Official Report: Minutes of Evidence

The Chairperson (Mr Gildernew): The Minister of Health is here today to brief members on his Department's priorities. I welcome Mr Robin Swann, Minister of Health; Mr Richard Pengelly, permanent secretary; and Dr Michael McBride, Chief Medical Officer (CMO). I invite the Minister to brief the Committee.

Mr Swann (The Minister of Health): Thank you very much, Chair. You are wasting no time. First, before I get into the formal presentation, I thank the Committee members for the support that they have given me as Minister and the Department through the difficult times that we have had over the past six weeks because of COVID-19 and coronavirus. It has been helpful, and the collegiate approach that we are presenting at departmental and ministerial level alongside Committee members and other MLAs is the responsible face of this place that the general public want to see when we come under pressure at times like this.

We are here today in an ever-changing public health situation. I will give members a brief update on recent local developments on coronavirus. We have moved to the daily reporting of cases, and we release figures now each afternoon. There are now 18 confirmed cases in Northern Ireland, and the contact-tracing process for the latest cases is under way. All appropriate actions will be taken quickly.

The increase in positive cases is not unexpected, and I advise members not to be unduly alarmed by those developments but to be alert. We had been planning for the first positive case in Northern Ireland and had robust infection control measures in place, which enabled us to respond immediately. The overall risk to individuals in Northern Ireland has not changed at this stage, and, on the basis of the advice of the UK Chief Medical Officers, the level of risk in the UK remains at "moderate".

We remain focused on the containment phase at this point, which is aimed at preventing the disease from taking hold here in Northern Ireland and across the United Kingdom. However, we will consider the scientific evidence, which will guide us in our next steps to flatten the peak of the outbreak in the UK, to delay and spread the impact on our health service, to push that peak away from the time of year and to protect those who are at risk. In all likelihood, we will move into the delay phase at some point. It is "When" not "If", at this point in time.

As members will be aware, there has been an increase in the number of cases in the Republic of Ireland, where there are now 32 confirmed cases, including two cases of community transmission. Everyone is aware now that there was one fatality in the Republic of Ireland yesterday. We pass on our sympathies to the family concerned, and we are aware that they have asked for patient confidentiality while they deal with the loss of their loved one. However, I want to make it clear to Committee members that we in Northern Ireland can also expect to reach that point: at some time we probably will see a bereavement here in connection with COVID-19. That is something that we have been preparing for as well. It will be a staged approach.

With regard to our reaction, extensive work has been undertaken to ensure that all trusts now have COVID-19 pods in place to enable patients suspected of having COVID-19 to be assessed and have samples taken away from routine hospital work. We continue to review the best use of testing and current clinical pathways so that individuals receive the appropriate care, recognising that many patients will simply present with a mild illness.

My Department and its agencies will continue to work closely with the relevant authorities and the public health agencies across the United Kingdom and the Republic of Ireland to ensure that Northern Ireland is well placed and prepared to deal with the situation as events unfold. We can expect significant and ongoing increases in the number of people testing positive for COVID-19 in Northern Ireland, and the same can be said for England, Scotland, Wales and the Republic of Ireland. Health systems across the globe are coming under extreme and increasing pressure as the virus spreads. Ours will be no different. It is bound to take its toll. Normal business in Health and Social Care will not be possible. Some activities will have to be scaled back.

I know that you have had a briefing from my senior officials on the Department of Health's priorities and those arising from the 'New Decade, New Approach' document. At this minute in time, from the Department's point of view, COVID-19 and our approach to coronavirus will become our day job, so we will see a scaling back and a stepping back from what we have been doing as a Department and at ministerial level and official level. We have been trying to manage both in a transition phase, but, as coronavirus transitions into wider society, so do we, and that starts to become our day job. We will, at some point, ask members' indulgence about how they can work greater at a machinery of government level and how they interact with us as a Department and me as Minister.

With regard to our other priorities, that work continues, but it will not continue at the same pace or intensity. You have had a briefing from my senior officials on the Department of Health's priorities, including those arising from 'New Decade, New Approach', so I will not go into those in my opening statement. However, I am happy to accept questions on them at a later date.

Members, following yesterday's announcement, I cannot ignore the elephant in the room: our budgetary position. You will be aware that the UK Chancellor announced the Budget yesterday, and I await the opportunity for the Minister of Finance and my Executive colleagues to consider it and agree the funding priorities in the Northern Ireland block. It is about making sure that we are in position so that other Ministers and Executive colleagues listen to what we have said about our budgetary needs. With regard to the 2020-21 Budget, what health and social care receives this month will be crucial. My Department anticipates a significant funding gap in 2020-21.

Our resource budget is £5,758·8 million. That is a recurrent budget baseline and will not fully meet the forecast costs of maintaining existing services. The total additional resource funding requirement for 2020-21 is £661 million, and that includes the £170 million already committed to by the Executive for Agenda for Change pay parity with England and safe staffing. The absolute minimum additional funding requirement to meet the inescapable costs of maintaining existing service levels and Agenda for Change pay parity is £492 million. However, that would not allow growth and transformation or allow the Department to deliver on the further commitments in 'New Decade, New Approach'.

Chair, I want to be clear with you and with members what that means for maintaining existing service levels. It means another year of frustration and falling short of the public's expectations with gaps in provision and unmet need growing. With regard to our waiting lists, it would allow a focus on red-flag and urgent cases, such as suspected cancer, but, overall, the current totally unacceptable waiting lists position will be unlikely to improve. An additional £169 million is required to implement the health and social care commitments set out in 'New Decade, New Approach', and that £169 million includes much needed investment in enhancing and developing services. For example, it covers the vital funding for enhancing and reforming the social care sector, growing the social care workforce and improving its pay levels. On hospital waiting lists, 'New Decade, New Approach' states:

The added pressures that coronavirus and COVID-19 put on that target have to be taken into consideration as well as the budget, because that commitment alone would cost in the region of £50 million. It should be seen only as the first step in dealing with what was our waiting list crisis to get to a more sustainable position. It will need sustained additional investment over future years not only to deal with backlogs but to bring about the much needed change.

I appreciate that £492 million to maintain existing services and a further £169 million to meet 'New Decade, New Approach' commitments is a significant ask. However, I believe that the public are entitled to demand more and better. I also acknowledge that the 'New Decade, New Approach' document has raised expectations significantly.

There are deep-seated problems across the health and social care system that will take years to put right. It will require major sustained investment, along with the transformation reforms. We need a multi-year funding commitment, which is necessary if health and social care services are to be put on a sustainable footing. Non-recurrent funding is not conducive to the long-term investment required to deliver the 'New Decade, New Approach' commitments and Delivering Together transformation programmes. A commitment to a multi-year settlement that supports 6% annual growth and the recurring incremental increases of £150 million per annum to support 'New Decade, New Approach' and transformation, is therefore essential. It is also important that we have in the Department the flexibility to reprioritise and internally reallocate funding across health and social care whilst operating in the context of the commitments set out in 'New Decade, New Approach' and in the Programme for Government that support transformation. I am grateful for the flexibility accorded to my Department, as it allows me to internally reallocate the resource funding available to me. It is important that that flexibility is also applied to the additional funding provided to tackle the waiting list backlog, to support the delivery of 'New Decade, New Approach' and the wider transformation.

My Department's capital programme aims to facilitate the delivery of modern fit-for-purpose services through the provision of appropriate infrastructure. Our ability to transform the way we deliver our services is directly linked to the capital resources available. However, over the last number of years, our capital needs have been considerably in excess of our budget allocations, and we have had to constrain our programme to match budget availability. That has led to a gradual deterioration of our existing facilities and a lack of investment in the modernisation that is needed to support changes in service delivery. Therefore, our existing capital programme needs to balance the prioritisation of our ongoing major projects with the need to maintain our existing infrastructure.

Looking to the future, over the last year, my Department has been undertaking some long-term capital planning, working with our stakeholders and our arm's-length bodies to develop a draft 10-year programme for the period 2029-2030. The work completed to date has been used to inform the information that we have provided to the Department of Finance on our needs for the next four years.

Our critical needs, which include new projects for redevelopment that cannot be delayed any further, indicates that we need just over £300 million in the financial year 2020-21. However, beyond that, the numbers increase, and it is clear that £300 million will not be sufficient in future years to meet those needs, let alone to begin any new investment to address the growing demand for our services or to transform the way that they are delivered. That applies to investments that we would wish to make across all our services, such as modernising our IT infrastructure, increasing emergency department and theatre capacity and investing in our emergency services, diagnostic equipment and primary and community care facilities. In particular, I want to mention our ageing mental health facilities, where there is a critical need to address the therapeutic environment provided for many of our most vulnerable patients. To do all that will require not only an immediate increase in my capital budget but a longer-term commitment that will enable me to transform how our services are delivered in the future.

I have highlighted transformation several times already: our health and social care service needs to be transformed. Over three years ago, we embarked on an ambitious journey to transform health and social care services. The reason for starting that journey was understood by everyone in this room: we spread our resources and our expertise too thinly and across too many sites for it to be resilient and sustainable. On top of that, the demands on our system continue to grow at a rapid rate. Our population is getting older, and people live longer with more long-term health conditions. That presents a huge challenge. Quite simply, our current service delivery model is no longer fit for purpose, and there are significant challenges in attracting and retaining staff. That we still manage to deliver the high-quality care that we do is testament to the hard work, dedication and compassion of our staff. To be clear, that is all our staff who work across health and social care. Everyone in our system makes a vital contribution to patient care. That is why I am committed to leading the work required, with the support of my Executive colleagues, to fully implement our transformation strategy, which is Health and Wellbeing 2026: Delivering Together. It is aligned with the aspirations set out in the Northern Ireland Executive's draft Programme for Government, but, unlike other transformation projects, Delivering Together and its initial action plan were agreed by the Northern Ireland Executive with cross-party support when it was launched in 2016. Importantly, it has provided Health and Social Care with a 10-year road map for the transformation of health and social care services in Northern Ireland. Delivering Together seeks to radically reform the way health and social care services are designed and delivered, with a focus on person-centred care rather than on buildings and structures. Delivering Together recognises that that transformation is a journey rather than a destination. It is an irreversible process that will be co-produced to ensure that the needs of those who rely on and work in health and social care services inform, shape and are at the heart of this important change. Delivering Together also makes commitments to partnership working, investment in our workforce, improving quality, driving collective leadership and making better use of technology and data.

As I said, we are over three years into that journey. We have strong foundations laid, but there is still much more to do. The speed at which it will be done will be determined by the resources available to deliver it. The scale of transformational change that is ongoing is immense, but the scale of transformative change that needs to be taken forward is even greater. The financial challenges that that presents cannot be understated. As I have said previously, the Department's budget, as it stands, is insufficient to meet demand. Among rising pressures are how to tackle the growing waiting list backlog systematically, with the added pressure of effective in-year savings.

In 2016, Delivering Together was agreed by the Northern Ireland Executive with cross-party support and recognition that the transformation of health and social care services in Northern Ireland would require a period of double-running. What I mean by that is the additional recurrent investment over and above what is required to run existing services. Thus, the pace of transformation will be determined by the funding available to maintain existing services while running transformation in parallel. To support that transformation, £200 million was made available through the confidence-and-supply agreement of 2018-2020. It has been successfully invested in over 170 initiatives. Whilst the confidence-and-supply funding has been a positive enabler, the result of the investment has impacted on the financial position for 2020-21, with an investment estimated at £150 million needed next year to continue and grow the initiatives that began over the last two years. It is important to note that the £150 million, while supporting transformation, does not include any funding to stabilise waiting lists or to meet the waiting list commitments in 'New Decade, New Approach', the total figure for which is estimated to be circa £80 million next year. However, we cannot spend money that we do not have, which means that we will have to continue to debate priorities and how best to use our limited financial resources.

The renewed commitment to health and social care transformation through 'New Decade, New Approach' has reaffirmed Delivering Together as our road map for change. It has outlined significant commitments that the Northern Ireland Executive have agreed to deliver for local people, including but not limited to further work on service reviews and additional nursing and midwifery undergraduate places. As I have said, we currently spread our resources too thinly to deliver resilient, sustainable services. Reviewing the configuration of hospital services is, for that reason, a priority in Delivering Together.

Work is ongoing to evaluate the projects supported by transformation funding in order to understand their impact and sustainability — a significant challenge in this already constrained financial environment. Most importantly, transformation is now moving to a new phase, from planning and foundation laying to implementation and the building of a modern, sustainable system. That new phase will see stabilisation, as well as reconfiguration and transformation, running in parallel with business as usual.

The changes will present many challenges: operational, strategic and, of course, emotional. We cannot hope to meet the challenges that we face in transforming health and social care services by doing the same things as we have always done in the same way as we have always done them. There must be an evolution of hearts and minds, as well as systems and structures, and difficult decisions will have to be made to enable the jigsaw pieces of transformation to come together.

Change means that things are no longer the same. That can be difficult for many of us to deal with, but it is necessary in order to have a system capable of meeting the needs of future generations. As the Bengoa report stated:

I welcome the priority attached to health by my Executive colleagues. We are all facing up to the scale of the challenges in our Departments, and I certainly owe it to patients and their families to be frank with them. My ability to transform services and start reducing waiting times will be heavily dependent on the budget allocation received by my Department this month.

The Chairperson (Mr Gildernew): Members, we have about an hour and a half or slightly more, maybe, for questioning, so I suggest that we take a round of questions first on the coronavirus situation and then move into a second round of questions on wider issues, if members are content.

Minister, thank you for your presentation. There have been references recently to legislation that may need to be developed to respond to the current situation. The Committee is keen to work to expedite that as the situation develops. Can you outline what steps are being considered?

Mr Swann: Legislation is being developed on a UK-wide basis, and the Department of Health has inputted into it, as has the Department of Education. The Secretary of State for Health asked the Opposition spokesperson in Labour to meet the Government yesterday so that they could start to go into some of the details. Measures will be introduced to enable us to move from containment to delay to mitigation. At this time, the drafting of the specifics is still being worked on, but the important point is that they are being done on a UK-wide level with Executive support.

The Committee will be given full sight once we see the drafted final copies, because it is important that we make sure that the people of Northern Ireland understand the measures that are brought forward and suggested. I do not want to get in to the specifics at this minute in time, Chair, because, to be honest with you, they are not public across the UK or outside the group that is working on them. At this time, we want to make sure that they are fit, robust and meet our needs when we move to the next steps. However, I say to members: as soon as they become public, I will make sure that you get a full briefing on the implications for the Health Committee and the wider Assembly.

The Chairperson (Mr Gildernew): While we are conscious that there may be time pressures, we expect that maximum scrutiny will be applied. We will expedite that process, and, if it takes additional meetings, we will do that.

Mr Swann: I appreciate that and the interaction that I have had with you and with the Deputy Chairperson in any steps that we have taken. It is important from the Department's point of view and for me as Minister that we do this together. The only way that we can challenge coronavirus in Northern Ireland is by working collectively. That is not just from us at a political level in the Assembly; it is how we address this at a societal level.

The Chairperson (Mr Gildernew): The Deputy Chairperson and I welcome that. The broader Committee is certainly keen to maximise that scrutiny.

Mr Swann: I appreciate that, Chair. Thank you.

The Chairperson (Mr Gildernew): The front-line workforce will, by all expectations, come under serious pressure. What steps are being taken to facilitate the return or re-entry of people who have left the workforce and to remove barriers relating to registration and costs that might be associated with that?

Mr Swann: The finer detail of that is part of the legislation.

Dr Michael McBride (Department of Health): One issue that was raised by the Deputy Chair at the last meeting is our flexibility in returning retired staff to the professional registers. Although retired — some very recently retired — they have significant experience that can be deployed to support our response. There are provisions in the draft Bill to facilitate that.

As a UK Chief Medical Officer, I have been working closely with the General Medical Council (GMC) — the body that registers doctors — to facilitate and enable that and with other professional bodies, for instance the Health and Care Professions Council, which regulates other healthcare workers. As Chief Medical Officers, we have communicated with all doctors, and I know that the Chief Nursing Officers are doing the same. We have qualified health professionals who are not on the register but have passed finals and completed exams etc. That may well be a resource that, we feel, is appropriate to utilise to minimise pressure on front-line staff.

The Chairperson (Mr Gildernew): OK. A number of sectors are expressing concern about the plan as it relates to them. That was raised with the Chief Social Work Officer in relation to nursing homes and the residential care sector. There are also concerns from undertakers as to what the guidance is for them. Are there plans to address the concerns of those sectors?

Mr Swann: There are. Up to now, the planning done by the Department has been second to none in the level of detail. When we utilise that and bring it forward for public consumption is the call that we have been making: when to go to the next steps.

The Chief Medical Officer has meetings and briefing sessions arranged with those sectors this week and in the coming weeks to make sure that they all have the information that they need for their guidance. Part of the proposed change in legislation will affect how we approach burials and cremations. That will affect not just us in Northern Ireland but the entirety of these islands.

That work is ongoing. I have heard the concerns. I would say to people to keep looking at the Public Health Agency's website. It is updated regularly and as soon as there is a change in guidance. Rather than somebody relying on a piece of paper on their desk that they printed off last Tuesday, keep going back to the website to see whether there has been any change in the guidance for your sector or for the general population.

The Chairperson (Mr Gildernew): Concerns have been raised in recent days about access for those who are not registered with a GP and whether they get the proper signposting and direction. Is communication with GPs up to scratch in dealing with the fast-moving pace of the situation?

Dr McBride: Chair, you raised the matter of someone — a foreign national, for instance — who was having difficulty registering with a GP. There are provisions for individuals, including foreign nationals, to receive public health treatment and advice whether they are registered with a general practitioner or not. On the basis of an issue that was raised with us, we have reaffirmed that information and recommunicated it to general practice via our colleagues in the Health and Social Care Board. I will not go through the list with the Committee, but there has been a series of communications — on 24 January, 31 January, 7 February and 28 February — with general practitioners, and our board colleagues have a dedicated web page for GPs containing all the GP-specific information. An FAQ section now includes the issue of foreign nationals who may not be registered with a GP. When dealing with public health issues, whether one is registered with a GP or not, there is a requirement to provide appropriate public healthcare in the interests of that individual and the wider population.

The Chairperson (Mr Gildernew): This is my final question before I go to members. We are all acutely aware that we are heavily exposed by our reliance on use locum doctors and agency staff. Are there guarantees in place that out-of-contract agencies will not be in a position to profiteer in any way from this crisis through what they charge? Also, are arrangements in place for sick leave for locum and agency staff that will support them to remain in the workforce or, if necessary, to go off work and self-isolate?

Mr Richard Pengelly (Department of Health): This brings into sharp focus an issue with off-contract agencies that we have been wrestling with for some time. We have made the point that running a health and social care facility requires a safe level of staffing. Otherwise, you cannot open the doors. At times, the reality is that the system is virtually being held hostage by some off-contract agencies when they know that we need staff at short notice. You are absolutely right: there is an opportunity for profiteering in this. We hope that common sense and some sense of civic responsibility will be brought to bear. We will keep an eye on that. Before this broke, the Minister had signalled that he wanted to focus particularly on reducing our reliance on agency and locum staff. He has tasked colleagues with looking at that, and that work continues. Of course, it has had to take a backward step in priority, but we are acutely aware of it. The sick pay for those staff is, at first pass, an issue for the agencies because they are the employers. We are certainly alive to that and will keep it under constant review.

Dr McBride: I need to add to that. I echo the Minister's comments that, as we move into the very challenging times ahead, I am absolutely confident that we can count on the professionalism, commitment and dedication of all our healthcare workers across every profession, which we see day and daily. Those attributes will come to the fore in the weeks and months ahead. It is our responsibility to ensure that we support them in that, and we will continue to do so and to get appropriate advice and guidance to them. We will continue to update that as and when is necessary.

Mr Swann: I will complete the triumvirate. We are working with union colleagues to ensure that they are well briefed. Over the past eight weeks, we have done a considerable piece of work with them, which should show them that we value the workforce's commitment to the National Health Service, as well as the role that they play. How we tackle contract and agency staff is a greater piece of work, and we are working on that with union colleagues. As I said in my opening comments, some of the day-to-day work that we were doing has had to be scaled back a little in different areas while we concentrate on what the health service is facing because of coronavirus.

Mrs Cameron: Thank you, Minister, Michael and Richard, for being here today. It is really important that we get this information at this time. Given that the risk posed by coronavirus is greater for the older population and those with underlying medical conditions, it is vital that the advice and support provided to those sections of the community are effective and proportionate. It is crucial that nobody is left behind or falls between the cracks. In that context, Minister, can you provide assurances that the welfare of vulnerable adults in a nursing home setting, for example, is at the heart of contingency planning? What advice has been provided to those working on the front line in such settings on what to do should COVID-19 be detected? You referred to safe staffing levels. The risks posed by coronavirus have embodied and reignited the debate on safe staffing levels and the need to ensure that medical staff have access not only to supplies but to equipment, personal skills and expertise. Given that, what steps have you taken to assess the current staffing complement in the relevant front-line services, as well as in nursing homes, to ensure that temporary absences for self-isolation do not impact on delivery or on contingency measures?

Mr Swann: Your first point, Deputy Chair, goes to the crux of the National Health Service, which supports everyone equally. One of the advantages that we have is that our National Health Service is free at the point of delivery — the point of use. Other countries do not have that reassurance or support. Therefore, when it comes to supporting the elderly and those with underlying needs, they are at the heart of our health service. They have been at the heart of our reaction and support, because that is what the National Health Service does best.

You asked about ensuring that we will have staff with the appropriate skills. I said — I have been very clear — that we will see a scaling back of some services. That scaling back is to allow us, as we get ready to move into the next phase, to increase the skill set of certain staff members so that, when we see a surge in patients who need more intensive support, that increased skill set is there. We are, therefore, preparing for the demand, and we will have that before we need it. That, critically, is what our surge planning is about: getting ready for the next phase, when it comes. Michael, would you like to add anything?

Dr McBride: Yes, on the guidance. You are absolutely right: we are crucially dependent on and partners with the independent sector, particularly as it relates to the provision of nursing care, residential care and, certainly, domiciliary care. Those are hugely important areas because some of our older people, particularly those with underlying health conditions, will be significantly at risk. We have issued advice to that sector, and, as the Minister said, it has been on the Public Health Agency website since 27 February. It is important that I again reiterate the importance of checking authoritative sources of online advice. Those include the Public Health Agency, NI Direct and our links to Public Health England advice. We are developing that guidance and advice at a UK level, using the best experts available to us.

As the Minister indicated, I am to have a series of engagement events today with the independent residential care home sector and, tomorrow, with faith-based groups and the Northern Ireland Council for Voluntary Action (NICVA), for instance. Throughout next week, I have similar events with professional bodies, colleges and a range of other organisations. I think that individuals feel the value of face-to-face conversations, in addition to the guidance that is produced, and I am committed to providing that. It is important that we issue that guidance at the appropriate phase and stage.

Due to the success of our response, to date, Northern Ireland remains in the containment phase. We are, however, moving into the delay phase. As the Minister said, community transmission is likely in the coming weeks, and we need to ensure that we minimise that impact across the health and social care sector. We will, therefore, produce additional guidance for around nursing homes, including visiting, as well as contingency plans for domiciliary care. We will also consider helplines for older people. We will have to think about, and put in place, plans to enhance training for staff in the independent sector, for instance, on infection prevention and control. Detailed planning for all of that is well under way as part of the surge planning for how we ready every part of health and social care for the pressures that we anticipate are likely. It is not a question of not providing guidance. It is about providing the right guidance at the right time and making sure that it is as fully informed and accurate as possible. I repeat that the advice will be continually updated. As the Minister said, it is such a rapidly evolving situation that relying on our traditional methods of writing a letter and saying, "Well, that it what was what the letter I got last Tuesday said", is not enough, because the advice may change the next day. It is important that we all fulfil our professional responsibilities by ensuring that we keep ourselves up to date.

Mrs Cameron: It is welcome that, on the back of that guidance, you will have a series of events to disseminate information, including to faith groups. Will that also include wider third sector groups?

Dr McBride: Absolutely.

Mrs Cameron: I am thinking of Age NI and charities that deal specifically with health issues that will leave certain individuals vulnerable. Will advice be given to groups such as Good Morning Antrim that are in daily contact with older people who might be a bit more isolated and do not have a lot of friends and family to visit them? If family members are self-isolating and unable to care for their loved ones, people might become more isolated. Will that information be spread more widely? Will you try to get it out there directly?

Mr Swann: Just as the Chief Medical Officer is meeting a number of those groups, I met Age NI last week. It was on another issue, but we had a discussion specifically on engaging with the older population. Age NI is up for assisting in any way that it can. Our voluntary and community sector — the third sector — is asking how it can help. There is a realisation across society in general that, if we work together, we can have a greater effect on how we tackle coronavirus and support those who are worried about being socially isolated. We want to isolate people from the virus; we do not want to isolate people from society. David Cameron used the phrase "Big Society": in Northern Ireland, we still have a caring, supportive population, should it be neighbours, loved ones or family members. It is at a time like this that the strength of Northern Ireland society will really show itself and come out to support the people who need it.

The Chairperson (Mr Gildernew): I would like make a point about engaging with informal carers' organisations, given our reliance on them across the system.

Mr Easton: Thank you for your presentation. You are doing a good job of getting information out and handling everything, so well done to you all.

Mr Swann: Thank you very much.

Mr Easton: I have a few wee questions. Is there any indication of how much of the £30 billion budget you might get to help Northern Ireland? Can you confirm that, as yet, there definitely has not been any community transfer of coronavirus in Northern Ireland? Are nursing and residential homes, including private ones, expected to look at the Public Health Agency website and so forth for advice, or is the Department or the Public Health Agency contacting them directly to ensure that everybody is following any actions that need to be taken?

Are you aware that a GP practice in my constituency has closed for a deep clean? Was it given advice to do that? Has the scaling back of services already begun? I am aware of people getting letters cancelling operations and stuff. Can you confirm that we are already at that stage?

Lastly, you said that we are sometimes held to ransom by agency staff. That needs to be looked at in the longer term, not just now. It causes a problem when trying to attract staff, because it suits some people to be agency workers rather than coming back to work full-time. It is a really big problem that costs us an absolute fortune.

Mr Swann: Are you finished? [Laughter.]

Mr Easton: But I did it quickly [Laughter.]

Mr Swann: I have sat in the same chair. Do not worry.

On your first point, Alex, about getting the information out there, I thank Assembly colleagues and the media. I have found the media in Northern Ireland to be responsive and supportive in getting the necessary message out to the general public. We have been doing that through regular briefings from the Chief Medical Officer and me. We have been doing the rounds of the TV studios and radio shows to make sure that we get the message out. Folks, we are still in the containment phase because the people of Northern Ireland are hearing and reacting to our message. It is important that we keep putting it out there. As I have said before, "Wash your hands for 20 seconds", "Cough into your elbow" and "Catch it, Bin it, Kill it", may sound like contrived statements, but they make a difference, possibly to one of your loved ones, and to how this virus might spread. The simple actions that we can all take will make a difference in how we tackle this.

The Chancellor made it clear yesterday that the budget to tackle coronavirus/COVID-19 was a UK one. There is no specific pot. No one said, "This is your bit". We were told that we will get what we need to tackle the virus. That is why I had to cut the length of today's presentation. I was meant to be here for three hours, but we cut it back to two because of the COBRA meeting this afternoon, which, I hope, will go into more detail on how that funding can be best utilised.

I am trying to think of everything that you asked. I covered the scaling back of services and sending letters to patients. It relates to how we prepare our current health service, the estate and our staff for the next steps that we will have to take and the increasing number of patients who will need to be hospitalised. We are not cutting back on surgeries or elective operations willy-nilly. This is strategic. We will prepare specific wards and areas, and we will train up cohorts of staff so that they can provide the additional support and training that we actually need.

Going back to what Richard said, I think that your point on agency work was well made. We have seen this, and we will work with our union colleagues. I want to support our National Health Service workers as much as possible, without having to rely on third agencies. Unfortunately, at the moment, we still need them to deliver the service. That transformation work will take time. Coronavirus has set us back in how we want to do that and the speed at which we want to do it. It is a general piece of work that we want to do.

Mr Easton: What about the GP practice?

Dr McBride: That and community transmission were the other two issues that you mentioned. Thanks to the hard work and dedication of the Public Health Agency, GPs and hospital trusts, we have not yet seen evidence of community transmission in Northern Ireland. That is not the case in other parts of the UK or in the Republic of Ireland. However, the absence of evidence does not necessarily mean that there is no such transmission. Given the ease of travel, and how close we are to other parts of the UK and the Republic of Ireland, it is, as the Minister and I have said, only a matter of time before we see community transmission. That is why we need to think now about the steps that we take as we move into the next phase.

Colleagues on the board and in the PHA will closely support GP practices. If, for whatever reason, there is a need to close a practice and deep clean it, it will be on the advice of the Public Health Agency. There is particular guidance on how that cleaning should be conducted. The Health and Social Care Board's primary care team will look at how individual patients from such a practice will be supported, perhaps by neighbouring practices.

These events will occur. We have seen them increasingly in the containment phase. We may see them less so as we move into further phases in which we have evidence of wider community transmission. We are working really hard in the containment phase. We will continue to take steps that relate to containment and trying to control the spread of the virus even as we move into the delay phase.

Mr Carroll: Thanks for the presentation, Minister. This is a pandemic and, by definition, affects everybody, but, as referenced, it affects vulnerable people — the sick and the elderly — most.

People tell me that there are not enough hand sanitisers in hospitals and public buildings. Is there a plan to intervene? Generally speaking, early intervention has worked. Italy delayed its response, which is one of the reasons why the virus spread so quickly there. In comparison, Taiwan, which is very close to China, acted very quickly and has fewer than 50 cases. Therefore, early intervention is key. Taiwan, in response to the severe acute respiratory syndrome (SARS) crisis, set up a national health command centre, which expanded research provision to ensure that COVID-19 and other respiratory diseases were researched and prepared for. We need to look at that here, too. There is also concern — this was mentioned on the radio this morning — that people are not being tested as quickly as they need to be. South Korea did its testing rapidly.

Generally, we need to ensure that public health is put before private profit. When you see the likes of Cheltenham being organised by large bookmakers and companies, you have to ask, "Are the market and the interests of the wealthy being put before the health of the vast majority of people?" That point has to be made in relation to coronavirus.

Finally, I am concerned about the lack of ICU beds. The EU average is 11·5 per 100,000 of the population. Italy has 12·5, slightly higher than the EU average, but it is obviously struggling to cope with the virus, for all sorts of reasons. We have 5·3 ICU beds per 100,000 of the population. Do we have enough beds? If not, are there any plans to acquire private ICU beds for public provision?

Mr Swann: Thanks, Gerry.Yes, we have enough stock of hand sanitiser. Keeping it is our problem. As I said in the Chamber on Monday, part of the problem — I think that I said this in answer to your question — is that hand sanitiser is being stolen from hospitals and GP practices. GP practices are reporting that, as patients walk out of the practice, they lift hand sanitisers and take them home. That does not help them, and the next patient who comes through the door has nothing to use. Chair, I would like to send out that clear message from this meeting: if, by stealing hand sanitiser from a GP practice or when visiting somebody in hospital, you think that you are helping loved ones, you are wrong — you are helping no one. We have the stock, but the problem is keeping that continuous supply. I ask people to respect the service provided by the National Health Service of making hand sanitiser available for us in those places. We will liaise with other Departments on how hand sanitiser will be distributed across the rest of the Northern Ireland Civil Service.

On the timeline for how we respond and move from containment to delay, I have very much been taking decisions in line with the UK approach, which has been science-based and science-led. To date, that has served us well. As Michael was saying, we have not seen community transmission. What we are doing has worked. We are able to trace any case that we have to the point of contact. Our contact tracing has worked.

It is about using the tools that we have in our box to fight COVID-19 at the right time. Using them too early would lessen the effect that they would have if used at the right time. It is all about how we flatten the curve so that the NHS is able to meet the peak, rather than being consumed by it.

Michael will be able to provide a detailed update on the number of ICU beds, but I want to make it clear that needing an ICU bed is not the final stage for everybody who contracts COVID-19. People can have COVID-19 and present as completely healthy. They may test positive, which is why we recommend self-isolation to make sure that they do not spread it to their families and loved ones.

Yes, we have a limited supply of ICU beds in Northern Ireland, but not everybody will need them. At some point, we may need to increase the number of beds that are supported by ventilators, and we do that by scaling back some of our other provision. We will not be using operating theatres, so we will not need the associated recovery rooms, which have ventilator points. It is not the use of ICU beds that will be the critical need but the availability of ventilators for some patients. I will let Dr McBride pick up on that point in a moment.

I was asked earlier this morning on 'Good Morning Ulster' about it taking 36 hours to get back test results. Michael is looking into that, because it is not something that we recognise. Here in Northern Ireland, we have one of the 12 accredited labs in the United Kingdom for COVID-19 testing. The make-up of the virus was known only in January, so the fact that the scientific world moved so quickly to test for it is quite an advancement. We will ramp up our testing capability, which involves moving to an automated system so that we can test more samples at once. That work is ongoing. That turnaround time for results, we do not recognise. I am not saying that it is not right, just that it is something that we are looking into.

You asked about the National Health Service looking for companies not to —.

Mr Carroll: They are not responding to the demand for a public health response to the situation, with some people viewing events as a way to maximise profit and wealth, which is disgraceful.

Mr Swann: That is morally wrong, never mind anything else. You made the point about Cheltenham and about big business running events for money. Our focus is on our National Health Service, and that is where we are at at the minute. Those decisions are outwith our control. It is something that people have to take cognisance of: what is more important to them? Do they want to see a horse race or do they want to make sure that their family is kept safe? There is a personal responsibility as well.

Michael, do you want to say anything about ICU beds?

Dr McBride: When it comes to ICU beds, our surge plan includes measures to expand our capacity to ventilate patients. If you remember, we had plans back in 2009-2010 to do the same for H1N1. The surge plan will include, as the Minister indicated, using ventilators as a downturn occurs in other activity, meaning that resources can be redeployed. It may involve, for instance, non-invasive procedures, where people are not anaesthetised and ventilated but are treated by way of non-invasive ventilation, using a mask. We will have to train and upskill staff outside of high-dependency units and ICUs in order to provide that. Those measures are all part of our planning and preparation.

You made a point about command and control. We have been in command and control and have had operations centres up and running for the past eight weeks. That has been the day job for me and my departmental colleagues, as it has been for Richard and the departmental team that supports the Minister. The Minister has been in our operations room. Similarly, our command-and-control operations room has been up and running for the same period for our Health and Social Care Board colleagues in the Public Health Agency. Extensive planning has been going on in our health and social care trusts, as you and the public would expect, for a significant number of weeks. Now is the time to refine those plans, as we begin to move into the next phases of our response to ensure that the appropriate information is given to health professionals and other sectors so that they can be equally prepared.

The issue of mass gatherings is a tricky one. There is a public perception that intervening in such events must be a good thing to do. The science suggests that there are other things that are more beneficial. That is not to say that there is not potentially some marginal benefit, but, again, there are more important things that would make a significant contribution towards containing spread and delaying it. As you say, this is about the public health response. If you think about it, if you are in an enclosed space, close to lots of people, the risk is greater than being in an outdoor space, perhaps with two people to your left, two people to your right, two people in front of you and two people behind you. We know that high-risk contact is significantly lessened if you are moving around in an open-air environment. In all of this, as the Minister has said, we will be guided by the science and consider the appropriate steps. We must consider the right combination of steps to take at the right time. If certain steps are taken too soon, we will have all the associated adverse downsides: the economic cost and the social cost. If they are taken too late, which you also referred to, we will not see the benefits. It is about having the right combination of interventions at the right time in order to achieve the maximum impact.

Mr Swann: Gerry, on the point about command and control, we have that in the Department of Health, but I will ask Richard to explain it. After that, it widens out to Executive level. It will be useful for the Committee to know about that.

Mr Pengelly: I acknowledge the point that the Minister has made, which is that, although, at a fundamental level, this is a health issue, the response to it needs to be societal rather than just a health service response.

I acknowledge the work of colleagues in the Executive Office. They are having weekly meetings of what is called "C3": command, control and coordinate. Those meetings look across the whole public-sector landscape. We had a planning exercise last week. Doing that is important for bringing all Departments together. As with any health issue, lots of really good work to manage the health risk is taking place outwith the Health and Social Care system.

Ms Bradshaw: Thank you, Minister, for coming along. I want to pick up on Dr McBride's last point. I have seen the advice that the Public Health Agency has provided to the universities for St Patrick's Day about the potential for mass gatherings in the Holylands in south Belfast. You will know that there are many house parties, with students going from one house party to another. They go into the street. They engage in alcohol abuse and/or illegal drug use. Considering that people will be coming to the Holylands from all over Northern Ireland, there is potential for fast community transmission, and the subsequent ability to undertake contact tracing would be minimal.

Section 16 of the Public Health Act (Northern Ireland) 1967 deals with:

Is there any way in which that legislation could be applied as a one-off for that day? I have written to the Chief Constable and asked him to provide additional resources. I have spoken to the universities. As you say, it is a public health issue. However, that one gathering has the ability to have a massive impact.

In the next hour, Leo Varadkar will make an announcement about the closure of schools and hospitals. What contingency is there for backfilling here if healthcare workers are off work to look after their children?

I have two other very quick questions. The first is about the information on the Public Health Agency's website and the message from an expectant father who, during the week, was concerned about his wife. There is brilliant information on the Royal College of Midwives' website. Is there any way in which that information can be linked from the PHA website?

Finally, what would happen if a GP gave the wrong advice to a patient or family by telling them to come in to be tested? What would happen in such a case, in which a GP has ignored Public Health Agency advice? Would it mean a referral to the GMC?

Mr Swann: Thank you very much, Paula. On your first point about student house parties and all the rest of it, that is an unintended consequence of Belfast City Council cancelling the St Patrick's Day parade. Every decision has adverse consequences, and that is what we are seeing now. Starting to cancel public gatherings before the science tells us that there is a clinical benefit to doing so has always been part of my concern. Similarly, if you move too quickly to cancel public gatherings or close certain facilities, people become weary and do not respect the decision when you actually need to do that.

Your point about the universities and how students react is well made. We could get the Public Health Agency perhaps to have a sit-down with the universities and even students' unions to reinforce the message to students to think about what they are doing. On St Patrick's Day, students sometimes do not think about what they are doing. That is why we end up with the difficulties that we have had in certain areas of Belfast.

I am not sure whether legislation could be enacted by next Tuesday. I do not think so.

Dr McBride: I do not believe that it would be a proportionate response.

Ms Bradshaw: I mean the powers in that Act.

Dr McBride: I do not believe that it would be proportionate response at this time.

Ms Bradshaw: OK.

Dr McBride: I certainly do not think that it would be a proportionate public health intervention at this stage.

Mr Swann: I have not seen the announcement that the Taoiseach will be making.

Ms Bradshaw: What about contingency planning for healthcare workers?

Mr Swann: We have a COBRA meeting this afternoon, and I would say that the issue of what the next steps will look like will be raised. The call will be made when those next steps are implemented. Our decisions will be considered in the round, but I put on record that we have very good interactions with our colleagues and counterparts in the Republic of Ireland. I have had a number of contacts with the Minister for Health, Simon Harris; the Chief Medical Officer has a good working relationship with Tony Holohan; our permanent secretary has regular phone conversations with his equivalent in the Republic of Ireland; and our Public Health Agency and the Republic's Health Service Executive have a good working relationship and share a lot of best practice.

We need to do anything that we can to support them, and vice versa. At the start, when it came to the contact tracing of people who had come through Dublin Airport and travelled on to Northern Ireland, we were able to work hand in hand, even when our advice was slightly different from that in the Republic of Ireland. Our notices were put up in Dublin airport that read, "If you are now travelling to Northern Ireland, this is what you need to be aware of". We have had that working relationship for the past eight weeks, and it is a strong relationship that we can utilise to share information. If there is information from the Royal College of Midwives that the PHA can pick up on, it should do so. We want to make sure that all people are getting the best and most up-to-date advice that applies to them.

Your question about GPs and the GMC is one for the Chief Medical Officer.

Dr McBride: As I said in answer to an earlier question, it is our professional responsibility as registrants, whether we are doctors, nurses, social workers, allied health professionals, physiotherapists or whatever, to ensure that our practice is fully informed by the latest available information and guidance. The challenge, and some comments have been made publicly about this, is the volume of guidance issued over a very concentrated period and the regularity with which we, for good reason, have had to change and update that guidance. I recognise that it is challenging for organisation and providers, whether working in the statutory or independent sector, to keep aware and fully abreast of the guidance.

The answer to your specific question about GPs is this: it would depend on the circumstances. The appropriate action would depend on whether a GP was not aware of a change to guidance or had acted outwith that guidance. I know our GP colleagues have been working extremely hard. We heard Dr Laurence Dorman interviewed last night, representing the Royal College of General Practitioners Northern Ireland. Our GPs have been taking a significant volume of calls and providing advice to people making contact who are concerned that they have symptoms.

Over the next weeks and months, all aspects of health and social care in the system will come under increasing pressure. It is important that we continue to ensure that we get the right advice to the entire system at the right time and at the right stage. As the Minister said, that information may change as we move into next week.

Mr Swann: It was beneficial to us to get access to NHS 111 so that we could triage people's concerns and symptoms initially. That was a big step. It took a lot of very quick work from officials to get us to the front end of NHS 111, which has been beneficial in alleviating some of the pressure on our GPs.

Dr McBride: Thanks to NHS 111.

Mr Swann: Yes. I thank NHS 111 for allowing us to use it.

The Chairperson (Mr Gildernew): I am conscious that time is pressing on. I ask Members to keep questions reasonably succinct, please.

Ms Flynn: Thanks for the briefing, Minister. I appreciate all the hard work that is being done by the Department and all our Health and Social Care staff.

You mentioned red-flag cases, including cancer. Outside of such cases, are there any other services or important areas of work that the Department is trying to protect alongside its planning and preparation for dealing with coronavirus? For example, at the meeting of the all-party group on suicide prevention, the PHA said that the pressure and strain that is being put on the Department might have a knock-on impact on the implementation group for the Protect Life 2 strategy. I am just putting that out there. I do not know whether it is even a possibility that the Department could look at installing an interim chair so that the process can continue at some level. Michael, I am conscious that, as CMO, your time will be taken up with dealing with the virus.

The Minister touched on stepping up capacity for the testing process and mentioned moving to an automated system. Do you plan to increase the number of testing pods? I know that you covered some of this when you spoke on Radio Ulster earlier this morning. When someone local tests positive for coronavirus, there is a second part to the validation process, whereby the results are sent to England. How long does it takes for the test results that are sent to England to be confirmed? Has any consideration been given to whether it might be quicker and more efficient to do that on the island instead? Excuse my naivety on the subject. If it works at present, that is all well and good, but I wanted to ask the question.

Finally, Gerry's point on ICU beds is an important one. We need to source them, be that from private or public facilities. It is really important that the message that we send out to everybody at home is that we can guarantee that anyone, regardless of economic status, can access to emergency care if required.

Mr Swann: Órlaithí, the core work that we do on mental health does not stop and will not stop. We are preparing to launch the mental health action plan in the next week and a half. That work has been going on. About Michael chairing Protect Life 2, if we need to look at that centrally, we will do so, because that work cannot stop, nor should not stop. I can make you that guarantee here today.

We are making sure that there is at least one testing pod in each trust area, if not each hospital. The number is being increased, but we are aware that we have to have the staff to man them. I will use this forum, if I can, to say that people should go a testing pod only if they have been referred there by a GP. We have had people turning up looking to be checked to see whether they have coronavirus. Having such people in a queue is delaying somebody who has been referred by a GP from being tested, so I again ask that people please act responsibly when it comes to utilising services that are there.

You asked about utilising ICU beds from private facilities. Whatever we have to do to tackle coronavirus, we will do. As I said at the beginning, the NHS is there to make sure that healthcare is free at the point of use and delivery, so a person's financial situation should not make any difference. The National Health Service is there to support every individual in Northern Ireland to the same extent.

Ms Flynn: My point about the validation process —.

Mr Swann: Yes, the testing. Michael can talk about the timeline. Once we get a positive test result here in Belfast, we declare that a presumptive positive, so anyone affected is treated as if positive at that point. The sample that is sent to England is simply to validate the first. We do not wait on the result coming back from England before telling anybody. The Belfast result is the one that people are informed of.

Dr McBride: Perhaps that is what was referred to in this morning's news reports. As the Minister said, technology was very rapidly developed to carry out the test for an illness that was first noticed on 10 December. The genome — the genetic make-up of the virus — was then shared early this year. In February, we were testing for the virus here as one of 12 centres across the UK. As we get more experience and get automated, the turnaround time for the tests will decrease.

We also need to think about how we use that testing in the next phases, because, as we have wider community transmission, the focus of the testing may need to be redirected to those who are hospitalised and receiving hospital care. Again, what we are doing in this phase and stage may not be what we do in the next phase and stage. We need to be very mindful of that, and the Minister will articulate that. We are in the containment phase, and although we will be doing many of the same things in the next phases, how we do some things may change. The advice and guidance will change as well.

Ms Dolan: Thanks very much for coming in today. I have two quick questions on the practicalities. First, if someone has been referred to a testing pod, is transport provided? I know that the person has only been referred and has not tested positive, but if we are trying to contain the virus, the mode of transport used is very important. Secondly, how do you plan to protect our homeless population?

Mr Swann: My understanding is that you go in your own car. You make your own way there. There is no transport laid on to go to a testing pod unless it is necessary, at which point the Ambulance Service is used. If you can use your own transport, please do, because it is safe to do so, and we cannot afford to be tying up our Ambulance Service. It is there to support people who cannot get to a testing pod, but we do not want to be —.

Ms Dolan: People who do need an ambulance can get one, however.

Mr Swann: They can get one, yes.

Supporting the homeless was raised in the House, and that is work that is ongoing. It is a cohort of people that is hard to interact with, even from a medical point of view. We have a nursing team in Belfast who work specifically with the homeless, so they have been provided with information.

Dr McBride: One of the things that we did under the transformation programme was to establish the homeless hub, for which there was specific funding. We have been able to maintain that service. We also have plans to enhance services in Derry/Londonderry for the homeless. Primary-care access, access to dental care, podiatry, and mental health input and support are provided at the homeless hub, as is advice.

To go back to Richard's earlier point, that is the sort of situation in which we work very closely with the Department for Communities as part of cross-government planning and preparation to ensure that we protect all our citizens, whether homed or homeless. The homeless are a particularly vulnerable group, as the Minister said. We are particularly mindful of their needs, and our Chief Nursing Officer has been in communication with the community and voluntary sector and the Simon Community, and we will work closely with them.

Mr Chambers: Minister, Dr McBride and Mr Pengelly, I speak for everyone by placing on record the public's appreciation for the work that you and your team have done to date.

What is the Minister's assessment of public buy-in to the containment advice from the Public Health Agency to date? My impression is that it has been quite positive.

Alex referred earlier to a doctor's surgery that needed to be closed for deep cleaning. Are there any examples of that actually happening? If it does happen, do the GP and surgery staff have to self-isolate for 14 days? Do we lose them in this battle against the spread of the disease?

I understand that Imperial College London is a world leader in data modelling of the spread of infectious diseases. I have no doubt that you have access to the information coming from there, and I am sure that that will help you shape your contingency planning. I appreciate that you cannot share a lot of your forward planning, and that is not to demonstrate a lack of transparency, but can you reassure the public that, as far as possible, you have eliminated the prospect of too many nasty surprises coming along?

I know that the next stage is the delay stage, and then we go into mitigation. Is there a point when testing ceases, when the concentration is on treating patients with the assumption that they have the disease, and the resources that would be tied up in testing will be deflected to the care of patients?

Mr Swann: The information that is getting out with regard to containment and the steps that we need to take is working. Of all the positive cases in Northern Ireland, none is by community transfer. We can go back to the source of infection, which gives us reassurance. People are hearing what we are saying, what the Public Health Agency is saying, and what the Health and Social Care Board is saying. To us, that information is getting through to the majority of people in Northern Ireland. I am content that it is working. When we move into additional or further steps, that information will ramp up according to what additional steps individuals need to take.

With regard to information and modelling, being part of the medical COBRA call with other Health Ministers across the United Kingdom, supported by the Chief Medical Officers across the United Kingdom, we get advice and guidance from the Scientific Advisory Group for Emergencies. Those people are not politicians or departmental employees; they are recognised experts in every field. When they come forward with scientific advice, it is non-biased and non-political. There is no self-interest in what they are doing.

Mr Chambers: It is in the public interest.

Mr Swann: It is for public and academic use. Some of them do not even want their names published, so they are not getting any glory. The information, advice and guidance that they give is sound, and that is what we have been following.

We will continue to test while in the containment phase, and into the delay phase as well, because we need to know where the virus is. If we ever get to mitigation, we will have to look at the usefulness of testing the wider public. That is further down the line.

You spoke about next steps and where we are with surge planning. I sat in on the transformation implementation group to see how we transform different parts of the National Health Service. We reconfigured that slightly to bring in departmental directors, the chief executives of our trusts, the Northern Ireland Ambulance Service and the Northern Ireland Fire and Rescue Service. We are doing strategic planning at that level. We are getting information from all parts of the health family. We have to remember that it is not just hospitals, GPs, domestic care, social workers, the Ambulance Service and the Fire and Rescue Service. Everybody is part of the wider response.

I will ask Michael to respond to the point about the deep cleaning of GP surgeries.

Dr McBride: Obviously, every case is individually risk-assessed, so I cannot give a blanket answer. In those circumstances, the practice concerned, in conjunction with Public Health Agency experts, would assess the incident and the risk to individuals, for instance, who had attended the practice or those who worked in the practice, irrespective of their role. The advice would be tailored to the degree of risk assessed. The risk relates mainly to close contact, sitting as I am beside the Minister for more than 15 minutes within two metres, or very close household contacts. My passing one of you in the foyer does not put me at significant risk, unless, as the Minister said, you or I are not following the good respiratory hygiene advice of "catch it, kill it, bin it". Cough into the crook of your elbow, use tissues when sneezing, dispose of those tissues and wash your hands. Wash your hands regularly, and before you touch your eyes, nose or mouth.

Those are really important things which we cannot emphasise often enough. As the Minister said, they are making a difference and will continue to do so. They will even make a difference when we see community transmission, because it will help us suppress that peak and push that a little bit further, relieving pressures on our health service. As I have said, we do not yet know whether there is some seasonality with this virus, so we may see that, as we get into late spring and early summer, the virus is less transmissible. Most respiratory bugs or viruses are less able to transmit during spring and summer.

Ms S Bradley: Thank you for your presentation. I would like to go back to Gerry's point about hand sanitisers. I appreciate that the Department may have its stock, but I am conscious that, across all Departments, public sector workers — for example, Roads workers and people who are out in society — need these things. Is there a check across Departments that they all have easy access either to washing their hands or, if not, to hand sanitisers?

My first question is about testing. I would like to understand better whether there are no financial barriers to testing. How much does a testing kit cost? Do we have enough test kits in stock for the projected peaks? Have we scoped out whether there are any human resource or employee barriers to carrying out the tests in laboratories? There may be a skill set in universities that could come into play. Basically, I am looking at the example, because whilst I appreciate and accept that we are leaning on best practice and good-quality scientific data, there is also live data coming from the likes of Korea, where they appear to have had success, which they benchmark against having intensive early testing. I hope that people looking at our data coming through take cognisance of that.

I want to ask about the vulnerable groups in society. Sometimes we ask questions and say things like, "We are not there yet." There are many good people across Northern Ireland, as you rightly pointed out, Minister, want to help in any way they can. However, with all the best intentions of some good Samaritans, they may be doing the wrong thing. This is a window of opportunity to prepare, plan and put information out to local groups, be it local GAA clubs or church groups, people who want to get organised in their communities to reach out to the vulnerable people who may go into isolation early because they recognise themselves as vulnerable.

To my mind, when I hear "suppress the peak", you are looking at the pressure that exists against the health service. From my perspective, I imagine that that pressure will come not wholly, but in large part, from that vulnerable group of people who will need hospitalisation. There is good sense in speaking to those people earlier. If they feel it is safer to go into isolation, they will need to have exchanged telephone numbers with people in their community where simple things can happen, like a phone call, to check that they are OK, they have their medication, and bread and milk is being delivered. It is just good neighbourly practice, carried out well. As chairperson of the all-party group (APG) on loneliness, I offer my support to do anything we can to get that clear, good-quality messaging out early to communities so that they can engage and everybody can play their part in helping.

I also ask for some clarity around the different stages. I remain unclear, when we move from one stage to the next, what the social implications of that are. Probably, all Members have had queries from people working within the health service, chemists, dentists, schools, GPs, carers and even people from the food supply chains or shops that sell food, wanting to know what stage of development has implications for them, so that they can also prepare. It is about being measured and timely and not creating panic, but allowing people to have the foresight to realise at what point they come into play.

The Chairperson (Mr Gildernew): Sinéad, I am conscious of time. Can you get to a question, please?

Ms S Bradley: I am also conscious that, in the South, it looks like the Acting Taoiseach will move to the closure of schools and public services today. If that is the case —. [Inaudible.]

Ms S Bradley: It may have happened. Yes, I think it has.

Ms Bradshaw: From Friday.

Ms S Bradley: If that is from Friday, there is a disparity across the island on where we are. I am thinking of border regions. If there are implications for any sort of social disruption, you may see a flurry of unintended consequences in areas where —. I really think it is time for us to work in unison.

Finally, I was concerned to hear that some misadvice had been given out over the 111 system regarding people returning from Italy, and I do not know if any scoping was carried out to find out if anybody from Northern Ireland was involved in that. I would be reassured to hear a final word that we are prepared in terms of volume across resources and services, be it ICU beds down to nebulisers for people who can be treated at home and can have access to oxygen.

Mr Swann: I have got nine questions here, Sinéad. [Laughter.]

Ms S Bradley: I could give you nine more, Minister.

Mr Swann: I was not trying to be facetious there. This is a good engagement on a very current and serious problem. I would rather not rush this section. I am conscious of time. Rather than moving away from coronavirus/COVID-19 and going into a more generic round of questions on the Department and my priorities in other areas, would it be helpful if we rescheduled that second phase for some time soon?

The Chairperson (Mr Gildernew): I am conscious that you are telling us that everything is going to be subsumed in dealing with this over the next period of time. What time do you need to get away from here today? There are questions on wider issues that we need to ask about as well.

Mr Swann: I need to be leaving here at 12.00 noon, because we have a COBRA meeting shortly after 1.00 pm that I need to get ready for. We are having a good discussion on what is a very topical and serious issue. If there are topics that we need to cover quickly in the second session, I am happy to do that, but rather than rushing the second session, I am saying that I will make myself available to come back to the Committee at a later stage to have a wider engagement on the more general issues that are facing health.

The Chairperson (Mr Gildernew): Are members content that we take that approach and continue to 12.00 noon on the coronavirus?

Mr Swann: If there are other issues that you want to bring in very quickly on that —.

The Chairperson (Mr Gildernew): If time allows.

Mr Swann: If time allows, Chair, I am more than happy, because by the time I answer Sinéad's nine questions we could be —. No, sorry, Sinéad.

The Chairperson (Mr Gildernew): Minister, we will expect you to come back, because there are other pressing issues.

Mr Swann: I am offering to come back, Chair.

Sinéad, you asked about testing kits. It is not specific physical medical equipment that is used to take swabs that are transferred to a lab that is used. We are not buying specific things to test people, if you understand; it is not a specific piece of equipment. Generic medical equipment is used to take samples. We are not curtailed by that. That is the process that we have, and that is why we are moving to the next stage, where there is more automation of the lab process. As the Chief Medical Officer was saying, we have been able to automate the process on the identification of the virus, how we test for it and how we look for it. That has been done very quickly with support from UK Government in the research and testing as well.

You asked about the vulnerable groups and how we engage them as quickly as possible. As the Chief Medical Officer indicated earlier, we are meeting NICVA, church faith-based groups, sporting organisations —.

Dr McBride: The Older People's Commissioner, Age NI, etc.

Mr Swann: All that work is there, but it is about providing them with the best and most up-to-date advice. Your concern was that people isolate too early. I do not want people to feel that they have to isolate too early because, as we were saying, I want people to isolate themselves from the virus, not from society. Sinéad is chair of the all-party group on preventing loneliness, and one of the worst effects that we could put on someone at the minute is that they feel that they have to isolate themselves and move away from society and from families quicker than they need to. It might be worthwhile for you to share details of the organisations and contacts you have through that all-party group. Let us use the offices that you have, or your all-party group, and reach out to it. It might not be Michael; it might be someone else. The PHA may even come and talk to that all-party group, because that engagement is useful.

One of the things that you hit on was around how people who self-isolate get their bread and milk. This is not the question you asked, but it is an answer that I am going to give you. One of the things that concern me is the panic buying, and you can see the shopkeeper, Mr Chambers, nodding his head beside you. There is no rationale for it. What has created the panic buying is panic buying, and a very good advocate for this is Aodhán Connolly from the Northern Ireland Retail Consortium. He puts the message across that they are there to do that piece of work of keeping the shelves stocked, the same way that the Department of Health is here to support people in their medical needs on how we tackle coronavirus. The message that I want to get out is that there is no need for panic buying; it is irrational. It is also putting older people and more vulnerable groups, who can only afford to do that weekly shop, in the situation that, when they go to the shops for those essentials to keep them going, they are not there because someone is hoarding them. It does not make sense, and there is no medical need or societal need for what is happening. I will use the opportunity of this Committee meeting to just reinforce the message that is coming from the Northern Ireland Retail Consortium: there is no need to do what you are doing.

Regarding the triggers of how we move from step to step, it is not a calendar. It is not a case of three weeks out from the initial case, we go to there. It is when we start to see, especially in Northern Ireland, community transfer and the number of cases increasing to a point where we need to move to delay, rather than containment. It is not a case of us deciding that we will do this next Tuesday. It is the indicators, the science, that leads us to when is the right time to do it. It will not be that we are doing it tomorrow or we are doing it at midnight tonight. There will be a lead-in time when we move from containment to delay. I want to make it clear that the things we are doing in containment do not just stop. It is not a clear-cut line between the two. You still continue to do certain containment practices even though you are in delay, because it makes good sense — good medical sense — to do that. So there are no specific dates. It will be a trigger of a number of scientific factors that moves us from one stage to the next, and that is how the Executive have reacted to this, through that scientific advice, because it has to be done in a timely manner and in a managed manner so that we do not panic people into taking reactions that we do not need to take. It is about being alert but not alarmed. That is the best message that we can get out about moving from delay to the next step.

I am trying to work through here. The surge planning — again, going back to where we are and how we are preparing ICU beds, and going back to Alex's point earlier about people receiving letters saying that they are not getting a procedure. That is the initial outworkings of surge planning. That is how we start to prepare certain areas, certain hospitals and certain members of staff. They need to be upskilled in certain areas so that they can support that need, as it comes through and when we need it, as a medical profession. That is how that system is already starting to kick in. It is the small steps that mean that, when we do need it, it is already there and already planned for. That work has been going on for the past eight weeks around how we get each one of those steps right and in sequence, because it is not about the big bang when we need to do it or there is large spike, and we are not suddenly left looking around as to how we cope with this. It is about making sure we have the steps in place.

Again, it goes back to how we involve society, which is your point — and it is a valid point. We need society to help us tackle this. We also need the Executive and every Department working alongside us. We need the Department for Communities to make sure that we are supporting the homeless and getting the message out on the change in welfare payments; the Department of Agriculture and Rural Affairs in how we support vulnerable people in the rural society; the Department for Infrastructure on how we interact at ports; the Department of the Economy on how we look at our flights and how we support people in employment and not in employment; the Department of Justice on how we support our people in prisons, how we keep the court service going and how we work with the police if there is a necessary downturn — what other Department have I not given a responsibility to yet?

Mr Carroll: The Executive Office.

Mr Swann: The Executive Office is the coordinator. It take overall control to make sure that Departments look outward in their response to support Health to tackle a situation that is going to be with us for a number of months. One of the messages is that, when we get through this, we still have a responsibility as a Health Department and as an Executive to pick up where we left off and make sure that we get society to the place that it is.

There is a wider responsibility there. I do not want to repeat it, but wash your hands, catch it, bin it, kill it. Those simple steps are not just there as mantras for us to make people think that we are doing something. They are about getting people to do something that supports and protects their loved ones — the vulnerable people in their homes and vulnerable people in society — or their friendship groups. If you are stopping the spread of the virus, you are helping them as much as you are helping yourself.

I think I have covered most of your points. Is there anything —.

Ms S Bradley: There is just that North/South misalignment, and the 111 query.

Mr Swann: When it comes to North/South alignment, while we have been having that conversation there has been a realisation that at certain points we will not be running in parallel on the advice that we are given. Usually, the science leads us to a point at which we are concurrent; that happened with travel advice in the past. However, I want to be clear as well that we are not in the same place as the Republic of Ireland at the moment. We do not have community transfer, because of the steps that we have taken. We have to take the steps that are our responsibility.

There are challenges for us because of the interaction at the border, and we have the common travel area as well. That is something that we are cognisant of, and that is why we work at the level that we do with our counterparts in the Republic of Ireland and the United Kingdom to make sure that there is an approach that works North/South and east-west. As the Department of Health for Northern Ireland, our aim is to make sure that we look after the people in Northern Ireland.

On the question of the 111 system and variances in advice and guidance, I cannot comment without reference to a specific case. We brought the 111 system in at very short notice, having done a lot of intense work, to ensure that we had the opportunity in Northern Ireland to get that professional advice on the initial steps to deal with coronavirus. We do not have access to the GP service which is at the end of 111. When you get the initial coronavirus advice, you are still referred back to your own GP in Northern Ireland, because it is a different health system. We have access to NHS 111 for the initial steps.

Dr McBride: It is fair to say that we are probably a victim of the changing travel advice from the Foreign and Commonwealth Office, which is the relevant UK Department. When that changes very rapidly, as it did because of changing events and decisions made by the authorities in Italy, the FCO has to rapidly update its advice, considering a range of factors, and then there is a need to rapidly update the narrative and the script for the NHS 111 call handlers. Those are some of the challenges; it is just the speed at which things are changing.

To come back to Gerry's point about the WHO declaration of a global pandemic, the virus is being transmitted in many countries around the world. It becomes increasingly less relevant to talk about geographical areas, because it is being transmitted and there is evidence of community transmission in many countries in Europe. The idea of where you travel to or where you travel from becomes increasingly less relevant. What it is —.

The Chairperson (Mr Gildernew): Excuse me, Michael. We have just had an urgent call to say that you and the Minister are required back at the Castle now.

Dr McBride: OK.

Mr Swann: OK. [Laughter.]

The Chairperson (Mr Gildernew): I apologise for cutting the session short.

Mr Swann: Was it something that we have done, Chair? [Laughter.]

The Chairperson (Mr Gildernew): Thank you. I want to reiterate the advice that you gave us that people should do the things they are being asked to do, including not stealing necessary equipment from healthcare facilities. That is very important. We can return to these issues.

Mr Swann: We will come back. Let us work to get a date to come back and cover the other general health issues. I thank you and the Committee members for the support that you are giving to me and my officials and everyone who works in the health service at this minute in time. Those words of encouragement and help mean a lot to the people who work in the health service. I put on record my thanks to you for keeping up that positive message.