Measures to protect care homes in Northern Ireland during the pandemic could have been handled differently, Chief Medical Officer Dr Michael McBride has said. Meanwhile, Health Minister Robin Swann defended his actions on protecting care homes, saying: “I’ve nothing to hide.”
Suzanne Breen talks to Health Minister Robin Swann on his department's approach to tackling the coronavirus pandemic in Northern Ireland's care homes.
Q. Half of coronavirus deaths here have been in care homes with around 300 residents dying. British Government guidance until March 13 was that it was very unlikely that care homes would be infected. Why was this disastrous guidance followed in Northern Ireland?
A. The advice that we were given, we gave to homes at that point, reflected the situation on the ground. The line from Public Health England in February related to the fact that at that point there was no community transmission of Covid-19. It wasn't a general statement of principle. I don't want people reading too much into that guidance. Where we were in Northern Ireland regarding the spread of the virus was a different point as to where England was. We were about 10 days behind.
Q. But were you not aware from late February of the serious risk to care homes from Covid-19? Had you not been watching TV and reading reports about how coronavirus was ravaging nursing homes in Italy?
A. When we put our surge plans in place for how the NHS would react to this, we were also working as to how we would support care homes as well. But the focus of the media when looking to Italy was looking at seeing hospitals overrun, unable to cope.
We were looking at doctors making decisions as to who would get a ventilator and who wouldn't, so the line of public concern was focused in that direction. The department and the care home sector were working away to address a lot of concerns.
Some of the surge plans we were doing for care homes was looking at a model of 20% of staff being off, and how to support that. We were looking at a level of infection we thankfully haven't seen.
It wasn't that we weren't alert to the care home issues - people weren't aware of the level of preparation and planning we were doing.
Q. We've been told of people with Covid-19 symptoms being moved from hospitals to care homes here without testing. There were later outbreaks of the virus in those homes. Who signed off that policy?
A. We were moving elderly people out of hospitals to the best place to actually care for them. The clinical view was that it was better to have old people in a care home rather than a hospital - a key frontline facility for tackling Covid-19. We need to see how many of those cases of hospital to care home infection that did actually happen. One of the things that we haven't seen in Northern Ireland, that we've seen in England, Scotland, Wales and the Republic, is Covid outbreaks in hospitals.
We didn't have Covid outbreaks in hospitals when these folk were moved to care homes.
Now we're testing people before we move them from hospital to care homes but the advice to care homes then was to isolate people to make sure they were Covid-free.
Q. But to move someone in hospital without testing into a care home where there are so many vulnerable elderly residents, was that not spectacularly stupid - something that even a first year medical student would know not to do?
A. I don't accept that 'spectacularly stupid' line. We weren't seeing outbreaks in our hospitals so we were moving people from what could have been a potentially hazardous situation into what should have been, and what was, a safe facility. We're looking to get detail and data on reports of infections regarding the people who were moved from hospitals to care homes.
Q. Your party was hugely critical of the DUP for acts of commission and omission regarding RHI. With RHI nobody died, but the UUP called it a scandal. Are the coronavirus care home deaths in Northern Ireland not a scandal?
A. Every death in Northern Ireland affects me. The worst part of any job I've ever done in politics is opening that daily report that records the number of deaths. There will be inquiries into how Covid was managed, but we're actually still battling this virus. Now isn't the right time to start to take people off the frontline to put them into inquiries.
I've no doubt there will be inquiries - nationally, internationally and locally - regarding how this pandemic was handled. I'll engage with that inquiry. I've nothing to hide. I'm taking and making decisions with the resources I have and the advice I'm given.
Q. But are these deaths not a scandal?
A. Every loss of life is a regret. How this pandemic has been handled will be judged by others. I'm not going to start to put adjectives on it now for the sake of a newspaper headline. I'd rather give you the straight answers you expect from me.
Q. Should you not apologise to bereaved families for the Department of Health's actions and inactions on care homes?
A. I regret every life lost in Northern Ireland to this virus. I took over a health service that was on its knees, a health service seeing nurses on a picket line over working conditions and safe staffing levels. To see it step up in a matter of weeks - from being on the picket line to being on the frontline dealing with a world-wide pandemic - I think that has been an amazing response from the Department of Health, the trusts, and staff.
Q. Northern Ireland only moved on Monday to a policy of universal testing in care homes - two and a half months after our first Covid case. Is this science for slow learners?
A. No, and I'm not accepting that language either. We're doing far better than any other part of the UK regarding testing in care homes. We've so far tested 5,000 out of 13,000 residents, nearly 40%.
We're now moving into testing in care homes where there are no Covid outbreaks so we can give reassurance to relatives, residents and also staff and management.
Q. But it's hardly a badge of honour to be the best in the UK, given the UK's awful record? The Republic has tested 100% of its care home residents and staff and the time of its first coronavirus case was the same as ours.
A. We're testing in care homes to the capacity of our testing programme. We know care homes is where it has to be focused.
Q. The South has tested twice as many people per head of population as Northern Ireland. If it frees up some of its laboratories and resources would you ask if we could make use of them?
A. I'll accept help from anywhere. We are increasing our own testing capacity here and we're working with public and private labs to do so. This isn't about ourselves alone. We'll give and receive help from the Republic, England, Scotland and Wales where necessary.
Q. Contact tracing stopped in Northern Ireland on March 12. Our Chief Medical Officer, Dr Michael McBride, said that was guided by 'sound public health considerations'. Then in recent days, SAGE member Jeremy Farrar has said it was a mistake for the UK to stop contract tracing. Do you agree with him?
A. At the point in time we stopped we only had a small number of people who were fit to do contact tracing. We were actually advising everybody to stay at home so people weren't out and about when we suspended contract tracing. We're back up and running now, and we've expanded our team. It's a vital tool for us coming out of lockdown as we try to return to a new normal.
Q. Is it not the case on care homes and contract tracing that your department has just followed London as opposed to deciding for itself what is in the best interests of Northern Ireland people?
A. No I don't accept that. We take decisions for ourselves. If we were simply following London's advice we would be following London's steps in coming out of lockdown. We've set our own pathway to recovery - one which, unlike London's or Dublin's, isn't date-based.
Q. Have you full confidence in the Chief Medical Officer, Dr Michael McBride?
Q. Unlike his predecessors, Dr McBride hasn't a background in public healthcare. Do you think that has been a disadvantage during this pandemic?
A. No because Michael was in office in 2011 when we tackled H1NI (swine flu) so it would be unfair to go in that direction. He has experience in the role he's in.
Q. There was a serious shortage of PPE (personal protective equipment) at the start of this pandemic. Are you confident we have adequate supplies for a second-wave of coronavirus?
A. I am. We are working on a national and international level and engaging with our own manufacturers in Northern Ireland as well to replenish our stock. However, the need for PPE is still there and we're definitely moving into a better place.
Q. How many people in Northern Ireland have had Covid-19 and do you think it was here before the end of February?
A. The estimates I've seen solely on modelling suggest up to 5% of people here have had it. I don't believe it was here in December. There may have been another virus with similar symptoms in, but I don't think it was Covid. Hospital and ICU admissions from December don't suggest it was here.
Q. What are the chances of a coronavirus vaccine?
A. I think we're a long way off one. I've never shared the optimism of those who were suggesting we'd have one in the autumn. We have to be very careful that it's fit for purpose as well.
Q. Could social distancing still be in place in two years' time?
A. I don't want to put a time-frame on it, but social distancing will be here for a good while, and it will be some time before handshakes and hugs return.
Q. Your seven-year-old son Evan was born with congenital heart defects. As Health Minister you have been out and about meeting people during this pandemic. How worried are you about that and do you take precautions when you return home?
A. It's in our mind as a family. I've a relative in a care home and another who has been put off his feet due to Covid. Evan hasn't received a shielding letter but obviously he has an underlying condition. When I come home at night, I change my clothes before I have contact with my family.