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OFFICIAL REPORT (Hansard) 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.
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