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 said before in this place that, when Bengoa started, we were asked to run a heath service and a transformation service. Recently, we have been running a health service, a transformation service and a COVID service. The more pressure that comes on our general services, the less that we can do on the first two. Sinead McLaughlin referred to the specifics around the Derry City and Strabane council area and how others could learn from that. One of the things that we saw when the additional restrictions went into the Derry City and Strabane council area was a reaction from elected representatives in Newry, Mourne and Down, and Mid Ulster and in other council areas, who really stepped up their messaging to the general public.”
“She will recall the debate that we had last week, where I brought forward our winter surge plans and paused our rebuilding programme, because we had an indication at that stage that we would have to look at steps to protect a service that is already fragile and to support a workforce that is already under pressure, but still provide the essential services that we see as core to our health service. The surge plans across trusts show how we can do that, but it is all dependent on how many COVID inpatients and ICU patients we actually end up with. Every step that we take that reduces the number of inpatients and ICU patients means that we can do that bit more that is in our surge plan in the normal running of things.”
“Her specific question was about what the Department and the trusts have done to prepare for the second surge.”
“We learn to live with the virus by following the guidance and restrictions that the Executive bring in. That is how we make sure that people live with the virus and do not die from it. The message that she relayed to those spreaders — the people who do not care — was this: "Stop it and wise up". I thank her for that blunt message, because it is what is needed to get through to that very small minority who think that they are above this virus, immune to it or just do not care. That is the bit that worries me.”
“Thank you, Mr Speaker. I will now refer to Members' comments, beginning with the Deputy Chair of the Committee's. She rightly pointed out that we have to get ahead of the virus. A line that has been used many times is this: the virus does not spread itself; it is our actions that spread it. Every recommendation from and every step taken by the Executive or the Department of Health is therefore about breaking those infection chains. Members have referred to this, but when these regulations came in, the majority of our transmissions were in households. That has now changed to community settings, so our reaction has to be to move with the virus. <BR /> <BR />It is often said, and it is a phrase that the Deputy Chair of the Committee used, that we have to learn how to live with this virus.”
“They did a fantastic job in the first wave. <BR /> <BR />I will come back to my comments after Question Time.”
“We can do that only by stripping ICU nurses from across the entirety of our health service in the Province. When we put that number of people into ICU beds, we need anaesthetists from across the Province. When we take anaesthetists out of our health service, no matter where they work or for which trust, that has an adverse impact on the number of operations that can be performed. When it comes to answering the question of how much we did and are doing to prepare, I say that I cannot create nurses or anaesthetists in two or three months. Beds are a physical thing, but I have said this before and maintain this view, and all of us in the House have championed them: it is the resilience of the health service staff and their flexibility and adaptability wherever they work across the health service that we rely on.”
“Long before COVID, when Bengoa proposed his changes, he made it clear that we needed to run a health service plus a transformation service. When the initial wave of COVID set in, we transformed to a COVID service, and many of our day-to-day services and elective surgeries were challenged and cancelled. We have got to a place in which we do not want that to happen again, but, given the current trajectory, if we do not have interventions and have them soon, we will have to revert to a COVID service, for the simple fact that we cannot turn people away at the door of a hospital because they have COVID. <BR /> <BR />When it comes to re-establishing ICUs and the specialty regional approach that we took in the tower block, we will need 100 nurses for 15 ICU beds.”
“The Chair indicated that the issue was the abuse of bubbles and how, if somebody was able to turn a bubble on and off in a matter of hours, if not the next day, that would start to undermine the whole principle and the benefit that bubbling brings in how we manage the transmission. <BR /> <BR />Where we were when the regulations were made — a number of Members referred to this — is a very different place from where we are today. That is why they have been and will be superseded. <BR /> <BR />The Chair then spoke as Sinn Féin's health spokesman. Given the current spread and trajectory of the virus, I can openly and honestly say, hand on heart, that it is clear that our health service is under pressure. I have said many times in the House recently that we have been trying to run three health services.”
“<BR /> <BR />I picked up on the Chair's comments about a lot of this being done by direction and about the departmental analysis that is allowed, the timing and the openness that the Committee gets. Some of the struggles and challenges are because the regulations are being brought forward by Health and many of the underlying issues are outwith the Health remit, such as soft-play areas, pubs and licensing. The regulations, however, fall to the Health Committee to analyse, and that is why I endeavour to ensure that my Department provides as much support as it can. <BR /> <BR />The Health Committee's conversation about bubbles was brought back to me.”
“In the current context, things move fast, and the observations and concerns of Members and colleagues are taken on board as we develop policy and work on the next set of amendments. The public must have confidence that the Executive are not acting without scrutiny, and, for that reason, I am happy to respond to questions and comments raised by Members during the debate. <BR /> <BR />As always, I thank the Chair and the Health Committee for their scrutiny of the regulations. As Mr Sheehan said, in normal times, the Health Committee would not be doing this, and the House would not be accepting the regulations. In normal times, I would not be introducing them. It is as simple as that — I have said that on a number of occasions — but we are not in normal times.”
“I am always at the House's call, and I have been since this place came back. <BR /> <BR />I am grateful to Members for their contributions to the debate. I deliberately widened my opening comments beyond the regulations that we are talking about today, because I am cognisant of the fact that, when we have come here to talk about such regulations, there has been a wide-ranging debate. Given where we are today, I thought that it was only just and right that the House had the opportunity to have a wider discussion. I appreciate the degree of goodwill that the Assembly has shown, given that this is not the usual process and that legislative scrutiny of the regulations is being applied only after the event. Nevertheless, it is important that scrutiny takes place in order to examine and comment on the measures that have been taken.”
“Mr Principal Deputy Speaker, I would prefer to start and see how much I get through.”
“I would say that it will take more than that, Mr Principal Deputy Speaker.”
“The role of our Chief Medical Officer and Chief Scientific Adviser is to provide advice from the health perspective. Other sectors will, quite properly, have additional issues and concerns. It is, ultimately, for the Executive to consider all factors together. It is not, nor would it be, helpful to focus on any of those perspectives in isolation. I will continue to respect the Executive by not making public the guidance that we give to them before they have had time to discuss it. <BR /> <BR />The purpose of the motion is to allow Members to examine the terms of this set of regulations and to debate their merits. I welcome the opportunity to address those issues in the Chamber, and I look forward to colleagues' contributions.”
“I inform the House that I provided the First Minister and the deputy First Minister with detailed recommendations on where Department of Health decisions should be taken. I confirm that I submitted a paper yesterday evening to the First Minister and the deputy First Minister spelling out the detailed advice from the Chief Medical Officer (CMO) and the Chief Scientific Adviser (CSA). That paper recommends that decisive action should be taken urgently in order to save lives, prevent the health service being overwhelmed and protect non-COVID services to the greatest extent possible. <BR /> <BR />We all in the House realise that the issues are complex and that we need to take into account a number of perspectives and implications.”
“Seven days ago, the seven-day average of the total number of positive tests across both pillars was 4·1%. In the last R paper, it was 8·94% — more than a doubling. The number of new positive tests among the over-60s in the last seven days is up from 189 to 420. COVID-positive hospital admissions in the last week are up from 43 to 77. The seven-day average number of COVID-occupied hospital beds is up from 44·7 to 76·1. The number of inpatients with community-acquired COVID is up from 51 to over 130 today. <BR /> <BR />There has been commentary in the public domain, but I firmly believe that decisions that are taken by the Executive should be dealt with in the Executive and not in the media.”
“The deterioration of the situation since 10 September has meant that the localised restrictions have now been applied across all of Northern Ireland, and even further restrictions, commencing a week ago, have been brought to bear in the Derry City and Strabane District Council area. This is the current direction of travel, reflecting the increased levels of infection and the increased risks to health. <BR /> <BR />At this point, I would like to read a number of things into the record. I alert Members to the fact that the average number of new positive tests per day over the last seven days has increased from 241·4 to 518·6 — a doubling. The seven-day incidence, based on new positive cases per 100,000, is up from 88·9 to 191·1 — again, a doubling.”
“Care homes and hospitals in those areas were advised to significantly curtail visits as soon as was practicable so that one member of a family is permitted to visit once a week while the restrictions apply. Medically vulnerable and older people living in those areas have also been asked to be particularly careful in following the advice on limiting household contact, social distancing, handwashing and wearing a face covering, given the local levels of COVID-19. The regulations place a significant imposition upon individuals and families, preventing them from socialising at home. <BR /> <BR />The Executive do not take these measures or any measure like them lightly, but the regulations are made for the purpose of preventing greater harm through the spread of the virus and the sickness and death of others.”
“Those are where all the people in the gathering are members of a bubble — the regulation provides the definition of bubbling — or where people are gathering for one of these specific purposes: childcare; building or maintenance works; the provision of a trade or profession at the home; the provision of care or assistance to a vulnerable person; giving or receiving legal advice or assistance or fulfilling a legal obligation; the provision of emergency or medical assistance to any person; a marriage or a civil partnership where one of the couple is terminally ill; a funeral or an event associated with a funeral; or a house move. <BR /> <BR />At the same time, advice was given to those living in the affected areas to avoid unnecessary travel outside the protected areas.”
“Principally, the regulations state that, in respect of the protected area, no one may participate in a gathering indoors in a private dwelling that consists of persons from more than one household, and no one may participate in a gathering outdoors at a private dwelling that consists of more than six persons or consists of persons from more than two households. <BR /> <BR />A number of important exemptions apply to allow gatherings to take place outside those limits in a number of specific circumstances.”
“The amendment regulations before the Assembly today placed additional restrictions upon gatherings at private homes within a defined period, which is referred to as the emergency period, and within a defined geography, which is referred to as the protected area. As Members will recall, on 10 September, the restrictions were initially introduced solely for Belfast and specific postcodes in the Ballymena, Glenavy, Lisburn and Crumlin areas, and BT60 was added on 18 September. Subsequently, from 21 September, they have been applied across Northern Ireland and remain in place. <BR /> <BR />The restrictions imposed by the regulations relate solely to the domestic sphere. They limit social interaction in homes and gardens, with the intention of preventing the spread of coronavirus.”
“However, through the support of the House and the Executive, we can get a health service that has been invested in and of which we can and should be proud.”
“To counter that, I have also heard the example of a mother who phoned the GP about her child, the GP referred them to a COVID centre because they had COVID symptoms, but the mother did not want to take her child there in case they caught COVID. As we go through the pandemic, education is needed on the different avenues that are being opened up to ensure that people access healthcare provision when and where they need it. There is a large job of work to be done by the Department and the medical professions to ensure that people get access. It is not good enough and needs to be better. It is one of the things that, as Minister, I have tried to do. The pandemic has set us back quite a bit.”
“We have GP vacancies that we cannot fill. We are looking to invest in that through the medical centre at Magee and the nurse training places that we are bringing forward, but there is no doubt that we do not have the number of people in our health service that we need to make it readily accessible. <BR /> <BR />I say to the Member's constituents that that is not a service that I want them to experience. I want their GPs to be as open and as accessible to them as possible. I am working with the Royal College of General Practitioners and the British Medical Association's general practitioners committee. They have issued statements and have encouraged their members to be as open as they can and to access as many patients as they can.”
“I thank the Member for her comments. As I said, I listened to the Finance Minister's statement before I came into the House. He spoke of nine years of underinvestment in the health service. I used that line in the House when I took over as Health Minister. We are now reaping the shock of that underinvestment, where we do not have the number of beds, we do not have the number of staff and we do not have the access to the health service that we, as a population in Northern Ireland, deserve. We do not have a health service that our staff working in it deserve, because of that structural, long-term underinvestment. This place has a place in and a responsibility to bring to bear on that. <BR /> <BR />When we talk about access to other services, it is because we have in the region of, I think, over 2,000 nursing vacancies.”
“When I hear the call from the Royal College of Surgeons, it is not a surprise to me. I have engaged with it, and it has carried forward that message about protection. We looked to the elective day-care centres in Lagan Valley and established the orthopaedic centres so that we could create facilities that are COVID-neutral. They will never be COVID-free — we can never guarantee that — but that is why we are taking those steps. <BR /> <BR />Regarding my statement, the Member will note the announcement that I will publish the cancer strategy tomorrow, which will deal with haematology and oncology. We know that we have to address those and to get on top of them on a regional basis and that we should no longer deal with them in the way that we were across trusts.”
“No, I do not, because the Royal College of Surgeons has been part of the medical advice that we have received. The Royal College of Surgeons has representatives who sit on the rebuilding board as well, and I meet them regularly. The point that it has made about ring-fencing beds and staff is about protecting those staff, beds and facilities from COVID and ensuring that we can continue with the surgery that we have started. The ring-fencing of beds and staff is an ask that the Royal College of Surgeons has been making for a long time. <BR /> <BR />The Member will know that our health and social care system is already badly bruised and scarred by COVID, but it is picking itself up and, once again, is ready to care for all of us, despite the immense pressures on the staff.”
“I wish him well and welcome him back to the House.”
“I welcome the Member back. <BR /> <BR />In an earlier question, Mr Nesbitt asked what I could say to those who deny that COVID is real and say that it is a hoax or a myth. I will ask the Member to update us later, in some shape or form, on whether what he went through felt like a hoax, a conspiracy or a myth. Anybody whom I have spoken to who has come through COVID-19, any family that has lost someone due to it or any member of our Health and Social Care staff who has treated somebody with it knows that it is not a hoax. <BR /> <BR />We use a number of tests. I do not have the details of the specificity or reproducibility of the tests with me, but I can provide them to the Member, because that question has been asked on a number of occasions. Different tests are used in different locations. I will get that to the Member in writing.”
“The target groups — the current groups eligible for free flu vaccination — are everyone aged 65 and over, pregnant women, those aged under 65 in clinical at-risk groups, those in receipt of a carer's allowance or those who are a main carer or the carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill, all children aged two to four, all primary-school pupils and front-line health and social care workers. The delivery of the flu vaccine to our health and social care system has started. A number of peer vaccinators have been trained and are already delivering the flu vaccine across the health and social care system.”
“While equipment will not be a limiting factor in the provision of critical care to patients in Northern Ireland, there is considerable stress on limited staffing resources, and there is no room for complacency. <BR /> <BR />Last year, 2019-2020, 670,000 flu vaccine doses were administered in Northern Ireland. Over 1 million doses have been procured for this year's programme in order to meet anticipated increased demand for eligible groups and to allow for the vaccination of additional priority groups. The amount procured for Northern Ireland this year is the maximum amount available to order to date, given global demand for the flu vaccines.”
“Since March 2020, the critical care network has procured 180 intensive care ventilators and 24 advanced patient transport ventilators to supplement our existing devices in treating our patients. Of those orders, 124 ventilators have been received, allocated and commissioned for use in HSC trusts. The remaining 80 ventilators are awaited from the supplier and are expected at the end of this month. In addition to that, 145 non-invasive ventilator devices have been procured for use by respiratory services in the region, as well as 300 high-flow oxygen devices. Each trust has identified local surge plans to meet additional surge demand for COVID-19 and non-COVID-19 patients, and the regional inventory of 348 invasive ventilator devices, which includes the 80 expected by the end of October, exceeds the current anticipated demand.”
“<BR /> <BR />There has been good working not just between me and my ministerial counterpart in the Republic of Ireland but between our Chief Medical Officers, Chief Scientific Advisers and our public health agencies. There is a good understanding of what we are doing. A memorandum of understanding formalises that engagement on information. There is now a request that our public health agencies work more closely together to identify outbreaks and the causes of the outbreaks that we have seen in border regions.”
“The Member may not be aware, but her party colleague, junior Minister Declan Kearney, and I met at the North/South Ministerial Council in health format on Friday. That was one of the issues that we covered, not only the surge plan but the understanding on both sides of the border of where and how we counter and challenge COVID. That could be through, as I said, the interoperability of our app but also greater understanding, as we see the spread of the virus on both sides of the border, in the Derry City and Strabane District Council area and in Donegal, where we see the same rates of increase and incidence of spread, should that be from community transmission as well.”
“It is not that it is being removed but that the next step is being taken to rebuild it by initiating that consultant-led urgent care centre, which will operate from Monday to Friday.”
“There will be a contact telephone number. The statement continues:”
“That is not something that I have prepared for, Mr Deputy Speaker. It is moving away from the topic. <BR /> <BR />With regard to the emergency department in the Downe Hospital, I know that a statement was released by the South Eastern Health and Social Care Trust last night that stated:”
“We have seen that come to fruition and provide benefit in recent weeks, when we have seen in the region of 1,300 identification keys coming from the Republic into Northern Ireland and 1,200 from Northern Ireland going to Republic of Ireland residents. The interoperability that enables our app to work in both jurisdictions is a key strength that stands us in good stead in Northern Ireland.”
“There is ongoing development of that app, what it contains and the additional information that is contained on it. One of the biggest steps that we have taken recently happened in the last week. Working with the Commissioner for Children and Young People, we were able to facilitate the app being downloaded by under-18s, which opened it up to a completely different tranche of people in Northern Ireland. That is why we went from 380,000 downloads at the end of last week to over 415,000 at the start of this week. We are seeing a new generation downloading it and seeing the advantage that it brings. <BR /> <BR />It is not a new innovation for the app, but one of its key abilities is that is can work across the border.”
“I ask those who think that it is smart or clever to put out that denial to think of the adverse impacts of their actions on the general public of Northern Ireland, particularly the most vulnerable and those who, like me, are asking everyone who can follow the guidance of good respiratory hygiene, good hand hygiene and social distancing to do so.”
“I have rehearsed my message to those individuals many times. They must think about their message and the damage that it does by undermining the health message that we put out and the one that comes from this place. Every person who hears their message and does not wear a face covering, does not wash their hands and does not practice good respiratory hygiene has the chance of contracting COVID-19, spreading it and putting additional pressures on our health and social care system. Those additional pressures mean more nurses having to wear additional PPE, more pressure on our ICU beds and more pressure on our doctors and start to challenge the delivery of our health service across the whole system.”
“I do not think that our test, trace and protect system relies on Excel spreadsheets, although I am sure that that is a pretty robust system for anybody that needs to use it.”
“The Member is slightly confusing two scenarios. He is referring to the number of positive cases across the water that were being recorded through a testing system and then manually transferred onto another system. I did not know that Excel runs out when you get to a certain number of cells. Our test, trace and protect system, which is held in the public health system, is developing a bespoke software package. If I am not correct on this I will get back to the Member, but I was originally led to believe that the initial software package was the same as one used for a hotel booking system because it allowed our test, trace and protect staff to follow through contacts and make use of contacts. It has moved on a wee bit from that.”
“It expires at the end of this month, but, as we go into the second phase, it is definitely something that I will seek to continue and ask for financial support to do. It is an important and vital tool in our box to prevent the spread of COVID-19 among a critical but undervalued workforce.”
“That is something that we have looked at in the past. The Member will be aware that it was one of the steps that we put in place for care home and domiciliary care staff. It was part of the package of support that we gave to providers — even to the independent providers — so that we could ensure that financial pressures did not make anyone in a care home or domiciliary care setting who had contracted COVID go back to work. We provided the ability for them to supplement their statutory sick pay so that there was no financial incentive or need for them to return to work and they could take the 14 days to self-isolate and, if they received a positive test, make sure that they did not spread COVID. That supplementary support measure is still there.”
“We have a number of fixed-base testing centres, as well as mobile testing units that we can move around Northern Ireland where we see large-scale incidences of COVID-19 outbreaks. I know that the Member will be aware that one of our districts with the lowest expansion in the number of positive cases in Northern Ireland is the Causeway Coast and Glens Borough Council, which is part of the area that he represents. I would rather that we maintained a low number of COVID outbreaks among the residents of that area by following "Hands. Face. Space" — I think that I got that right — rather than needing to put in a testing facility. The residents of the Member's constituency are doing what they are meant to do. I encourage them to do more, and, in that way, we will not need a testing facility in East Londonderry.”
“"Hands. Face. Space" is the message that we have been putting out. Every member of the Health Committee, we in the Department of Health and every healthcare professional has been pushing that message and asking every member of the population in Northern Ireland to maintain and observe good hand hygiene, to wear a face covering — I see that the Member is wearing one — and to give space, which is the social distance that we should maintain at all times: the recommended 2 metres. By following those simple steps, we will prevent the spread of COVID-19. COVID-19 does not spread itself: we spread it. By observing the simple steps of "Hands. Face. Space", we can prevent the spread of COVID-19. <BR /> <BR />The Member asked about the establishment of a testing centre in East Londonderry.”
“<BR /> <BR />No matter where we are now, one of the things that I know is that we do not have a large enough footprint for hospital provision in Northern Ireland to do what we need to do safely, when social distancing and the need for distancing for people who are waiting, getting surgeries and all the rest of it are taken into account. I am using every footprint that I have in my Health and Social Care system. That is why we have used the Whiteabbey facility as the second Nightingale facility. It was already in our ownership and care, so it made sense to redevelop it as our second Nightingale facility.”
“We cannot provide a long-term commitment to any service at this minute in time while and until we get through COVID. One of the things that I have always done as Minister, whether on supplies of PPE or anything else, is not to give a commitment that I cannot stand over. I therefore cannot give the Member that commitment, but I will ensure that we will do all that we can to retain those services, where they are safe to be retained and need to be retained. I hope that the Member takes me at my word: I will not give any commitments that I cannot stand over, and I will not do that to the Member.”