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“The onus is now on all of us” | Health Minister Robin Swann’s statement to NI Assembly



ORAL STATEMENT TO THE ASSEMBLY BY HEALTH MINISTER ROBIN SWANN – MONDAY 23 NOVEMBER 2020 – COVID 19 DECISIONS


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Mr Speaker,


As this House will be aware, the Northern Ireland Executive has decided to introduce tighter restrictions to break the chains of infection of Covid-19.


These measures were detailed in a written statement to Members which I issued following last Thursday’s Executive meeting.


They take effect first thing this Friday morning for two weeks. In summary, we will in large part revert to the lockdown situation that applied earlier this year during the first surge of the pandemic. The major difference is that schools will remain open.


I will set out in this oral statement the rationale for our new restrictions. In summary, they are essential to prevent a further spike in infections overwhelming our hospitals.


The onus is now on all of us to strictly follow public health advice; and comply with both the letter and spirit of the tightened restrictions.


We can each play a part in saving lives, in preventing avoidable deaths. That’s how serious this is. That’s how high the stakes are.


As a society, we can now look forward to 2021 with some optimism, given the progress towards mass vaccination. I don’t want to have to look a grieving relative in the eye next year and say yes we could have taken action before Christmas that would have saved your loved one’s life. I don’t want to have to say them I’m sorry we didn’t intervene, I’m sorry they are not here with us to enjoy these better days.


I would today make a heartfelt plea for unity around this Assembly chamber. The public are watching and are looking to us for united leadership.


It is of course the duty of this chamber to hold the Executive to account and to scrutinise policy decisions without fear or favour. That’s the Assembly’s job. There are strong and legitimate opinions and feelings have run high.


However, that does not mean we have to descend into party political point scoring. This is far too important an issue for that.


The last few weeks have not seen devolution at its best. That is something of an understatement. Frustration and anger are widespread.


We could spend hours in this chamber raking over the decisions that were made and not made. I have made my own views known inside and outside the Executive.


Nevertheless, I fail to see where another bout of division and recrimination will get us now. What good would it do? Whose cause would it serve?


We could also spend hours pointing fingers about years of underfunding of health and social care, years of underinvesting in staffing. Again, what would that achieve today?


I trust that everyone in this House is united in wanting the new restrictions to work. We have to give our hospitals and their heroic staff some vital breathing space. If we successfully drive down infection rates, we have the opportunity of a better Christmas. It won’t be a normal festive season by any means but we all have the power to help change the atmosphere. We can do that by abiding by the new restrictions and strictly following public health advice.


I would urge all Members to promote public health messaging at every opportunity. Please do not undermine it.


Please choose your words carefully both inside and outside this House, today and in coming days and weeks.


Let’s remember that many countries, including near neighbours and indeed large swathes of Europe, are currently in lockdown. This includes countries with different health services to our own. We should not kid ourselves that we are so special or so unique that we can avoid similarly tough decisions. We cannot simply wish this virus away.


Mr Speaker, the paper I presented to the Executive last week made a compelling case for strengthening restrictions, in light of the path the pandemic is taking.


With schools open and existing restrictions in place, the R rate had settled at around 1 by last week. That meant we had reached approximate equilibrium with regard to community transmission of the virus.


There has been a sustained reduction in cases per day since the onset of restrictions, but numbers of cases, admissions, hospital inpatients, ICU occupancy and deaths remain at a relatively high level. In particular, hospital inpatients are at a higher level than was reached in wave 1 and have been declining only very slowly. As a consequence, the hospital system and staff remain under very serious pressure.


By last week, we were on the verge of permitting a significant relaxation of Covid restrictions.


It was highly likely that this would have resulted in the R rate rising significantly above 1, with a subsequent increase in cases, admissions, inpatients, and ICU occupancy in December. This increase in transmission would have been occurring from a relatively high baseline, meaning an already serious situation would rapidly become much worse.


Without a decisive intervention, the hospital system would be at risk of becoming overwhelmed in mid to late December. To care for the increasing number of critically ill Covid patients, we would have been forced to halt some or even all planned activity for other conditions, some of which would be urgent in nature. We would be facing the prospect of a significant increase in both COVID and non- COVID deaths.


In such circumstances, it is also likely that even a full lockdown beginning around the 14 December would have been insufficient to prevent the current levels of hospital pressure being significantly exceeded.

That is the bleak picture the Executive was faced with last week. That is the context for the lengthy and difficult discussions we had.


I know Members will want to ask if there were other measures that could have been deployed. The reality is that, given our current position and the rates of transmission, there was no feasible alternative. As I have already stated, other countries with different health services to ours have arrived at the same conclusion during this second surge in Europe.


There has been considerable interest in the potential of rapid mass testing to reduce transmission of the virus. However, it is important to recognise that this is largely based on theoretical considerations and there has been as yet no clear demonstration anywhere in the world that mass testing can significantly reduce transmission in a short period against the background of a high level of community transmission.


Modelling suggests that repeated mass testing of most of the population would be required to maintain control of transmission by this means. This would require a very high degree of population buy in and would present huge logistical challenges. Both Slovakia and Liverpool have required military logistical support to deliver their programmes and at least a two-week run-in period before testing was implemented. It remains unclear whether the required number of tests would be available to us in Northern Ireland. I have written to the Secretary of State for Health Matt Hancock to request four million rapid Lateral Flow Device tests for Northern Ireland.


I want to see us playing a pivotal role in the UK pilots on mass testing. My ambition is evident. At the same time, it needs to be remembered that we are still at the stage of pilot programmes. These will help us assess the effectiveness and accuracy of the rapid testing technologies.


Reliance on mass testing alone would represent a high-risk approach in the run up to Christmas. It may not be viable for logistical or test supply reasons.


There may be scope to target more limited mass testing to high risk areas. This would be of help but, again, would not avoid the need for Northern Ireland wide restrictions at this time.


Mass testing is an exciting development and together with a vaccine it offers great hope of a way out of our nightmare. But it is not a panacea, and certainly not at this time and certainly not without restrictions in place before Christmas.


Enhancing hospital capacity is also cited in some quarters as the answer.


In theory, measures to increase hospital capacity would allow an increased epidemic level to be managed without a further lockdown. However, this would inevitably be associated with increased deaths and might be limited by the need of staff to self-isolate as a consequence of healthcare related outbreaks in hospitals or clusters and outbreaks in the community. It is also the case that the associated levels of community transmission would inevitably result in a further significant increase in outbreaks in care homes among extremely vulnerable older people as was experienced in the first wave, which will result in excess deaths in this population.


However, for practical purposes it is simply not possible to increase hospital capacity in the short to medium term. The key factor here is the supply of staff, and given the specialist skill set required, there is a very long lead time for this. While some marginal gains in capacity can be made in specific areas such as ICU, this comes at the cost of reduced capacity elsewhere in the system, as it involves the redeployment of existing staff.


In addition, when doubling time for cases is 7-10 days, even a doubling of hospital capacity where that achievable would buy only a limited period of relief before intervention was required.


It is of course important to give our people hope as we face into this most difficult of winters. There are real grounds for optimism, given the progress on vaccines, the development of rapid mass testing and improvements in treatments.


I also need to be candid with the public. I will not offer false hope or pretend that there are shortcuts available to get us through these next few months. We all have to hunker down and play our part. Abiding by restrictions, staying at home, working at home when possible, cutting our contacts, keeping our distance, wearing a face covering and washing our hands. We can do that. We must do that.

The restrictions that start on Friday will make a difference. We all have to play our part in making them work. That includes everyone in this chamber by our words and deeds.


The Executive must now put the last few weeks behind it.


These are extremely difficult decisions. Governments around the world are grappling with the same awful dilemmas.

We need a collective spirit and a unified purpose, not just in this chamber but across society.


Everyone across Northern Ireland must do their bit. We can help change the course of this pandemic. We can help save lives.


Hope is on the horizon. A happier new year stands before us.


Let us do all we can to make sure as many of us as possible get to enjoy much better times in 2021.

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