Committee for Health

OFFICIAL REPORT (Hansard)

COVID-19 Disease Response: Mr Robin Swann MLA, Minister of Health; Dr Michael McBride, Chief Medical Officer

4 March 2021 NORTHERN IRELAND ASSEMBLY

Committee for Health

COVID-19 Disease Response: Mr Robin Swann MLA, Minister of Health; Dr Michael McBride, Chief Medical Officer

4 March 2021

Members present for all or part of the proceedings: Mr Colm Gildernew (Chairperson) Mrs Pam Cameron (Deputy Chairperson) Ms Paula Bradshaw Mr Jonathan Buckley Mr Gerry Carroll Mr Alan Chambers Ms Órlaithí Flynn Ms Cara Hunter Ms Carál Ní Chuilín

Witnesses: Mr Swann Minister of Health Dr Michael McBride Chief Medical Officer

The Chairperson (Mr Gildernew): I welcome the Minister of Health, Robin Swann, and the Chief Medical Officer, Dr Michael McBride, who are here to update the Committee on the pandemic. Good morning.

Mr Swann (The Minister of Health): Good morning, Chair.

Dr Michael McBride (Chief Medical Officer): Good morning, Chair and members.

The Chairperson (Mr Gildernew): I invite the Minister to brief the Committee.

Mr Swann: Thank you very much, Chair. As in previous briefings, I will keep this short to allow more time for questions and engagement.

As we know, good progress is still being made. The number of people in hospital with COVID-19 is still high, and there has been a slight growth in case numbers again. We hope that that severe pressure will not follow. Therefore, I must emphasise that, if we increase social contact too quickly, we may find ourselves back in the cycle that we have seen previously.

The roll-out of the vaccination programme continues to progress, and we expect it to have a substantial impact on the epidemic in the medium to long term. This week, we have opened booking to priority group 7, and we expect that to be followed quickly by other priority groups with the aim of offering everyone in the Joint Committee on the Vaccination and Immunisation (JCVI) priority groups 1

1 to 9 — those aged 50 and over — a vaccination in April. That will be a monumental step in the population-wide vaccination programme. We will then quickly proceed to the 18-to-49 age bracket.

As the vaccination programme continues, we expect the roll-out to be expanded to community pharmacy stores across Northern Ireland in addition to our GP practices and the regional vaccination centres. As I have highlighted before, there is an ongoing risk of increased transmissibility from new variants of the virus that have been identified elsewhere. In addition, in the past week, cases of the South African variant have been confirmed in Northern Ireland, Scotland and England. However, cases of the Brazilian variant, as it has been called, have not been reported here. The full impact of the new variants will be seen only when measures are relaxed and the R number may rise more than has previously been the case.

I welcome the publication of the Executive's pathway to recovery document, which provides assurance for all of us that there are plans for the economy and society to reopen when it is safe to do so. However, it is critical that we do not respond to the success of the vaccination programme and the announcement of the recovery plans by letting our guard down, because now is not the time to do that. We do not want more cycles of relaxation and lockdown, with all the harm that that brings. We must take small steps and watch the consequences in order to avoid a return to the epidemic growth of the virus.

As the pressures from this wave begin to reduce, I turn my mind yet again to the rebuilding of our services. I made it clear to officials that I expect to see action to repair some of the damage and the delays that the virus has inflicted. I am aware that the Committee is to get a full update next week, but, needless to say, the waiting list position in Northern Ireland is not good, and you know that.

I have agreed that the health and social care system should follow some of the key principles as we de-escalate ICU and rebuild elective care services. Those principles include the need to de-escalate as a region and that the Nightingale facility in Belfast City Hospital be prioritised for de-escalation. That is because Belfast City Hospital normally hosts our complex high-priority surgery on behalf of the region, so I am keen that we scale up that high-priority surgery as quickly as possible. It can be achieved by initially creating "green pathways", as they have become known elsewhere, on the site, eventually turning the Belfast City Hospital into a green site that will serve the region. That will be facilitated by delivering critical care for COVID-19 patients at the Mater Hospital once again.

Elective care rebuild must reflect a regional prioritisation to ensure that those most in clinical need, regardless of place of residence, are prioritised. At the same time, all trusts should seek to develop green pathways and begin to schedule theatre lists two to three weeks in advance. The aim will be to allow for any given staffing availability to maximise theatre throughput.

I have also asked our trusts to proceed with developing ambitious rebuild plans on the basis of those three principles. The initial period will be from April to June, and I intend to publish those in due course. I am happy to take questions or comments from members.

The Chairperson (Mr Gildernew): Thank you, Minister. I acknowledge the continued benefit that the roll-out of the vaccination programme is bringing. There is certainly cause for hope but not, as you say, for complacency.

You have given us some detail, but where are the trusts with red-flag cancer surgeries and other life- threatening conditions?

Mr Swann: As you are aware, we have taken a regional approach to the first step in rebuilding those specific surgeries. We are seeing surgeons and teams and patients willing to travel. Between 1 January and the end of February, 1,076 surgeries were cancelled. To date, 86·2% of those have been rescheduled or completed, so 149 are still being worked on, with the aim of getting them theatre slots that we have developed. The number still waiting has continually decreased over the past number of weeks, so it is work that is ongoing. We have established a regional board, so there is a prioritisation now of patients at a regional, rather than a trust, level at this stage.

The Chairperson (Mr Gildernew): Is there a particular difficulty or concern with paediatric surgery? Do you have an update on that?

Mr Swann: We met the paediatric surgeons just over a week ago regarding access facilities, and we are trying to get a regional centre established specifically for high-level paediatric surgeries that they

2 may need to take forward. Again, it is about why we move through those rebuilding plans and opening accessibility to footprint provision that we already have. The teams are keen to get back to work on their specialties and work through the lists.

The Chairperson (Mr Gildernew): OK. Minister, I know there have been recent difficulties with the roll-out of the vaccination programme to carers. It was welcome that carers were identified, as they are a very important cohort. Do you agree that the lack of detailed information or a register of carers in each trust has been an issue? Is that being looked at? If we cannot identify carers, it is more difficult to signpost or support them. In response to the information on carers raising its head as an issue, has anything been done to ensure that trusts have an accurate register of carers in their area?

Mr Swann: Chair, you have hit the nail on head, shall we say? Northern Ireland does not have a central carers' register. There is no central database of carers connected to the Department or the Department of Education. When we started to allow carers to access the vaccination programme, Patricia Donnelly had detailed engagements with all our carer representation organisations. Those organisations may not even be identifiable or notifiable to the trusts, and that is why we took that approach at the start. We are keen to progress the work of establishing a central carers' register when we have the time and space because it is vital to support those who provide care. It is work that will be undertaken if I can get the time and space to get to it. However, it has to be cross-departmental, as carers are not solely based in Health and the trusts. We need to get a central database to make sure that we can support everyone.

The Chairperson (Mr Gildernew): I recognise that time and pressure are factors. However, my concern is that a lot of the COVID response impacted directly on carers when services closed and a lot of the already onerous caring responsibility fell on those people. I urge you to prioritise that issue.

Can you give a quick update on the one-off payment for carers to be made in recognition of the COVID burden?

Mr Swann: Again, Chair, it is proving difficult for exactly the reason that you raised: the identification of carers. Since the payment is a cross-cutting issue, I have produced a paper that is ready to go to the Executive. As the Department identified the carers and groups to process payments for, it was found that it was not within its legal locus or ability to make those payments, as we do not have the mechanisms. There may be other Departments that have easier mechanisms for making payments to carers. We have set aside a sum of money to enable the payment to be made, but I will look for support from my Executive colleagues to process the payments. Chair, you know as well as I do that the support is there across the Executive, but it is about how we process the payments and identify the carers who should receive it

The Chairperson (Mr Gildernew): I have a final question before I bring in members. Last night, a number of us had a meeting with Fairness IN Fertility and members of the public from across the North who have been affected by the postponement of IVF services. I know that it is a difficult subject. However, one of the issues raised at that meeting was that people who are on the list or whose procedure was postponed due to COVID should not be penalised on the basis of time. Can you commit that no one will fall out of the system as a result of something that was beyond their control?

Mr Swann: We made a commitment during the first lockdown when services were reduced. We increased the age range capacity because it had been a restricting factor in the past. We are keen to work with anyone who was on the list or had started treatment to make sure that they progress through the treatment that was stalled due to COVID and services being stepped down for that period.

The Chairperson (Mr Gildernew): Do you have a date for the resumption of those services?

Mr Swann: The Belfast Trust is due to start services shortly, if it has not already done so, on a small scale. It is something that I asked to be prioritised during the first wave, so it is known in the trusts to be something that I want to see started. Michael, do you have any details?

Dr McBride: You are correct, Minister, that services have restarted, although, in more complex cases, it has been on a small scale. The trust is committed to increasing provision as soon as is practicably possible, which, as the Minister said, is something that we wish to see.

3 The Chairperson (Mr Gildernew): Thank you, Minister and Chief Medical Officer. I will go to members for questions.

Ms Hunter: I thank the Minister and Michael for being here again. I have a few questions, one of which is about the stock and supply of the vaccine. Earlier this year, Patricia said that there were difficulties at the start with shortages. As we prepare to vaccinate the general population later in the year, do you foresee any issues with the stock and supply of the vaccine? What assurances can you give the public that that will not be an issue?

Mr Swann: That is something that we have always been conscious of when talking about the next steps in our vaccine programme. We are dependent on a supply chain, and we have an indication of what we will receive about two to two and a half months in advance. That is what we plan for, so the assurances that we give are based on the surety of our supply. Usually, what we are told we will get is there or thereabouts what we do get.

The additional challenge that we will see, which we will have to factor into the programme, is that, although we are moving on to other cohorts, we are moving into the phase in which people will be entitled to their second vaccination. The issue is about how we manage vaccine supply and our vaccine programme facilities, staff and the entire logistical programme to make sure that we bring people forward for their first vaccination as well as ensuring that people get their second vaccination.

You have had regular updates from Patricia and will know the detail of what she has planned, but we always look to the two to two and a half month projected cycle to make our plans. We do not call people forward unless we are sure that there will be vaccine supplies for their cohort.

Ms Hunter: My next question is about COVID passports. Over the past number of weeks, that has been an issue in the news, and a few constituents have reached out to seek clarity on the matter. Do you foresee COVID passports in Northern Ireland for access to services or travel?

Mr Swann: That is very topical. There was a coordinations call last night at First Ministers' level that I was part of, and it is work that Her Majesty's Government are undertaking. That will bring particular challenges, especially for us. If we introduce a COVID certificate, passport or whatever it may be called for access to services, the issue, which the deputy First Minister raised, is ensuring that it is concurrent across these islands not just throughout the United Kingdom. The additional challenge is how the matter is perceived internationally. Will some countries insist on a having a vaccination certificate or passport prior to entry for holidays, for example? If so, it is something that we will have to develop to allow that to be a part of travel.

From a political and personal point of view, the development of a system in Northern Ireland that requires people to provide certification of vaccination to enter a cinema or a restaurant would not sit comfortably with me. With regard to proof of vaccination for international travel, we already have such requirements for travel to certain regions; for example, certification of vaccination for yellow fever. That proof may become an international requirement, but I do not think that the Executive or the Assembly would be entirely comfortable with it for accessing services.

Ms Hunter: That is a good answer, Minister. My next question relates to a change in service provision. Our tabled papers show that addiction inpatient services have been temporarily stood down in the Northern Trust. Why is that? When do you foresee them being restored fully? The Northern Trust is not mentioned in the notes under "Active outbreaks", so why have they been temporarily stood down? Is it because of staff redeployment?

Mr Swann: Cara, you have answered your question: it is due to staff redeployment. Decisions on any of the services that we have had to stand down are based on what staff we need to redeploy and where they can be redeployed from. In my opening statement, I talked about rebuilding services, and the Chair mentioned fertility services. It is about how quickly we can get those services stood up again, because they are there for a reason. It is about getting them back to support and serve the people who need them.

Ms Hunter: Is there a timescale for when those crucial services will be restored?

Mr Swann: I do not have that detail for the Northern Trust services. If it is not in your briefing or answered later on, we will get you an update, if the Clerk gets in contact with the Department.

4 Ms Hunter: My final question is on gym closures. I am sure that other MLAs will agree that a lot of people have been asking questions about gyms, as they create a sense of community. At yesterday's dual diagnosis all-party group, Gary from Derry's ARC Fitness, talked about the use of gyms in helping people recover from drug and alcohol dependency and of the sense of community and the sense of hope and support that that creates. The pathway was announced earlier this week. Will you update us on how decisions on gyms reopening will be made?

Mr Swann: They will be taken in the round. When the Executive look at any relaxation or step that they take, they look at the specific time and where the priority is. An overall balance and assessment is made with each step. One thing that we have to be conscious of is that each small bit that is opened, no matter where or what it may be, has a cumulative impact. We may think that an activity has only a small impact, but another small activity will have a similar impact, and, when you look at the overall cumulative effect, you see that those small steps have an effect on what we are trying to do. It is about how the Executive take a proportionate response to where we see the measures and take those steps at the right time. We understand the benefits of physical activity on physical and mental well-being, and the Chief Medical Officer is on record in that regard.

The Chairperson (Mr Gildernew): We are tight for time with the Minister, so I would appreciate questions and answers being as succinct as possible, as they have been so far. Thank you for that.

Mr Buckley: Thank you, Minister and Michael, for coming to the Committee. I fully appreciate the difficult job that you are involved in. It is certainly not easy. I express our thanks for everything that is happening in the health service.

I want to talk about the pathway to recovery. Like many others across the country, I looked upon the document with a lot of frustration. I was frustrated at the lack of clarity [Inaudible] reopening and at the Committee's lack of involvement on a potential way forward prior to the release of the document, given our central role throughout the pandemic. This may be a question more for Michael at this stage. We have been told that the document is a data approach, and significant forecasting has been carried out throughout the pandemic in monitoring pressure on our [Inaudible.] Could you elaborate on where that data comes from? If this document is data-focused and not date-driven, why could we not use the data to provide indicative dates to give people a sense of the timescales so that they could prepare for a potential reopening if the data was consistent with your forecasting?

Mr Swann: I will come in with regard to the document, and I note Jonny's comments about the Committee not being involved. It would not be up to us to involve the Committee in an Executive document pre-release, Jonny. This is an Executive pathway, not solely a Department of Health document; in fact, we were presented with it so that we could give our input.

With regard to your comments about the frustration, we want to be honest and upfront with people. While there is the hope of better days ahead, putting in dates now for possible relaxations weeks away could not be done with confidence or certainty. As an Executive, we understand that businesses need time to prepare to reopen, so we will continue to engage will all the sectors and work in partnerships for a safe reopening when the time is right.

Each relaxation will need to be informed by the impact of the previous relaxation on community transmission and the Rt number. The Executive are committed to a four-week review cycle, when we will monitor the data on a range of health and societal impacts before considering which relaxations can be made safely. While I acknowledge that, Jonny, that is the opening paragraph from one of the documents co-signed by the First Minister and deputy First Minister on how the document was constructed and how it is set out as to the approach it takes in regard to the approach agreed by the Executive.

With regard to the data, the document states:

"We will continually monitor a broad range of data, information and statistical indicators to inform our decisions on whether to relax restrictions, or whether we need to return to strengthening them."

The health trends that we will look at, as we have always looked at:

"will be based on the World Health Organisation's [sic] conditions for adjusting restrictions and will include: • Maintaining the Rt number below 1

5 • Health service capacity for COVID and non-COVID • Test, trace and protect data and intelligence • Population immunity", which now includes benefits from our vaccine programme, and the emergence of new variants. The pathway document also states:

"Economic data and indicators are critical to ensuring that decisions will have the best impact on starting the road to economic recovery", and those are listed.

I know the frustration that you express, but I need to be clear that the pathway document is from the Executive and that is why, when it was published, I had to make sure that that was clear.

Mr Buckley: Minister, I understand that it is an Executive document, and I have read it, by the way. We were told throughout the COVID-19 pandemic that forecasting informed decision-making. I think it was said in the run-up to Christmas that there was a forecasting of the pressures on hospitals and how that would lead to restrictions needing to be put in place. Given that, why can we not use forecasting now to give indicative dates if the data stays as it is and the forecasting model is accurate? We could then give some clarity to industry as to the forecasting models in line with a potential date for reopening. Maybe Michael could answer that.

Dr McBride: Thank you for the question. We have never done forecasting, and we have never made predictions. What we have been relying on throughout the pandemic is modelling on the very criteria and metrics that the Minister has just outlined — the number of cases and the pressures on the health service — and modelling on the basis of those. Modelling is not forecasting, and it most certainly is not prediction.

The Minister indicated and we need to bear it in mind that this is a public-facing document. On page 27, as you are aware and as the Minister outlined, it articulates clearly the measures that will provide us with an assessment as we walk our way back out of restrictions and the answer to several important questions. The first important question is, "Do we still have the epidemic under control? Yes or no?". There are certain measures: for example, the number of cases, the number of positive cases and whether the percentage of positive tests is under control. We are now used to those sorts of numbers. The R number is really important. If it goes above one, the epidemic is growing and we do not have it under control. If we keep the percentage of positive tests consistently well below 5%, we know that we have the epidemic under control. That is in the WHO criteria that the Minister has alluded to. Those are just some of the questions and data streams that we will look at to inform decisions about whether the epidemic is under control. We will look at how many cases are related to background community transmission from our surveillance systems; we want to see a low level of those and for cases related to clusters and outbreaks, with our contact tracing system, we are identifying all of those contacts.

Those are the clear measures and metrics that will identify whether we have the epidemic under control and similarly, whether we can continue to provide health care, as we discussed, for non- COVID patients and any surge in COVID cases. The WHO criteria that the Minister has alluded to are in the public domain and are accessible.

Mr Buckley: OK, you have explained a lot there. Will someone confirm the exact stage that we are at at present? Given the review dates —.

The Chairperson (Mr Gildernew): Very briefly, Jonathan, please.

Mr Buckley: With regard to the review date of 13 May, if the data stays consistent with what is being presented at the moment, will those review dates lead us to move to the next stage, date by date, given what is in the pathway to recovery?

Mr Swann: Our modelling will not go that far in advance. That is why we put in specific review dates. We have been clear that, for each step we take, we take time to assess what impact it has had before we go to the next phase. While the four dates are specific review dates for the regulations, I caution people not to see them as an exact date for moving to each stage. The First Minister and deputy First Minister have both indicated that there may be opportunities to move down one of the nine pathways

6 quicker, should the indicators take us in that direction, or some may move slower. That is the approach that we took in coming out of the first lockdown. We took the steps that were appropriate at the time, and that worked for us. That is why we got into such a good position in Northern Ireland last summer.

Mr Buckley: Thank you.

Mr Carroll: Minister, we have talked a lot about mental health when you have been at the Committee previously. I want to home in on some particular aspects.

Two weeks ago, the 123 GP Campaign released figures showing a lack of in-house counselling services in GP practices. In my constituency of West Belfast, 50% of GP practices do not have any in- house counselling services, and we have a big problem around mental health issues in that community. It is very worrying and is set to increase with the aftermath of the pandemic, whenever that may be. I have a couple of questions about that. What assurances can you and your Department give that no one will be forced to wait for more than 28 days before getting access to a counsellor? I understand that no targets are being reached for in-house counselling at the minute. There is no measurement of waiting times in GP services, and in-house services are not mentioned in the mental health draft strategy. Can you give a response to those questions, Minister, and I will follow up on your replies?

Mr Swann: GPs can bid to have access to the in-house services in their surgeries. Again, because they are based in GP surgeries, it will be up to the GP surgery to seek that support or that provision, the same as with the multidisciplinary team support and provision. There are steps that we take to do that and support it. That work is ongoing. Where necessary, people with mental ill health are referred by their GP to secondary care mental health services, across the five trusts. It is the same with independent contractors. GPs have the choice to provide the services for their patients. Our Health and Social Care Board (HSCB) meets regularly with GP representatives to encourage GP practices to contract their services where uptake is lower than in some other areas, so that would fill those gaps. The multidisciplinary teams are running, unfortunately under transformation funding as well. The more surety I can have about funding, the more the multidisciplinary teams will open out. I take your point that they are not mentioned in the mental health strategy. That had not come to my notice, Gerry, but it is certainly something to follow up on.

Mr Carroll: Thanks, Minister. I appreciate that. With respect, the answer that there is money there and they can apply for it is not really addressing the fact that there is such discrepancy between different areas. In some constituencies across the North, 100% of GPs — I think it is in East Antrim — have these services. That is great for people in East Antrim, but in West Belfast and other parts of the North, the uptake is not high. That is concerning, and something needs to be done to address that.

There is also a discrepancy in the amount of money being spent on these services. It is several million pounds. I think that it is about £3 million from the Health and Social Care Board, and around £10 million per annum is spent on drugs for treatment of mental health. That is important for some people and some conditions, but there is a concern that there is an over-reliance on medication rather than using counselling services. I will move on because I know that time is short.

Minister, last week, Charlotte McArdle, the Chief Nursing Officer (CNO), said that only one third of care homes are operating the care partner scheme that you announced last year. Why is it that the vast majority of care homes are not acting on your direction? What action is being considered or being taken to ensure that all private care homes abide by your direction and make sure that loved ones can have access to their family members who are in care homes at this very difficult time? Have you considered fines or financial penalties?

Mr Swann: Thanks, Gerry. I feel strongly that, when those changes are made in regulations, the care homes should move to facilitate them. From 1 March, from Monday, there was a change in the COVID alert status — we moved from level 5 to level 4 — and that changes visiting guidance and regulations as well. I met Charlotte and a number of our chief officials last night to discuss care home visiting. I spoke to the Commissioner for Older People as well because he was, rightly, raising his concerns about that area. We continue to engage with care home providers to see what difficulties they are having, because, again, the guidance and regulations are there, but the funding and support mechanisms are also there to facilitate more visiting.

7 We identified care partners as those being able to access the vaccine to facilitate that, because some care home owners raised with us that, although residents and staff have been vaccinated, they are concerned about letting care partners in. We covered those issues under the carers protocol. I think that about 1,200 people have taken up the vaccine as care partners. Charlotte indicated last night that, at the latest count, in the region of 48% of care homes are now implementing care partner status.

One of the things that the Commissioner for Older People for Northern Ireland (COPNI) raised with me — it is one of our concerns that I want to see being addressed — was the issue of a self-reporting mechanism. We have asked the Regulation and Quality Improvement Authority (RQIA) whether it could do more to ensure that homes that say that they are delivering care partner facilities actually are doing so. For those that are not, we will see what can be done. We have been clear, as has COPNI, that legal action could be taken, although it would be unfortunate if anybody had to go to those lengths. All the support mechanisms and the change in visiting status should encourage more care homes to do that.

We should note that, on 11 January, we were supporting 150 care homes that had an outbreak. Yesterday, that number was 23. We can see a direct correlation to the success of our vaccination programme, especially taking the approach of care homes being the initial cohort that we indicated and called up.

The Chairperson (Mr Gildernew): That is certainly welcome and encouraging. I am sure that we are all relived about that significant drop.

Ms Bradshaw: Good morning, Minister and Chief Medical Officer. My first question is about special educational needs teachers. As you know, Minister, I have not tried, at any stage of the vaccination programme, to prioritise one profession over another. I believe in the clinical vulnerability and at-risk criteria around that. However, there seem to be delays in rapid testing in SEN schools. A high number of SEN teachers are also off sick. Married to that is the fact that the parents and carers of those children have been living on their nerves for a year and the very rigid test that the Public Health Agency (PHA), through community paediatrics, is introducing as to which SEN teachers will be vaccinated. Is there no way in which you, Minister, can intervene and try to have a blanket approach to SEN teachers?

Mr Swann: Thanks, Paula. As regards a dual approach in regard to vaccination and testing, Paula, there is not. I have maintained JCVI status and guidance from the beginning. That is the approach that has been taken across the four nations. There are many individuals and cohorts for whom you could make a special argument, but there are so many that it would start to prove difficult to provide a vaccination programme. One of the latest updates that came from JCVI was about something that it had been looking at: the prioritisation by occupation. Its guidance is that, if you were start to prioritise specific work cohorts at this stage, it could end up slowing down the vaccination programme. We are now looking at the mass supply and accessibility of vaccines, so its guidance is that it is better that we move quickly through cohorts by age profile, which, hopefully, will catch all the interest groups and special groups that need support.

Do you want to talk about the specific testing, Michael? We are making stages in regard to testing in not just special schools but other schools.

Dr McBride: Thank you, Paula, for the question; it is a very important area, as you have rightly identified. As the Minister indicated, we have worked very closely with the Public Health Agency, the Education Authority (EA), the Department of Education and local paediatricians to identify the children with particularly complex needs who would benefit from those working with them having the vaccine. It is all about protecting vulnerable children, as you indicated. That work has been completed. I understand that a communication will shortly be going out to special schools. I thank everyone who has been involved in that. I hope that that vaccination programme will get under way in the very near future.

The testing has been agreed. My understanding is that the roll-out of that has commenced in five schools, with a view to it being rapidly rolled out to the other 39 remaining schools. Obviously, it is a complex process for parents, children and, indeed, staff. As I say, that will be facilitated through loop- mediated isothermal amplification (LAMP) tests, which are saliva-based tests, so less invasive for the children. I am grateful to Queen's University. It will work closely with PHA and EA to facilitate those test results and get them to teachers, pupils and parents. That work is well under way and progressing, Paula.

8 Ms Bradshaw: My second question relates to post-viral conditions. Obviously, long COVID is one, but another is ME. Minister, you will recall how long your former colleague Jo-Anne Dobson campaigned for a medical clinical lead in ME for the 7,000 patients in Northern Ireland. The taking forward of that by the Health and Social Care Board has, obviously, collapsed. There is the potential that ME could be brought in with long COVID for assessment and diagnostics. The concern amongst those 7,000 patients is that they will actually be sidelined. They feel very aggrieved that, nearly nine years since Dr Henry moved out of that post, they do not have a dedicated service. Now that there is more attention and focus on post-viral conditions, how will you support the 7,000 ME patients in Northern Ireland?

Mr Swann: Thank you, Paula, for that recognition. It was one of those campaigns that Jo-Anne was very passionate about and led very strongly [Inaudible.] With regard to additional support for those 7,000 people who need it and the additional provisions that we want to put in place for long COVID as well, we will look to see where there is crossover of supports that may be beneficial to both cohorts. With regard to ME provision specifically, there has been difficulty. As you say, it has been nine years since that post was occupied. That piece of work is still being looked at. Unfortunately, I cannot give you a positive, or any, update at the minute. I was not prepared for that question. However, I will get back to you. If you are content, Chair, I will update the Committee with an answer to that specific question.

Ms Bradshaw: Can I just ask one quick question, or maybe just put the issue on your radar, Minister? It is off the back of the issue that Colm raised about the regional fertility centre. Associated with that is that, as I understand it, the endometriosis consultant left his post a year ago and that post has not been filled. Some of the women on the call last night and constituents whom I have dealt with are in a really bad way with endometriosis. Their surgery was delayed a year ago, and, now, when they have gone back, they have found that they have organs that are fused with those adhesions and surgery or other treatment will be incredibly invasive, if not impossible. Can you, please, look into that lack of an endometriosis consultant, because it is so important that that post is filled?

Mr Swann: Again, thank you for flagging that issue, Paula. Michael, do you have anything to add specifically on that post?

Dr McBride: No, there is nothing that I can add to that, Minister. I appreciate the distress that is caused by what is, often, a very debilitating condition. Often, there is significant delay in diagnosis in the first instance, given the nature of the complaint and the symptomatology. That has very profound implications for the long-term sequelae of that, as you have indicated, with regard to [Inaudible] pain, etc, and requires a complex multidisciplinary surgical and support approach. I am very happy to get back to you on the detail of how that is being progressed.

Ms Bradshaw: Thank you.

Mrs Cameron: Thank you, Minister and Chief Medical Officer, for your attendance at the Committee. I want to kick off with something that the deputy First Minister mentioned on Tuesday in her statement to the House about the pathway out of restrictions. She mentioned that infection rates here are much, much worse — that is not a direct quote — than everywhere else; I think that she meant in the UK and, possibly, the Republic of Ireland. Can you give us an update on the infection rates and comparisons with each part of the UK and the Republic of Ireland? That is my first question.

Mr Swann: Thanks, Pam. I do not have the updated slide. Michael, do you have the updated slide that we presented yesterday on infection rates? I do not have the exact figures, but I know that we were somewhere around level with Scotland and lower than the Republic of Ireland and England but higher than Wales. I am sorry, but that is just off the top of my head. I will ask the Chief Medical Officer for an update.

Dr McBride: I do not have the exact details of the slide in front of me. As you will recall, however, we have been saying over the past couple of weeks that the relative test positivity rate, if we look at the seven-day cumulative total cases per 100,000 as published by the respective countries, has changed and that the differences among the five nations have narrowed. At various points in time, going back a significant number of weeks, the Republic of Ireland was at a very high level compared with the United Kingdom. As a result of the measures that were taken there, the rate then fell very rapidly.

For the past few weeks, Northern Ireland, going by the data, had a [Inaudible] higher level than Scotland and Wales, but that gap has narrowed in the past week. The data that I shared publicly

9 yesterday as published information demonstrates that the gap between Northern Ireland and Scotland has narrowed. The prevalence is higher here than in Scotland and in Wales, but it is below that in the Republic of Ireland and England. That is a fluid position, however, and if I were to look back at the figures from last week, it would have been different again.

There are other ways of estimating that. One of the other important studies is the Office for National Statistics infection survey. In the interests of time, I will summarise it, but it estimates that about one in 104 people in England has been infected with COVID, while it is one in 195 in Northern Ireland. The rate is one in 225 in Wales and one in 205 in Scotland, so, again, they are lower. From looking therefore at the two different measures, we know that the estimated prevalence here is higher at present than it is in Scotland and Wales, confirming the published data for those who have tested positive, and it is lower than it is in England.

The Chairperson (Mr Gildernew): May I come in here? There is a bit of background noise bleeding into the conversation. I ask everyone who is not speaking to ensure that they are on mute, please.

Mrs Cameron: Thank you for that detail. For clarity, do you agree with the deputy First Minister's assessment yesterday that infection rates are much, much worse here than in the rest of the UK and the Republic of Ireland?

Dr McBride: I did not hear the deputy First Minister's comments yesterday, nor do I know the context of what she said or whether it was said in a statement or in response to a question. I do not want to be drawn into commenting on that, because I do not know the context and did not hear what was said.

Mr Swann: It is not a description of our infection rates that I would use.

Mrs Cameron: OK. Thank you. I welcome the move to have the over-50s vaccinated come April. I understand the calls from other professions, particularly from the police, to be vaccinated, given, for example, what they face dealing with policing the restrictions. I also understand the call for teachers to be prioritised. I do not necessarily agree with prioritisation of professions, but the ultimate solution is still to get everybody vaccinated as quickly as is humanly possible.

That leads me on to my previous calls for a 24/7 roll-out. Many more supplies of the vaccines will hopefully be coming very soon. Minister, even for a short time — a week or a weekend — would you consider a pilot scheme or a trial of 24/7 roll-out to see whether people would be willing to come in overnight and in the early hours of the morning to take slots and have their vaccination? People are desperate to move on and get past the restrictions, and the vaccine is the most helpful way out of them. We really need to pull out all the stops and ensure that the vaccine is offered to as many people as possible. I understand, however, that that is dependent on supply. If you have the supplies, are you prepared to roll out the vaccine 24/7?

Mr Swann: Pam, what we are doing is dependent on supplies of vaccine. Our next step is to make vaccination as accessible as possible, and that is why we are moving to having a mass vaccination centre. It is going to open at the SSE Arena, where we hope to be able to vaccinate 40,000 people a week. That centre will be run alongside our six other regional facilities, GP practices and, towards the end of the year, community pharmacies. We need to find out how many of them are able to do it, where they want to do it and whether they want to have some centralised function. Rather than time, this is about location. We want to get vaccination taking place as close to people as possible.

At the SSE Arena, we are looking at extended hours, although not to 24/7. We will see what the uptake is and how the bookings are progressing, and then base decisions against supply. It is something that we will look at. As for going 24/7, I do not think that we are there, but maybe we can run later into the night, rather than just from 8.00 am to 9.00 pm or 8.00 am to 8.00 pm, as we do now. That is an option that we will keep on the table at all times, because, like you, I want to get as many people as possible vaccinated as quickly as possible.

Ms Ní Chuilín: Good morning, Minister and Dr McBride. How are you? My questions relate to workforce planning. We had the CNO and the Deputy CNO before the Committee last week. I found it a bit shocking that there is almost a relaxed position being taken over the safe staffing legislation not coming through. I am concerned about the horrendous year that our Health and Social Care (HSC) staff have been through. A legislative intervention needs to be made to look after them a bit more.

10 My other question concerns red-flag surgery. Pre-COVID, approximately 900 surgeries a week were being done in Belfast. At the minute, it has been stepped up from what it was post-COVID to around 200, which is welcome. Belfast City Hospital will become a regional centre. What will be the average number of surgeries done a week? The CNO also said that COVID patients will be moved to the Mater Hospital. Does that include ICU facilities? We need clarification on that.

Finally, the Committee would appreciate some feedback on the workforce planning issue. It has been with us for some time. We have all paid tribute to our Health and Social Care staff, and been sincere in doing so, but we now need to step in and look after them a bit better than we have been doing. The absence of safe staffing legislation is disappointing, to put it mildly.

Mr Swann: Thanks, Carál. You will find no stronger advocate of supporting our staff than me. Our staff were on strike when I came into post, and that strike was about pay and safe staffing. A Bill team has been established to bring about the legislation, and it is now engaging with trade union side on what that Bill should look like. We want to get it right, rather than rush it. Like you, I think that we need to put such legislation in place. Time is against us, however. We have a year left of this mandate. We have looked at the Scottish model and are looking at the Welsh model to see what best suits and what can be done. Can we bring in provisions earlier through a framework that is not legislation-based? I do not think that our Chief Nursing Officer is taking a relaxed position, quite the opposite. Sorry, I should say that it is definitely not a relaxed position when she is talking to me: shall I put it that way? Charlotte is passionate about her workforce.

We are also looking at the differentials in legislation in other jurisdictions. I will see whether it can be about other staff. I know that other regions focus specifically on their nursing staff, which is a very important cohort, but I would rather provide a holistic approach for all staff across the health and social care system. For too long they have been forgotten, and it was our staff who were allowed to take the hit when there were cuts, from no matter whose budget. To bring our nursing provision back up to the standard that it should be at, we had to create an extra 300 training positions over three years.

Ms Ní Chuilín: Minister, you are asking for almost £300 million to look after agency staff, who are needed. We are going to be on this trajectory unless you get a grip on the workforce planning issue properly, and that is not happening.

Mr Swann: Carál, as you know, I can do that only with recurrent funding. The recurrent funding that I got was for safe staffing. The only recurrent funding that I have at this time is the £52 million for the change in salaries for Agenda for Change. The commitment from the Executive was for an additional 300 training places for nurses over a three-year period, but that only fills the gap. To get a grip on this, as you correctly acknowledge, we need those agency staff now, because there is such a large shortfall in recruitment. Numbers have increased, and our vacancy rate has decreased dramatically since 2017, but it is still staggering, Carál. It is far too large.

Ms Ní Chuilín: We are 3,000 staff short.

Mr Swann: Yes.

Ms Ní Chuilín: You are handing back £90 million.

Mr Swann: I am not, Carál.

Ms Ní Chuilín: You did.

Mr Swann: No. Sorry, Carál, but, if we go back to that cycle, it was a one-year budget. I got COVID relief moneys towards the end of the year. I was then able to go back to Conor to ask for a further £150 million for PPE. On paper, I may have handed £90 million back, but I then asked for £150 million. I am therefore £60 million up on that ask because of what we were able to do with PPE.

If could have reallocated those moneys that we got towards the end of the year and put more nurses on the ground there and then, I would have done, Carál. That is not something that we can physically do, however, because it takes time to train staff.

11 Ms Ní Chuilín: In the meantime, what happens to the beleaguered staff who are exhausted and emotional and who feel unappreciated and undervalued because they are on £23,000 a year? Seriously?

Mr Swann: Carál, those are the pay rates that we inherited. As you will remember the Executive collectively led the negotiations with trade union side to get the pay settlement: to get parity with England restored and to get pay increased again. I will continue to do that, because I value the staff that we have in the service. We all do. I have said before that we undervalued them for so long. People saw them as being there only when they personally needed them. As a country, an Executive and an Assembly, we now see them for what they do and for what they deliver. We therefore need to get long-term, sustained investment to allow us to make the changes that we need to make.

The Chairperson (Mr Gildernew): May I interrupt? A tone from somebody's phone is definitely coming through. I ask everyone in the meeting to check that they are on mute unless they are speaking.

Carál, if you have anything further that you wish to say, you have a short time available.

Ms Ní Chuilín: I have a question on the Mater Hospital's ICU being used for COVID patients. Michael, you will appreciate that I represent North Belfast, where the rumour mill is running riot. Even if it is bad news, I would like some clarity, please.

Mr Swann: Michael, do you want to respond?

Dr McBride: The priority here has to be to get [Inaudible] surgery regionally. Carál, are you picking me up OK?

Ms Ní Chuilín: Sorry, but I missed the start of that, Michael.

Dr McBride: We discussed earlier that the priority must be to re-establish regional complex surgery. Clearly, a lot of that surgery is carried out on the Belfast City Hospital site, which is currently the Nightingale escalated critical care facility. The priority must be to de-escalate the ICU in the Nightingale facility and then to use the regional prioritisation of surgery so that we maximise the number of individuals who, as we discussed earlier, are still waiting for their red-flag surgery. In other words, we will create green sites and green pathways again in the City Hospital and at other sites. That will again mean that we will have to manage COVID patients who require complex respiratory care or ICU at other sites. In the past, in the Belfast Trust area, that was at the Mater Hospital. My understanding is that the plan will be to support those patients on the Mater site in the short term. Hopefully, we will suppress community transmission of the virus further. As we said earlier, with the roll-out of the vaccine, the pressures related to COVID will become less. We will continue to keep the services that are required at which site under continuous review.

Ms Ní Chuilín: This is my final question, Chair, sorry.

The Chairperson (Mr Gildernew): [Inaudible.]

Ms Ní Chuilín: Michael, you are saying that the ICU in the Mater will be opened temporarily to deal with COVID cases and, in particular, complex respiratory cases. Does that mean that those ICU intensivists will stay?

Dr McBride: I am not across the detailed plans of the operational arrangements that the trust is currently considering. Those are very complex arrangements, and, as we have said already, I pay tribute here to all those staff who have relocated — nursing staff, medical staff, support staff, OTs, physios — and are working across sites to provide care to very sick COVID patients who are still in our hospitals today and will be for many more weeks.

Mr Swann: Carál, have you had a meeting or do you want a meeting with the Belfast Trust?

Ms Ní Chuilín: Thanks, Minister, but I have organised one. In fairness, the Belfast Trust came back to me fairly quickly. I want to put that on record.

12 Mr Swann: That is all right. I would have facilitated one if that would have been useful.

Ms Flynn: Thank you, Minister and Dr McBride. I will try to be quick. I am glad that Gerry raised the GP counselling issue and that Cara touched on the issue of addictions. The pathway to recovery is positive and full of hope, but there have been conversations about the budget, and you have so many priorities and are working to a tight budget. In the context of the pathway to recovery, however, I have serious concerns that we will not be in a great place with mental health.

I will give you some reasons for that. At the minute, there are no inpatient beds for people with addictions. I think that we have only 30 beds right across the North. I learned recently that the money has been stopped for the rapid assessment, interface and discharge (RAID) service, which is the crisis service in the Belfast Trust. We know that new mental health patients are being seen later, and they are presenting with much more acute needs. Non-patients are now also presenting with greater needs, and the number of people being detained under the Mental Health Order is now three times that of pre-COVID-19 levels.

I appreciate that the fourth meeting took place with the mental health and suicide prevention Executive subgroup yesterday, which is great, and that £6·5 million was announced for the emotional health and well-being framework, which is also great. Minister, what I am really asking you today is this: will you commit in your future budgets, as tight as they are, to attempting to increase, in some shape or form, the proportion — that 5% to 6% — of shared funding for mental health services? Officials briefed us a couple of weeks on the budget, and I asked them the same questions. I know that you have recognised that mental health services are underfunded and that there is insufficient money. The officials said that the Department is on a journey towards increasing funding and that they will do a sense check. I just wanted to put that to you today. I know that it is a priority for you and that you have made all the right sorts of noises, and I appreciate that. When it comes to funding and investment, however, can you give a reassurance today that you will try to increase the percentage of available funding?

Mr Swann: Órlaithí, I can give a commitment that I will try to do that. You know that I am passionate about that. I want to do something about it, and I have been consistent on that since coming into post. Even during COVID, we have kept work going on the mental health action plan and the mental health strategy, which is a long-term, 10-year in mental health provision in Northern Ireland. We have the opportunity to make this place a world-class example of how to support people who have mental health challenges, and that is where we should aim. As you rightly indicate, my budget is challenging. What we need to do is complex across wide range of [Inaudible.] Over a number of years, mental health, like staffing, has been at the sharp end of a lot of the cuts, and that has affected the provision of facilities. We have therefore put in additional funding bids for capital and additional borrowings so that we can improve our facilities.

Our spare bed capacity for mental health provision concerns me, especially as we approach every weekend. It also comes down to staffing challenges, however. There are gaps in staffing provision, especially for mental health services. This is therefore about a long-term commitment and a long-term journey. That is what our 10-year plan is about, and we have to focus on that.

I welcome the Executive's commitment. I mentioned yesterday's meeting of the subgroup, which was the fourth such meeting. I do not mean this in a negative or derogatory way, but it is at those meetings that we hear the most engaging, thoroughly thought-through contributions from our Ministers, and that is because all the Ministers around the Executive table get the need to do this, and do it right. It is not just about the Department of Health investing in mental health services but about how each Department contributes to that. When it comes to addiction services, it is about how we tackle the source of the supply. The paramilitary crime task force (PCTF) has a role to play in supporting addiction services, because, if the illegal supply is not there, we can challenge addiction. It is about DAERA making sure that we have wide open spaces. It is about the Department for Infrastructure and the Department for Communities working together on some of our interlinking projects.

Our bridges project across the Westlink and the M2, for example, will contribute to the mental health and well-being of people in those areas, and the investment will provide early prevention so that people feel better. We do a lot of preventative work, and that is what the investment is about. Unfortunately, now we have to invest in the people who were not invested in a number of years ago. It is about how we support them. Siobhán O'Neill, the mental health champion, was at yesterday's briefing with Michael and me, and her clear message was this: if you need help, ask. It goes back to that phrase, "It's good to talk". It is also good to ask. If you need help, there is somebody there. There

13 is Lifeline. There are GPs. There are counselling services out there that can provide a listening ear, if that is what people need. They can also provide signposts for those who need to know where to go.

Mr Chambers: Minister, earlier this week, the Assembly received an Executive Office statement on a road map back to post-COVID normality delivered by the deputy First Minister in the presence of the First Minister. It is not unreasonable to assume that the statement represented a corporate and collectively agreed Executive position, and the central theme still seems to be that we are all in this together. Disappointingly, some of the comments and questions during that debate appeared to represent a few members of parties in the Executive taking a position of perhaps not being happy with the collective position, and subsequent remarks in the media further confirmed that some elected reps are not happy with the democratic collective decision-making process. Does that make the public health messaging more difficult?

My second question is about calls for road map dates to be published. It is hugely disappointing to be given a date and then find it being pushed back. It is not as though the various variants are sharing their future plans with us. Can you confirm that the road map as published will be subject to constant review and that the stages of recovery will not be delayed one day longer than necessary?

My third question is about comments that Carál made, highlighting the staff pressures currently. Can the Minister remind me what party held the Health portfolio before he took it over, just over a year ago, with a pandemic coming down the line at him?

Mr Swann: Thanks, Alan. The four set review periods and four dates are contained in the plan. They tie in with the agreed Executive position that we will review our regulations every four weeks. We have agreed to do that, and it is in our regulations that they will be formally reviewed every four weeks. We have also made it clear that, if there is the opportunity to review them in-between times, we will do that as well. The Executive are on record as saying that we want to keep the restrictions in place for as long as is necessary and that they are proportionate as to where we see the spread of the virus.

Alan, before me, nobody was in position. We had three years without a Minister. I came into an empty office, and that is well documented.

On public health messaging, I have often said that we need the support of the general public. We need the public working with us while we get through these next weeks and months, because that is where the opportunity and the hope is. It is in how we get through these next weeks and months with the restrictions that we have in place, and there is also the opportunity that the vaccine brings. The vaccine will not do all the heavy lifting for us. It is not the panacea for everything. It is a mixture of people following the guidance and the restrictions that we have in place plus the benefit that the vaccine brings. The message from me and from the Health Department clearly has always been to follow the guidance and the regulations and to take the vaccine when you can get it. The simple messages of social distancing, good hand hygiene and good respiratory hygiene still apply, but one thing that we are clear on and one thing that I am clear on is that, when everyone is given the same message, everybody hears the same message. That is when we get the response from the people of Northern Ireland.

Alan and Chair, I am thankful to the members of this Committee for the support that they have given to my Department, to the health service and to that public health messaging. It has been consistent. This Committee, having sat and heard some of the testimonies and some of the evidence sessions, is well aware of the effect that the virus is having not just on our health service but on our community. I think that that is why there has been a consistent approach and message from members of this Committee, and I thank you for that.

Mr Chambers: Thank you.

The Chairperson (Mr Gildernew): Thank you, Minister and Chief Medical Officer, for your attendance today, for addressing members' questions and for your presentation. I reiterate our support for the public health messaging, and I ask everyone to continue to do all that they can to keep themselves, their families and their communities safe. I do note the badge that Michael is wearing about safe distancing and social distancing.

Minister, we are all acutely aware that the data will be important moving forward, and you touched on that in the earlier part of the meeting, particularly around critical care and that element of things. Given that it will be so important, I would like some specific information to be forwarded to the Committee.

14 Will you commit to sending us all the minutes and associated papers, since August 2020, of the critical care hub meetings, the respiratory hub meetings and the oxygen supply meetings? Those are three key areas, moving forward.

Mr Swann: I will take that into consideration. I will not give the commitment until —.

The Chairperson (Mr Gildernew): I do not expect you to have that information to hand. That is why I left it as I have. That is the critical care hub, the respiratory hub and the oxygen supply meetings.

Mr Swann: I will take it into consideration to see if they can be shared.

The Chairperson (Mr Gildernew): Thank you, again, and good luck in the time ahead. We are moving into difficult territory, because we need to negotiate and navigate our way out of this lockdown in a safe and sustainable way. Our best wishes to you, your team and your front-line staff, who are still battling and working harder than many of us will ever understand, perhaps in circumstances that many of us will never experience, I hope, or understand. Thank you.

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