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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“<BR /> <BR />Since March of this year, Woodlawn House has operated at a reduced capacity due to a staffing shortage. That is at the core of the issues there. At the time when the matter was escalated to the Department, the Southern Trust was reporting a staffing deficit — this is quite shocking — of 60% to 70%. There were multifaceted reasons, including staff being lost to sickness absence, maternity and career progression, but it was a really significant staffing gap, and, of course, it resulted in a reduction of service that was necessary to maintain the safety of the staff and of the people whom we were supporting. It was a regrettable decision, but we had to be mindful that Woodlawn supports people with very complex needs, and they require a fully staffed, multidisciplinary team.”
“That is the learning disability service model that I have just mentioned, which is out to consultation. <BR /> <BR />Woodlawn House is a nursing-led statutory facility that gives short breaks for adults with a learning disability. The purpose-built home has eight beds and includes a separate unit that can offer support to those with the most complex needs. It opened in 2008, and, since then, it has played a really important role in supporting adults with learning disabilities who have complex medical needs. That is why it is nursing-led. Of course, there can be a lack of alternatives when provision is impacted on. I am aware of Woodlawn's temporary closure in December 2023, which was to accommodate an emergency placement, as I said earlier. I will come back to that.”
“I very much appreciate the clarification, and I apologise for misinterpreting. I thought that you meant that we would have additional capacity. <BR /> <BR />Let me give an overview of the challenges that are faced by Woodlawn House in particular, of the action taken by the Southern Trust and my officials, and of the wider strategic work that is under way to address the clear gap between capacity and demand for short breaks for people with a learning disability. I will be clear to families, because they may well be listening, and to the people whom we support that we need to increase provision in Woodlawn House and, indeed, in overall residential short break capacity across Northern Ireland. A model and a plan have been developed to achieve that regional change.”
“I will give way in a moment. <BR /> <BR />If, given the shortfall in the Health budget, I were to go back to the Department and suggest that we start having capacity sitting around and waiting, I think that I would be taken in for a random drugs test. <BR /> <BR />I will give way.”
“Some of the circumstances of Woodlawn House are unique, but a lot of this is universal, based on the fact that it is a very fragile service in that it takes only very little of an unexpected nature to happen to throw it into chaos. Mr Gildernew said that it would be great if we had spare capacity, not least in the workforce. In an ideal world, of course, it would be great if we had beds, facilities and workforce to be tapped into when one of those things occurs. If, however, I were to go back to the Department —.”
“If somebody with severe learning difficulties comes from out of the blue and needs residential care rather than short break care, the entire home, potentially, will then be closed to those needing short breaks. <BR /> <BR />I agree with Mr Gildernew in that I am concerned about families and burnout. He knows, as I do, that, for those parents in particular, the biggest concern is, "What happens when I'm gone? Will my son or my daughter be OK?". That is what keeps them up at night. Of course it does, because those are their loved ones. <BR /> <BR />Mrs Dodds will have to write to me about the £13 million that she mentioned, because I will not be able to give her chapter and verse on that. She is not, however, shy about writing to the Minister of Health.”
“I take it that that is for the consultation that we are doing on the learning disability service model. That is important. I encourage everybody who has an interest in that to attend one of those public meetings, because that may set the template for how we do business for a good number of years to come. <BR /> <BR />I speak to service users a lot. I speak to mums and the workforce that works in that area and to officials in the Department. When I speak to people about the state of the service, there is a common theme. It can be summed up in one word: fragility. It is really fragile. When people go off on sick leave or maternity leave, meaning that the workforce is unavailable, it is fragile, and it breaks down.”
“Thank you, Mr Deputy Speaker. I will cut straight to the chase. Mr Gildernew asked whether I will visit Woodlawn. Yes, of course I will. I will visit it and speak to the residents, the workforce, the carers and the parents. I get out and about every week. That is important to me. I can sit behind that desk in Castle Buildings doing paperwork and having internal meetings, but it is not real until I get out into health and social care delivery settings. I will be more than happy to do that. My diary is pretty chock-a-block, so it might take a bit of time, but it is important for me to do that. <BR /> <BR />Mr Gildernew mentioned a meeting. Is that next week?”
“I warn again that we need £200 million of that £600 million in order to action pay parity, which was, first, a commitment in New Decade, New Approach but was subsequently endorsed by the Northern Ireland Executive. If we cannot do that, we are going into the potentially uncharted waters of industrial and strike action. <BR /> <BR />I apologise to Members that I am not doing as much as I would like to do in mental health, but it is not for lack of trying. It is because of a lack of resource and funding. There is no quick or easy fix. I had a meeting today to look at next year's financial position, which is bleak. There is no other way to put it. We are in for rough waters over the rest of the mandate.”
“<BR /> <BR />I campaigned for a mental health champion many years ago. Previously, I tabled a debate in the Chamber and was unsuccessful, but, when Robin Swann took over the Ministry, we were able to appoint Professor Siobhan O'Neill. The appointment of an independent mental health champion was no small thing. She is now able to stand up, as she did last week, and criticise the lack of the delivery of the mental health strategy. That happened only because I and then Robin Swann pressed for the appointment of a mental health champion, who turned out to be Professor Siobhan O'Neill. <BR /> <BR />Lastly, I have to return to the Department's overall financial position. We are facing the most significant shortfall that the Department has ever faced: around £600 million. That is unprecedented and, frankly, unmanageable.”
“I take the Member's point, but you have to separate what is happening in the community from what is happening in the hospitals. My overall aim, together with the permanent secretary, is to move health and social care as close as possible to people's front doors, if not delivering it at home. This is about trying to get services as close as possible to people's front doors and to keep them out of hospital. That is not something that we are going to be able to do in a day, a week or a year. <BR /> <BR />A cross-departmental coordination action group was established by the mental health champion some time ago, in October 2023, in order to consider crisis services and suicide prevention in Derry/Londonderry and to develop actions to address suicide prevention, along with other relevant issues at the river and the bridges in the city.”
“Service improvements will be progressed in order to ensure timely mental health assessment of those who are presenting in need to emergency departments and to ensure that we have a regionally equitable crisis response and home treatment service that provides acute mental health care in the community as an alternative to psychiatric hospital admission.”
“A regional mental health liaison and crisis response home treatment care network has also been set up. It has a focus on pathways, operating procedures, thresholds, documentation, information, training and equity.”
“That funding is to promote awareness raising and prevention and to support local work on delivering the Protect Life 2 strategy actions right across Northern Ireland. <BR /> <BR />In addition, EY has reviewed the scale and scope of the community and voluntary sector across Northern Ireland in order to enable a greater analysis to be done of its provision and of how it can work in partnership to achieve positive outcomes.”
“The Member either misinterprets me or misheard me. I said that we did not withdraw funding from Northlands or the CCIS, and that is the case. <BR /> <BR />I will move on to what is available. The Western Trust's home treatment team offers crisis support alongside GP out-of-hours provision and people can access emergency departments. There is still a range of partners in the community and voluntary sector, and, of course, Lifeline provides round-the-clock community assistance. Over the summer, we saw the publication of the new Protect Life 2 action and implementation plans, which will substantially enhance our efforts to reduce suicide and self-harm. Budgets remain a significant challenge. I have reallocated around £300,000 of funding to year 1 of the action plan.”
“Rather, their applications were simply unsuccessful.”
“I will address that, because two Members said that the Department withdrew funding, as if it were a deliberate act. It is inaccurate and unfair to suggest that it was a deliberate act. I looked at the core grant scheme when I was appointed Minister, and it was frozen. I wanted to bring the scheme back into operation, but I also wanted to review it, because its application process had not changed in over 20 years, meaning that no charity set up in the past 20 years could apply to the old scheme. We worked with the Northern Ireland Council for Voluntary Action (NICVA), which facilitated workshops at which the community and voluntary sector told us how the core grant scheme should be redesigned. It is an unfortunate fact that, when it applied, Northlands was unsuccessful. We did not withdraw funds from Northlands or the CCIS.”
“From autumn 2021 until March of this year, Extern received £504,989 from the mental health support fund via the Community Foundation. That money came out of a one-off, three-year scheme to support mental health organisations that was funded using unspent COVID-19 funds. Given the well-documented position of my Department's budget, with all the resources having been allocated, the scheme has now ended. My Department identified a further £42,300 of non-recurrent funding to allow for an extension until June of this year, but, unfortunately, given our ongoing extreme budget challenges, no further funds could be found. <BR /> <BR />Via Extern, the CCIS applied to the core grant scheme for the 2025-26 funding round but was not successful.”
“Underlying that are high levels of the social determinants of mental ill health, such as poverty, poor housing, domestic violence and economic inactivity. In 2008, 39% of the population in Northern Ireland reported experiencing a traumatic event related to our 30 years of conflict. Members will know that I am determined to do something about mental health, as I have campaigned on the issue since I was elected to the House in 2011, so everything points to the fact that we are facing a financial crisis in the Department of Health. <BR /> <BR />Funding for the CCIS, as one Member pointed out, was initially provided by Derry City and Strabane District Council as a pilot from 2018 to 2021. The Health and Social Care Board provided £27,000 of support in 2020. Subsequently, my Department provided some funding to allow the project to continue.”
“Thank you, Madam Principal Deputy Speaker, and thanks to everybody who spoke in the debate. Let me be very clear that I very much regret what has happened to the community crisis intervention service. As has been pointed out, it has helped over 3,400 people through one-to-one interventions since 2021. <BR /> <BR />Before turning to the detail of the situation, it might be helpful to speak to the wider context of mental health, given that so many Members have turned to it. Northern Ireland has the highest prevalence of mental health problems in the United Kingdom, with a 25% higher overall prevalence of mental health problems compared with England. The proportion of the Budget in Northern Ireland devoted to mental health is around 6%, which is half that in England.”
“I thank the Member for giving way. Just to be technical about it, deaths by suicide is a matter for NISRA — the Statistics and Research Agency — rather than the Department.”
“I thank the Member for giving way. For clarity, I think that I said that the interim advice came from the SPPG, but I misspoke. The interim advice came from the Public Health Agency. Its lead on those issues is a clinician.”
“I have no confidence, however, that the answer will change from being one of it is not possible. My focus is on making the mother-and-baby unit happen, because I have a vested interest. For 30 years, mothers have been going through the experience that I witnessed in January 1995, and that, by definition, is simply not good enough.”
“The Chair of the Health Committee made the point that if the issue were to affect only men, we would not be talking about a 20- or 30-year wait but, rather, would be celebrating the fact that the unit is in operation and would instead be examining and scrutinising how well it is delivering. <BR /> <BR />I will finish where I began. The mother-and-baby unit is not overdue or long overdue but long, long overdue. If it is the will of the House, I see no reason that we cannot get on with it, but doing that will take time. If we can find a way of doing it somewhere else more quickly, we will do that. If there is a way of putting in place an interim arrangement, I am open to that idea. I will not go against clinical advice, but I will ask the clinicians and others to have one final look at providing an interim solution.”
“Alongside that, we have been upskilling clinical staff, including midwives, mental health nurses and health visitors, so that they are better equipped to identify and respond to perinatal mental health issues. For my family, one of the saviours — I use the word "saviours" deliberately — was the community psychiatrist nurse, who was incredibly important in the journey that my wife had to go on. <BR /> <BR />I ask the Members who tabled the motion to exert their influence over their party colleague the Minister of Finance, because we need the money — not just the capital, as I said — to make the mother-and-baby unit a reality. It is not just a clinical necessity but a statement of our values and of the extent to which we value one another.”
“I confirm to Members that I explored with the previous Health Minister in the Government of Ireland the possibility of working together and, perhaps, tapping into the Shared Island Fund to secure a mother-and-baby unit. Unfortunately, those discussions did not produce a positive outcome. We are, therefore, basically on our own in that way. <BR /> <BR />I thank Members who have acknowledged that the Department has been working to strengthen community-based perinatal mental health services across all five of our geographic trusts. We have invested in community-based specialist services, ensuring that mothers can access support close to home.”
“<BR /> <BR />Transferring a mother and baby to a specialist mother-and-baby unit elsewhere in the UK under an extra-contractual referral has been considered for some cases. However, many mothers have talked about the emotional stress of being separated from their families, friends and local support networks. Often, those considerations outweigh the potential benefits of receiving care further afield. <BR /> <BR />Members talked about building a mother-and-baby unit that would accept mothers and babies from across the island. I have asked officials to check whether there is any legal impediment to a child being transferred into our jurisdiction. I am not entirely confident that there is a solid answer to that, but it is certainly something to be explored.”
“What I have asked the officials to do is broader than that. I have asked them to look at whether there is any possibility of an alternative venue that could be an interim base for a mother-and-baby unit, and the answer that I have got back is, "No, there isn't". If Members wish, I will ask them to look yet again, because it is an incredibly important issue to me. <BR /> <BR />Several Members mentioned the fact that we are not trapping the data. A group has been set up to try to look at how we start to do that. There had been some coding issues. I do not want to get too technical, and I certainly do not want to hide behind technicalities, but it seems that Encompass should be able to help us in achieving that goal.”
“I can check whether the clinical evidence has been provided to the Committee. Maybe the Chair of the Committee knows. If it has not been, we are more than happy to provide it, as well as the criteria, as defined by the royal college. <BR /> <BR />As I say, we are going to look in order to be sure and potentially rule out any other long-term venues.”
“For clarification, does the Member mean the best practice from the royal college?”
“If Members want me to overrule clinical advice, I am very nervous — very, very nervous.”
“On an interim fix, I will first put on record the best practice requirements, as defined by the Royal College of Psychiatrists. A mother-and-baby unit should be co-located with a mental health acute inpatient unit; located close to an obstetric-led maternity unit; capable of facilitating a six-bed unit, which is the current plan; capable of facilitating all clinical services on the ground floor; have dedicated direct access to secured and exclusive outdoor space, desirably gardens; and offer easy access to wider public open spaces and amenities. As I have said, the Department received clinical advice, including from the SPPG, that there is no such facility that we can use as an interim location. If Members want to challenge that and say that they know of a location, I am all ears.”
“I thank the Member for the intervention. Yes, we are considering them. We are considering all options.”
“The position will be confirmed as part of the development of the capital investment plan, with a number of other important projects also to be taken into account. Those include the Antrim Area Hospital mental health inpatient unit, the Cityside Health and Care Centre in the north-west and Altnagelvin's new emergency department. However, before I finally commit to the proposed Belfast City Hospital site, I have asked officials to undertake a short, urgent review of possible alternative options. I want to be absolutely certain that we have considered all possible options, and I stress that that will not cause a further delay. It will be done as work continues on the business case.”
“However, let me emphasise again that, in my assessment, a mother-and-baby unit is right at the top of that list. <BR /> <BR />The trusts and my other arm's-length bodies have identified capital funding requirements of around £3 billion over the next four years. That is more than £1 billion higher than the capital funding that we expect to receive. That suggests that the capital budget outcome may only be enough to address inescapable pressures. I simply want to manage expectations here. While I hope that the Budget outcome agreed by the Executive will also allow some partially committed projects, including the mother-and-baby unit, to be taken forward as planned, the possibility remains that there will need to be some form of delay.”
“However, following the announcement, in June, of the outcome of the UK-wide 2025 spending review, the Department of Finance has commissioned a Budget exercise that will determine the capital budgets for Northern Ireland's Departments for 2026-27 to 2029-30, so my ability to commit funding for any new capital projects will depend on my Department's capital allocation from that Budget process and the identification of sufficient additional recurrent funding to meet any additional resource departmental expenditure limit (DEL) costs associated with a capital project. We do not expect the draft Budget outcome to be confirmed until later this year, but it will inform the development of the Department of Health capital investment plan, and that will set out the projects to be taken forward over the next 10 years.”
“As part of developing the business case, that has to come under review because we know that building costs continue to rise in the current environment. My officials recently secured Department of Finance approval to increase the delegated limit for capital projects. That involves hospital development, so the good news is that that means that time will not be spent on securing Department of Finance approval for the mother-and-baby unit project.”
“I want that to be done at pace, but I also want it to be done accurately. Members will be aware that the Department of Health and Health and Social Care have not exactly had a glowing record with capital projects in recent years. However, when the new, interim permanent secretary took up his post and came to see me, he asked, "What do you expect of me?". I said, "I will tell you in one word, Mr Farrar: urgency. I want to see urgency". My officials know that I do not believe that I have seen urgency — or sufficient urgency — in developing the business case for the mother-and-baby unit. One of the big delays was a debate over whether it should be a six-bed unit or a seven-bed unit. The conclusion is six beds. <BR /> <BR />The projected capital cost began at £11 million.”
“To minimise further delays, my officials are already working in parallel to review and assess the business case.”
“To establish a mother-and-baby unit, we will require significant capital and revenue investment, because it is not just about infrastructure; it is about staffing, training and ongoing service delivery. Let me be clear that I am fully committed to establishing a regional mother-and-baby unit. <BR /> <BR />We began with an outline business case, which was submitted to the Department by the Belfast Trust on 22 September this year. That led to economic and financial analyses. Normally, those are done first by the Belfast Trust and then by officials in my Department.”
“However, one in five is a huge number that we need to address. Please be in no doubt that I consider the absence of a dedicated mother-and-baby unit in Northern Ireland to be an absolutely glaring gap. As many Members have said, we are the only part of the UK without such a facility; indeed, there is none in the Republic of Ireland, and I will come back to that. <BR /> <BR />We have to go straight to the finances. Members are well briefed on the context in which I operate. The health service is under immense pressure, with unprecedented demand across all areas and resources stretched thin. The funding gap of £600 million is unprecedented, and, at the moment, I am finding it unmanageable.”
“Deputy Speaker, thank you very much. A mother-and-baby unit is not overdue or long overdue: it is long, long overdue. Mr Robinson took us back 20 years: I will see his 20 years, and I will up it by 10. On 27 January 1995, my first son was born in the Royal Victoria Hospital. The first clinician to come in and examine his mother wanted to separate the two. They wanted to keep the baby, PJ, in the Royal and send Lynda to Knockbracken. I will never, ever forget the look of horror on her face. I found the strength from somewhere to call for a second opinion, and the two were not separated that night. <BR /> <BR />Sian Mulholland talked about the joy and the life-affirming experiences that women have when giving birth, and we should remember that. It is pretty joyous for dads as well, by the way.”
“In that case, Principal Deputy Speaker, I suppose that the answer has to be yes.”
“On the last point, I assure the Member that an early alert system is in place, and not just for the Belfast Trust. I have put it into the intervention framework at level 5, which is the highest level. I have sent in two experts — one clinical and one an expert in organisational culture. I have just received their interim report, and I hope to have a verbal briefing on that tomorrow. Jennifer Welsh took up post as chief executive on 1 October, and we are in the process of beginning to advertise for a new chair of the Belfast Trust. I think that that combination of measures and interventions by me and the Department will yield fruit, and part of that fruit will be an increase in public confidence in what is delivered by the Belfast Trust.”
“It is an electronic patient record system. It is doing away with paperwork. That frees up efficiencies. It is not designed for what you have just said that you want to see.”
“As people get more and more used to it and the functionality within it, it will switch from being simply an electronic patient record for an individual patient to a magnificent tool for delivering public health initiatives at scale.”
“The Member will be aware of Encompass, which is a new electronic patient record. It is now rolled out across all five geographic trusts, from Northern to Southern, Western to South Eastern and Belfast. The potential for public health initiatives from trapping that data is immense. As for a working practice for an individual, you might not notice much at the moment, but some of the doctors, clinicians and consultants who I meet weekly have said that they had been working in healthcare delivery in the health and social care system for two or three decades and that this was the best thing that had ever happened. Yes, it is extremely expensive, but it is not only the future, it the present.”
“I am not aware of the 700 to 800 figure, but access is not what it should be. As a matter of principle, online has an important part to play going forward. I was in Sheffield and London looking at examples of the neighbourhood model, and there is no doubt that online triage is a thing. It seems to work well in the GP practices and primary care networks that we looked at, and I see that being part of the future. As a matter of principle, it would be fantastic if people were able to go online and book an appointment for the next day, or the next week if it was a non-urgent case.”
“The Member will be aware that the BMA General Practitioners Committee is in dispute with my Department over contract arrangements for the current financial year. On that basis, I would wish to try to encourage that committee to come back and start talking about next year's contract and about my desire to introduce a neighbourhood model that will facilitate the shift left that I talk about, which will put care as close to people's front doors as possible. I do not want to say anything prescriptive today that might discourage the GPs from re-engaging.”
“<BR /> <BR />To answer the Member directly, I say that my Department's medicines regulatory group works with partners across government and policing in order to combat the unlawful trade in medicines. The medicines regulatory group monitors online channels for evidence of illegal activity. It takes proportionate enforcement action, and I will ask that the content of GenderGP is reviewed with immediate effect.”