Official Report: Minutes of Evidence

The Chairperson (Mr Gildernew): We have the Minister of Health and the Chief Medical Officer (CMO) with us this morning to update the Committee on the COVID-19 crisis. I welcome Mr Robin Swann and Dr Michael McBride. Minister, we obviously have a lot of questions and your time is limited. We are aware that you have a briefing for the Committee this morning, but if we could keep that quite short, we can get to the questions as quickly as possible. We welcome you, Minister, and please go ahead.

Mr Swann (The Minister of Health): Good morning, and thanks for having us again. I am conscious that officials are due to brief the Committee after me in regards to the 2019-2020 budget and the adjustments, and also the 2020-21 budget, so I will take the opportunity just to update members with the latest developments regarding COVID-19.

As I said yesterday when I did the press conference, it is startling to realise that it is only eight weeks ago today that the first confirmed case of COVID-19 was reported in Northern Ireland. I was in front of you six weeks ago, along with the Chief Medical Officer and the Permanent Secretary, when we had to leave early, if you remember, to go and brief the First Minister and the deputy First Minister with regard to steps that the Republic of Ireland had taken to put restrictions in place.

All of us have been affected by this virus and by the steps that we have had to take to contain its spread and mitigate its worst potential impacts. We have all seen our lives disrupted, with limitations on our ability to visit family and friends, our children unable to go to school or to play with their friends, and unfamiliar restrictions on everyday activities such as going out to the shops, going out for a meal or taking a walk in the park. Many of us have suffered economically due to the loss of jobs or the slowing of business. Many of us have had the disease or have seen loved ones suffer from it. Too many of us have, sadly, lost loved ones, and have not been able to say goodbye to them in the way that we would choose to.

These past eight weeks have also seen countless daily examples of the quiet heroism of our health and social care (HSC) workers as they go about their jobs to keep us all safe. We have also seen our communities come together as never before to look after and support one another. Ordinary people across Northern Ireland have accepted the disruption and uncertainty with good grace and patience, and have willingly traded their personal freedoms to buy vital time to help our front-line services deal with the unprecedented challenges that they have faced over the past weeks.

I spoke with you just three weeks ago on the work that is ongoing to manage this emergency, and, since then, much progress has been made, so it is timely that I provide you with a further update and take this opportunity to look at what may lie ahead. The first and most important thing that I wish to say is that we are by no means out of the woods yet. In the past eight weeks since the first confirmed case in Northern Ireland, we have seen 2,874 confirmed cases of the disease, and, sadly, 250 people have passed away. I am aware of the concerns that have been raised in recent days in relation to the reporting of COVID-19 statistics. The daily figures are compiled for surveillance purposes to help us track the virus and keep the public as informed as possible. They will always be subject to some degree of revision, as deaths will be officially registered at different times in busy hospitals and other locations. The weekly bulletin produced by the Northern Ireland Statistics and Research Agency (NISRA) provides a more complete picture of COVID-19-related deaths across hospital and community settings, but every loss of life to this disease is a tragedy and a source of grief to us all, and I want to reassure members and the public that the protection of life remains the overriding concern of my Department in its approach to managing the pandemic.

I want now to take some time to explain the approach that I have adopted to deal with the emergency, and to outline some of the significant actions that have been key to our response. Testing has a significant role to play in our fight against COVID-19, and I would like to reassure you that testing is growing and will continue to do so as rapidly as possible. As of yesterday, the total number of individual tests for COVID-19 in Northern Ireland stood at 16,378. That figure includes 5,013 health workers, although it should be noted that, since we were not specifically testing healthcare workers at the start of the process, that figure may actually under-report the true number of healthcare workers who have been tested. On Tuesday,1,112 tests were run across the system, and that included 122 as part of the national testing programme. Members will be aware, however, of the difference between the number of individual tests and the number of individuals tested, as many people require more than one swab to be taken.

You will be aware that testing is now also carried out at a number of Driver and Vehicle Agency (DVA) sites to support local trust capacity, and, through the national initiative, at the SSE Arena testing site. A second site became operational at Derry rugby club on 17 April, and a third site will go live at Craigavon MOT centre. In addition, an expert working group has been established to lead on the expansion of testing across all our laboratory services in health and social care facilities, and to consider options for the utilisation of other testing facilities, including those in the commercial sector. In the testing strategy, which has been shared with my Executive colleagues and members of the Health Committee, I have made it clear that overall testing policy will be adjusted over time as testing capacity increases and priority groups for testing are expanded. Similarly, the strategy includes a pledge that testing will soon move towards surveillance of COVID-19 in the population to inform the planning of services, including surge capacity, and to estimate population immunity.

You may be aware that yesterday I announced a further expansion of testing, to now include additional symptomatic front-line workers and members of their household. Importantly, that now includes front-line workers in the private sector, with a focus on staff delivering key medical, energy, utility, transport and food supplies, and that will be delivered as we continue to expand the local capacity of the national testing programme. Employees who think that they are eligible and need to be tested are being instructed to speak to their employer as and when they need a test. The details of how to be tested will be widely circulated by the Public Health Agency (PHA) across local industry. This latest expansion of testing will allow even more vital workers to return to the front line. A number of extensive studies of testing will be taken forward over the next few weeks and will focus on care homes, general practices and emergency departments. The planned programmes include testing in care homes, which will begin to enhance and support optimum care for residents and support staff and will inform our understanding of the nature of COVID-19 in care homes. On the subject of testing and surveillance in general practices and emergency departments, it has also been confirmed that anyone who leaves hospital to go back into a care setting will be tested 48 hours before discharge.

I have been clear about the challenges of personal protective equipment (PPE). COVID-19 is having a worldwide impact, and protecting staff and patients is as much an issue elsewhere as it is locally. The pressures on supplies are significant globally, and, as I have said on a number of occasions, there is not a country in the world that truly knows the path that the virus is going to take. My aim, along with Executive colleagues, is to ensure that we have a sufficient stock of PPE to allow our HSC staff to perform their roles as safely as possible. That is why I am committed to ensuring that we rigorously pursue every viable supply source, both locally and elsewhere. None of us can work on our own in our battle against COVID-19, so the four nations' PPE plan was published on 10 April, and we are working closely with England, Scotland and Wales on all aspects of that plan. We have already supported each other by way of mutual aid, and that will probably continue in the weeks and months ahead. Equally, we continue to explore new supply lines with the Republic of Ireland. We have also significantly increased supplies from local agents and local industry, which is to be commended as it continues to show itself to be adaptable, innovative and responsive to the challenging environment.

China is the most significant source of worldwide supplies. The work that is led by my Department and the Department of Finance to secure PPE is important and is at a critical stage. We continue to work to ensure that all possible steps are taken to open up a supply chain that meets our needs and supports our four nations' approach. Additionally, clear specifications and photographs will be requested to ensure that stock is compliant with our requirements.

I have already underlined the importance of distribution and deployment to all front-line settings, and I have stressed that all staff must know where to turn to in their organisations when they have concerns or questions. That is why a new email contact was established for HSC staff to raise PPE concerns. The email address will be checked every day, and the anonymity of the staff who use it will be protected. That is the latest demonstration of just how seriously we are treating staff concerns about PPE.

On surge planning, a key component in the emergency response has been the work to maximise our HSC's capacity to treat COVID-19 patients. Each trust has taken steps to significantly increase critical care capacity at local hospitals, and further plans are in place to scale up the total number of ventilated care beds as required. Today, as we stand, 36 COVID-19 patients and 40 non-COVID-19 patients are occupying adult ICU beds, of which there are 115 available. Of those patients, 56 are undergoing mechanical ventilation. That means that, as it stands, and before even more beds come online for a further increase in critical care admissions, we have 38 spare adult ICU beds and sufficient stocks of equipment to provide ventilation and other forms of respiratory support. In total, we currently have 197 mechanical ventilators, and further orders in place with various suppliers will bring the total to over 400 mechanical ventilators if required. We will continue to plan beyond the reasonable worst-case scenario. However, for the time being, our latest data modelling indicates that further critical care capacity will not be required during the current wave of transmission in Northern Ireland. Northern Ireland's first Nightingale hospital, located in the tower block of Belfast City Hospital, is a key part of surge plans. The new Nightingale hospital can treat up to 75 ventilated patients, and that figure can be scaled up to 230 ventilated patients from across Northern Ireland should it be necessary.

As regards the treatment of non-COVID-19 patients, I stress that much of the day-to-day, non-COVID-19 business of the health service continues. People are still having strokes and heart attacks, and that is why I urge anyone who suspects that they need to talk to a doctor or present themselves to a hospital to do so. In addition, HSC trusts are now accessing hospitals in the independent sector to treat non-COVID-19 patients across a number of elective specialities. It is expected that up to 135 procedures a week will be carried out across a range of red flag and urgent cases.

Those will include breast surgery, gynae cancer surgery, plastic surgery, urology procedures, general surgery and ophthalmology. There is also the potential for a small number of local anaesthetic procedures to be undertaken. HSC will fund that activity on the basis of compensating the independent sector on a net-cost-recovery, not-for-profit basis.

The work that is being undertaken by the COVID-19 modelling group is key to informing the decisions that Executive colleagues and I will need to make in the weeks and months ahead. The projections provided by the group are informing the work that needs to progressed to ensure that sufficient PPE is available; that testing is scaled up; that our hospitals, GP services and community pharmacies have capacity to deal with the demands that they are facing; and that key services in the community are prepared to deal with the challenges that they are facing today and every day, and until the disease has been defeated.

Latest modelling suggests that our health service has a realistic prospect of coping in this initial period if a sufficient proportion of the population continues to adhere to the social-distancing and self-isolation measures. The number of deaths during the first 20 weeks of the epidemic — from 18 March to 4 August — has been reduced, under the reasonable worse-case scenario, from 3,000 to 1,500. That number is based on there being a continuation of the current measures. Although that is positive news, I reiterate that there are no grounds whatsoever for dropping our guard. Projections underline the point that the continuation of rigorous social distancing will save many lives and protect our health service from collapse. Even a relatively moderate increase in transmission could lead to an increase in the number of cases within a matter of weeks. In addition, the absence of a vaccine means that we will have to plan for a potential future second wave of COVID-19 cases later in the year.

Despite the potential for breaches of the rules by members of the public, especially with the perceived confusion about where and how exercise can be taken, police messaging and the technical deployment of resources appear to have been extremely successful in encouraging most to do the right thing and stay at home. It seems clear to me that the PSNI is adopting an appropriate and graduated approach to enforcement. It is providing advice and guidance to those leaving their homes without good reason and using the threat of the reality of enforcement powers in the small number of cases in which that advice is blatantly being ignored. I commend the PSNI for that and ask that it seek to maintain that critical element of its response to COVID-19.

On the next steps, I very much wish that I could provide some certainty on what the future holds for us all. Modelling has indicated that we are now in the peak of the first wave of the pandemic, but it is too early to confirm whether the current figures represent the peak. As I said, in the absence of a vaccine, we will have to plan for a potential second wave of COVID-19 cases later in the year, once restrictions are eased or lifted and normal life gradually resumes.

Although there are grounds for hope that the outbreak can be brought under control through maintenance of the current restrictions, coupled with the continuation of the high level of compliance that has been observed by the people of Northern Ireland, the outbreak has not yet reached the point at which some of the restrictions can be relaxed. The progress achieved through good adherence to the restrictions by the people of Northern Ireland will be lost very quickly if there is any adverse change in compliance with the existing social-distancing measures or relaxation of some of the restrictions that help achieve that compliance. It is clear that, in Northern Ireland, like elsewhere in the world, the restrictions are causing hardship, distress, anxiety and economic harm. They represent a level of interference in family life, work and religious practice, social and cultural activity, and leisure, sporting and educational pursuits that is alien to our way of life. However, if we stick firmly to the measures that we have in place, the time will come for those discussions. We have to face them together, honestly and openly. They will not be easy decisions, because simply maintaining the current lockdown indefinitely would have serious repercussions for many people's mental and physical well-being. That is why we must continue to review and challenge the regulations that we have. We will all have to weigh up our options very carefully, working closely with colleagues across these islands to ensure that we take the right decisions at the right time.

The Chairperson (Mr Gildernew): Thank you, Minister. At the outset, I acknowledge that progress has been made since we last spoke. There have been additional deliveries of PPE, but there are still many questions and concerns out there. There is testing, and you have ensured that capacity has not been exceeded in hospitals, and that needs to be acknowledged. That is no doubt as a result of the entire system's tremendous commitment. I know that questions will arise as we go forward, but that is important to state.

I have a couple of quick questions, if I may. Were the figures given for the number of deaths a mistake? If so, was it a systemic mistake? How did it come about and what is being done to address it?

Mr Swann: I want to be clear, Chair: no matter what system or country has been reporting COVID-19 deaths, it has experienced the same time lag in reporting deaths. The Chief Medical Officer in the Republic of Ireland indicated that in his press conference yesterday. The First Minister of Scotland always prefaces her report on the number of deaths by saying that the figures are not concurrent and that there will be a time lag. Therefore, the piece of work that we did yesterday was done to make sure that any deaths that were outlying were brought in, in order to bring the figures up to date. As soon as we had that piece of work done, I thought that it was right that we presented it. Those deaths would have fed into our system over the next number of days, but when they were presented to me yesterday after that work was done, I thought that it was right and proper that we made them public then. Their release was never going to be delayed: it was about the timeliness of their being reported, based on the timeline.

Dr Michael McBride (Department of Health): I have made it very clear from the outset that we are talking about different things here. The source of authoritative advice and comparison for deaths, either as a direct consequence of COVID-19 or in cases in which it has been suspected that there is COVID-19 but that has not been confirmed, as well as other excess deaths because of the things that we have had to do at the present time, is NISRA. Those are published official statistics. What we are using is data that allows us to track the impact of measures, and it is hopefully a positive impact. We are seeing the positive impact of the social-distancing measures that the public are adhering to. The first instance of that, as I have said repeatedly, is a fall in admissions to hospital and intensive care, and then, in due course, a decrease in deaths.

The process of registration of deaths is complicated. It is more timely in Northern Ireland than it is in the other part of this island and, indeed, other parts of the United Kingdom, but there will always be a delay between the tragic circumstances of the death of an individual and the completion of the death certificate by the doctor and the subsequent registration of that death. I am very grateful to colleagues in NISRA for moving over the past couple of weeks to weekly reporting of deaths and excess deaths. That work includes separating out from other deaths those deaths where COVID-19 has either been confirmed or is suspected. NISRA will publish that data again tomorrow.

I am also very grateful that NISRA separated out for us information on deaths that have occurred in the community in care homes and kept that separate for us from deaths that have occurred in a hospital setting. It is a very complex situation. We do not normally report daily on deaths from any condition. As the Minister said, this has been a very rapidly evolving situation. On 26 February, we had our first case in Northern Ireland. That seems like a lifetime ago for all those who have been working on the front line, all those who have been affected and all those who have, sadly and tragically, lost loved ones.

The Chairperson (Mr Gildernew): As you acknowledged, the reporting of statistics caused some alarm, and there is that potential for concern, so we welcome that clarity from you.

You mentioned the importance of modelling as we move forward. Is that modelling now taking place? Can we avail ourselves of the figures from the South? Can we input our figures?

Mr Swann: One thing that has been helpful is the modelling that we are doing here with our own modelling team in Northern Ireland, now that we are progressing through the virus and through a timeline. Modelling has also been beneficial in establishing the memorandum of understanding. We have been able to have access to the modelling that the Republic of Ireland has commissioned, plus we are still part of the scientific advisory group for emergencies (SAGE) and privy to the UK-wide modelling that comes out. We are therefore able to produce a fuller report.

The Chief Medical Officer had a long engagement on modelling with his counterpart in the Republic of Ireland yesterday, and the Chief Medical Officer and the Chief Scientific Adviser will provide an update to the Executive tomorrow on where we are and our projections for Northern Ireland. There is always a caveat, Chair: the modelling figures that we produce are a model; they are not a prediction or us saying, "This is what's going to happen". We always need to be cognisant of the fact that this is modelling and not something that we should pin up as targets to be achieved or not achieved.

The Chairperson (Mr Gildernew): That brings me on neatly to my next point. I agree that modelling will only ever be a prediction. It is testing that tells us what is happening. That is the crucial element. On 24 January, your written ministerial statement said:

That is from an early point. On 29 January, you said that it was not unreasonable to assume that, at some point, we would have a positive case. Therefore, work was already under way to scale up testing from that point. I acknowledge that you provided regular updates and statements — I thank you for that. However, your written statement of 28 February confirmed that contact tracing was taking place. On 2 March, you said that the Department had contributed to the UK-wide coronavirus action plan. On 19 March, you stated:

I believe that the aim at that point was to get to 1,100 tests — I will go back to that — but I am still confused. We had requested the testing strategy, and we received a paper, dated 6 April, from you on 9 April. We considered that COVID-19 testing strategy at the meeting, but we have not yet seen the actual strategy that you signed off on. Can we get a copy of the testing strategy that was employed until that date?

Mr Swann: The one prior to what you received on 6 April?

The Chairperson (Mr Gildernew): Yes, so that we can get an idea of what the testing strategy was before it changed.

Mr Swann: At that point, our testing strategy was to concentrate on the priority groups. The first group was those who were in hospital presenting with COVID or COVID-like symptoms. We wanted to ensure that they were being treated in the right place. The second priority was to extend testing to our front-line healthcare workers, and the third was those who were in cohorted living accommodation, be that a care home or supported living accommodation. That was the strategy. Those three priority groups were laid out from the beginning of our strategy. I will check whether we have a specific document entitled, "Strategy", but those were our key aims and key target groups. You mentioned the 1,100 target. As my opening statement on Tuesday said, we hit that target of 1,112 tests completed — that is not the number of individuals tested — and we have achieved that. In the next week or so, working with partners in the Agri-Food and Biosciences Institute (AFBI), we will bring its labs online. That will enable us to increase our in-house capacity even further.

Dr McBride: We have been very clear throughout all of this in our approach to testing and about our commitment to delivery against increased testing capacity. I put on record again my thanks to all the laboratories across Northern Ireland. You will remember that Northern Ireland had one of the first 13 laboratories in the UK to begin testing back in early February. I pay tribute to the staff of the regional virus laboratory in the Belfast Trust. We have extended the testing across trusts in Northern Ireland. At the Minister's request, I established a consortium with Ulster University, Queen's University, the Clinical Translation Research and Innovation Centre (C-TRIC) in the Western Trust, AFBI and a range of other partner organisations to rapidly scale up our testing capacity. At the outset, we were able, and had a capacity, to test 40 individuals a day. That is now in the region of 1,700. We compare very favourably, as I said to the Committee before, in respect of the number of people tested per 100,000.

The Chairperson (Mr Gildernew): Let me interrupt you there, Michael. When Robin was giving his figures, he said that 16,000 tests have been carried out. On a very quick calculation, taking a period of six weeks with testing on five days week, that equates to about 500 tests a day. So, what is the current capacity?

Mr Swann: As the Chief Medical Officer said, we have increased the capacity to 1,700.

The Chairperson (Mr Gildernew): OK. There is capacity for 1,700. How many are being completed?

Mr Swann: We completed 1,112 on Tuesday, and, as I announced yesterday, that is why we have increased those eligible to test. I can give the data here that we announced. We have now included front-line staff in the private sector, with a focus on staff delivering key medical, energy, utility, transport and food supplies. Those listed can appear at a test centre without an appointment and, by producing their ID, get tested. That includes NHS ID, any central government Department ID, Health and Safety Executive —.

The Chairperson (Mr Gildernew): Sorry, Robin. I am very conscious of members wishing to ask questions, and I am very conscious that your time is short.

Mr Swann: We have increased testing and extended it to those working in the private sector to include supermarkets, the telecoms industry and Royal Mail, which have all been contacted directly by the national partners. Employees who think that they are eligible and need to be tested should speak to their employer, who can then contact an email address through which their employee can seek access to that testing. I will share that email address with the Committee. As we increase our capacity, we fill the slot, if you understand what I mean. As we stand today, our capacity is up to 1,700. On Tuesday, we carried out 1,100 tests. So, we have capacity for a further 600 tests a day. That allows us to continue to expand our catchment to make sure that we can fill that capacity.

Dr McBride: There is an important point, Chair — you interrupted before I had finished — around your question and the answer to your question. We will not test this virus into submission. This virus is not going away. We need to use our testing capacity intelligently, and, as this epidemic has evolved, so, too, we have evolved and continue to evolve how we use our testing. As the Minister announced, we are moving to put in place surveillance in general practices because it is crucial that, before we get to the next phase and any decisions that the Executive make about relaxing social-distancing measures, we have early intelligence in the community as to how the virus is behaving and whether there is a resurgence of the virus. Similarly, next week, we will introduce that surveillance into our emergency departments for people who are presenting there.

As the Minister indicated, we have taken a range of steps in a rolling programme of surveillance in the independent care sector. As we move forward, we will, from the very outset, use our testing differently. As we move forward into the next phase, the challenge will be to ensure that we have ramped up our testing capacity and contact-tracing capacity, because we will begin to see, potentially, further surges and the emergence of outbreaks. So, it is not a matter of just testing and testing numbers; it is about the intelligent use of those tests, where we target them and how we use them to inform what we need to do and the action that we need to take. That is crucial.

The Chairperson (Mr Gildernew): I absolutely agree with that, Michael. We recognise and welcome the fact that progress has been made. The World Health Organization (WHO) has said very clearly that you cannot fight a fire blindfolded, so it is crucial that the testing is informing the next steps, which are contact tracing, further testing, isolation and all of that. People are wondering why there is excess capacity and think that you should be able to match the capacity to the testing that is being done. I think that people are saying that, given that this is such an important issue, why can you not maximise the testing?

Mr Swann: We will not deliver a testing programme and then have people turning up without being able to be tested. So, we increase our capacity and then move to fill that capacity rather than the other way round. If we had told those groups to turn up to be tested but did not have the capacity to test front-line health workers or those in hospital, that would have failed them. It is always about increasing capacity and then increasing the groups who fill it. That is how we get into that wider space.

I will pick up on what the Chief Medical Officer said: we have to be careful about the message on testing. Testing does not create a vaccination or immunity. It is a measure at a given point in time of whether someone has the virus. You could be tested at 12:15 this afternoon, Chair, and come up clear. By 12:30, you could have COVID-19. It is a measure in a moment of time. I want to make sure that people do not assume that a clear test means that they will be clear for ever.

The Chairperson (Mr Gildernew): We understand that.

Mr Swann: I know that you do, Chair, but it is critical to get that message across.

The Chairperson (Mr Gildernew): You need a high level of community testing to advise when you can start to relax the restrictions. That includes double testing, so you need to factor in that people need to be tested at another time.

I will move on to members and take a group of questions on testing. I ask you to take a note of the questions and keep your answers as succinct as possible. I will start members who are on the phone. Are you there, Pam?

Mrs Cameron: I am, yes. I thank the Minister and the Chief Medical Officer for being here today. You will be aware, I am sure, that Eddie Lynch, the Commissioner for Older People, has called for all staff and residents to be tested. What is your reaction to that? Do you have the capability to do that or will you have it in the near future?

My second question is about care homes. I have recently been in touch with a funeral director who had serious concerns after being contacted by a care home — I will not name it — about the removal of a deceased resident. The funeral directors were advised that the person had tested negative for COVID-19. They took the body and treated it, including embalming, only to, then, be told that the deceased had tested positive for COVID-19. They are now very concerned about safety and are asking whether all deaths in nursing homes should be treated as high risk, with the coroner taking control of those death processes.

The Chairperson (Mr Gildernew): Thank you, Pam. Members, for those whose question has been asked, we hope to have a second round of questions.

Órlaithí, do you have a question?

Ms Flynn: Issues have been raised by psychiatrists and mental health staff who are working in community and inpatient settings about access to testing and appropriate PPE. There is a wider issue there. I know that an email facility has been set up to deal with PPE concerns in particular so that staff can contact the Department directly to flag up those issues, but there was also an announcement, over two weeks ago now, from the British Government about a mental health helpline number for NHS staff. I have been trying to get more information about that over the past couple of weeks, and I cannot. I am concerned about support for staff who are dealing with those issues and concerns in their place of work, particularly in the mental health inpatient units. What support do they have outside of that email address? Is that mental health helpline up and running for our staff?

I have other mental health issues to raise, but I will come in later, if that is OK.

Mr McGrath: The Chief Medical Officer is reported as saying that aspects of our population density in the Republic and in Northern Ireland mean that the impact on the island is different from that in GB. Given that and the low transit rates between GB and NI at the moment, are we planning to test and trace on a cross-border basis? What practical measures are being taken to deliver that, and what can we see on the ground to prove that that is happening?

Mr Sheehan: It has been flagged up regularly that contact tracing is an important element in combating the virus. Why did the Minister stop contact tracing in the middle of March?

Mr Easton: Thanks for your presentation.

Am I allowed to ask only one question on this?

The Chairperson (Mr Gildernew): Yes.

Mr Easton: Are all nursing home residents being tested or just those who may be showing symptoms? I ask because I think that nursing homes are hotspots, to a degree, and it would probably be best if they were all tested.

Ms Bradshaw: Minister, you talked about the data that was being collected for surveillance purposes. Are you also carrying out a rolling clinical audit of the medical history of all cases? I am conscious that, as we move through the pandemic, you will have to put in place new systems and programmes in primary, secondary and tertiary care, so I wonder whether you are looking at patients' medical history.

Mr Chambers: Minister, there has been an impression created in some quarters that Northern Ireland is playing catch-up, and maybe failing, on testing. As recently as last week, contributors to the Committee indicated that, compared to England, Scotland, Wales and the Republic of Ireland, Northern Ireland is actually doing the best in testing. Is that still the case?

Mr Carroll: On PPE, we are hearing concerning reports about health workers who are concerned about the guidance from England. It is my understanding that they have not been reassured that they will not have to use PPE twice. That is very concerning; the Royal College of Nursing (RCN) and Unison have expressed concerns about it. The Department's guidance in our pack says that PPE should be used for one episode of care, so I am concerned that there are different messages going out and that we will have instances of PPE being used again when it should not be. To make the Minister aware, I have been informed that there is due to be a significant delivery of PPE by a major employer here, next week, of 40,000 items. I can give him the details if he wants. In my view, that should go to our front-line staff and not to a non-essential business that will be open next week.

Mr Swann: With the 40,000, if you let us know, Gerry.

Mr Carroll: It is Bombardier.

Mr Swann: In regards to the guidance on PPE, concerns were raised about when Public Health England (PHE) issued its guidance about the potential for reuse. Our guidance has not changed. I was very clear when I said, about that guidance, that I want to make sure that there is enough PPE for all our staff. At this minute in time, we are able to do that. I was asked to give a commitment that I would never ask staff to reuse PPE. I will be clear, as I was when I was asked the question, that I cannot give that reassurance, because I cannot, hand on heart, sit here and say that in two, three or four weeks' time we may not be in that position. That is why we are doing everything that we can to make sure that our PPE stocks are supplemented and fulfilled, no matter what the source: working with the Republic of Ireland, the UK, sourcing our own in China or working with large and small manufacturers in Northern Ireland to make sure that that warehouse is full so that we can maintain and implement the guidance that we have in place in Northern Ireland. That is our direction; that is our work. However, I cannot sit here, hand on heart, and make such a promise. I would not do that. It is not, and has never been, my way of working to make a promise that I know that I might not be able to keep in two or three weeks' time.

That may not be what the member wants to hear, but I hope that he takes it from me that I am being genuine when I say that staff should never be placed in that position. We set-up the email address so that employees can contact us directly, and it is being used across the sector from front-line workers, to domestic care and to community care workers who are emailing their concerns. We can address those and go back to the employing trust or the employer.

On the issue of testing, care homes are a major focus of what we are doing. That is not just in testing but in additional support, because we realise that the most vulnerable and susceptible to the worst ravages of COVID-19 are the elderly. We are aware that, because of the structure and because of where they are, care homes and nursing homes have the potential for outbreaks and the development of larger outbreaks. That is why we are working with care home providers, the private sector, independent homes and our own ones to make sure that the support mechanisms are there, and that includes testing. We have started a testing programme in care homes, which I will ask the Chief Medical Officer to update you on.

Pam asked about the funeral director. I am happy to take those details off line, because that is a case that we need to follow up on internally. I know that you do not want to give the detail out here now.

Órlaithí asked about psychological support and whether our staff at any level will have access to that GB number. We set up our own internal structures last week, because we realise the mental trauma, angst and pressure, as well as the stress and strain, on our staff who are working to tackle COVID-19 and to care for non-COVID-19 patients throughout the system. It is important that we provide psychological support for our staff.

That covers the majority of the questions. The Chief Medical Officer will pick up —.

The Chairperson (Mr Gildernew): What about the staff testing that Pam asked about?

Mr Swann: Sorry. As I said, our front-line staff, and anybody employed by the NHS, is eligible for testing. All they have to do is turn up with an NHS ID, and they will be tested. Access for staff testing has always been there and will remain in place. It is one of our key priorities.

Dr McBride: I am happy to pick up on some of the questions. Pam and Alex's questions were about care homes. We are absolutely aware of the concerns about care homes and the vulnerability of the individuals in them. As you said, Alex, we have seen outbreaks in the sector, and that is concerning. This is a new virus, and we need to understand how it behaves in that sector. From the outset, when we introduced our testing priorities in early March, healthcare workers in that environment could have a test. There always has been a programme of testing individuals where there is an outbreak, for those in the residential nursing sector. We have now extended that to include everyone in the care homes where outbreaks have occurred, including staff, and there is a rolling programme of expansion of that testing.

In relation to the coroner, under section 7 of the Coroners Act, there are clear conditions in which cases are referred to the coroner if there is a cause for concern or if the death requires further investigation. Not all deaths from COVID-19 require to be reported to the coroner.

Colin and Pat asked about contact tracing and testing, given the interface between Northern Ireland and the Republic of Ireland. In the containment phase, our focus was very much on testing and contact tracing. When you move into the phase where there is widespread community transmission, the benefit of continuing active contact tracing and testing is diminished, because, essentially, anyone in the community could be a source of infection. If you recall —.

Mr Sheehan: That is not what the WHO is saying, Michael.

Dr McBride: Sorry, Pat, if I could answer the question. As we moved into the next phase, as you will recall, the decision was made, supported by the Executive, to put in place a range of measures on social distancing that involved two very specific elements. It involved us communicating clearly to the public what the symptoms were, recognising, even at that early stage, that, given the levels of transmission in Northern Ireland, there would be other reasons why people would have a continuous new cough or fever, but advising those individuals and their household contacts to stay at home. We know that those are the individuals most likely to —.

Mr Sheehan: I am sorry to interrupt you. I understand all that. What I do not understand is why contact tracing was stopped here, around 12 March, given that the advice from the WHO, and from eminent professionals in the field of epidemiology, infectious disease, public health and so on, people like Gabriel Scally and Sam McConkey, who is also from this parish, have all been calling for testing on a community basis, as well as contact tracing. Why did we stop it here?

Dr McBride: I think that I have answered your question, Pat, if I am honest. We are guided by expert scientists actively working in the field, based on expert scientific analysis and on —.

Mr Sheehan: Who are those experts?

The Chairperson (Mr Gildernew): Pat, just hold on a minute. You need to make your remarks through the Chair.

Dr McBride: I cannot answer the question if I keep getting interrupted.

Mr Sheehan: Chair, with respect, I do not think that I am getting an answer to the question.

The Chairperson (Mr Gildernew): First, I am going to seek some clarity. Matt Hancock said yesterday that we need to test, trace and isolate.

Dr McBride: Exactly.

The Chairperson (Mr Gildernew): Was the decision to stop contact tracing for a period a mistake, looking back?

Dr McBride: No. It was based on sound public health considerations. What I was trying to get on to say, Pat — this is the important point that Colin also raised — as we move into the next phase of our response to the pandemic, what we are likely to see, once we get through this initial wave, is further outbreaks in the care home sector and perhaps in hospitals. We will see local pockets of community outbreaks. That is why the surveillance that I mentioned earlier is crucial. What we then need to do is to ramp up our capacity to contact trace and test so that we can ensure that we very quickly get on top of those local pockets.

This is not a question of saying that testing is not important or that contact tracing is not important. The important point is the timing of their introduction: the time when we moved into the delay phase with communication to the public about self-isolation and household isolation and into a different phase where we need to target our testing capacity and resource into managing that wave of the pandemic. As we come out the other side of that, the contact tracing and testing will be crucial. On Colin's point in relation to how we do that, it is crucial that we work collectively with our colleagues in the Republic of Ireland, and I had a conversation yesterday with Tony Holohan's team about that. That is the close cooperation that the Minister referred to between our respective public health bodies, our scientists in Northern Ireland and in the Republic of Ireland, the Chief Scientific Adviser in Northern Ireland and using common platforms where that is possible, using technology, digital apps etc to support the contact tracing effort.

This will be contact tracing that we have never seen or experienced before. We need to rapidly ramp up the capacity. Our own Public Health Agency, colleagues in the Health Service Executive (HSE), and colleagues right across the UK are doing that. This is not saying that testing and contact tracing are not important; it is saying that they are becoming increasingly important and will be more important in the next phase of our response.

The Chairperson (Mr Gildernew): You said that you received scientific advice on the decision to stop contact tracing. Can the Committee get that advice from you?

Dr McBride: The scientific advice that was provided to us by SAGE will be available in due course.

The Chairperson (Mr Gildernew): Why in due course? This is a number of weeks ago, I take it.

Mr Swann: When it is available, we will make it available to the Committee.

We did not pick up on Paula's question on the clinical audit. That is important, because, if members recall, when we saw our first COVID-19 deaths in Northern Ireland, and across the world, they were always recorded as having an underlying health condition. So, it is important that we do that piece of work on people who are hospitalised and people who are presenting through our COVID-19 centres, because it is important for us to realise that if there is an underlying health condition that makes the spread of COVID-19 more prevalent or more ravenous when it infects an individual, it is important that we know that so that we can manage and can prepare the health service for the next phase when it comes.

Ms Bradshaw: Is that a commitment that you are going to start doing that?

Dr McBride: We have been doing that.

Mr Swann: We are already doing that, but it is one of those things. When we get through this first wave, we will be able to concentrate on how we manage and prepare the health service for the next wave.

It will come to the point that, if we see an underlying condition that is more prevalent or more susceptible to the worst ravages, we can target those people, as we did for the social isolation and shielding letters that went out from GPs. People with specific medical conditions were judged to be more susceptible and more of a concern, so they were asked to shield for 12 to 14 weeks initially. When we can look back historically, we will work through who presented, whether they were hospitalised and whether they went to ICU. We will be able to use that data to make sure that, when it comes to the next stage, the next phase or the next surge, we are prepared and can support the people who need it most. In our National Health Service, there is no difference, no barrier or no judgement as to who can access it or when they access it. It is important that we get the steps in place to protect and support everybody equally.

Dr McBride: We are sharing that information because it is an important point. This is a new virus. SARS-CoV-2 first emerged on 8 December of last year. It is remarkable that it is such a short time ago. We are learning more about COVID-19 by sharing intelligence about how the virus is behaving, but how it is affecting people is also crucial. Initial reports from China suggested that those who smoke cigarettes were at greater risks of complications. We know that obesity seems to be a factor, as are, as the Minister said, underlying health conditions. Internationally, clinicians are cooperating and sharing intelligence and information, including that about the most effective treatments. Intensive care societies, across these islands and internationally, are sharing information about how best to provide respiratory support to individuals, and we are rapidly learning in that space.

Another important aspect is that, unfortunately, a vaccine is some time off and will be challenging. In the interim, it is crucial that, quickly and as soon as possible, we develop effective prophylactic treatments or drugs that could perhaps delay or prevent individuals acquiring the severe disease and also to treat COVID-19. Active clinical trials are going on right across these islands, Europe and globally. In Northern Ireland, our patients and researchers are fully participating in that. In the gap between what we see now and, hopefully, at a future date when we have an effective vaccine, in the area of clinical trials — randomised clinical trials — people will benefit from being enrolled in those trials and we also develop our knowledge of what works. It is crucial that we continue to develop that effectively.

The Chairperson (Mr Gildernew): I have a final question on testing. What percentage of testing will be dedicated towards community surveillance in GPs? Will a few areas get full community testing, and how will those areas be chosen?

Dr McBride: Primary care testing commences this week. We have a well-established system in place of spotter practices for flu sentinel surveillance. You may recall the report that you receive each year during flu season about the levels of flu activity. We will be using those 36 GP spotter practices, which represent about 10% or 11% of GP practices, across Northern Ireland. We will start that, initially, in the 13 GP spotter practices within the greater Belfast area — the Belfast Trust and South Eastern Trust area — because that is where we are seeing, at present, the greatest rate of community transmission of COVID-19. The following week, that will be extended to all the 36 practices right across Northern Ireland, and I can provide details of those.

We are also working very closely with our colleagues in primary care, GPs, the Royal College of General Practitioners (RCGP), the British Medical Association (BMA) and the Health and Social Care Board (HSCB). We are keen, if it is practicably possible, to also look at our COVID-19 centres where individuals are presenting. As you know, at the minute, individuals with symptoms who phone their general practitioner are red/amber/green (RAG) rated. Those rated green can self-isolate and manage at home and contact the GP if they have problems; those rated amber need to be assessed at a COVID-19 centre. Whilst recognising that COVID-19 centres were not established for testing — they were there to provide assessment and clinical care — we wish to consider and to work with colleagues to see if we can introduce testing there.

Similarly, we will introduce testing into the care home sector — I cannot give you the exact percentages at this time, because those numbers have not yet been completely worked through — and, then, also into emergency departments. We will start with one emergency department, again, in the greater Belfast area, with a view to moving out into the west and north-west, and, indeed, ultimately, across all emergency departments in Northern Ireland. Again, the intelligent use of the testing capacity will be crucial as we move into the next phase, so that we can get the public health data about how the virus is behaving and whether we are beginning to see it re-emerge, which might be an early indicator of further problems and, perhaps, a second wave.

The Chairperson (Mr Gildernew): OK. I want to get in another quick round of questions. You are looking at your watch, Robin. I think that we actually need to address that issue. It has been regrettable. We have tried to create maximum space, but members do have a duty to scrutinise.

Mr Swann: That is why we are here, Chair.

The Chairperson (Mr Gildernew): I think that we will need to ask you to come back next week, because the questions are rolling on. We will need to do that.

Mr Swann: Chair, I think that it would be helpful, then, when we do get to that stage, that we get different questions, rather than the same questions being repeated.

The Chairperson (Mr Gildernew): In fairness, it is up to the members of the Committee to decide what the questions are, Robin. I do not think that there has been huge repetition of questions. What there has been is a lack of clarity on what the actual steps are. It has been acknowledged that the capacity for testing has not been utilised fully. There is wide concern in the community. The World Health Organization has said that, in order to defeat the virus, we need to detect all cases, test, contact trace and treat. There is concern in the Committee. With due respect, it is up to the Committee to decide what the questions are.

Listen: I do want to get in a quick round of questions. In particular, there is ongoing concern about the spread in care homes and the vulnerability of care home residents. I know that we have touched on testing. I am not asking you to go back over the issue of testing. I welcome the fact that you have announced additional support for care homes, but what will that support look like? Will repurposing staff into care homes be mandatory? It is welcome that, as a result of measures that have been taken, the situation in hospitals is better than it could have been. That provides an opportunity, now, to do better by care homes. Can you give us some information on that?

Mr Swann: Repurposing staff will not be mandatory. It will be voluntary. That is why we have engaged with the unions on that support. We have asked them, because we will not mandate staff to go into the independent private sector. We are seeing good uptake from our own staff members and also from volunteers who have stepped up to our call, so that we have the support mechanism there for independent private care homes and our own care homes to make sure that we can provide security and reassurance for those people, who are, basically, in their home. We need to be cognisant of that. In the past, there have been studies of the stresses and strains that are caused when you take somebody who has lived in a care home and move them to a different facility. That has an adverse impact. That is why we are trying to put in the mechanisms to allow residents to stay in their own facilities and somewhere that is known to them.

A number of care home providers have indicated to us that they are under additional financial pressure through having to source their own PPE and also pay staff members who are off work due to self-isolation or because they have tested positive. There is the provision of statutory sick pay and the cost of having to bring in additional staff. We are working through a number of those issues to consider how we support them.

The Chairperson (Mr Gildernew): We have time for a few really quick questions. I have Gerry first, then Paula, and, then, I will check the phone. I want your questions to be really short.

Mr Carroll: Thanks, Chair. I concur with your comments. I know that you have done your best, but time has been rushed. I understand that the Minister is, obviously, busy responding to the crisis, but I think that more time for maximum scrutiny is essential.

The issue of deaths is, obviously, very sensitive. The 'Financial Times', a reputable newspaper, has indicated that the death figure could be closer to 500. The Chief Medical Officer said that it might be a few years before we know the full death toll. Mike Tomlinson of Queen's University has indicated that the number of deaths per million of the population is higher in the North than in the South. Obviously, the death of hundreds of people in any circumstances would be worrying, but I am also concerned that we may not have an accurate figure for the total number of deaths. That is a concern in and of itself. If we also talking about exiting the lockdown —.

The Chairperson (Mr Gildernew): Gerry, come to the question, please. I want to get other members in.

Mr Carroll: My question is this: are we in a situation where we are unsure or we have an inaccurate number of deaths at this time?

Mr Swann: As the Chief Medical Officer said, the official reporting body is NISRA. There is a week of time lag in the report that it does, when it studies and analyses death certificates that are presented to it. It is the professional body that we look to for that. What is concerning is the disparity on the year-on-year comparison, and that is a piece of work as well. We still encourage people to come forward to emergency departments and GPs, because our concern is that people who are not presenting with strokes or suspected heart attacks are actually adding to that increased figure.

I think that some of the comparators that are currently out there are misinformed and ill-judged.

Ms Bradshaw: Minister, not all front-line key workers have access to a car. Are there any testing facilities that are not drive-through facilities?

Mr Swann: Some testing facilities are still hospital-based, and, when we move to GP-based testing facilities, they will have access to them. I am also aware of the fact that the Belfast Trust has worked with one of the taxi providers and provided a shielded car. They have taken a car and put Perspex between the passenger in the back and the driver. Therefore, if anybody needs transport to one of those testing facilities, they can get it. If somebody needs to be tested, we will make sure that they get tested and do not have to drive there, Paula. It is important for us to do that.

Ms Bradshaw: The Public Health Agency said that it was not responsible for that. It was not in Belfast; it was outside. Could you look at that?

Mr Swann: The Public Health Agency will not be responsible for getting somebody to a test. We will make sure that support mechanisms are there, and, if you have cases —.

Ms Bradshaw: I have emailed you.

Mr Swann: Right.

The Chairperson (Mr Gildernew): Alex, and then Alan. Sorry, Alan, I had Alex first and then you.

Mr Easton: Thank you, Minister. I am worried about the potential for a second wave. What plans are we putting in place for that? Obviously, as we move on and things get better, we will start to lift the restrictions. What are you planning for that?

The Chairperson (Mr Gildernew): Just one question, Alex. Sorry. I have to be fair.

Dr McBride: I will pick that up. The important elements are that our health and social care system is ready for any surge. That will be right across, from beds in hospitals, intensive care and, importantly, capacity in the community sector, in nursing homes and care homes, and making sure that there are resilient surge plans. We are working very diligently, right across the sector, to ensure that that is in place. You are absolutely right: now is the time to do that.

The second element of that will be putting in place the aspects that I referred to earlier around the enhanced capacity for testing and contact tracing and ensuring that we are able to exchange that information rapidly across this island, recognising that there is, absolutely, a flow of people. People often live in the same town, where half of the town or another part of the town is in the Republic of Ireland. We are working very diligently to enhance our capacity in that respect.

It is crucial that we have both those elements covered.

Mr Chambers: We are aware that ailments in nursing and care homes can spread very quickly. If a resident of a care or nursing home is showing symptoms of the virus, are they immediately removed to a hospital setting or are they treated and isolated within the nursing or care home?

Dr McBride: Basically, it is whatever is appropriate for the individual, and it will depend. There are two aspects to it. Firstly, there is the clinical care of the individual: the person will get the most appropriate clinical care, in discussion with the individual, where that is possible, and with the involvement of their family, the general practitioner and the hospital, as appropriate.

The other element is the management of that outbreak. Obviously, it is very important that the individual is appropriately nursed and managed with appropriate PPE to protect the staff member but also to protect other residents. It might also include the cohorting of individual patients if there is an outbreak in a care home. In those situations, the Public Health Agency does a rapid risk assessment, working closely with the care home, and provides all the advice that is required on PPE, the isolation and cohorting of patients, and appropriate cleaning etc. We also have the RQIA, which has been repurposed to provide support to the sector, and that has been very successful as well.

The Chairperson (Mr Gildernew): Pam, you indicated that you had a question.

Mrs Cameron: Yes, thank you, Chair. I want to ask about communication, Minister. I have been contacted by members of the deaf community. As well as being deaf, many of them do not read, because the English language is not their first language; it is signing.

They are very concerned that there is nothing in place for signing and, therefore, communication in the midst of the COVID-19 crisis. There is very great concern about how the critical messages are communicated, especially for those who may be potentially affected by COVID-19 and how they can communicate in different scenarios and settings apart from hospital.

Mr Swann: I know that the Deputy Chairperson has worked hard on this and has raised it before. We have been working with the Department for Communities and the Health and Social Care Board, and we hope to have something in place tomorrow, which will include two elements: a video relay service and a video remote interpreting service. The detail is being finalised, and it will be announced, tomorrow, by us, the Department for Communities and the Health and Social Care Board. We have been conscious of that. You have raised it with us. Hopefully, tomorrow, we should have steps towards a temporary solution to that — it will not be a permanent one — to try to alleviate those concerns and to make sure that the support that is there is for everyone in the community.

Dr McBride: It will be in British and Irish sign language.

The Chairperson (Mr Gildernew): Does it take account of the particular cultural and sign language issues within the community?

Dr McBride: It does.

Mr Swann: We will do both, Chair.

Mrs Cameron: Thank you.

The Chairperson (Mr Gildernew): Órlaithí, you indicated that you had a question.

Ms Flynn: Yes, thank you, Chair, and thanks to the Minister and Dr McBride. There has been plenty of talk today, and rightfully so, about planning for a future second wave, which is obviously really worrying, and the Department needs to do all the planning that it can to deal with that.

I am also really concerned about the mental health aftermath of the pandemic. Is the Department doing any planning or modelling on dealing with that? It is a wave that will also come at us. Is the Department monitoring any of that? Are assessments ongoing of people who are mentally ill and are currently in services and getting worse and of people, on top of that, who are coming through services? We are going to have a wave. We already had a mental health pandemic before this virus broke out. Is any planning happening? I know that some plans are taking place in the NHS England and Scotland. What is our Department doing here?

Mr Swann: We realise the stresses and strains that are there due to the regulations but also due to the fear factor that is COVID-19, so we have been working to make sure that our mental health strategy and action plan is kept alive, and it is more relevant as we work through this.

One of the things that I asked the Department and the permanent secretary to do is to bring forward the recommendation that I had in the mental health strategy and action plan about the appointment of a mental health champion. We are moving to put that in place, in the next period of time, so that they can begin the independent work of seeing where the mental health action plan and strategy lies and how it will need to be refreshed and revisited in regards to, I suppose, the aftermath of COVID-19 and the additional strains and stresses that it has placed on people.

The Chairperson (Mr Gildernew): Go ahead, Michael.

Dr McBride: Órlaithí, it is an issue that concerns me greatly, as Chief Medical Officer. I think that there are various levels to it. There is the psychological impact that there has been on every one of us who has been traumatised as a result of this, and I mean everyone in the population, because of the impact that social distancing has had on all our lives. You are absolutely correct: it is acutely felt, particularly by those in disadvantaged communities and others who perhaps do not have the access to networks and supports, such as the elderly; those who are shielding and feel the impact of isolation from family and friends; and those with underlying mental health problems. This is having a very significant impact on the population's mental health and well-being.

As you are aware, the Public Health Agency has been working very hard — as have colleagues in England and Scotland, as you mentioned — to get messages out and provide online support to individuals. Most importantly, we will have to ensure that, as we move into any next phase, as well as managing and planning for any future wave of impact of the virus, we are able to deal with the wave of impact on mental health, psychological ill-health, the trauma associated with that and the impact on other important services. The number of people who were waiting for treatment prior to the virus was already too high, and it is even greater now. We are very actively planning as to how we can address the totality of that.

We are still not out of this wave but, just to reassure you, and in response to Alex's question, while we are planning for next waves, we are also planning for that important part in the middle about how we get back to ensuring that, as the Minister said, people have confidence in accessing our services and, when they need them, they can access those services in a timely way and we get through some of the backlog of problems that we have created as a result of our efforts to save lives during the first wave of the pandemic.

The Chairperson (Mr Gildernew): OK. Pat and Colin, quick questions.

Mr Sheehan: Who is taking the lead in the Department on contact tracing? Has the Department begun the recruitment process yet for contact tracers? If so, how many have been recruited so far?

Dr McBride: I am happy to provide those numbers for you. I am taking the lead on that, working very closely with PHA colleagues. We are actively working with a range of bodies to increase the recruitment of contact tracers, and we are working closely with the Department for Communities, local government environmental health officers, medical students and nursing students to put a training programme in place. We are going to pilot that enhanced contact tracing early next week. We have planned a four-week programme to provide the training for those individuals so that we are ready to turn that service on when it is required. I am happy to provide further details.

Mr Sheehan: Michael, you just broke up on me a wee minute there.

The Chairperson (Mr Gildernew): Pat, I am going to have to move on to Colin.

Mr Sheehan: I did not hear how many he said had been recruited so far.

Dr McBride: We have offers of 400. We estimate that we will probably need somewhere between 300 and 600 in the next phase of our response. We have a graduated plan to increase those numbers to start the training. As I said — maybe the line broke up — we will be piloting the first element of that at the beginning of next week, on 27 April.

The Chairperson (Mr Gildernew): You say offers of 400, Michael. What does that mean?

Dr McBride: That means individuals, for instance, such as environmental health officers who currently work in local government — a very skilled cadre. We have 800 nursing students whom we can retrain and repurpose. Similarly, we will have medical students. Our volunteering scheme has already had something like 16,500 applications, which has converted into 11,000 people who have completed applications and over 4,000 who are now work-ready.

Just to reassure you, Pat, I am confident that we will have the numbers to carry out the contact tracing. What will be crucial is the timeliness of the training programme. We will also be using digital technology. I probably do not have time to go into the detail, but we are plugged in to colleagues in the Republic of Ireland using the digital platform that they are using to enhance contact tracing. Obviously, the two systems will have to talk to each other, as I said in response to Colm's question, because we are going to have to share information very actively.

We are working with colleagues in NHSX in England on the digital telephone app and, similarly, colleagues in the Republic of Ireland on their digital app, which, as I explained before, will allow individuals who test positive, using a unique identifier on a voluntary basis, to confirm, and then their mobile phones will contact those with whom they have been in close proximity. We can programme the phones to ensure that, back to the first phase of the response, that identifies individuals who have been in contact at less than two metres for more than 15 minutes. That is a very active piece of work at this time, and I am happy to provide further details on that.

The Chairperson (Mr Gildernew): I am not still not clear, Michael. When you say "offers", how many have actually been recruited? I assume that there is a recruitment process where you sign a contract with people to provide training.

Dr McBride: There is.

The Chairperson (Mr Gildernew): How many people have been recruited?

Dr McBride: I do not have those numbers with me, but I am happy to provide that.

The Chairperson (Mr Gildernew): OK. Colin is next, and I will bring in Alan if I have time.

Mr McGrath: There has been much reference today to the issue of modelling. Is that model just simply handed to us by London, or is it something that we can have a full input to? Are we permitted to take that model and look at it on an all-island basis? The virus does not know any borders, and we are on an island. Is the modelling that we are doing taking into consideration that the approaches need to be harmonised, North and South?

Mr Swann: Colin, our modelling is our modelling. It is a Northern Ireland model, and we are not handed it by anybody. I have established our own group that does that work with the Chief Medical Officer and the Chief Scientific Adviser. Our modelling is our modelling, and, as I said earlier, we have the conversations North/South and east-west in regards to how they best plug in to each other, to use the phrase that I think you used. We have those conversations regularly. As I said, the Chief Medical Officer had a conversation with his counterpart in the Republic of Ireland earlier.

The Chairperson (Mr Gildernew): Just a final question from me on childcare. When additional funding was announced, a childcare scheme was rolled out. Can you give us a quick update on the take-up of that scheme and how effective it is being to give key workers childcare to let them get out to work?

Mr Swann: I do not have the numbers, Chair, but that is something that we did in conjunction with the Department of Education. It involved putting someone into a key worker's home. I do not have the figures to date, because Education was doing a lot of work in conjunction with us in that and was facilitating that where it could. I do not have those numbers, but I can get them again. Again, it is something that is crucial in making sure that we get support to get some of our key workers back online. The majority of our staff are female, so it is about giving as much support as we can to make sure that they have the support that they need to get back in.

I will take one from Alan; do not worry.

The Chairperson (Mr Gildernew): I think that you are being given a wee indulgence, Alan.

Mr Chambers: I have a very quick topical question, Mr Chairman, around cemeteries. Can the Minister tell me whether there is any medical or scientific reason for cemeteries to remain closed?

Mr Swann: Maybe I should not have taken it. Again, it is a topical question, Alan, and I made clear yesterday my personal preference. I do not see any reason why cemeteries should be closed at this time. They could be managed appropriately, with appropriate measures and supports put in place. Órlaithí made the point about the mental health support that we need to give individuals. There are a number of people in our community who get that reassurance, that mental health support and strength, by going to a graveyard and visiting a grave. Again, it is about the balances that we put in to make sure that the support mechanisms and the restrictions and regulations that we put in do not have an adverse effect. The Chief Medical Officer and the Chief Scientific Adviser are providing an input into a number of questions to the Executive tomorrow. At that point, the Executive will make the decision, because, although the regulations that are in place are in the name of Health, I brought them forward on behalf of the Executive. The decision will lie with the Executive to either ease or strengthen those restrictions.

The Chairperson (Mr Gildernew): Thank you for your presentation and for your answers to the questions. From the outset, the Committee has said that we would engage with you constructively, and we will seek to continue to do that, but I think that the key word in that is "engage". We will need to engage with you directly.

Mr Swann: Sorry for my outburst earlier in regard to questioning, but, every now and again, we do seem to get the same questions. There is a lot more stuff that I would love to be telling you about where we are and what we are doing. We are willing to come back. I am not sure whether we can do it next Thursday, but I have no problem engaging. I update the Executive on a Monday, a Wednesday and a Friday on where we are. The Committee and the role that it has played are equally important to us because of the work and the support that you are giving to the messages that we as a Department want to drive home and the messages that we need the public to hear. Your support, encouragement and understanding through what has been a very difficult time are welcome.

As a Committee, your role in scrutinising us and supporting us in what we are doing is vital. That is why I provide you and the Deputy Chair with as many regular updates as I possibly can when there are things that I think you need to know, and vice versa. I think that we have good communication with you and the Deputy Chair. We have no problem with keeping you up to date. To be frank, I know that we preach social distancing, but I think that this is a better model than trying to phone in. When I did it the last time, it was difficult to interact with members, so I appreciate the steps that you have taken to do that today.

Once again, I thank members for their continued support and enhancing and pushing out the message that we need to get across while we work through this phase and, at some point, get back to the more routine things that we were doing just over 10 weeks ago, which seems like a long time ago.

The Chairperson (Mr Gildernew): We absolutely need to deal with the fundamentals. We need to anticipate and prepare for further waves. We need to therefore apply the lessons that we have learned from across the world, but also from what has happened here, and to ensure that we do not repeat any issues and that we can pick up on the lessons and implement them. Thank you very much. I wish you both all the best. Good luck for now.