Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“I requested that those reports be published at the same time as they relate to the full cervical screening pathway and because they need to be viewed in their entirety and in conjunction with the reports previously published. I will make a written ministerial statement to coincide with their publication and to update Members.”
“To ensure that we have a full understanding of the potential issues in the Southern Trust laboratory, several additional reports were commissioned. I advise Members that three separate reports are due to be published jointly by the Southern Trust and the Public Health Agency this Wednesday, 5 November. Let me emphasise that I am not publishing and the Department is not publishing; the three reports will be jointly published by the Southern Trust and the Public Health Agency. They are an independent expert's opinion on the factual reports that were published in December last year; an independent review by NHS England of the PHA's quality assurance arrangements for cervical screening in Northern Ireland; and a summary of the multi-patient serious adverse incident findings and learnings.”
“As a result of the review, 64 women were invited to attend a colposcopy or gynaecology review. Of those, 56 attended their colposcopy appointment: 21 had a negative or normal result and therefore required no treatment and were discharged; 24 had evidence of precancerous changes to their cervix that did not require treatment; and 11 had precancerous changes to their cervix or another significant incidental finding that required treatment. Those women have either completed or are undergoing a treatment pathway. <BR /> <BR />There is a second report, entitled 'Cervical Cancers in the Southern Health and Social Care Trust Area'. It is a comprehensive review of cancer rates in Northern Ireland from 1997 to 2021. That report concluded:”
“The reports provided the factual information collated from the review and drew on data reported by the Northern Ireland Cancer Registry and the audits of the invasive cervical cancer process. <BR /> <BR />As Members will recall, no cervical cancers were identified during the CCR. The cervical cytology review outcomes report noted that 96% of the women included had no change to their original smear test result on review and required no further follow-up. Therefore, while the review in itself did not provide all the answers that we needed, it went some way in reducing the concerns that were raised in the RCPath report, which stated:”
“It was, however, a necessary and important step to help establish the facts, to check the accuracy of the original screening results and to check whether those who were screened were on the correct pathway. Although the Southern Trust laboratory played no role in it, the review took longer than was initially anticipated and was completed in the autumn of 2024. Following its completion, two factual reports were published on 11 December last year: the 'Cervical Cytology Review: Activity and Outcomes Report', for 2008-2021; and a separate, companion report, 'Cervical Cancers in the Southern Health and Social Care Trust Area: A Summary Report', for 2009-2023.”
“It found that there was a significant performance issue with a number of screening staff. The report also found that the trust failed to take appropriate action to manage the underperformance. So, yes, it was management and screeners. <BR /> <BR />The Southern Trust and the PHA considered the report's recommendations and, taking into account ethical considerations, decided to carry out a precautionary physical review of the records of over 17,000 women who had been screened during the period in question. The review became known as the cervical cytology review, or CCR. I fully acknowledge that the news of the review naturally caused a lot of worry and upset for the women who received letters.”
“In the Republic of Ireland, the age-standardised incidence rate is 10·43 cases per 100,000 females for the period 2018-2022, which is just a year out from our own data. I urge Members to ensure that that message is not lost. <BR /> <BR />I also remain committed to understanding what happened in the Southern Trust cervical screening programme. As Members may recall, the background is that, in 2021, the Southern Trust's senior management received internal notification that raised concerns of poor performance in the laboratory going back several years. That was formally raised with the Public Health Agency in February 2022, triggering a series of meetings that led to the royal college's being commissioned to undertake a desktop-based risk assessment. The pathologist's report was received in May 2023.”
“It is important to repeat that point: screening is not diagnosis. False negative and false positive tests occur in all screening programmes. <BR /> <BR />The screening programme is aimed at healthy women with no symptoms. Its purpose is to reduce the incidence of cervical cancer and to prevent women from dying. Screening has been shown to be effective in helping reduce the risk of developing cervical cancer, and, like other Members, I urge all women to take up the offer of screening when invited to do so. The programme's effectiveness is reflected in comparative data across the UK for 2017-19, which shows that the European age-standardised incidence rate for cervical cancer in Northern Ireland is similar to the UK average. In Northern Ireland, it is 9·1 new cases per 100,000 females, while the UK average is 9·9.”
“<BR /> <BR />As Members will be aware, a population-based cervical screening programme is a complicated process and involves a number of steps. The UK National Screening Committee states:”
“Let me list a few points. All the recommendations contained in the royal college's report have been implemented. All cervical screening activity in the Southern Trust has been ceased. There has been the full implementation, since December 2023, of human papillomavirus, or HPV, testing, which is a better and more reliable automated test. Cytology is now used as a second line of testing, undertaken for screening samples that test positive for the presence of HPV. Since November of last year, a single regional laboratory service, managed by the Belfast Trust, has been established. I will return to Mrs Dodds's concerns about that later. Consequently, the cervical screening programme has been significantly improved over the past two years.”
“I recognise that it has now been more than two years since the publication of the Royal College of Pathologists' report on 9 October 2023, and so, of course, I regret the time that it has taken to reach this point. However, it is essential that we gather all the relevant information, because we have to fully understand the full picture of exactly what happened in the Southern Trust cytology laboratory. While I am conscious of the time that it has taken to reach this point, a significant amount of work has been undertaken in relation to the screening programme in the meantime.”
“Deputy Speaker, thank you. If anybody was in any doubt that all healthcare is personal, this debate and this issue are the proof. I will begin by trying to assure Members that, right from the beginning, from taking up my post, I have given this matter my full focus. I have listened to those who have been affected and have met some of the women and some of their families, not just their spouses but their children. On several occasions, I have met the Ladies with Letters group. I have listened to their concerns, and I believe that I understand their frustration and anger. One thing that, I am sure, we all agree on is that the affected women must and will remain the key focus for all of us. <BR /> <BR />With regard to information sharing, I have sought to be as open and transparent as possible right from the get-go.”
“If the Member is looking for specific numbers, I will have to write to her. There is certainly a shortage of social workers and social care workers, so I am afraid that what she is telling me does not come as a huge surprise. I will have to get back to her in writing with the fine detail.”
“If double ED waits are still happening, I would be concerned about that. The Member is nodding to say that that is still happening. I will certainly take that away, because I was of the impression that we might well have seen that problem off by now.”
“Again, let me check exactly where we are with the double ED waits. It was the RQIA assessment of the impact of moving emergency general surgery to Altnagelvin that exposed to the public the idea of people having a wait for assessment in the ED in the South West Acute Hospital but then having to do that again when they get to Altnagelvin. I think that the trust was already on it, as it were, but had not cracked it. It was aware that it was an issue that needed to be addressed and that we did not have to have the double ED wait. Of course, under Encompass, instead of having to put a big physical file in an ambulance with a patient, you can say, "This patient will be with you in whatever time", and the incoming team can look at Encompass and see the diagnosis and all the rest of it.”
“I thank the Member. I will write to him on that, if he does not mind, because, while ambulance waiting times have been bad down the years, I am getting a hint that there is some really solid, positive Northern Ireland-wide news that includes Altnagelvin. I will listen to the follow-up question, but a focus is being put on that issue, and that focus is beginning to yield results.”
“The Member will obviously be 100% against that, and I might agree with him on the one about mandatory detention of people without going to the courts to get permission. The second thing is to say, "Let us think about all the other issues that have arisen since 1967 that we do not have covered". I would like to think that, in the next mandate, we will do a new public health Bill that will be more to the Member's satisfaction — not entirely so but more so.”
“It is because I do not accept the Member's assessment that there were "atrocious" decisions made in the Department of Health at that time. The Member and I clearly disagree absolutely fundamentally, and it is fine that we should do that. The 1967 Act deals only with infectious diseases. We are in the 21st century, and we need to consider all hazards and take in the biological, chemical, nuclear and all the horrible threats that have developed down the years. Although I am saying that we will not bring the legislation forward in this mandate, I have said to officials that we have to re-engage with people and try to make them understand two things. The first is the implications of what we have, which are some fairly draconian measures in the 1967 Act about how you can detain people.”
“<BR /> <BR />A former leader of the Member's party used to say that Ministers do not go out to consultation until they have decided what they are going to do and that the consultation is only to see whether there are banana skins that they have not spotted. I do not take that approach, and that is why, for example, I put in mandatory vaccinations as an option. I did not support the proposal, but who am I to tell the population of Northern Ireland that people cannot even have an opinion on that? That is why I put it in, but I made it clear that, personally, I would not be supporting it. Overall, the 1967 Act contains some draconian measures, but people are not aware of that. It was in the context of it being so soon after COVID that I realised that we are making people fear for their civil, religious and human rights and liberties.”
“It was more of a broad acknowledgement that there was concern about human rights and about government being in a position in which it will potentially overreach into people's personal freedoms and decision-making. <BR /> <BR />Let me make a broader point to the Member, however. It was early in my tenure that I was asked to sign off on the consultation. Had I been in post longer, I might have come to the view that it was too soon after the COVID-19 pandemic to go out to public consultation on the proposed Bill, because that is the clear impression that I get from the 8,000-plus responses to the consultation and, indeed, from the reaction at the time.”
“Again off the top of my head, I suggest that, if the Member holds such information, he should immediately pass it on to the Police Service of Northern Ireland and potentially to the Safeguarding Board for Northern Ireland.”
“Off the top of my head, I am not aware of any such concerns.”
“It absolutely is. We are pretty much there, but could we use £50 million or £60 million? Yes, we could.”
“I am pretty confident that it does, because the workforce challenges remain. Although we have invested heavily and increased the overall workforce that delivers health and social care, there are still major gaps. <BR /> <BR />Before coming to the Chamber, I was slightly delayed because I was listening to somebody in the Long Gallery who has MS. It was awkward for me to get up and walk out on somebody who was giving a personal testimony. His point was that we do not have enough workforce in neurological services. He said that we do not have enough psychological staff and that we do not have enough trained nurses and consultants. That is a common call that Members will hear made right across health and social care delivery. <BR /> <BR />To my mind, the Member's question is valid. Is the £40 million being spent to best effect?”
“I would like to think that it is the former, but, even at that, we have to review the situation and make sure that every penny that we spend is spent properly. Every pound that is misspent in the Department of Health is a pound that is not spent on education, on housing or on all the other areas that are in charge of the social determinants of ill health. We therefore have to spend every penny wisely, not just for Health but for everybody else.”
“I thank the Member for her question. I was not aware that that was happening until that report was published, and I found it quite shocking. The range of activity and the scale of Health and Social Care are such that it is challenging to stay across every development. I did not welcome what I heard, because we are in very constrained financial times. The question then becomes — I do not have the answer to this yet — whether people are actioning and signing off on those procedures because they think that they are in the best interests of patients and service users or whether it is because people are not properly focused on the fact that we have that unprecedented and, frankly, unmanageable, pressure on our budget.”
“On the substantive point, yes is the short answer. However, the context that the Member tried to place it in is deeply unfair. The Assembly, as he knows, was down twice during that time, and the only other person in recent years from this party to hold the position of Minister of Health was Robin Swann, who got hit immediately with a global pandemic, which became nearly his entire focus. He did manage, for example, to appoint a mental health champion and get out a mental health strategy, so he did do things. However, those were done under the most constrained circumstances that any Health Minister has faced since devolution in 1998. The context is not fair, but, as for the intent of doing better with cancer services, I am with you.”
“I do agree, and I can only assure the Member that that is an area of focus for me. Introducing the regionalised booking service for breast assessment is not the beginning and the end of what I intend to do in that area.”
“When I need a repeat prescription, I go on the internet and fire off an email to my GP pharmacy, and it comes back and says, "Yeah, we got that all right". However, they print out a script, and the local pharmacist has to walk up the hill, collect the script and walk back down to the pharmacy. I do not understand this: if it can get from me to the GP, why can it not get from the GP to the community pharmacy, and why does it take so long? However, it does, apparently, take that length of time.”
“On the latter point, I believe that GPs and, indeed, community pharmacists are very aware of the need to check for unintended errors, so I do not expect that there will be any lack of focus there. An electronic system allows you to build in objective tests rather than to rely on individuals' subjective eyesight and thought processes. <BR /> <BR />Even though there will be potential benefits in the system for patients, I am very focused on the benefit that it will have for GPs. Every GP whom I talk to when we bring up the idea of paper-based prescriptions says, "That is so time-consuming. It would be transformational to have an electronic system." <BR /> <BR />I take five tablets per day on repeat prescription.”
“I remain hopeful that, subject to securing the required funding, the project can commence in 2027 and be completed by 2032.”
“The Department is currently leading on an ePharmacy programme, a central component of which is the electronic transfer of prescriptions (ETP) project, which will introduce a fully electronic system to replace the current paper-based prescription process. That system will enable the secure transmission of prescriptions from prescribers to community pharmacies and onward to the Business Services Organisation for processing and payment. <BR /> <BR />The Department has included the ETP project in its 10-year capital investment plan, with an indicative start date of 2027 at the earliest. Work is currently under way to develop an outline business case that will set out the strategic, economic and financial justification for the project.”
“To answer the Member's question, I expect to receive the completed review with recommendations by March 2026, with the usual proviso that, sometimes, our deadlines are not met.”
“I thank the Member for his question. We have looked at the provision of CCNs, but it is imperative that we ensure that all children have safe access to education that is supported by the necessary therapeutic support. The Public Health Agency is leading a comprehensive analysis in order to identify what the assessed therapeutic needs are for children and young people who attend special schools. We need to know that the development of an effective model of therapy provision is being planned and that we have the associated workforce in development and planning. That will include a comprehensive scoping exercise to capture the assessed needs of children and young people in respect of occupational therapy, physiotherapy and speech and language therapy.”
“After engagement and discussion with the Department and the South Eastern Trust, the presence of an on-site nurse in Knockevin School was stepped up again in mid-2025, and, currently, a CCN is on site two mornings a week in addition to the presence of allied health professional colleagues. <BR /> <BR />Following last month's publication of the Public Health Agency's review of the healthcare needs of children attending SEN schools, officials in my Department have commenced work alongside colleagues from Education in order to ensure that all children in SEN schools have access to necessary healthcare.”
“All special education needs schools across Northern Ireland have community children’s nurses (CCNs) available to them in order to manage the identifiable healthcare needs of their pupils. For historical reasons, of the 40 SEN schools in Northern Ireland, only eight have on-site CCNs in place, who are split across the Belfast Trust and the South Eastern Trust. <BR /> <BR />In the 2023-24 financial year, the delivery model in Knockevin School changed to an in-reach model, with CCNs providing assessment and care planning for children with complex healthcare needs. The nurses provided knowledge and skills-based training to key staff in the school and were available for queries and guidance as necessary.”
“The Fire and Rescue Service is, however, keen to optimise that in order to support the effective and efficient operation of the college. I know that representatives of fire services in the Republic have been to see it and that there has been interest from across Great Britain and, I believe, further afield.”
“I thank the Member for his question. Yes, absolutely. The first thing to say is that the college being there has led to a reduction in costs for several training topics for the Northern Ireland Fire and Rescue Service itself. Those include breathing apparatus instructor training, road traffic collision instructor training and hazardous material officer training. The college also has a flood facility, which is absolutely spectacular. <BR /> <BR />The college is primarily, of course, for the use of the Fire and Rescue Service here, but other emergency services, including the Ambulance Service and the Police Service of Northern Ireland are already making use of the site. The Fire and Rescue Service operates a cost recovery model for third-party usage, which, at present, remains under development, so its full potential is not yet fully known.”
“The Northern Ireland Fire and Rescue Service Learning and Development College in Cookstown represents a transformative investment in firefighter training, public safety and regional development. It is world class. I will repeat that, because we do not have many facilities that meet that criterion: it is world class. It has been operational for 11 months. Several benefits have already materialised, with further gains expected. <BR /> <BR />The college's state-of-the-art facilities provide trainees with multiple opportunities to experience realistic and repeatable training simulations in a controlled environment under expert supervision. That leads to personnel being better prepared than they were previously, and that, in turn, enhances the safety of the public and firefighters alike.”
“I do not think that I have that statistic to hand. I am not sure whether we even trap that statistic, but I will certainly look out for it for the Member if we have it.”
“I am not sure how that relates to transportation. We are very conscious that cancer waiting times are getting longer, that that is not good and that it delivers very bad outcomes. The longer a patient has to wait, the less likely they are to get an optimum outcome. It is a very important issue, but it is not relevant to this question. I will write to the Member, because I was not expecting to be asked about that on a question on transport.”
“As referenced in my previous answer, the Department for Infrastructure, the Department of Health and the Department of Agriculture, Environment and Rural Affairs are engaged. Officials have been tasked with looking at how we can help to get people who do not have their own transport to and from health and social care settings. That involves community organisations, such as community transport providers. They are looking at how we can work with those organisations to deliver better outcomes for patients and service users, so it is happening.”
“A couple of months ago, we escalated that to being an inter-ministerial meeting, because we felt that there was not enough impetus. The focus will be on getting people to and from health and social care settings. It is very much on the radar.”
“If you need a procedure, and your local facility does it once a week, but a facility 30 miles away does it 10 times a day, five days a week, I think that I know where you will go. However, the question is whether you can you get there and back, and, therefore, transport becomes particularly important. It is absolutely essential for a relatively small percentage of the population. I think that the larger percentage can get there and back one way or another, but, for those who cannot, transport becomes critical. We are looking at all those schemes. <BR /> <BR />The Member may be aware that there are ongoing discussions between the Department of Health, the Department for Infrastructure and the Department of Agriculture, Environment and Rural Affairs.”
“I thank the Member. I should have added in my opening remarks that we have a cancer support services directory and that, for those on low incomes, there is a hospital travel costs scheme that may provide financial assistance. <BR /> <BR />On the broader point, the Member knows that I consulted on a strategy that would create a hospital network for better outcomes. I believe that many people, probably including me until relatively recently, wanted every procedure to be delivered at their nearest hospital, whether it was an acute hospital or not. That is neither possible nor particularly desirable, given the fact that we have the potential to move to create hospitals that are specialists in particular procedures.”
“Additionally, Cancer Focus NI provides a free volunteer driving service for eligible patients, which is accessible via a referral from a health professional. Other charities may offer similar support, though availability varies by region.”
“The Northern Ireland Ambulance Service (NIAS) provides non-emergency transport for patients who, due to clinical need, cannot reasonably travel independently. The service operates under my Department’s transport strategy for health and social care services, which promotes safe, equitable, and patient-centred transport. Eligibility is determined by clinical need, including mobility, medical condition and any requirement for professional assistance. Once approved, transport is coordinated by NIAS in partnership with the health and social care trust. NIAS does not restrict transport by trust boundaries, with patients routinely being transported across regions to ensure continuity of care and timely access to treatment. <BR /> <BR />NIAS also operates a voluntary car scheme, which supports immobile patients who cannot use public transport.”
“I understand that the Member represents the west. I represent Strangford, as a constituency MLA, but I have to park that and perform the role of Minister of Health for the whole of Northern Ireland. It was made abundantly clear to me that the variation in waiting lists for breast cancer assessment was not acceptable, and I have done the right thing. It is a two-part move, as I have explained. I regret that people in your area may have to wait a bit longer, but hopefully that will only be in short term. That is a matter of regret, but I have to look at the big picture, which tells me that I am doing the right thing and to roll out the change.”
“I agree with the Member. We are driving down the variation, which demonstrates that we can then turn to areas such as mental health. I want to get away from postcode lotteries and move to having consistent and standardised services regionally, so that nobody feels disadvantaged by their postcode. Postcode lotteries are in no way consistent with the idea of the founding fathers of the National Health Service.”
“She noted the variation, with the Western Trust having the best — or shortest — waiting times. What do I say to that person? I say that I am very sorry and hope that she gets the best outcomes when she is seen. What do I say to two people who are neighbours but, because the dividing line for the trusts runs between their houses, have had weeks of variation in their ability to get an appointment? That is not right either. To achieve what I wanted to achieve, we had to do two things. The first was to level up, which we have. Unfortunately, to drive down the longest waiting lists, the shortest waiting lists have to nudge up in the short term, but the two then equalise. The second was to drive down waiting lists across Northern Ireland towards the 10-day target. We have not yet achieved that, but we are working on it.”