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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“COVID-19 continues to have a devastating impact right across the globe, with the recent surge of cases in Northern Ireland highlighting the need for ongoing vigilance. In order that our health and social care sector is in the best possible position to respond to the virus, and to reduce the impact on local people, it is essential that we take expert advice and learn from international practice.”
“The Member makes a valid point that it has always been there. With domiciliary care, the demand far outstrips the supply that we currently have. That is why it is a significant step that we have increased the number of registered workers since 2009 by more than 3,400. Demand is currently outstripping the provision that we have due to members of that profession being off due to COVID and the community incidence. It is about putting in that support package for employers but also making it a profession that people want to go into. As the Member will know, many individuals who work in the sector are there by vocation because they want to support people in their communities. They do that to a very high standard and are currently under very extreme pressures.”
“It is one of those areas that is continually under pressure due to the reallocation of some of our staff. It is a piece of work that is being done on a regional basis to ensure that there is equity of service across the entirety of Northern Ireland.”
“One of the things that we did through the first wave of the pandemic was to make sure that every provider, every care supplier and every employer had a direct line into the trust. Those supply chains are established through our Business Services Organisation into trusts, and any care supplier can draw down PPE as and when needed.”
“In addition, health and social care trusts continue to support providers with millions of items of free PPE every month.”
“I covered that point briefly in my initial answer. I introduced financial support measures, which covered the period from June until the end of October, for domiciliary care providers who were contracted to the health and social care trusts. Under those arrangements, providers had their incomes supplemented to a level that was 100% of an average of the three months prior to the pandemic. In return for that support, providers are expected to ensure that workers were paid at least 80% of their normal earnings above statutory sick pay when they are on sick leave for reasons related to COVID-19. <BR /> <BR />I have also recently agreed a fund of £5 million for providers to claim against reasonable expenses incurred as a result of the COVID-19 pandemic.”
“I thank the Member for that very specific follow-up question. She asked that in a question for written answer, and I am aware of the reply, but we will look into it, now that she has asked for it, and see whether that is feasible and to make sure that there is a useful outcome should that information be gathered.”
“It will be challenging, given the current financial pressures and uncertainties, to meet those costs and it will need Executive support, but I am determined to do my best to make it happen. Throughout the pandemic, we have also made sure that domiciliary care providers have access to PPE where they need it and that the health and social care trusts continue to provide millions of items free of charge.”
“However, at the onset of the pandemic, many service users and their families opted to suspend their existing domiciliary care package. My Department moved quickly to put in place a guarantee of income for domiciliary care providers to ensure that there was no loss of capacity in that critical service at that time. In return for that guarantee, we asked providers to improve their sick pay for staff unable to work for COVID-19-related reasons. <BR /> <BR />Power to People was clear, and I am clear, that the only way to make the service sustainable in the long term is through improved terms and conditions. My officials are finalising a business case that sets out some of the costs for achieving that.”
“Domiciliary care workers provide a vital service to over 23,000 people in Northern Ireland, allowing them to continue to live independently. While there are sometimes particular challenges in rural areas, given the longer travel distances, we have seen increasing pressures right across our domiciliary care service provision for a number of years. <BR /> <BR />I am pleased to say that, over the past 12 months, the social care workforce has expanded significantly, with an increase of 3,409 registered workers since 2019. While that is very welcome, more staff are clearly still needed. That is not least because the COVID-19 pandemic has had a profound effect on the ability of domiciliary care providers to deliver services. One impact was the number of staff unable to work because they were required to self-isolate.”
“I think that I have answered that. It is something that was raised by the Member's party leader and health spokesperson, and we have looked at going back not just 48 hours but seven days. <BR /> <BR />One of the challenges is people's ability to remember where they were seven days previously and whom they were in contact with. Those are the additional challenges for the programme as we expand backward-tracing. We saw that our online system is easier to use because you sit in front of a computer and can come back to it several times, rather than simply doing it through a single telephone call.”
“The test-and-trace facility that we have in place is always subject to review and improvement. We introduced "Digital First" in the last number of weeks, which involves sending text messages to those who have tested positive. That was followed up by being able to do a self-certification using an on-site website. We have established the StopCOVID NI app, which puts out data as well. We have the ability to go back 48 hours. The Member's party leader and the health spokesperson have brought to our attention the usefulness of going back seven days, rather than 48 hours. We have run a pilot, and, as we strengthen the service that our test-and-trace facility provides, we look to introduce and embed that.”
“I very much agree. I can say as much as I want from the Dispatch Box in that regard, but, when you speak to someone who has suffered from COVID-19 or has lost someone to it, they give the most powerful testimony of the effect of the virus and its impact on our health service. One of the most moving and realistic stories of the experience of people who have had to utilise ICU and ventilation was a testimony given by the Member himself as someone who had experienced it and come through it. With his experience, he would not want anyone in Northern Ireland to have to go through that. That is especially the case with what is termed "long COVID" and the after-effects of infection.”
“We have that workforce but only because we take it from elsewhere. It is not readily available. We cannot simply divert people from a standing stock of health service professionals who are waiting. <BR /> <BR />We have put out our workforce appeal again, asking anybody who holds those skill sets to come forward. They would be more than happily accepted into the workforce. We published that appeal a couple of weeks ago, and, so far, over 1,700 people have been successful in their application for work. Of those 1,700, nearly 900 have been appointed. They are deployed in the service, on standby or on bank jobs.”
“My understanding is that the restrictions include bowling alleys, but I will get that in writing to the Member, so that she has it not just in Hansard but in writing.”
“The Member asks a valid question. I shall answer simply: the regulations supported a five-party agreement and plan that had come together earlier in the week. The implementation, drafting and detail of the regulations was, as anybody who has had experience of drafting regulations will know, more complicated, diverse and intricate than first envisaged because they were not a simple copy and paste of the first lockdown restrictions. They were more detailed, nuanced and targeted on the areas where, we thought, action needed to be taken.”
“What we did last week has now been proven correct, and other areas are following us. We have seen the actions taken in the Republic of Ireland, in Wales and in large parts of England. I am sure that Scotland will shortly take steps in the same direction. What Northern Ireland cannot afford is what we see elsewhere across Europe. The Health Minister in Belgium has, I think, said that coronavirus is now out of control in that country. As Health Minister here, I do not want to have to stand up and say that.”
“I do, and I not think that that should even be questioned. I welcomed and highlighted it when the Executive unanimously endorsed the steps that we took on restrictions for four weeks and the extended two-week holiday for schools. It was a unanimous Executive decision because we recognised the difficulties that taking those steps and making those decisions had across Northern Ireland society, whether it was the impact of COVID-19 on our health service, the economy and even on social interactions among children and in wider society. The Executive did not take the decision lightly, but it was unanimous. The First Minister made a statement here last Wednesday on behalf of the Executive. I was in the Chamber to support her in making those recommendations because, as an Executive, we realised what had to be done.”
“I thank the Member for his question. This afternoon, there will be a section on my Department's website that publishes data and scientific evidence that we have received and that we have provided to the Executive. That will be supplemented and updated with a more detailed breakdown as time goes on.”
“The critical point that we need to get through to anyone listening is that the virus is no respecter of political persuasion, religious belief or economic or social background. As our party leader said, it is an equal opportunities killer.”
“I thank the Member for his supplementary question. The crucial point that he got to was that, for Northern Ireland to get back to where we were after the first surge of COVID-19, we have to do it jointly. We have to do it as one society, one Assembly and one Executive. It is vital that the health message that is put out is consistent. Any weakening or undermining of that message gives succour to those who do not believe it, do not want to believe it or want to undermine it for the sake of undermining it. It is a vital message. We have to come together to support our health service and the front-line workers as they support patients who contract COVID. Our nursing staff, doctors and hospital porters do not care about the religion or political affiliation of their patients, and nor does COVID.”
“One of the things that we all have to do —”
“That is not evidence that we hold in the Department. What we look at and provide is a breakdown of incidence per council area and now by postcode. We do not ask anybody who has contracted COVID-19 about their political or religious affiliations.”
“A joint piece of work was done in which schools supported the contact-tracing programme within schools, supplemented by the Public Health Agency. The Public Health Agency, as far as I am aware, supplied information to the Department of Education and the Education Authority on the number of positive cases and the number of outbreaks, and that allowed the Education Minister to provide that information yesterday. <BR /> <BR />In regard to the specific details of how contact tracing works in schools, intensive work needs to be done during this two-week period to make sure that we provide a safe space for our schools to get back and support the principals and teachers who want to get back and educate our children in a safe environment.”
“Some of the support mechanisms that the PHA put in place to support our schools and allow them to keep open and the collaborative approach between us in the Health Department, the Department of Education and the Public Health Agency have demonstrated that, although the Education Minister reported that there were 1,500 positive cases, such joint working was a benefit and showed how Departments worked well in a short space of time to ensure that the schools could remain open and that we could support the staff and pupils who tested positive and who were contacted.”
“This place has to be honest and open about what that review looks like and the questions that it asks. It needs to see what more we could do for our National Health Service. No matter how many people try to denigrate some of the service and some of our delivery, I maintain that the National Health Service that we have in Northern Ireland and the people who work in it is something that we all should be proud of and be behind.”
“The Member makes a valid point. It is something that I have said in previous answers, even here today. It was the reduction of the staff — not the beds — who could maintain the beds and who could look after the patients who needed to utilise those beds.”
“I thank the Member for his question. I keep referring to the Nightingale facility at the Belfast City Hospital tower. When other places looked to build temporary hospitals, we utilised the footprint that we had. We utilised the staff that we had and we produced that on a regional basis. The surge capacity is still there in that facility to go up to 158 ICU beds incrementally. If we were not utilising those ICU beds for COVID-19 patients, we could be using them for something else or for somebody who needed elective surgery or who needed to use that facility. The fewer COVID-19 patients we have coming through, the more our service can do.”
“I thank the Member for her question. I have said in the House before that, when I need to, I will not hesitate to ask for help, no matter what source it comes from, as it would be a dereliction of my duty as Health Minister not to do that.”
“The ICU bed usage reached a peak of 96 occupied beds in total. That included 57 COVID-19 patients. However, maintaining services at that level was challenging for ICU staff and required significant redeployment from other services. During future surges, I will not hesitate to recommend proposals to the Executive on reinforcing control measures where necessary to ensure that the HSC does not become overwhelmed. <BR /> <BR />The revised regional ICU surge plan provides the ability to flex capacity to a maximum of 158 ICU beds. It is important to note that the level of staffing required to deliver that level of ICU capacity would be impossible to sustain for long and would have a major impact on other services, including complex elective surgery.”
“I thank the Member for that point. It was a challenge. However, one of the inbuilt solutions that we produced, during the first wave, was the Nightingale facility at the Belfast City Hospital tower. During the first wave of COVID-19, detailed plans were developed to increase our ICU surge capacity at incremental stages, producing a regional model for those patients who needed intensive care and ventilation. It used the Belfast City Hospital tower and the regional ICU Nightingale facility. That will continue and has been stood up to be available during future stages. <BR /> <BR />The introduction of social distancing and other measures to control the spread of infection ensured that the number of patients in Northern Ireland using this facility did not get close to full capacity in the first wave.”
“The regional inventory of 348 invasive ventilation devices, which included the 80 ventilators that are expected by the end of October, exceeds the currently anticipated demand. <BR /> <BR />Whilst it is vital that we have the necessary ventilators and other equipment in place to meet the needs of patients, that equipment is unlikely to be a limiting factor in the provision of critical care to patients in Northern Ireland. The most considerable stress across the health and social care system comes from pressures on staff resources, including those staff contracting, or self-isolating because of, COVID. That is why there is no room for complacency and we must all play our part in the efforts to control the virus.”
“I thank the Member for his question. Since March 2020, the critical care network has procured 180 intensive care ventilators and 24 advanced patient transport ventilators to supplement the existing devices in the treatment of the most sick patients. Of those orders, 124 ventilators have been received, allocated and commissioned for use across our trusts. The remaining 80 ventilators are awaited from the supplier, with the order due to be fulfilled by the end of this month. An additional 145 non-invasive ventilation devices have been procured for use by respiratory services in the region, along with 300 high-flow oxygen devices. On 6 October, I published individual trust surge plans alongside the Department's surge planning strategic framework.”
“I thank the Member and welcome him to his usual place as the champion of the Downe Hospital. He never misses an opportunity in the House to extol the skill set and dedication of the staff, of which I am highly appreciative. As I said in an earlier answer, as we get into the second surge over the next couple of months we will continue to look at where we can deliver services safely. If the Downe Hospital's footprint is one that we can use, I am sure that it will be explored.”
“I thank the Member. She wrote to me with a suggestion that was not about a complaint or what we are doing, but actually offered a solution or a different way to look at things. I know that her offer on behalf of that client body has been taken forward and is being advanced in the Department.”
“I do. I have said that many times about the length of our waiting lists across all sectors in the health service. I said that when I took over as Minister. That is why it was important that New Decade, New Approach, pre-COVID, assigned £50 million to tackling waiting lists, and cataract services was one of those key priorities. COVID overtook that, but so did the underfunding of the health service over the past number of years, which left us in a position where we were seeing ever-increasing waiting lists due to an ever-decreasing availability of staff and a reduction in staff numbers.”
“<BR /> <BR />As a second COVID surge and associated winter pressures continue to have an impact on all areas of service delivery, the cataract day-procedure centres will continue to play their part in reducing waiting lists. It is anticipated that, where other elective surgeries may need to be downturned in acute hospital sites during the second surge, the day-procedure units will continue to act as a resource for the region.”
“The centres are designed to improve flow whilst maintaining quality and safety, with the efficiencies gained aimed at improving productivity and reducing waiting lists. Inevitably, COVID has impacted on that performance, although the centres remain open for business. <BR /> <BR />A combination of reduced capacity due to workforce shortages and infection control measures, including social distancing and the use of PPE, has impacted on the service delivery. In addition, the redeployment of theatre, medical and nursing teams, patient cancellations and the need for patient testing prior to surgery have further reduced performance delivery.”
“I thank the Member for his question. Demographic pressures and a misalignment of demand against funded capacity have created challenges across many aspects of elective surgery, including the requirement for cataract surgery. It was for that reason that the Department moved to establish elective care centres, which are now called day-procedure centres. Working across traditional trust boundaries and acting as a resource for the region to improve access and reduce waiting lists, these centres will provide high-volume, non-complex surgical treatments and procedures. <BR /> <BR />Cataract surgery was identified as a prototype model, and three elective care centres for cataract surgery were established in December 2018, offering assessments and treatments at the Downe Hospital, the Mid-Ulster Hospital and the South Tyrone Hospital.”
“I thank the Member for his point and welcome him to the Health Committee, where he has, I think, taken over from Mr Easton. <BR /> <BR />The Member will be aware that, every Friday, the Northern Ireland Statistics and Research Agency (NISRA) produces a weekly update on excess deaths, including those from cancer. NISRA is the official recorder of statistics in Northern Ireland, and, using the information recorded on death certificates, it provides a breakdown of additional deaths and their causes. NISRA provides that data to my Department.”
“<BR /> <BR />Theatre capacity was prioritised for category 2 cancer patients from 29 June to 20 September. In addition, £12·1 million of non-recurring funding has been made available for 2021 for elective care and has been targeted in the first instance at patients with the highest clinical risk who are waiting for a diagnostic test, including those with suspected or confirmed cancer. In the main, that activity will be undertaken by the independent sector providers.”
“We utilised the independent sector during the first wave, and it is my intention to do so again. The impact of COVID-19 on HSC's operating capacity and the significant reduction in productivity that resulted from that mean that HSC has continued to require access to the independent sector's capacity to deliver core services. <BR /> <BR />The Health and Social Care Board (HSCB), on behalf of HSC, entered into contracts with three independent hospital providers from 1 April to 29 June. The contracts were agreed on a not-for-profit and full cost-recovery basis, and they provided trusts with full access to those independent sector hospital facilities. That arrangement ceased on 29 June as the independent sector moved to restart its services for privately funded patients.”
“Dealing with the pandemic continues to create additional pressures on health services. However, the recovery and restoration of screening services remain a priority. It is vital that anyone who has experienced any of the symptoms associated with early-stage cancer contact their doctor rather than waiting for a screening test.”
“The need to maintain social distancing in clinical settings, the implementation of enhanced infection control measures and the continued requirement for personal protective equipment will also present challenges for service restoration.”
“It is likely to take some time for screening services to return to pre-COVID levels, and, inevitably, the pace of rebuilding will be influenced by the progress of the pandemic.”
“I thank the Member for raising that point because it is one of the more challenging aspects, especially with regard to where we were in the first wave. The bowel, breast and cervical cancer-screening programmes were paused from mid-March to the end of June 2020 as a response to the COVID-19 pandemic. All paused screening programmes have recommenced. The immediate priority is to clear the backlog of patients who are waiting for diagnostic procedures and to issue invitations to those whose screening opportunities were paused. This has been happening over the summer, and good progress has been made. <BR /> <BR />A key aim over the coming month is to develop a screening contingency plan, and that will outline the measures and steps that are necessary to maintain population screening during a resurgence of COVID over the months ahead.”
“<BR /> <BR />The Member mentioned the surgeries that are potentially going to taking place in Daisy Hill Hospital, and that is where we look to our proactive and reactive service so that we start to utilise our footprint around the Province, no matter where it is. It used to be the case, when I came into this place, that the biggest cry was that patients would not travel; they always wanted the service on their doorstep. Patients are now willing to travel, as are our surgeons and nurses, but I really want to stop the travel to stop the spread and contamination of COVID-19 in this society. Doing that will allow me to release more of those front-line and critical service health workers back to the jobs and the service delivery and the likes of the services for your aunt, which is where they should be.”
“The Member articulates that sense of frustration, hurt and anxiety that many families across the province have been feeling since we had to cancel surgeries, diagnosis and screening programmes. However, it is not simply, at this moment, about throwing money at my Department. I need the nurses, staff and trained clinicians. One of the largest impacts that we have is that the more people we have going into ICU, the more need we have of anaesthetists, who are moving from theatres to support people who are being put onto ventilators. Highly skilled theatre nurses are then transformed and transposed to support additional ICU beds as well. Every ICU bed that we have to open and support through staff has that knock-on effect.”
“However, we should be under no illusion that there are challenging times ahead. Services are already coming under pressure, and if the number of COVID-positive inpatients increases, that will have a negative impact on the ability to maintain other services. One of my primary aims in the difficult weeks ahead will be to ensure the continued delivery of high-quality diagnosis and cancer services, provided, of course, that it is safe to do so.”
“I thank the Member for his question. COVID-19 has undoubtedly had a severe impact on diagnostic treatment services. However, urgent cancer diagnostics and treatments were delivered during the first wave, and they will continue to be delivered during the second surge, as safely as possible, in COVID-19 safe spaces and using the independent sector hospitals where it is appropriate. The COVID-19 surge planning strategic framework provides the overall structure and parameters within the HSC trusts, and they will develop further plans for managing the response, in the event of further waves of COVID-19. The framework can be viewed on the Department's website. <BR /> <BR />Lessons learned from a first surge of coronavirus combined with the aforementioned regional approach have the potential to continue to improve resilience against COVID-19.”