Health Minister Robin Swann's statement to Assembly members today.
Mr Speaker. I wish to give members an update on recent local developments in relation to COVID-19 and the rebuilding of services.
Yesterday, for the 14th consecutive day, Northern Ireland recorded no covid-related deaths. Whilst this is hugely reassuring, we must never forget that the virus is still here and it still presents a serious threat to public safety. And as always, we must keep those families who have lost loved ones to the virus to the forefront of our thoughts.
I would like to thank the people of Northern Ireland for continuing to adhere to the social distancing measures and current regulations. However nobody can become complacent. We must continue to do our bit in helping to reduce the spread of COVID-19. Keep your distance, wash your hands and don’t keep touching your face.
I would once again emphasise to all those listening, if you develop any of the symptoms please do not leave your home and instead go to the PHA website or ring 119 to book a free test.
I know a lot of members and their constituents were taken by surprise at the weekend by the re-introduction of the 14 day quarantine period for people arriving from Spain. This 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 previously stated the international quarantining regulations and the countries 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 which accelerated rapidly in the latter half of the past week. I appreciate that people returning from Spain and its islands will now be faced with 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 what 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.
Mr Speaker I have to reiterate that Saturday night’s decision was not taken lightly. Experience has shown how COVID-19 can be spread by international travel. The quarantining arrangements have been introduced to help keep people safe.
Testing in Care Homes
The Department has continued to actively monitor and assess the current and emerging science and evidence relating to COVID-19, to further inform our approach to testing in care homes.
As a COVID-19 test will only confirm whether someone has COVID-19 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 now 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 will commence on Monday 3 August 2020. This will involve testing all staff on a fortnightly basis and all residents on a monthly basis.
The position on 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 an excellent cohort of professional contact tracers in place 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 this 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 of 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 this particular incident has highlighted the benefits of that approach.
This 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 potentially 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 vitally important.
And whilst I absolutely recognise that the issue of face coverings divides opinion in wider society, I would repeat the point that the medical and scientific advice is clear – wearing face coverings in retail settings will help protect our fellow citizens.
Mr Speaker I am pleased to be able to say that Northern Ireland citizens will very soon have access to a smartphone app which 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 Commissioners Office “Privacy by Design” principles and therefore uses only anonymised information in its operation.
I would appeal to all Members to encourage their constituents to download the app. If we can get significant numbers to download it will play an important part in augmenting the existing contact tracing process in our efforts to stop the spread of COVID.
I am also pleased to say that the app will be interoperable with the one already in use in the Republic of Ireland and is also highly likely to be compatible with apps introduced in future across the UK and Europe. This will be the first instance of such a solution worldwide; and will be the first example of such apps operating in an interoperable manner.
Rebuilding HSC Services
When I published the 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 within the prevailing COVID-19 context.
As we try to increase capacity, patient and staff safety will remain at the very centre of everything we do. Our health and social care 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 on a procedure or a diagnosis, I will say this: We will, as a system, do all we can to make sure 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, use of PPE, staff availability and the need to plan for future potential COVID-19 surges are just some of the issues that continues to weigh on our ability to diagnose and treat patients.
It is in this context that our Health and Social Care Trusts published their first three month Rebuilding plans on 10 July, covering the three months until end September. My intention is that these will be followed by further successive three month plans in due course.
In addition to these Trust plans, work is underway to develop regional approaches to service delivery across a range of areas. All of this work is clinically led and developed using co-production principles.
The Rebuilding Management Board continues to meet and will continue to oversee all of this activity, reporting directly to me.
Today I announce the way forward for two important services, day procedure centres and orthopaedic surgery.
I believe it is in the public interest to move forward with the implementation of these service changes as quickly as possible 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.
This will allow us to maintain robust infection control preventative measures at these 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 these services, while other hospitals are treating COVID-19 patients.
I will now turn to the details of these service important service changes which I have published in a Policy Statement for Elective Care Day Procedures and a Blueprint for Orthopaedic Care.
Day Procedure Centres
Our waiting times for elective care are the worst in the UK and even prior to the pandemic, waiting times for hospital surgery were totally unacceptable.
The impact of COVID-19 on the HSC has been profound and will undoubtedly be long lasting and 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 this 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 they will not be competing for operating rooms, staff and other resources, leading 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 to 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 both 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 would like to take this opportunity to thank everyone from across the system whose combined efforts have helped to bring us to this point, and who I know are continuing to work tirelessly to improve the quality and timeliness of the care we provide.
Day Procedure Centres are equally, 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 last few months. Day procedures must now be taken forward in the context of the continued need for social distancing and for Personal Protective Equipment at volumes 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 daycase procedures to avoid further detriment to patient health and, in recognition that this will need to be taken forward on an incremental and prioritised basis, I am planning to concentrate delivery initially on one ‘hub’ Day Procedure Centre site.
The ‘hub’ site is Lagan Valley Hospital in the South Eastern Trust and this ‘hub’ will interact with several hospital sites (the spokes) around Northern Ireland.
Lagan Valley Hospital has a day procedure unit and it has demonstrated its ability to successfully deliver a range of daycase and endoscopy procedures.
As one of the locations on which the varicose veins prototype was delivered, it proved popular with staff and with patients in terms of accessibility and patient experience. Furthermore, throughout all of the engagement with clinicians involved in developing proposals for day procedure centres, Lagan Valley was consistently recognised as a suitable site for a day procedure centre in terms of its accessibility for both patients and staff alike.
Drive time statistics show that almost 73% of the population are within a 60 minute drive time of Lagan Valley Hospital.
In relation to the Emergency Department at Lagan Valley, 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. As such, the additional travel will be an isolated event rather than a long term passage of care requiring multiple visits. Service users are currently experiencing unacceptably long delays in accessing daycase 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 as such it will take forward the establishment and management of the regional Day Procedure Centre model in the first instance. I will keep this 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. This 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 in terms of 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 in order to minimise the impact on existing service users.
Before I set out my plans for orthopaedics, I want express my condolences to the family of Kyle McDonald, a Consultant Spinal Surgeon in the Belfast Trust.
Kyle tragically passed away suddenly on Sunday. He was a dedicated and successful surgeon and a credit to his family and his profession.
My thoughts are very much with his wife, his children, his parents and the entire family – and also with his colleagues in the health service.
I know I speak for the entire House in extending our deepest sympathies.
Just like day procedures, unfortunately waiting times for orthopaedic surgery here are among the worst in the UK, with patients waiting an appalling up to 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 patients in others. For a country the size of Northern Ireland, such a post-code 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 procedures and have therefore been halted to ensure both the availability of resources and patient safety for those affected by COVID-19.
While these measures will have an immediate positive effect on COVID-19 patients at that time, they will also mean that unfortunately other patients in the healthcare system will become de-prioritised and in particular, this will have a significant impact on those patients who are already waiting the longest.
It is now critical to focus efforts on the regional rebuilding of the service, and 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.
It is for that reason that I am planning to focus elective orthopaedics initially from two ‘hub’ sites. The ‘hub’ sites that I am proposing are Musgrave Park Hospital and Altnagelvin Area Hospital, both of which would be well placed to increase regional orthopaedic services immediately utilising ‘Covid light’ facilities.
Both sites provide good geographical coverage for the population of Northern Ireland in terms of their accessibility for both patients and staff alike, and they each have well established orthopaedic units which could be easily ring-fenced and protected from both unforeseen and predictable increases in pressures on the health service as a whole. This will be particularly important in this phase of rebuilding.
Focussing on these sites initially will allow patients of both lowest risk and highest priority to undergo orthopaedic surgery.
It is important to note that this is not a plan to centralise services or to remove existing services from where they are currently being delivered. On the contrary, my plan is 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 terms of waiting times and practice.
To oversee the development of this model, I will establish a clinically led Regional Network which 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 in terms of equity of access to the same level of care, reduced waiting times, and improved quality and outcomes.
In terms of governance, 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 this arrangement under review as the model develops.
I believe it is in the public interest to move forward with these changes as quickly as possible 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. This will allow us to maintain robust infection control preventative measures at these 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 these services while other hospitals are treating COVID-19 patients should this occur.
Because of the need to get these new centres up and running as quickly as we can the public consultation and engagement with trade unions and professional bodies on these service changes will take place during the implementation planning stage which starts from today. This engagement will be led by the HSC Trusts who 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 this.
Mr Speaker having published today my Department’s plans for rebuilding daycase elective procedures and orthopaedic care I wish to bring to the attention of the House that I am also 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 within the context of preparing for a potential second wave of COVID-19. Because of the need to maintain high levels of infection control 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 provide additional investment to embed these.
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’m sure that all of us in this chamber can agree that it is vitally important that we ensure that the available capacity within 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.
Health and Social Care Framework Document consultation
Mr Speaker 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 these responses my Department will during August launch a full 12-week public consultation on these changes.
It should be noted that the Management Board in the short period since it was established has proved its worth by progressing 3 months rebuilding plans for each HSC Trust area, the policy statement and blueprint that I have launched today for rebuilding elective daycase procedures and orthopaedic care with further regional plans at an advanced stage. While I acknowledge the concern of some stakeholders I would again stress 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 this 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 and 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.
Robin Swann MLA
Minister of Health
Notes to editors:
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- Launch of joint DoH/DoJ consultation on ‘The establishment of a Regional Care and Justice Campus for children and young people’ 21 October 2020
- Evidence bank documents underline extremely difficult choices 21 October 2020
- Health Minister Robin Swann self-isolating after receiving exposure alert 21 October 2020
- Covid-19 evidence bank is published 20 October 2020