COVID-19 and Service Rebuilding

Ministerial Statements – in the Northern Ireland Assembly at 11:45 am on 28th July 2020.

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Photo of Robin Swann Robin Swann UUP 11:45 am, 28th July 2020

I wish to give Members an update on recent local developments in relation to COVID-19 and the rebuilding of services.

Members will be aware that, yesterday, for the fourteenth consecutive day, Northern Ireland recorded no COVID-related deaths by the Department of Health measure. Whilst that is hugely reassuring, we must never forget that the virus is still here and still presents a serious threat to public safety. As always, we must keep the families who have lost loved ones to the virus at the forefront of our thoughts.

I thank the people of Northern Ireland for continuing to adhere to social-distancing measures and current regulations. However, nobody can be complacent. We must continue to do our bit in helping to reduce the spread of COVID-19 by keeping our distance, washing our hands and not touching our faces. I once again emphasise this to all those listening: if you develop any of the symptoms, please do not leave your home and, instead, go to the Public Health Agency (PHA) website or ring 119 to book a free test.

I know that a lot of Members and their constituents were taken by surprise at the weekend by the reintroduction of the 14-day quarantine period for people arriving from Spain. That decision was not taken lightly, and I fully understand that the announcement will have caused concern, particularly to those currently holidaying in Spain. As I have said previously, the international quarantine regulations and the countries that they cover are kept under continual review and are liable to change. As Members can appreciate, there is no ideal time to make such a decision. A phased introduction would not have made sense, and public health considerations must take priority. The decision was taken after consideration of the latest data. COVID-19 cases in Spain had increased in recent weeks, a trend that accelerated rapidly in the latter half of the past week.

I appreciate that people returning from Spain and its islands will now face an unexpected period of quarantining. The Executive and I met yesterday to consider what support or advice measures for employees, employers and the self-employed and other actions may be needed. The advice from the Chief Medical Officer and Chief Scientific Adviser is that a negative COVID-19 test immediately on return from Spain would not exclude infection, so a period of self-isolation would still be required. I reiterate that Saturday night's decision was not taken lightly. Experience has shown how COVID-19 can be spread by international travel, and the quarantining arrangements have been introduced to help keep people safe.

Testing in care homes has been an issue that we have dealt with and worked through. The Department has continued to actively monitor and assess the current and emerging science and evidence related to COVID-19 to further inform our approach to testing in care homes. As a COVID-19 test will confirm whether someone has COVID-19 only at the time the test takes place, the introduction of a regular programme of testing in care homes is necessary and will play a significant role in helping to minimise the risk of COVID-19 in care homes and ensure the continued safety of residents and staff. I am pleased to be able to announce a planned programme of regular COVID-19 testing for all residents and staff in "green homes", which do not have a confirmed outbreak of COVID-19. It will commence on Monday 3 August. It will involve the testing of all staff on a fortnightly basis and all residents on a monthly basis. The position on the frequency of testing for both staff and residents will continue to be kept under close review and will need to remain flexible, depending on emerging evidence and on the community transmission rates of the virus in Northern Ireland in the coming months.

The establishment of an effective contact tracing service has been a key priority for me over recent months as part of the wider Test, Trace, Protect strategy that you will all now be familiar with. We have in place an excellent cohort of professional contact tracers with a wide range of experience, including health professionals and staff from an environmental health background. Contact tracing will also help us to understand the transmission of COVID-19 in Northern Ireland and to reduce transmission in tandem with all our other measures. There is a strong international consensus that the work is a critical measure for bringing down the value of R and thereby preventing or minimising further waves whilst allowing restrictions to be lifted.

The recent cluster in the Limavady area was an early test for the service, and I have been reassured by how quickly the service was able to respond by making contact with all those concerned and offering appropriate advice. The workforce planning model is based on the ability to flex staff numbers up and down to deal with emergency situations as they occur, and that incident has highlighted the benefits of that approach.

The virus has the potential to make its presence felt in any district and at any time. Everyone should act on the basis that it might be in their street or on their road right now. That is why following the public health advice on maintaining social distance and ensuring the highest standards of hand and respiratory hygiene remains vital. Whilst I absolutely recognise that the issue of face coverings divides opinion in wider society, I repeat the point that the medical and scientific advice is clear: wearing face coverings in retail settings will help to protect our fellow citizens.

I am pleased to say that Northern Ireland citizens will soon have access to a smartphone app that will further enhance our ability to break transmission chains and reduce the reproduction rate of the virus. The StopCOVID NI app is due to go live imminently, but the date that it will be released for download will be subject to the review process undertaken by the App Store and Google Play. The app was designed using the Information Commissioner's Office's (ICO) "privacy by design" principles and, therefore, uses only anonymised information in its operation. I appeal to all Members to encourage their constituents to download the app. If we can get significant numbers to download it, it will play an important part in augmenting the existing contact tracing processes in our efforts to stop the spread of COVID-19.

I am also pleased to say that the app will be interoperable with the one already in use in the Republic of Ireland. It is also highly likely to be compatible with apps introduced in future across the UK and Europe. It will be the first instance of such a solution worldwide and the first example of such apps operating in an interoperable manner.

When I published 'Rebuilding Health and Social Care Services: Strategic Framework' on 9 June, I was clear that increasing activity would be a significant challenge. COVID-19 continues to be with us and will continue to impact on the extent to which and how we deliver health and social care services. I have been clear that we need to increase service activity as quickly as possibly in the prevailing COVID-19 context.

As we try to increase capacity, patient and staff safety will remain at the very centre of everything that we do. Our Health and Social Care (HSC) staff have put in a tremendous effort and continue to do so as we now seek to rebuild our services. To the many citizens who may be waiting for a procedure or a diagnosis, I say this: we will, as a system, do all that we can to make sure that you get an appointment and treatment as soon as possible. There is, however, a need to prioritise services, given the significant constraints that our health and social care services continue to face. Social distancing, the use of personal protective equipment (PPE), staff availability and the need to plan for future potential COVID-19 surges are just some of the issues that continue to weigh on our ability to diagnose and treat patients. It is in that context that our health and social care trusts published their first three-month rebuilding plans on 10 July, covering the three months until the end of September. My intention is that those plans will be followed by further successive three-month plans in due course. In addition to the trust plans, work is under way to develop regional approaches to service delivery across a range of areas. All of that work is clinically led and developed using co-production principles. The rebuilding management board continues to meet and will continue to oversee all of that activity, reporting directly to me.

Today I announce the way forward for two important services: day procedure centres and orthopaedic surgery. I believe that it is in the public interest to move forward with the implementation of the service changes as quickly as possible to address the adverse impact of the COVID-19 pandemic on elective care waiting times and to enable HSC to have in place dedicated treatment centres ahead of potential further waves of the pandemic. That will allow us to maintain robust infection control preventative measures at those dedicated sites to enable procedures to continue during any future outbreaks of COVID-19. While we cannot guarantee that that can be achieved in all circumstances, it should give us a high level of confidence in our ability to continue to deliver those services while other hospitals treat COVID-19 patients.

I turn to the details of those important service changes, which I have published in a policy statement for elective care day procedures and in a blueprint for orthopaedic care. Our waiting times for elective care are the worst in the United Kingdom. Even prior to the pandemic, waiting times for hospital surgery were totally unacceptable. The impact of COVID-19 on HSC has been profound and will undoubtedly be long-lasting. I recognise that addressing the backlog of patients on waiting lists will be challenging, given the reduced operational capacity across health and social care. The establishment of day procedure centres has been central to our plans to eradicate that scourge on our service. Day procedure centres are designed to provide a dedicated resource for less complex planned day surgery and procedures. Crucially, they operate separately from urgent and emergency hospital care, meaning that they will not compete for operating rooms, staff and other resources, and that will lead to fewer cancellations of operations.

The ‘Health and Wellbeing 2026 - Delivering Together’ document provides the overall blueprint for transforming health and social care services in Northern Ireland so that they better meet the needs of our population. A key commitment in the associated action plan was to bring forward proposals to establish elective care centres to provide a dedicated resource for less complex planned surgery and other procedures. Evidence from elsewhere shows that such centres can reduce waiting times for planned care and provide a better experience for patients and staff.

Since 2017, my officials have been working with doctors, nurses, allied health professionals, service managers and other health professionals from across the health and social care sector to consider the evidence base, to establish two prototype centres and to develop proposals for a regional model for day procedure centres. I thank everyone from across the system whose combined efforts have helped to bring us to this point and who continue to work tirelessly to improve the quality and timeliness of the care that we provide.

Day procedure centres are equally important or even more important in the context of the ongoing pandemic. The COVID-19 pandemic has further demonstrated the vulnerability of having elective care and unscheduled care co-located on multiple sites. For infection control purposes, there are clear benefits in separating elective care from the more unpredictable unscheduled care. The environment in which elective care services are delivered has changed significantly in the past few months. Day procedures must now be taken forward in the context of the continued need for social distancing and personal protective equipment at volumes that were not required prior to the pandemic. Consideration must also be given to the latest emerging professional guidelines and the impact of testing and isolation.

Given the urgent need to begin rebuilding day case procedures to avoid further detriment to patient health and in recognition that that will need to be taken forward on an incremental and prioritised basis, I plan to initially concentrate delivery in one hub day procedure centre. The hub site is Lagan Valley Hospital in the South Eastern Trust, and it will interact with several hospital sites — the spokes — around Northern Ireland. Lagan Valley Hospital has a day procedure unit and has demonstrated its ability to successfully deliver a range of day case and endoscopy procedures. As one of the locations on which the varicose veins prototype was delivered, it proved popular with staff and patients in terms of accessibility and patient experience. Furthermore, throughout all of the engagement with the clinicians involved in developing proposals for day procedure centres, Lagan Valley Hospital was consistently recognised as a suitable site for a day procedure centre due to its accessibility for patients and staff.

Drive-time statistics show that almost 73% of the population are within a one-hour drive from Lagan Valley Hospital. In relation to the emergency department (ED) at Lagan Valley Hospital, the layout of the site means that there are different entrances for patients using the ED and those using the day procedure centre. Importantly, the two services can, therefore, be managed separately without impacting on each other. For the vast majority of patients, attendance at a day procedure centre will be a rare occurrence. The additional travel will be an isolated event and will not form part of a long-term passage of care that requires multiple visits. Service users are experiencing unacceptably long delays in accessing day case elective care procedures, so the clear trade-off for the additional travel will be shorter waiting times for treatment. Lagan Valley Hospital sits within the South Eastern Trust and will take forward the establishment and management of the regional day procedure centre model in the first instance. I will keep that arrangement under review as the model develops.

I will also establish a clinically led regional network to oversee the development of the day procedure centre hub and spoke model based in Lagan Valley Hospital in the first instance. The regional network will be tasked with driving forward a whole-system, integrated approach to the delivery of day procedure centres to achieve benefits for patients through reduced waiting times and improved quality and outcomes. I expect that the development or reconfiguration of Lagan Valley as a regional day procedure centre will be carried out in a phased way to minimise the impact on existing service users.

Before I set out my plans for orthopaedics, I want to take a moment to express my condolences to the family of Kyle McDonald. Kyle was a consultant spinal surgeon in the Belfast Trust and, tragically, passed away suddenly on Sunday. He was a dedicated and successful surgeon and a credit to his family and profession. My thoughts are very much with his wife, his children and the entire family, his patients and his colleagues in the health service. I know that I speak for the entire House in extending our deepest sympathies.

With regard to orthopaedics, as with day procedures, unfortunately, waiting times for orthopaedic surgery are among the worst in the UK, with patients waiting an appalling four or five years for operations such as hip replacements. There is also considerable variation in practice regionally, which means that patients in some trust areas are subject to much longer waiting lists than others. In a country the size of Northern Ireland, such a postcode lottery is indefensible. A new approach is needed to ensure that patients can access high-quality services when they need them.

During the COVID-19 pandemic, most elective orthopaedic procedures have been deemed to be non-essential and have, therefore, been halted to ensure the availability of resources and patient safety for those affected by COVID-19. While those measures will have had an immediate positive effect on COVID-19 patients at that time, they also mean that, unfortunately, other patients in the healthcare system have become deprioritised. In particular, it will have a significant impact on the patients who were already waiting the longest. It is now critical to focus efforts on the regional rebuilding of the service. The reintroduction of elective orthopaedic services provides an unparalleled opportunity for positive change.

It is important to understand that COVID-19 has drastically changed the landscape of the health and social care service and rebuilding will, therefore, require careful consideration of that landscape to ensure that services can be re-established as safely as possible. For that reason, I plan to focus elective orthopaedics initially on two hub sites. The hub sites that I propose are Musgrave Park Hospital and Altnagelvin Area Hospital, both of which are well placed to increase regional orthopaedic services immediately, utilising COVID-light facilities. Both sites provide good geographical coverage for the population of Northern Ireland with regard to accessibility for patients and staff. They each have well established orthopaedic units that could be easily ring-fenced and protected from unforeseen and predictable increases in pressures on the health service as a whole. That will be particularly important in this phase of rebuilding. Focusing on those sites initially will allow patients of lowest risk and highest priority to undergo orthopaedic surgery.

It is important to note that this is not a plan to centralise services or remove existing services from where they are currently being delivered; on the contrary, I plan to utilise existing services in the best way possible at a regional level, to increase activity and to ensure that resources are used most effectively. My ultimate aim is to work towards introducing a region-wide network of orthopaedic practice based on an alliance of the existing orthopaedic units to produce a standardised and equitable practice of orthopaedic medicine for all patients in the region, removing geographical variations in waiting times and practice. To oversee the development of the model, I will establish a clinically led regional network that will be tasked with the regional planning and commissioning of the service across Northern Ireland. My key aim is to move towards a system where patients have the opportunity to move around the region as they wish to avail of the quickest and highest-quality service that can be provided, delivering benefits for patients on equality of access to the same level of care, reduce waiting times and improve quality and outcomes.

For governance, the Belfast Trust will host the regional network, providing governance and oversight of the administrative management of the service on behalf of the region. I will keep that arrangement under review as the model develops.

I believe that it is in the public interest to move forward with these changes as quickly as possible in order to address the adverse impact of the COVID-19 pandemic on elective care waiting times and to enable the HSC to have in place dedicated treatment centres ahead of potential further waves of the pandemic. That will allow us to maintain robust infection-control preventative measures at the dedicated sites to enable procedures to continue during any future outbreaks of COVID-19. While we cannot guarantee that this can be achieved under all circumstances, it should, however, give us a high level of confidence in our ability to continue to deliver those services while other hospitals are treating COVID-19 patients, should that occur.

The need to get the new centres up and running as quickly as we can means that the public consultation and engagement with trades unions and professional bodies on the service changes will take place during the implementation planning stage, which starts today. This engagement will be led by the HSC trusts, which have lead responsibility for implementing the changes. I hope that all stakeholders will understand that because of the untenable position facing elective care services, in the wake of the first wave of COVID-19, my Department is taking this approach because we believe that the public interest is best served by it.

Having published today my Department’s plans for rebuilding day case elective procedures and orthopaedic care, I wish to bring to the attention of the House that I am finalising a further service rebuilding plan for cancer services. My aim is to ensure that we provide as much capacity as we can to deliver oncology and radiotherapy services while preparing for a potential second wave of COVID-19. The need to maintain high levels of infection control means that it will be important to further develop the new ways of working for cancer services that emerged during the first wave of the pandemic and to provide additional investment to embed them.

Similarly, I am considering a plan to reshape the delivery of urgent and emergency care, along with a plan for preparing the HSC for potential further surges of COVID-19. I am sure that all of us in the Chamber can agree that it is vital that we ensure that the available capacity in the system for urgency and urgent care is fully utilised in anticipation of a further wave of COVID-19 and to prepare for the annual winter pressures.

I am grateful to those stakeholders who responded to my Department’s invitation to comment on the recent temporary changes that I made to the health and social care framework document and the establishment of the management board. Having considered the responses, my Department will, during August, launch a full 12-week public consultation on the changes.

It should be noted that the management board, in the short period since it was established, has proved its worth by progressing three-monthly rebuilding plans for each HSC trust area, as well as the policy statement and blueprint for rebuilding elective day case procedures and orthopaedic care that I launched today, with further regional plans at an advanced stage. While I acknowledge the concern of some stakeholders, I stress again that the decision to move forward quickly with these temporary changes was taken to address the grave situation that health and social care is facing and the need, therefore, to move swiftly to begin the rebuilding of services.

As I have stated to the House previously, it is important to emphasise that it will not be possible to return to business as usual. The rebuilding of services will not happen overnight. It will require an agile and adaptable response to ensure that we can respond to further potential COVID-19 surges.

In conclusion, I am conscious that I have taken some time to provide this update and have covered a wide range of areas. However, I hope that it has been useful and has, hopefully, covered a number of points that Members intend to raise.

Photo of Colm Gildernew Colm Gildernew Sinn Féin 12:15 pm, 28th July 2020

I will remove my mask, as I did yesterday, to assist those who may have hearing difficulties in making out what I am saying.

I thank the Minister for his statement. I note that there is a lot in the statement, and I have no doubt that the Health Committee will want to look at and scrutinise all of it in more detail.

I congratulate the Minister on bringing forward the app, which, I believe he said, is the first one that is interoperable across the entire country. That is a welcome step and is of huge importance as we work to maintain control over the spread of the virus in the future.

The Minister has announced some considerable changes here today, many of which look a lot like health transformation. He mentioned 'Delivering Together'. That document, he will know, refers to "co-design" and "co-production". I am concerned that these changes have been announced with no engagement or co-production with service users and staff. What level of engagement did he feel was necessary?

I know that the Minister recognises that all types of carers have been hugely impacted by the initial withdrawal of services. Indeed, the difficulties in reopening some of the day centres and respite services are placing additional and ongoing pressures on carers. Will he consider a one-off cash payment for carers to help with changes to their circumstances and additional carer needs?

Photo of Robin Swann Robin Swann UUP

I thank the Committee Chairperson for his support. He rightly indicates the extent and the depth of what is being proposed here today. He acknowledges the building blocks of 'Delivering Together' and all the previous work that has been done. When I announced that there would be a transformation board, I was asked, "Is this going to be another piece of paper that sits on a shelf?" We have seen enough of those in Health over time. This work is about bringing together the building blocks that have been put there by previous Ministers in 'Transforming Your Care' and 'Power to People', and all the work that has already been done.

As regards the co-production piece for both those initiatives, as I said in some of my commentary in the statement, which I had to shorten because I could still have been speaking about a lot of the detail on these issues, it has been done in consultation with clinicians and the development of the hub-and-spoke model has been led by clinicians. I am due to meet the transformation advisory board (TAB) later today about the timing of the announcement. This morning, we wrote to the unions to advise them of that. The engagement to get to this stage has been very much clinician-led for both models, using the buildings blocks that are already there. We will now have serious engagement with our trade union colleagues, with the professions and with stakeholders to move the programmes forward. As I made clear in the statement, we need to do this now. We need to make the changes. When you look at the numbers of people on orthopedic waiting lists and elective care waiting lists, you see that we need to move now. Those lists got longer during the COVID shutdown.

In regard to the specific ask for carers, I know that there is an ongoing conversation between Carers NI, Families Involved Northern Ireland (FINI) and officials in my Department about what additional packages and support measures can be looked at. A one-off payment has been part of those discussions. I cannot give the Member a commitment at this point in time, but I know that that is part of their discussions. Two weeks ago, an all-party motion raised those concerns. The feeling of helplessness that many carers feel was brought to the Chamber. I committed to ensuring that there was engagement. That engagement has commenced. It is about making sure that we get carers the provisions and the support mechanisms that they need.

As trusts start to move on their three-monthly phased rebuilding plans, they are looking at re-establishing day care provision as appropriate, depending on space and staff to ensure that social distancing is in place. That piece of work continues to support the carers in our community at this time.

Photo of Alex Easton Alex Easton DUP

I thank the Minister for his comprehensive statement. What measures are being put in place for those who have to quarantine for 14 days after travelling and have to face the consequences of their employer maybe not being too happy? The app for contact tracing is great, so can the Minister tell us how many people are involved in contact tracing? Is there scope to have more people involved in it? Also, for those who have to isolate from —.

Photo of Gerry Kelly Gerry Kelly Sinn Féin

Excuse me. We are dealing with one question to the Minister, so he has a choice of which one to answer.

Photo of Alex Easton Alex Easton DUP

I will leave it there.

Photo of Robin Swann Robin Swann UUP

I thank the Member for his questions. I will answer both. In regard to the support measures, which I talked about when answering the question for urgent oral answer yesterday, the Executive met yesterday afternoon to see what reassurances or support we could give to people who are returning from Spain. The Minister of Finance, Conor Murphy, confirmed this morning, I think to the Executive, that anybody who had been furloughed can furlough again, so engagement is going on there, and the Minister for the Economy is engaging with the major employer representatives.

We have 92 full-time staff working on contact tracing in a shift pattern. As I said, one of the differences between us and other regions is that we have not just call centre staff working on it. The staff are professionals, so there are nurses and consultant public health professionals on call so that any advice and guidance that we can give when we are working through that test, trace and protect system is appropriate and specific, and it can be personal medical advice in order to make sure that people are getting the support that they need.

When we saw the recent outbreak in the Limavady area, we were able to scale up very quickly and bring in additional contact tracers to make sure that we got all those contacts covered as quickly as possible. As indicated, we were able to get to a fourth-level contact from the initial point of infection. It is a system that, when we had to step it up very quickly, reacted well, and that initial Limavady incident was a good test of whether everything that we had put in place actually worked.

Photo of Gerry Kelly Gerry Kelly Sinn Féin

Just before I call on the next Member, in fairness to all Members, I should say that we have an hour for questions. There may be time at the end to have some supplementary questions, so I ask Members to allow for those coming in after them.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I thank the Minister for his statement and for his commitment to rebuilding health services, especially in the south-eastern area. I know that there has been an announcement of dozens of additional beds for the Ulster Hospital, and now there is today's announcement about all the additional services for the Lagan Valley. I am going to go for the hat-trick to see whether we can get some commitment for the Downe Hospital, which is the furthest away from other services. Does the Minister agree that facilities such as the Downe Hospital are ideally placed to deliver services in the future? There is a willing staff, excellent facilities and the capacity to deliver. All that we need is the Department and the trust to give us those services.

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. Funnily enough, I have a page all about the Downe because I do not think that there is a statement that I have made or a question that has been asked where the Minister — sorry; I am maybe pre-empting stuff — the Member has not raised it. As we look to expand the hub-and-spoke model in a number of procedures, whether they are in orthopaedics or elective day care centres, I will say that, at this minute in time, we will struggle to have capacity in our current footprint, because, with social distancing, we are looking at wards that had 20 beds now holding 12 beds. It is about looking at capacity and at how we can utilise our entire footprint, and the Downe is one of those facilities. The Member did not ask a question that I thought he would, but I am sure that he is fully aware that Monday 19 October 2020 is the planned opening date for the emergency department in the Downe Hospital.

Photo of Alan Chambers Alan Chambers UUP

Minister, it is important that the House recognises the achievements that your team at every level of health and social care has delivered in extremely challenging circumstances. It is also important to place on record the appreciation not only of the House but of the people of Northern Ireland for the leadership that you have shown in your six months in office. Mountains have been moved from the standing start that saw our valued nursing staff standing on picket lines.

It would be easy for you now to stand back and catch your breath, but you are moving forward through this statement with a compassionate and urgent approach to attend to members of society who are currently experiencing pain, particularly in the field of orthopaedic procedures, by not delaying movement with pre-action public consultation but, rather, getting things up and running urgently in the interests of public health. Will the current postcode lottery be removed, and will your plans offer those in pain some hope that their issues will be resolved in a timely and structured fashion?

Photo of Robin Swann Robin Swann UUP 12:30 pm, 28th July 2020

I thank the Member for his question, and I really thank him for his kind words. They are appreciated, and, as I have said many times in here, it is not about what I have done; it is about what the departmental officials have done, what our carers have done, what our nurses have done, what our cleaners have done and what everybody across the health and social care service has done, from community pharmacy to GPs. Everybody acting as a team over the past six months has brought Northern Ireland to the place where we are.

The Member highlights the crucial point and the underlying point on the development of the two models, where we look not to a centralised service but to a regional service so that we can remove the postcode lotteries for people on waiting lists where even the side of the village that you live on can determine a six-month differential on a waiting list. In a place the size of Northern Ireland, that should not be, so, with the development of both the models, my intention is that we remove the postcode lottery that so long has dogged many people waiting on waiting lists where, because of where they live, they have to wait longer. The models should address that, and it is my intention that they do.

Photo of Kellie Armstrong Kellie Armstrong Alliance

I thank the Minister and again pay tribute to him. I do this all the time, Robin. I pay tribute to him and to all of his staff and the staff of the trusts, who have performed amazingly throughout the pandemic. I am delighted to hear about the day care and the respite care coming forward. We all agreed with that.

I agree with the Chair of the Health Committee, Colm Gildernew. I thank him about his mask. I hate those masks with a passion, as I have said plenty of times, but we need to wear them to keep ourselves, our families and others safe. The UK Government have recognised the Action on Hearing Loss recognition of clear masks. Can the Minister confirm, when he is rebuilding our health system or building it back better, whether a proportion of those clear masks is coming to Northern Ireland? Can he give us any update on those?

Photo of Robin Swann Robin Swann UUP

I have been aware of those since health professionals started to wear masks on a full-time basis. We had interactions with Royal National Institute of Blind People (RNIB) on how we communicate with people with disabilities, should that be hearing loss, sight loss or speech difficulties. I do not have the detail on the specific delivery of see-through masks or clear masks with me today, but I will get that for the Member because I know that she has campaigned for that and has raised it with my Department and with me on a number of occasions. I will get her the specifics on that.

Photo of Gary Middleton Gary Middleton DUP

I thank the Minister for his statement. In late 2018, the Department announced two prototype day procedure centres: one in Lagan Valley and another in Omagh, giving a good geographical spread. Minister, in your statement today, you refer to one day procedure centre hub in Lagan Valley. Minister, can you outline specifically what that will mean for day procedures in the Western Trust, and will there be a reduction in services in Omagh?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. I could not expand on that in the time that I had for my statement, but it will be contained in the further updates. For elective day-care procedures, Lagan Valley will be the hub for the spokes, so the provision that we already have in Omagh and the primary care complex centre at Lagan Valley Hospital for varicose veins will continue. The cataract team will continue at the Mid-Ulster Hospital, the Downe Hospital and the South Tyrone Hospital, so we have proven that those elective day-care centres work, and it is about keeping them there, utilising them and developing the model and the learnings that we got from them and expanding them.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

Gabhaim buíochas leis an Aire as ucht a ráitis. I thank the Minister for his statement. The foundation stone of any changes to our health and social care system must be co-production and co-design. Anyone who has a stake in our health service must have a voice in it. I acknowledge that the Minister has said that the rebuilding plans are based on co-production principles, yet we hear from many stakeholders, including trade unions and patient advocates, that they are being marginalised and excluded from the process and are being consulted only after decisions have been made. Can the Minister explain that anomaly? Also, can he explain why he did not mention a review of urgent and emergency care in his statement?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his points; they are well made with regard to the engagement process that we have had and the speed with which we have had to move. As I said, we are meeting TAB this afternoon, and I have further engagement with the health unions on Thursday with regard to this. We have had weekly meetings with the health unions with regard to other points. With regard to the details here, they have mostly been developed through co-production and have been clinician-led, both in orthopaedics and elective day care. This is wide-ranging work, but we need to move on with it, with the buy-in of as many people as possible. The engagement on how the blueprint and the policy look on the ground starts now, to make sure that we have buy-in. We cannot afford to have people spending longer on waiting lists while we go out to a 12-week consultation. It is about taking the action now and moving forward with the change.

The Member said that I did not mention emergency and urgent care in my statement: I did. I said, if I can find it, that:

"I am considering a plan to reshape the delivery of urgent and emergency care, along with a plan for preparing the HSC for potential further surges".

That work is already ongoing. I know that it was a lengthy statement; maybe the Member just missed that part of it. That work is ongoing. We are in a place where we can bring the two models forward today, so I thought that it was important that, before the House rises, I give Members as much detail and as much opportunity to question as possible on where we are. The work on urgent and emergency care is ongoing.

Photo of Harry Harvey Harry Harvey DUP

Thank you, Minister, for your statement and for your great work to date. Have you the necessary funding and available kits to carry out tests in the care homes for as long as the need exists?

Photo of Robin Swann Robin Swann UUP

That is a good point that the Member raises. Look at the frequency with which we now undertake testing in care homes: residents once a month and staff members every fortnight. It is a considerable testing programme, because we have access to the national testing programme. It is the mobile units that are supplied as part of that national testing programme that will be mostly utilised for testing in the homes that are green — the COVID-free homes that we have at this minute in time.

Just as an update, out of our entire care home sector, we are managing and supporting only 15 homes at this minute in time that have either a confirmed or a suspected outbreak of COVID. We have closed out outbreaks in 167 care homes to date. The work that we are doing with care home providers, staff, residents and families is proving efficient. That is where the testing programme will become beneficial in making sure that we maintain those green homes in the situation where they currently are, so that we can even expand visiting access, which is something that, we are conscious, has been sadly missed by many care home residents and their families.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

I thank the Minister for the statement. As the Minister said, obviously, the decision regarding Spain was made at the weekend, and it was the right decision. Recently, at the Health Committee, we heard that the Chief Scientific Adviser (CSA) was the person responsible for looking at and assessing the data. What is the data based on? Is it a local rate for the North, a combined rate for the island or a rate across Britain and the North? Finally, can the Minister confirm whether there are other areas that are currently being considered as a potential risk?

Photo of Robin Swann Robin Swann UUP

There is nowhere that we are looking at, as far as I am aware at this minute in time, where we see the incidence and prevalence that we saw across Spain. That is not to say that something may not move as quickly as we saw in Spain. As I said yesterday, when we saw the change in positive cases — going from 4,400 up to around 9,800 in the space of a week, I think — we had to move. The advice and guidance we got in regard to Spain was from the Joint Biological Centre, which is all four Chief Medical Officers (CMOs) and CSAs working across the United Kingdom. The decision to remove Spain was taken by all four Health Ministers at the same time: the SNP in Scotland, the Labour Party in Wales and us in Northern Ireland. It was a joint decision. Any differential could have left a back door somewhere that could have been opened or accessed, so we made that decision on a UK-wide basis.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I begin by offering my condolences to the family, friends, colleagues, patients and community of Kyle McDonald, an esteemed orthopaedic surgeon and consultant and a past pupil of my old school, the Abbey in Newry. Kyle's sudden passing will have sent shock waves through all the people who knew him. My sympathies are with them all. I measc na naomh go raibh sé. Today also marks a year since the passing of another Abbey student, Brian Conlon, and my thoughts are with Julie and Brian's family, colleagues and community.

Minister, you mentioned the reopening plan and the plan to reshape the delivery of urgent and emergency care, but you have not referred to the Daisy Hill emergency department. I note and applaud the exceptional work of the trust and all the staff of Daisy Hill and Craigavon Area Hospital in dealing with the pandemic and the work of the pathfinder group in ensuring that there is a plan to restart Daisy Hill emergency department. They have included that in the first reopening and rebuilding plan, and that is scheduled to happen before the end of September. I know that nurses, doctors and other hospital staff have been displaced in the pandemic, and I know that there will not be a return to business as usual, but can you give a firm date for when Daisy Hill emergency department will reopen and give the people of Newry and Mourne, south Armagh and south Down some comfort?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his initial comments in regard to Kyle's family.

The Southern Trust is working to reopen emergency medicine in Daisy Hill Hospital by the end of September, and, as the Member has rightly profiled, the Daisy Hill pathfinder group is working in partnership with the trust to develop new models of care in line with other emergency departments in Northern Ireland to ensure that services are safe. As with all of the restart programme, the new models of care will require considerable engagement with the community to ensure their success. That work goes on in regard to the rebuilding projects that each trust is bringing forward on the three-month staged process. The engagement has been there, and emergency medicine will reopen in Daisy Hill Hospital by the end of September.

Photo of Robbie Butler Robbie Butler UUP

I thank the Minister for his lengthy statement and for his service. He rightly pointed out the good work not just of his Department but of those who have served on the front line. It is good, as an MLA from Lagan Valley, to note that the Lagan Valley Hospital has been recognised today for its capacity, its reputation for excellence and its central location to provide the hub for the elective procedures, moving forward. Will the Minister join me in thanking the staff of the critical care unit, who changed their unit into a COVID response ward and, at great cost to themselves, performed heroically? I put on the record my thanks to them and to those like them throughout the health service in Northern Ireland who have stepped up to the plate at this challenging time.

Photo of Robin Swann Robin Swann UUP

I thank the Member for his comments, and I add to the Member's my personal thanks to those he mentioned. As I said, we are where are today in Northern Ireland in respect of COVID and the response to COVID because of the dedication of so many health professionals at all levels across our service who really stepped up to the mark and really delivered and really proved the benefits of a National Health Service and what it actually means to the people of Northern Ireland. To every individual who stepped up I say "Thank you", and it is a personal "Thank you" as the Minister of Health that I give to each of them for the dedication and commitment they gave, while always remembering the sacrifice that their families made as well in allowing their loved ones to go out to work, which was always in difficult, trying and challenging times.

Photo of John O'Dowd John O'Dowd Sinn Féin 12:45 pm, 28th July 2020

We are approaching 31 July, and the Minister will be acutely aware that the advice to members of the public who are shielding will now change, and they will be able to go out and about more. One reason that people have been advocating the wearing of face masks in shops and other places is to help to protect those who are shielding. What advice about the future is being given to those who are coming out of shielding, particularly their concerns that they may have to shield again?

Photo of Robin Swann Robin Swann UUP

I thank the Member. For those who have been shielding over the past four to five months, 31 July will be a joyous day for some but a challenging day for many. That challenge will be seen when people come out their front door and enter a society that looks different from the time when they started to shield. A letter providing guidance went out from the Chief Medical Officer that there should still be social distancing, good hand hygiene and respiratory awareness. The greatest guidance is not for people who have been shielding but for those who have not been shielding. I make a request not only on my behalf as Health Minister but on behalf of family members, friends and everybody who has been shielding — the 98,000 to whom we sent letters: please respect them, please give them space, and please allow them to re-enter society at their speed, giving them space in retail shops, on public transport and on footpaths to allow them to come back into the general population, because it will be challenging.

The Patient and Client Council undertook some work and engaged with all those who are shielding, whose biggest concern was stepping outside the front door again. There are also mental health implications for people who have had the assurance of staying inside their homes. Our guidance has been very clear: 31 July is a pause to shielding. That language was used deliberately because we have to be aware that we may have to ask a section of that 98,000 to go back to shielding should there be a second spike or an outbreak of COVID-19 in certain areas. The advice may revert to advising and guiding people to stay in their homes for another period of time.

Photo of John Blair John Blair Alliance

I begin by associating myself with the thanks given by my colleague Kellie Armstrong to the Minister's departmental staff and healthcare providers everywhere. We truly are grateful. The Minister is to be commended for the way in which he shared his thanks with those front-line staff.

We are all mindful of the autonomy of GP practices, and the Minister will be aware of the struggles that the public face in trying to get GP appointments. Is it likely that face-to-face appointments will resume, bearing in mind the difficulties faced by those, particularly many of our elderly population, who cannot easily access online or telephone services?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his initial comments. He will be aware that GP practices are independent operators. We have been able to give them guidance and support, but, at the end of the day, the provision of services, and how GPs deliver that, remains within the management of each practice. We have always been assured that, if people need a face-to-face consultation, they should be able to get one. Changes have been made to telemedicine and telephone consultations, and those should be utilised where possible. However, if someone needs to go in through the door and see a GP, that facility should always be available. It is not always about the initial reason that somebody goes to see a GP. It is often at the point when patients are about to go out the door, with their hand on the handle, that they say, "By the way, I meant to ask you about —". That is when the real reason for the GP appointment comes to light. Face-to-face consultations are always important. There will be changes in practice with telemedicine, telephone consultations, ordering repeat prescriptions and things like that. Good practices have come about in our GP services, but face-to-face interaction should always be available if necessary.

Photo of Dolores Kelly Dolores Kelly Social Democratic and Labour Party

Minister, like others, I thank you, and the staff throughout the health and social care system, for their hard work throughout the pandemic. I will ask about cancer services. I spoke yesterday to a young mother, who had a routine smear test last December, and has been told, within the last two weeks, that she has cancer. No date has yet been set for her surgery. You talked about restarting. What are the time lags between the routine diagnostic test, informing a person of the diagnosis and surgery? What measures, or confidence, can you give to people like this young mother, who faces such dreadful news?

Photo of Robin Swann Robin Swann UUP

If the Member writes to my office with specific details of that case, I will have it looked into. As I said earlier, in the statement, the re-engagement of our cancer services is a priority. They must be re-established as soon as possible. The time lags between diagnosis and treatment should not, to my knowledge, be as lengthy as the Member indicates. I will look into that case. We always red-flagged urgent procedures, even throughout the pandemic. We made provision for them. We could not identify them all, but we identified the majority of the urgent referrals. If the Member contacts my private office, I will follow it up.

Photo of Steve Aiken Steve Aiken UUP

I thank the Minister, his Department and the healthcare professionals for all their hard work. Will the Minister outline how he has managed to deliver the globally unique, functioning, pan-border StopCOVID NI app? Will he also thank the software industry for its hard work in delivering the app? It is indeed, Members of the Assembly, a unique thing that we are seeing across these countries.

Photo of Robin Swann Robin Swann UUP

I thank the Member for raising that specific point. It was mentioned by the Chair of the Committee.

With regard to the contact tracing app, we started with a foot in both camps. We watched what the Republic of Ireland was doing, and we were also conscious of what NHSX was doing. The chief digital information officer, Dan West, and his team in my Department worked on it. He presented the app to the Health Committee and the Executive Committee last week. I thank him and his team for doing an astonishing piece of work. That very small, dedicated team has delivered the app that we will launch shortly, once we get it into the Apple Store, to go through that provision. Not only has the team developed it but it made sure that the concerns that many Members raised about data security and data sharing were at the centre of what it was doing. That small team, led by Dan West, should be commended as much as any other health professional or member of my Department.

The key point, an interesting and integral feature of our app, is interoperability, which gives us the ability to access information from either side of the border, so that we do not see an anomaly. That was the concern at the start: people would have to have two or three apps to travel throughout this island. It is also reassuring that the platform that NHSX is now progressing on will allow east-west interoperability as well. We will have an app that works across all these islands and internationally. I understand that it has progressed to the extent that it will interact with some of the main European apps, from Germany and other countries, because we use the same platforms.

Photo of Daniel McCrossan Daniel McCrossan Social Democratic and Labour Party

I thank the Minister for his statement and for providing updates to the House during the pandemic, particularly on the important issues that continue to be raised.

On elective care, specifically orthopaedic surgery, the Department received an additional £90 million earlier this year and the Executive will receive a total of £600 million of new money from Westminster to tackle the COVID-19 pandemic. What total additional funding will be allocated to elective care to ensure that surgery and appointments take place? Also, will the Minister update the House on what work has been done, aside from the important task of tackling COVID-19, to ensure that waiting times are reduced from the four- or five-year period that people have been told about?

Photo of Robin Swann Robin Swann UUP

One of the points and, I hope, one of the outworkings of the orthopaedic and elective day-care surgeries will be a reduction in those waiting times. They were bad in January, and they got worse over the period that we were closed down because of the pandemic. This regional approach should start to tackle and reduce the current waiting lists to get them back to a place that is manageable and respectable. We need to get on top of four- or five-year waiting times and bring them down. That was already a challenge for my Department, and £50 million was promised under New Decade, New Approach to address waiting times. We got £10 million in our last bid. At that point, we were looking at using the independent sector and enhancing the provision that we had. Some of those avenues have closed down, so, although we may be tackling the current waiting times, it will not be to the extent that we previously hoped.

All these proposals have been worked up and costed, and bids will go to the Department of Finance and the Finance Minister in relation to the announcement of the new COVID support monies that have come forward. However, the important point on waiting times — I ask Members to support us on this — is encouraging people to look across Northern Ireland for a place to which they can go to get their procedure, operation or diagnosis. Let us break the regional perception that it must always be in your local hospital. I would rather that people were now able to look at accessing medicine in days, weeks, and months, and in miles, rather than years.

Photo of Rachel Woods Rachel Woods Green

I thank the Minister for his statement today, and I thank all the hardworking health staff for their ongoing work in our NHS. The Minister will be aware of the impact of coronavirus on maternity services and antenatal care. According to the latest information on the maternity website, the South Eastern Trust says that all educational classes are cancelled, and there is no information in the Minister's statement or online on when they will resume. Parenting classes are extremely important in supporting the parenting journey and are part of a wide range of services that are essential for women preparing to give birth. Can the Minister provide an indicative date for when he expects the resumption of the normal service provision of antenatal care and maternity services?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her point. I will come straight out and say that I do not have the answer with me today, but I will get it for her because I realise the importance of the issue. She will know that it was one of the services that was stepped down. I think that there was an attempt to put the service online so that prospective mothers could access it and have that guidance, but there is nothing like the personal attention of a midwife when preparing for the birth of a child. I do not have a specific date for the Member, but I will get details to her on how the service is being worked up across all trusts, not just the one that she mentioned.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

It is welcome news that there have been no deaths in the last two weeks. However, as the Minister indicated, the virus is still with us and still very dangerous. What is his and his officials' assessment of the safety of all pupils returning to school without wearing masks, particularly teenagers and older pupils? I understand that the position of the Minister, if not the Executive, is that people should wear masks in shopping centres. It appears that the Education Minister might be going on a solo run that could put pupils at risk. What is his assessment of masks for pupils and staff in schools?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. On interaction with the Education Minister, I am having a meeting with him, the Chief Scientific Officer and the Chief Scientific Adviser this afternoon on the next building plan and the opening up of the Education Authority and schools. I am sure that that issue will be discussed.

Photo of Gerry Kelly Gerry Kelly Sinn Féin

We have heard from all Members on the list. We have some considerable time left: more than 20 minutes. If there are any other questions, Members should indicate.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I did not think that I would be called so quickly, but I am glad to be called. I would like to ask the Minister about strike pay for healthcare workers. The Health Committee is being led to believe that, sometimes, the issue is with the Finance Minister; sometimes, it is with the Health Minister. What is the Health Minister's assessment of where it is? Does he still believe that healthcare workers should be given the strike pay that they lost out on earlier this year?

Photo of Robin Swann Robin Swann UUP 1:00 pm, 28th July 2020

I thank the Member for his question. It reflects back to a question that he asked me prior to COVID, just after the strike. He asked me whether I would like to see the strike pay reimbursed. At that time, I indicated to him that there may be legal ramifications. Although the Minister of Finance has supplied us with the money, my Department is actually looking at the repercussive nature of the reimbursement of strike pay. It would be the first time that strike pay has ever been reimbursed, so it would set a precedent not just in Northern Ireland but across the United Kingdom. It would hit the Department of Health, because of that repercussive nature, if we were to do that as policy lead. Say, the Member had raised Education. If, for example, teachers went on strike, and the Minister of Education decided to reimburse strike pay to teachers, the bill would come to my Department because it had set the precedent. Therefore, where we are at this minute in time is that I have a paper with the Executive. It was last tabled on 9 July. If the Executive take the collective decision to take the unique step to reimburse strike pay, we can proceed with that. It would take a while to be able to work that. We have the money, but what I need is the reassurance that any future reimbursement of strike pay by another Department, either in this jurisdiction or across the UK, does not come back to impact Northern Ireland's Health budget, which is currently my understanding. Therefore, at this minute in time, we are not proceeding because I need that reassurance from the Executive that, should that ever happen in the future, the Department of Health and my budget would not suffer as a result of that decision.

Photo of Rachel Woods Rachel Woods Green

The Minister will be aware that many people are having ongoing issues with accessing physical appointments with their GPs. I have written to him and the South Eastern Trust on that issue. Some of my constituents have been offered telephone appointments, which have not resulted in any diagnoses or referrals, and some have been told that they should probably go private. At what stage will the resumption of GP services, with all the necessary PPE and safety measures, if there is an indicative date for the next stage of the recovery programme, be announced?

Photo of Robin Swann Robin Swann UUP

I refer the Member to my earlier answer to John Blair on GP interactions and the services that they provide. GPs are independent providers. We have supplied them with PPE. Anybody who needs a face-to-face appointment should get one. We have moved, in certain cases, to telephone or online triage services. As regards advising people to go private, the Member might want to give me the specific details of that. She says that she has written to me. I am not sure where it is in the system, but we will certainly look at that. I encourage GPs, and patients as well, that, if patients need a face-to-face consultation, it should be open to them.

Photo of Colm Gildernew Colm Gildernew Sinn Féin

The Minister referred in his statement to the travel regulations. It is widely accepted that there is a great degree of confusion about travel regulations. I welcome the fact that the Minister has sought closer cooperation with his counterpart in the South in order to try to streamline some of those issues. It is important to say that the issue is South/North as well as North/South, and if we are going to truly maximise the benefits of having a single epidemiology unit, that work will be crucial. Can the Minister update the House on the memorandum of understanding or any other work that is being done to ensure that we can deliver, as far as possible, the aims of the independent SAGE 'A Better Way To Go' document; that we work together to reach a COVID rate that is as close to zero as possible in as short a time frame as possible?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. It is actually one of the very few for which I had a prepared answer. The memorandum of understanding between the Health Departments in Ireland and Northern Ireland was signed on 7 April, signalling the willingness of both jurisdictions to promote cooperation and collaboration in response to the COVID-19 pandemic. Both jurisdictions are committed to working in partnership to predict the likely impact of COVID-19 and to enable evidence-based decisions on how best to respond across the island of Ireland. We have been working closely with our Irish colleagues since the start of the COVID-19 crisis, and we shall build on that relationship to continue to share information and learning. There are regular meetings between the CMOs of both jurisdictions and their teams to discuss areas of mutual information.

As regards the Member's specific question, I think that I said to him yesterday — I went slightly off course from the Member's question — there will be a North/South Ministerial Council meeting this Friday, which will discuss the memorandum of understanding and should there be any further relationship-building that we can do, considering a new Government are in place. I had a good relationship with Simon Harris, the previous Health Minister, and I have had a number of engagements with Stephen Donnelly. We are very proactively engaging because we both have the same challenges as to how we tackle COVID-19 and how we rebuild our services as well.

There is good work going on in regard to travel. We have had some challenges with the travel locator forms with regard to the sharing of information. I am now led to believe that the matter of how that information can be shared is with the Irish Attorney General and the Dáil. We have made progress with that. I think that it is not so much a matter of not wanting to but of not being able to make progress at this time. Hopefully, at Friday's discussion, we will be able to get a solution to that problem and we can move on. We have had good working relationships with the Health Minister, the Chief Medical Officer, the PHA and HSE, and I think that is something we can build on.

Photo of Daniel McCrossan Daniel McCrossan Social Democratic and Labour Party

Again, Minister, I want to put on record my thanks to you for your leadership on the huge challenges that have been thrown at you since you were appointed as Health Minister. I ask you to reinforce your message on hand sanitisation. Hand washing is very important, and it is important that that message does not get lost or fade.

In relation to mental health services, Minister, you will realise that, throughout the pandemic, a huge number of people have been very badly impacted. People are fearful and anxious, and all that feeds into their mental ill health. What extra funding will there be, if any, from the £600 million from Westminster COVID-19 moneys that might support mental health services that are so badly in need of it at present?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. Again, the point is well made because of the stresses and strain that we have seen COVID-19 put on not only those who are shielding but the people working on the front line and their families.

In the last monitoring round, a bid of £1·5 million was made and accepted for the 'Mental Health Action Plan' work, which we kept going, and we published it last month. That 'Mental Health Action Plan' was adopted and includes COVID-specific work as well. Since then, we have been able to appoint our mental health champion, Professor Siobhan O’Neill, who is doing a fantastic job already in interacting with stakeholders and all Departments.

One of the bids for the additional moneys will be an application for the further development of multidisciplinary teams that are working across a number of areas in Northern Ireland and through which we are able to bring different professionals, including psychologists and psychiatrists, into GP practices. That model had worked well, but we did not have the funding to expand it to other areas, so additional money will be sought to expand it. However, it is also dependent on having the professionals to fill the posts. It is not just about the money, although the money is always welcome; it is about making sure that we have the right people in the right place at the right time.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

To follow on from Mr McCrossan's question, I do not mean to sound critical of the Minister — that is not my intention — but he will know that, after the monitoring round that included that £1·5 million, and although there is a bid for £7 million for the multidisciplinary teams, I said publicly that that was not enough, given the challenges that we face with mental health.

At the Health Committee last week, the issue of trauma and the psychological impact of COVID-19 was discussed and the fact that we still have not seen what will come next. The Minister referred to the 'Mental Health Action Plan', and there is a section in it on the COVID-19 response. I know that the report stated that that is a fluid piece of work that will change. Is there anything concrete on actions under the COVID-19 mental health response?

Photo of Robin Swann Robin Swann UUP

I do not have the detail with me because of the scope of the statement that we are covering today, but I will get the detail of that. The Executive Committee on mental health, well-being and suicide prevention meets again tomorrow. So, as we come out of the Executive's response to COVID, those additional strands of work are being put back in place. There are a number of presentations to it in regard to work that is coming forward. That even includes members from the voluntary and community sector. The Elephant in the Room youth mental health initiative is presenting to the Committee tomorrow afternoon as well.

It is about how we get all those pieces to work together and deliver the support that we need as we come out of COVID and see more people presenting with challenges. I know that it is something that the Member continues to raise and has a passionate interest in, and I commend her for that. Never worry about the "but" that comes in your statement. Keep bringing it and keep asking it. It is only by raising those concerns and questions in this Chamber that I can keep it firmly on the platform not just in my Department but in the Executive.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

Will the Minister commit to meeting the British Dental Association (BDA) and its Chief Dental Officer to address the serious impact on dental practices at the moment as a result of the regulations? They have made many representations to the Committee and to Members, and there is a threat to the viability of practices going forward. I know that he has extended the urgent dental care centres to the end of August, but I do not want to get to another cliff edge at the end of August with those problems. Will he undertake an assessment and meet those individuals to try and resolve any problems going forward?

Photo of Robin Swann Robin Swann UUP

I met the BDA and the acting Chief Dental Officer two or three weeks ago. At that stage, I had quite a good engagement with them. So, some of the fallout and comments that I have seen recently were not my takeaway from that meeting. I understand the pressures that our dental profession is under. The acting Chief Dental Officer is due to meet them and engage with them in regard to a number of funding packages — I am not even sure whether the BDA is aware — around additional money that is there in support for other industries and service providers that have fallen through the gaps, I think, is how the Finance Minister has described it.

I have written to the Minister for the Economy to see whether there is some sort of support mechanism that she could bring forward to the private side of our dental profession. Where we can support and fund the national health side, there is also that private side of many BDA businesses that need additional support. That engagement has commenced. The BDA wrote to the First Minister and the deputy First Minister and the Executive as a whole last week, and that is the step that I took in response to that letter.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

In my haste to get two questions in the first time around, I probably did not frame my question around urgent and emergency care too well. What I was asking is: does the Minister have a date when that review will be published? That was the last question. This question relates to plans for care homes in the event of a second surge. In your statement today, you outlined plans for extra testing in care homes, but are there other plans in place to deal with a second surge?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his clarity. I was not sure about his question because I had mentioned that in the statement. I hope to be in the position to publish that in August if not September. I know that we are in recess, and I do not want Members thinking that I am doing it because we are in recess, and it is a good time to do it. When it is there and it is in the final position, I will do it, but I will make sure that we are engaged with the Health Committee as well to make sure that members have interaction and some input and knowledge of what is being done. So, hopefully, in August, or September at the latest, that urgent emergency care piece will be published.

In regard to care homes and the supports that we are getting, we have been looking at best practice across all jurisdictions in the support of care homes. The Chief Nursing Officer is leading an urgent review into the provisions that were put in place not just here in Northern Ireland but in other jurisdictions and even worldwide practice as well to see what additional measures can be put in and at what point you can still have visitors etc.

It is about all those challenges, and all those steps bring about different challenges for residents and families. It is about making sure that care homes are provided for. We will be in a better place than we were with the initial outbreak because of what we know about COVID, how it works and how it interacts with care homes. We have established a good working relationship with the care home sector in how we work together to make sure that we protect and support the residents of those homes.

Photo of Gerry Kelly Gerry Kelly Sinn Féin 1:15 pm, 28th July 2020

We have just over six minutes left. With the indulgence of the Minister, I know that Colm Gildernew has indicated that he would like to ask another question. Is there anyone else?

Photo of Colm Gildernew Colm Gildernew Sinn Féin

I thank the Minister again for taking a range of questions on all the issues. My question is linked to the question that Pat asked about care homes. Across the islands, there has been a sense that we could do better for care homes in a potential second wave or in future pandemics. Is a specific look being taken at discharge policy into hospitals and out of hospitals into care homes that may be of benefit during a potential second surge? I know that work is being done in England on that. Is specific work going on here on discharge policies during a second surge?

Photo of Robin Swann Robin Swann UUP

The number of admissions and discharges from hospital settings into care homes and the testing policy are part of the work that the Chief Nursing Officer is leading on. We had a testing policy in place, which meant that testing was carried out 48 hours before discharge from hospital into a care home. If there is a second surge, that will be there from the very beginning. That policy has been established, and we ask people who are transferring from hospitals to care homes to go into isolation for 14 or 7 days, as appropriate. Those steps and measures are all being looked at in the rapid review that the Chief Nursing Officer is bringing forward. We are cognisant of that and are doing the work on it. It will be part of that review.

Photo of Rachel Woods Rachel Woods Green

It is great to get to ask so many questions. I thank the Minister for answering them.

I welcome the roll-out of the COVID-19 app, the announcement of which has been done in conjunction with the ICO. I previously raised questions with the Minister about the legal advice that was given about the roll-out of the app and data protection. Will the Minister confirm that the collection and storage of data in the app will be based on a decentralised model, whereby data is only held locally on your phone?

Photo of Robin Swann Robin Swann UUP

It is fortunate, because I had a prepared answer for that question, unlike most of the questions that were asked in the rest of the hour.

The data will be stored on your phone, and information will be shared only when you enter and fire the key. The information will be shared with a secure server in the Business Services Organisation that has been specifically developed and will be managed for that. The interoperability with the system in the Republic of Ireland is also done by secure measures to make sure that they talk and act together. We have undertaken wide engagement.

I reassure the Member that the draft data protection impact assessment for the proximity app, while it is being finalised to take account of comments from the Information Commissioner's Office, will be available and will be published to give users and those who know what that means the ability to have a look at it before we go live. That gives that reassurance. One of the things that I, as the Minister, and we, as an Assembly and an Executive, want is for as many people as possible to use that app. It will start to open up many other avenues as we ease restrictions.

Photo of Gerry Kelly Gerry Kelly Sinn Féin

I call John Blair for a very quick question.

Photo of John Blair John Blair Alliance

Thank you for your patience, Temporary Speaker. I also thank the Minister for his perseverance. In his statement, which we are grateful for, the Minister touched on the resumption of cancer services. It has been reported that cancer diagnoses are down by somewhere around two thirds, and Cancer Research UK says that as many as 200,000 people across the UK are not being screened for cancers such as bowel, breast or cervical cancer. Can we have any more information on what is being done to prevent the non-detection of a high number of early cancers?

Photo of Robin Swann Robin Swann UUP

I thank the Member for his point. It is valid and ties in with the point that was made by Dolores Kelly. In relation to screening, the strategic framework for rebuilding HSC services was launched in June with the direct aim of rebuilding health and social care services in prevailing COVID-19 conditions. It outlines a phased restoration of screening programmes as quickly and as safely as possible. The PHA is leading on the restoration of screening and has produced a recovery plan for each of the paused programmes to ensure that they are reintroduced safely and that the benefits of screening are greater than the clinical risks associated with COVID-19. Given the ongoing pandemic and the continued need for enhanced infection control measures, screening throughput is likely to be slower, and it will therefore take some time to catch up on postponed appointments and to restore services to pre-COVID levels of activity. I assure the Member that that work is ongoing to make sure that we catch up on what has been missed.

Photo of Gerry Kelly Gerry Kelly Sinn Féin

That concludes questions on the statement from the Minister with some second questions to deal with. I thank the Minister for his indulgence.

I ask Members to take their ease while we get ready for the next item.

(Mr Deputy Speaker [Mr Beggs] in the Chair)