools on its fire safety message, which is to stay alert, not…”
“There has been a lot of talk of sport in this place over the past few days, with everybody concentrating on UEFA. One sport that is going on across Northern Ireland at the minute is cross-community and goes across all age groups without fear, favour or distinction: pigeon racing.”
“I want to put on record that, since this place passed the amendment that recognised pigeon racing as a sport under the 2016 Act, over the past five years, pigeon racing clubs across Northern Ireland have been able to obtain £113,000 of rates rebates through the sports and recreation rate relief, allowing many of those clubs to continue ra…”
“There was much coverage on social media over the weekend of an incident in Staines in England, in which a police car rammed a young calf to bring it under control. It has restarted the conversation about animal cruelty. <BR /> <BR />I am dealing with a specific case in my constituency.”
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“I thank the Member because I know that he has raised a number of issues specifically in regard to ICU nurses and the banding and pay grades. Our Chief Nursing Officer is currently reflecting on that to see what can and should be done and how and when to do it. <BR /> <BR />A lot of the work in the health service is strenuous and stressful no matter where it is, but ICUs are one of the most strenuous and stressful places at the moment. Staff there are under advanced and extreme pressures because of the number of patients that they are working with. That was the additional strain that I referred to earlier in the debate. We are looking at care ratios which are not normal practice. They are being supported by other healthcare workers and other professionals workers but there is stress. There is the expertise of those ICU nurses.”
“We will take this time and this pilot to see what needs to be or can be improved and what does not work. <BR /> <BR />One of the things that we have seen though the network of clinicians, GPs and those in primary and secondary care who have brought forward the majority of the work and recommendations in this report is that we must see primary and secondary care working side by side. One of the things coming out of COVID is real joined-up work and the breaking down of silos between primary and secondary care. I want to make sure that we can maintain that, post-pandemic.”
“I thank the Member for her question. She will be aware, as are many Members, that one of the things that was commissioned pre-COVID was a review of urgent and emergency care and how it could be delivered and improved across Northern Ireland. The publication of the 'No More Silos' report was expedited and published by my Department a couple of weeks ago. One of the things that is in it is Phone First, as an option. The pilot will start tomorrow in the Causeway Hospital to see how it operates. Anybody seeking support from an emergency department can phone first to make sure that they can have quick and timely access to the provision that they need. <BR /> <BR />It is a pilot. It one of the 10 recommendations in 'No More Silos'. If it is successful, the intention is that it will be rolled out across all our emergency departments.”
“I thank the Member for his question. He refers, of course, to Exercise Cygnus, which was brought forward in 2016. The outworkings of that tabletop exercise are now published on the Department's website. There is a detailed breakdown of the recommendations and their outworkings as they were carried out by the Department. They were carried out by the Department when this place was not sitting or in being. They are available on the Department's website. I can forward the link to the Member for his information.”
“I thank the Member for her point. Mr Speaker, I apologise for the temperament in which my previous answer was delivered. It is not usual for me in this House, but it frustrating when I hear accusations levelled against the healthcare staff in my Department and the advice that the Department is giving. <BR /> <BR />What I will say to the Member is that it will take a coordinated, unified Executive response to drive down the rate of community transmission of COVID in Northern Ireland. One thing that we cannot factor into any of the surge plans presented by my Department or the trusts themselves — all six trusts — is the failure of some on the Executive to listen to the medical and public health advice that is brought forward.”
“— on the Executive, we might not be in the position in which we are currently. <BR /> <BR />If I were to bring in a public health professional, I think that one of the things that they would do would be to point out the failure on the Executive to support the recommendations from the Chief Medical Officer, the Chief Scientific Adviser and the Department of Health. Instead, those recommendations were voted down on a cross-community basis, through a cross-community vote that was brought against a Unionist Minister.”
“Apologies, Mr Speaker, but I will not take a lecture on what the Department should bring forward in surge plans, when I brought recommendations to the Executive over a week ago that we should extend our current regulations and restrictions for another fortnight — another two weeks — so that we could take some of the pressures that we are talking about today off our health service and our healthcare workers. For the Member to try to insinuate that it is a failure of mine or of my Department's when, if his party colleagues had perhaps supported me and my Department —”
“Perhaps the findings of such an expert would be in awe. One of the first things that they may question is the utilisation on the Executive of a cross-community mechanism —”
“That group has met, and I am awaiting the outworkings of its report. A piece of work that it has completed is comparing what is currently in our advice to those who are extremely clinically vulnerable with what advice was given to those in England who were advised to shield when it went into its advanced stage of lockdown, in order to see what the difference is and what additional advice we need to bring forward. That work is ongoing, and I am looking forward to the Chief Medical Officer updating the guidance based on the advice coming out of the shielding advisory group.”
“The Member raised that last week during Question Time, and I informed her that the Chief Medical Officer was bringing together the shielding advisory group.”
“<BR /> <BR />I await a response from the expert advisory group on testing. I had indicated that we would bring a paper to the Executive on that shortly, so I am not sure if Sir Jeffrey had received advance notice that I intended to bring that work forward to the Executive. Maybe he was asking for it to be brought forward knowing that it was coming.”
“I did not see the headline, but, in response to a supplementary question that was asked during the earlier question for urgent oral answer on mass testing, I said that my Department's expert advisory group on testing is fully linked into the national mass testing programme, which is being led by the Department of Health and Social Care. We will utilise and work with colleagues across the United Kingdom to make sure that any advances that we use when mass testing becomes available are fully utilised to suppress the further spread of COVID-19. <BR /> <BR />Those plans are progressing, and we are working with a range of local partners and experts on testing pilots across different settings. Those will include universities, meat factories and healthcare facilities, along with repeat testing of asymptomatic healthcare staff and employees.”
“That is why it was critical that we put in place in the Department's mental health action plan back in May that specific response plan to COVID-19 because we all know that that is what will face us towards the end of the year.”
“That includes the dedicated COVID-19 mental health response plan, which provided immediate action across seven of the themes to support mental health and emotional well-being in the face of the pandemic. <BR /> <BR />There have, however, been some changes to how services have been delivered, and, unfortunately, many of those face-to-face meetings have changed to accommodate remote working, which includes phone calls and video communication. So, while we approach that service utilising different tools, the problem still maintains. When we get through the COVID pandemic — I believe that we will get through it — there will be a challenge for our mental health systems, which we are already factoring in.”
“I thank the Member, especially for his mention of Anti-Bullying Week. I think that the House can send out a strong message that bullying should not be tolerated anywhere. I have never condoned or supported bullying, and, being the height that I am, I can assure you that I have often been in receipt of it. Never mind that, I have been in receipt of it in the past few days, as attempts were made to shift me from my position. Having been in receipt of many a bullying incident in my younger days, I can assure you that it is hard to shift from that mentality. Young people who are on the receiving end of bullying incidents in the early stages of their life carry those mental challenges through into their adult lives. <BR /> <BR />On 19 May, I published my Department's mental health action plan.”
“I welcome the announcement today by the Minister for Communities, who is from the Member's party, that she has increased the payment rate for those who are seeking COVID support. That is done through the Department for Communities. As I have said in the past, the response to COVID and test, trace, protect and isolate is a cross-Executive effort, not solely a matter for Health.”
“In the week preceding 10 November, of the 3,519 cases that were transferred to test, trace and protect, 3,317 were successfully contacted. That is 94·3%, even with that high level. Of the 4,987 close contacts that were identified, the test, trace and protect system was able to complete 4,898 contacts. That is 98·2% of successful contacts being made from those contacts. That far exceeds what is deemed to be an effective system. Most effective systems are graded at being 80% effective or above. Even with the high numbers coming into our test, trace and protect system, it was still achieving high levels of successful percentage outworkings. <BR /> <BR />In the past, the Member has asked in this place about the protections and the support mechanisms that are put in place for anybody who tests positive.”
“Regarding the Member's criticism of our test, trace and protect system, when the PHA was in front of the Health Committee, he also used language that, I think, was unfair. Last week, I gave an update to the House during Question Time on our test, trace and protect system. At that point, we had 220 tracers employed over three different employment contracts so that we could flex up and flex down the number of tracers who were working at any time. Test, trace and protect works best when we have a low number of cases, and that is where I agree fully with the Chair of the Health Committee. That needs to be our strategy, not how we increase beds or how we improve test, trace and protect; it is how we reduce the number of people with COVID in our community. That is where the real challenge is. <BR /> <BR />I will update the Chair.”
“When we have to utilise more of those beds, that is where we see the pressures on the number of beds across our health and social care system.”
“At the start of the pandemic in February, we identified where we were going to need additional skills. Staff members across our health and social care sector started to upskill and retrain in what would be a very critical part of our action against COVID: the maintenance and utilisation of ICU beds and the challenge that that brings those staff members not just physically but emotionally and mentally. That is why we put in place mental supports for those staff as well. <BR /> <BR />The Member indicated that our hospitals are operating at overcapacity. Much of that is in regard to what are termed our "general medical" beds, which are there for general medical conditions.”
“I thank the Member for her supplementary question. It is important that she does not confuse the two issues of bed numbers and overcapacity, including ICU. Since March, the critical care network has had its surge plan in place. Getting to 158 ICU beds involves the utilisation of the Nightingale facility at the tower. It also involves — this is one of the most stressful points for our ICU nurses and specialists — moving away from the 1:1 care ratio. Moving to our high surge and then our critical surge, which allows us to flex up to those 158 beds, means moving away from that 1:1 ratio. No matter how much I am challenged or criticised about what we have not done over the past two or three months, one thing that we cannot do in two or three months is train an ICU nurse.”
“Behind what may be construed as party political press releases being issued, that is the truth of the matter. It is testament to the tireless dedication of our Health and Social Care staff. I challenge any Member to stand in the shoes of any of the medical directors across any of the trusts for even a single day to see the level of preparations that they had made and, even with all that, the gravity of the decisions that they now have to make every day. Were we ready? Yes. However, I could never have planned for the situation where the scientific and medical advice given to the Executive was blocked. Only when the spread of the virus is minimised can we hope to reduce the COVID-19 pressures on our health service. That is what is really needed, and it is needed now.”
“In terms of inpatient or day-case procedures, 4,859 were delivered in April, compared with 13,301 in October. Similarly, there were 39,907 outpatient reviews in April compared with 56,071 in October. I could go on. Overall, there was over 73% more activity in October than April. That was because of our surge plans and rebuild plans.”
“I have also taken action to commission the critical care plan through the critical care network. That allows for the potential to flex up to 158 critical care beds through the use of our Nightingale facility at Belfast City Hospital. I have also commissioned an additional Nightingale facility on the Whiteabbey Hospital site. That will be an intermediate care facility that will provide up to 100 additional step-down beds. It will be operational on a phased basis in a matter of days. <BR /> <BR />The insinuation that not enough planning or preparation for future surges was undertaken is not correct; in fact, it is deeply unfair on our clinicians and HSC managers who produced the plans. During the first wave, our HSC system delivered 12,150 new outpatient consultations in April. There were 29,163 in October.”
“Our latest published statistics demonstrate the scale of the problem. As of 30 June, this year, we carried more than 5,000 vacancies across the health and social care system. The largest numbers were vacancies in relation to nurses and midwives, with a total of 1,786 across the system. In addition to those vacancies, the system is experiencing a higher than normal rate of absence due to COVID-19. The latest available figures show that almost 1,900 staff are absent across the health and social care sector, ill with COVID-19 or self-isolating. That adds 2·6% to the absence rate across the system. <BR /> <BR />I have taken action to try to address that issue through the workforce appeal. The response, to date, has been positive, with more than 5,000 applications, of which more than 3,000 are from Health and Social Care (HSC) staff.”
“Mr Speaker, with your permission, I will take slightly longer than the two minutes to answer. I believe that this is an important issue. <BR /> <BR />When I published the surge planning strategic framework on 6 October, I was clear that our health and social care service was likely facing the most challenging period in its history. That prediction is coming to fruition, with our health service under immense and sustained pressure. The surge planning strategic framework includes 19 key actions. I can confirm that 11 have been completed and eight are ongoing. The trusts are managing the pressures that they are facing within their available capacity and in line with their individual surge plans. <BR /> <BR />The key issue facing our health and social care service is staffing capacity. Let me be clear: our health service is our staff.”
“I thank the Member. The importance of getting the flu vaccine has been well rehearsed, especially, as I say again, as our colleagues across GP practices, practice nurses and Community Pharmacy go to the effort of organising the flu programmes and flu vaccination programmes that we have seen across the country. I encourage everybody to utilise the slots that they are offered, because they are being delivered in a timely and efficient manner to make sure that we not only get the efficient uptake of flu vaccines here in Northern Ireland but make best use of our professionals' time.”
“I have gone through the percentages, especially in the over-65s, we had ordered enough for an 85% uptake with a 7% wastage rate, but, on top of that, we have received additional vaccines from the Department of Health and Social Care (DHSC) in the UK.”
“That is inaccurate, and I stand over that comment. It is in Hansard as well. <BR /> <BR />In regard to the uptake, work is ongoing by GP practices, the Health and Social Care Board, Community Pharmacy and the PHA to make sure that we can roll out the second batch of vaccine, which has now been delivered to Northern Ireland. The programme was paused because of the success of the delivery of those mass vaccination programmes, which were delivered by GPs in the first instance. We actually got in front of the delivery of vaccines that we were expecting and the additional ones that we had ordered over the summer. They are now in Northern Ireland and will be distributed to GP practices, as necessary, to meet the demand.”
“I thank the Member. He made a comment about the PHA: I noted his exchange with PHA officials in the Health Committee a number of weeks ago, and I do not think that his comments were edifying. I do not think that an elected Member of the House should speak to any official in that way, no matter how much they disagree or want to challenge the evidence that they bring or what they say. I do not think that how the Member spoke to the PHA officials who were before the Committee did him any good. <BR /> <BR />In regard to my comments about the reporting, I actually said that the BBC report had incorrectly stated:”
“I thank the Member. He has raised that with me in correspondence. We talked about the protocols and the advances that we have seen in GP surgeries. The drive-ins and the underground car parks are great advances, but our GP colleagues, community pharmacy and our practice nurses have always made available the ability to walk into clinics, should they be in community halls or church halls, so that people can avail themselves of the flu vaccine. What is being done at GP level is that, if people do not make themselves known, other ways of obtaining the vaccine will be made available to them. I think that I have given that answer to the Member in writing as well.”
“To back up what the Member said, it is important that any COVID vaccine is safe to use and that we promote it as widely as possible. Those who are eligible to get it should get it. There is no barrier, for want of a better word, and nobody who has contracted COVID in the past or tested positive for COVID will be ineligible for the vaccine.”
“One of the points of concern expressed by the GPs that I share is that we need to get the flu vaccination programme out of the way before we can commence the COVID one. There is advice and guidance that there should be at least three weeks between the vaccines being delivered to ensure that both have the maximum effect. <BR /> <BR />In regard to whether there are any known studies, I am sure that that is ongoing. As we are well aware, neither of the two COVID vaccines that are now reported to be available have gone through the full clinical and safety trials for utilisation in the community, and, until that process is completed, I do not think that they will be used widely in the United Kingdom. That work still has to be done.”
“That is not one of the vaccines that were part of the UK pre-procurement exercise, but I am led to believe that the UK Government are in negotiation with that company to make sure that, if it becomes available safely on the market, they will have access to it. By default, we will get our share as part of the United Kingdom. <BR /> <BR />It is widely believed that some vaccine will be available by the end of this year, but it should not be perceived as a panacea for everything or for COVID. Any of the experts who have spoken about the efficacy and utilisation of vaccines have indicated that it will be well into next year before we see the real effect of the vaccines in combating COVID in the community.”
“I thank the Member for his question. I am here to answer questions about the flu vaccine, but I am happy to talk about the coronavirus vaccine as well. What we saw in the media was an advance statement by a company that it has a vaccine that is 90% effective. That is one of the vaccines that the UK Government have pre-bought, so we will be part of that uptake, as I reported to the House last week. Off the top of my head, our allocation will provide enough vaccine for, I think, 275,000 individuals in Northern Ireland. <BR /> <BR />There are reports today of another vaccine coming on to the market, which its makers claim to be 95% effective.”
“I thank the Members for his question. Following the meeting today, I asked for weekly updates on where we are with the flu vaccination programme, not just on the distribution of the vaccine but on what the percentage uptake has been across all groups. While we are specifically talking about the over-65s today, a number of other groups are also eligible for the flu vaccine, including all pregnant women, all individuals under 65 with current chronic medical conditions, primary-school children and front-line healthcare and social care workers who are employed by a trust. A number of additional groups are eligible for the flu vaccine, and I have asked the PHA and the board to make sure that I receive regular updates on how the remaining part of our flu vaccination programme is progressing.”
“Our flu vaccination programme is well ahead of schedule of where we would be in any normal year, but, as everyone in the House, including the Member, knows, this is not a normal year. I welcome the Member's acknowledgement of the GPs, community nurses and community pharmacies that have taken forward the vaccination programme. <BR /> <BR />Everyone over 65 is eligible for the flu vaccine, no matter where they are resident.”
“I thank the Member for his questions. One of the points that the CMO has been making in the last number of weeks and months is about how vital it is that nobody should contract flu and COVID at the same time.”
“I thank the Member for her point. As I said earlier, our original estimates were for an 85% uptake target, which equated to 275,000 vaccines. We actually purchased 286,000. We have received an additional 10,000 and, as I said to Mr Chambers, an extra 15,000 has been agreed by the Department of Health and Social Care for part of the Northern Ireland allocation, so we will have in excess of 311,000. Our current population of over-65s sits at 323,000, so there is enough there — not for everyone, but for the vast majority — and far in excess of the percentage uptakes that we have seen in previous years.”
“The plans are progressing with a range of local partners and experts for testing those pilots across different settings, including healthcare settings. That will include repeat testing for asymptomatic healthcare staff. The new test for asymptomatic people aims to identify those at risk of spreading the virus, reduce the risk of onward infection and to find positive cases earlier to actually reduce transmission of the virus. Those pilots are something we are watching, and watching with interest, to make sure that the equipment is effective and efficient enough to bring benefit to what we want to do.”
“They are actually testing the viability of the testing machines, their protocols and their utilisation to make sure that they use them in the best way to support the residents, the patients and the staff. <BR /> <BR />With regard to testing hospital workers, which I think was part of the Member's question as well, in line with our current testing protocols, testing is prioritised for all our healthcare workers, and that includes hospital staff who are symptomatic or whose household contacts are symptomatic, to help enable those essential workers to return to work as soon as possible. The position with regard to testing of all hospital staff is kept under active review. <BR /> <BR />With regard to the new testing technologies that I was talking about, there are emerging plans — sorry, it is the technologies which are emerging.”
“With respect to the Member, I am aware that this is something that has been raised in a number of press releases from her party, although not connected directly to the flu vaccination programme. What I will say to the Member is that the number of care homes that are currently indicated as having outbreaks is due to our positive and reactive testing programme that we have introduced — something that I know the Member supported. The Commissioner for Older People supported it as well. <BR /> <BR />The Member spoke of a number of pilot programmes that are currently ongoing in Liverpool and, I think, in a number of care homes in the south-east of England which have been in the media today. One of the things I will say is that we are fully plugged in to those pilots, because that is what they are.”
“We must make sure that GPs, Community Pharmacy and all the other aspects have clearly identified those people and that we put in place a process and locations for doing it safely. I talked earlier about some of the fantastic work that GPs and community pharmacies have done in delivering mass vaccination programmes. I do not think that any of us in the House, even this time last year, would have envisaged flu vaccination programmes being completed in underground car parks, but those have proved to be highly effective and deliverable. In most cases, people were able to do it in the comfort of their car. It is about making sure that we get the communication phase right when the COVID vaccine becomes available.”
“I thank the Member. Her last point is bang on the money. It is about communication. As I said, I had a conversation this afternoon with the PHA and representatives of the board about how we get right the communication on how the distributions of the vaccines work, especially the COVID vaccines. There are now two COVID vaccines on the market, one of which the UK has pre-ordered. There are logistical challenges regarding how that is managed because it has to be stored at -70°c for a period before it can be stored in normal fridges for the last five days before its use, so there is a large piece of logistical work. <BR /> <BR />However, it is also about communication to identify the cohorts that will be eligible in the early stages.”
“I thank the Member. He makes a valid point. As I said earlier, specifically for the over-65 age group, we had set an 85% uptake target, which is 275,000 people. We approved the purchase of another 10,000 vaccines, which arrived on Thursday 5 November. I can report to the Member and the House that, having contacted Matt Hancock, over the last 24 hours, we have been able to obtain an additional 15,000 vaccines. So, in addition to the vaccines that we had ordered to achieve the 85% target that we set ourselves, we now have more vaccines on the way, which will be put into a further programme of vaccination.”
“I thank the Committee Chair for his questions. The planning that we did this year was for an uptake target, specifically among the over-65 cohort, of 85%. As I said in an earlier answer to Mr McGrath, last year, we saw a 74·8% uptake and, the year prior to that, a 70% uptake. The numbers that we ordered to target an 85% uptake even allowed for a 7% wastage rate, which is normal in a large-scale vaccination programme. Those calculations were done by the PHA. We ordered that additional vaccine over the summer to complement our original order, which was made at the start of the year to allow for production and delivery.”
“<BR /> <BR />The Member's assertion was, I think, an attempt to talk down the programme, but the early uptake was exceptional, as was the delivery and coordination between the PHA, GPs, Community Pharmacy and nurses. Now that we have those structures in place to enable us to run vast vaccination outreach programmes, should they be in community halls, church halls or car parks, including underground car parks, where we have been doing in-car vaccination programmes as well, it sets us up with a sound basis for what the COVID vaccination programme will look like once that vaccine becomes available.”
“I do not think that it is in contrast, if you listen to what the PHA actually said. There was a pause in the supply of the vaccine. The Member may not be aware that the delivery of flu vaccines comes in two batches; the initial batch is the one that we ordered at the start of the year; the additional batch is the one that we ordered in the summer. Some clinics were paused to allow for the delivery of the second batch. In the initial set-up of the mass flu vaccination programmes, we saw an exceptional uptake. I referred to that when answering a question from the Member's colleague Paula Bradley in the House last week. Some GPs reported that 499 people attended in response to their sending out 500 letters. In the past, the maximum uptake was in the region of 75%.”
“We use different strains for children, the under-65s and the over-65s. The concern seems to be in the over-65 population, and my original answer details how our order equates to an uptake of 85% in that cohort, which is far in advance of what was used this time last year, when we had an uptake of 74·8%. We have ordered additional vaccines. On top of those, we are getting additional vaccines to ensure that those cohorts can be vaccinated. We are working with GPs to ensure that we can get those vaccination programmes and mass vaccination events back up and running in order to ensure that vaccinations are given in a timely fashion.”
“I thank the Member for his questions. Prior to coming to the House, I had a meeting with representatives of the Public Health Agency (PHA) and the Health and Social Care Board so that we could discuss how that communication failure came about. A meeting of all parties last week seems to have led to what I think has been described as inaccurate reporting by the BBC. Its report incorrectly stated that Northern Ireland did not receive its full vaccine quota. One million doses were ordered; the BBC claimed that between 500,000 and 600,000 were delivered. My first answer has assured the House of the number procured, ordered and delivered to Northern Ireland. <BR /> <BR />The Member mentioned uptake, and I am due to receive a report by the end of this week on the normal uptake of the different flu vaccines.”