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 assure Members that I will continue to do all that I can to achieve safe and sustainable local service delivery for those services in as short a time frame as I can. <BR /> <BR />Just under 700 new patients per annum are diagnosed with leukaemia and lymphoma in Northern Ireland. In answer to Mrs Dodds's question, the number of CAR T-cell patients from Northern Ireland treated in the past couple of years is as follows: 28 in the financial year 2023-24; 11 in the financial year 2024-25; and, to date, 11 in this financial year up to August. Some within that referral figure may, unfortunately, not proceed to treatment. <BR /> <BR />As always, we must remind ourselves that those numbers represent real people: family members and loved ones living in our community.”
“Mr McGuigan asked a question: the answer that I have is that it would take the Republic longer to increase its CAR T-cell capacity than it would take us to develop and replace ward 10 north at Belfast City Hospital. <BR /> <BR />I can tell Members that we have had a North/South cancer and policy group since March 2023, about two and a half years. If, for example, the Shared Island Fund could be used to advance capacity, I would go there. I invite Mr McGuigan and his Committee to test the information that I have been given by officials, which is, to repeat, that we cannot do increase capacity until we have the new haematology ward at Belfast City Hospital — it looks as though we will not have it until 2030-31 — and that it will take the Republic longer to increase its capacity to take on board patients from Northern Ireland.”
“<BR /> <BR />The therapy can have severe side effects and can be provided only in specialist cancer units that meet a detailed National Health Service specification. Given the very specialised nature of treatment, that therefore limits the options for available specialist centres, with those specialist centres currently located in Great Britain and the Republic of Ireland. Following confirmation of eligibility for CAR T-cell therapy by an expert panel, patients here are referred to a specialist centre in Great Britain. The centres there are the only specialist centres that currently accept or have the capacity to treat patients from Northern Ireland. <BR /> <BR />We have spoken to colleagues in the Department of Health in Dublin, and the issue is capacity.”
“I hope that Members will recognise that asking people to travel to Great Britain is, for me, counter-strategic and counter-intuitive, but it is currently the only option. It is my ambition to improve patient access to all cancer services, including CAR T-cell therapy, which we are considering today. <BR /> <BR />Chimeric antigen receptor T-cell therapy is a type of cell-based gene therapy that alters the genes in a person's T-cells, which are a type of white blood cell. In turn, that helps attack cancer cells. It is highly complex and innovative and a specialist cancer treatment. It has been specifically developed for individual cancer patients, in particular those with quite advanced cancers where other available treatments have failed.”
“Thank you, Principal Deputy Speaker. I thank Mr McGrath for tabling the motion and all the Members who have contributed. Like them, I begin by offering my deepest sympathies to the family of Catherine Sherry. I know that it has been a very difficult time for her husband, her three young sons, the wider family and her friends and community. <BR /> <BR />Members will have heard me say many times that, in an ideal world, when somebody needs health and social care, they will get it at home and, if that is not possible, they will get it as close to home as possible.”
“I believe that I am in that position. I certainly have not been made aware that there was any leakage of personal data or, indeed, any other data. As I understand it, the system simply stopped working, which means that it was not transmitting any information. If that is the case, that is the assurance for the Member.”
“From a personal point of view, yes, there is concern. That concern will remain until I am satisfied that we know not just what happened but why. As the Member suggested, I imagine that updates to IT systems happen all the time. On my smartphone, apps seem to be updated hourly, or perhaps even more frequently. That is one of the issues on which my chief digital officer will report back to me. The core point is that, until we know why it happened, I will remain concerned, and I may be concerned once I know the reason.”
“The Member said that this was "catastrophic". I wonder what descriptor she would have used if somebody had actually died in an incident like this. There is not a lot left in the thesaurus above and beyond "catastrophic".”
“Once again, there may be learnings for all the trusts, because, as I said, a form of mutual aid was employed, not least with ambulances going to emergency departments in hospitals in other trusts.”
“The trust did the best that it could in communicating in live time with patients, service users and the population more generally. Of course, that was compounded by the fact that the IT systems were down, because the IT systems are the primary means of communication. That will, of course, be part of the review. <BR /> <BR />Two processes in the review will follow what happened on 17 and 18 September. In the first instance, it will be a core review of why it went wrong. That review will be shared across the trusts in case there are learnings for the other trusts. The other review will be of how well the trust was able to employ its business-continuity arrangements — in other words, to continue to try to serve patients and service users.”
“All of our health and social care trusts are on encompass, but it is like that old saying: when it works, it's great; when it doesn't work, you have a major problem — and I very much regret that.”
“I concur with the Member: you can invest and invest in all sorts of areas of health and social care. I make the point again that there is a gap of many hundreds of millions of pounds in the current budget for health and social care. However, on IT, particularly encompass, I emphasise yet again that what happened was not a cyberattack, nor was it some sort of systemic failure in Epic, which is the engine that drives encompass. We still do not know why it went wrong. However, encompass is a world leader. <BR /> <BR />The Member will be aware that, when Labour came to power, the Secretary of State for Health and Social Care in London, Wes Streeting, said that he wanted to achieve three shifts, one of which was moving from an analogue to a digital healthcare system. We are ahead of the game.”
“Yes, I agree with the Member. As I indicated, clinical decisions will be made about the 1,600 who had their elective procedures postponed. That will have a knock-on effect for others who are on the list, waiting for procedures, because it will be done according to clinical priority. <BR /> <BR />I also commend the trust for the speed and effectiveness with which it instigated its business-continuity arrangements; in other words, how it dealt with that very serious incident. All staff are to be commended on their efforts during the incident and for restoring access within 24 hours of the outage. That was a lot quicker than any early estimate, so, once again, I commend the staff for that.”
“I will not endorse the Member's description that it was a "catastrophic event". It was certainly a very serious event, particularly for the 1,600 people whose elective procedures were cancelled. However, the hospital continued to function to some degree and emergencies were dealt with, so I will stick with a "very serious event" rather than a "catastrophic event". <BR /> <BR />As to the allegations that there was some sort of glitch on the evening of Monday 8 September, that is news to me. Believe me: there will be officials in the Department who are listening to and watching this, and they will be on the case, trying to verify or otherwise what happened.”
“I thank all the staff involved and recognise the moral distress that that put them under. <BR /> <BR />As to whether that mutual aid will continue, with other trusts accepting some of the 1,600 patients for procedures, that is a clinical matter to be decided by the Southern Trust in liaison with the other four trusts. I am not aware of where that conversation has got to. I have spoken to my chief digital officer twice today about the time frame for figuring out why what went wrong went wrong. There will be other meetings today about how we prioritise those 1,600 people on the elective lists.”
“I should take the opportunity to say that it was stressful not just for patients and, to some extent, service users but for the staff who found that they could not perform as they had intended to. Some of those staff have built up personal and professional relationships with patients over a period. The fact that our waiting lists are far too long has probably compounded that, with professionals becoming much more accustomed to meeting and greeting and building those relationships with people. <BR /> <BR />I should also say that mutual aid was first-class in the early assessment. We are talking about, for example, emergency departments in other trusts receiving ambulances that otherwise would have gone to Daisy Hill or Craigavon Area Hospital. I was pleased with that.”
“Its exact existence is to be a backup when things start to go wrong. <BR /> <BR />As to the 1,600 people, what the trust will have to do now is look at the clinical priorities when rescheduling. It is inevitable and logical to assume that some people who have a date for a procedure will be asked to endure a postponement, because their condition is not as urgent as, perhaps, some of the 1,600 people whose appointments were postponed last week on 17 and 18 September. That bit of work will be ongoing over a number of days, if not a short number of weeks, because it is complex.”
“The incident lasted over two days because there had to be a great level of concern that rebooting the system, if I may use that phrase, too quickly could have led to a further collapse in the system. That is why it was brought on gradually with those priority areas, which, as I said, were the labs, emergency departments, ICUs and night-time medicines. There had to be caution about coming back on. As we stand, a few days on, we know what happened. A planned upgrade of software went wrong, but we do not know why it went wrong, so we need to know why. I am particularly interested to know why the two data centres malfunctioned. I am looking at it from the point of view of there being a primary system and a backup system. Clearly, if there is a backup system, that should not fall along with the primary one.”
“The major incident was formally stood down on the morning of 18 September. However, recovery efforts will continue for some time. <BR /> <BR />Of course, I empathise with and sincerely apologise to all who were affected.”
“<BR /> <BR />Both of the data centres impacted were restored by 5.00 pm on 17 September, providing access, in the first instance, to priority systems — that is the labs, emergency departments, intensive care units (ICUs) and night medicines — and Daisy Hill Hospital and Craigavon Area Hospital then recommenced the receipt of ambulance arrivals at 9.00 pm and 10.30 pm respectively. The trust has commenced the rebooking of appointments in line with clinical prioritisation. My Department will support prompt rebooking via waiting list funding if required. Initial or verified data indicates that approximately 1,600 patients were impacted by postponements. It should be noted that there were no postponements beyond 17 and 18 September and that adult community clinics were not impacted during the major incident time frame.”
“In accordance with my written ministerial statement of 19 September, I reiterate that the Southern Health and Social Care Trust experienced an operational IT outage on the morning of 17 September. The issue was isolated to the Southern Trust, but, of course, it impacted across its sites. There is no suggestion that it was a cyber-related matter. The outage led to a loss of the computer network via two data centres, preventing access to key systems across the trust. The resultant impact necessitated the postponement of elective activity on 17 September and 18 September and the diversion of ambulances to other trust emergency departments (EDs) throughout 17 September. Community services were impacted to a lesser extent.”
“I absolutely acknowledge the challenge that it creates for people who do not have ready access to their own transport or to transport laid on by relatives or friends. We have to live in the real world, however. The minor injury unit at the Ards Community Hospital was closed and the service moved to the Ulster Hospital, 4·6 miles away on a dual carriageway. I do not think that that was a particular issue for the majority of people. That delivered better outcomes, because the MIU was then situated beside the ED, X-ray machines, CT scanners etc. I accept, however, that, for a minority of potential patients, a distance of 4·6 miles is an issue. I continue to look at it with Executive colleagues.”
“Those public transport arrangements are a matter for the Department for Infrastructure. As I have said, Minister Kimmins, Minister Muir and I discussed community transport and how we might better realign it to get the sort of outcomes that we are looking for. At this stage, with the resource and financial constraints that are upon me, I cannot commit to doing it, because if I were to do that for the Member's constituents, I would have to do it right across Northern Ireland. There certainly is not the budget or the resource available to do that.”
“We are aware that there is vaccine hesitancy. I am not sure that the research suggests that it is quite as embedded in the societal psyche as some people think. We are not currently spending money on paid-for advertising such as TV promotions, but we will work with the primary care sector to encourage people to take up the boosters. Certainly, I get a message every year from my GP surgery, encouraging me to come along and book a session for the two jabs, which I get on the same day.”
“I am aware that we are going to have a booster programme this winter. It will be linked in with the influenza vaccination offer as normal. I am not across the detail, so I will have to write to the Member.”
“I say gently to the Member that it is not me who takes steps; the Western Health and Social Care Trust has to take steps. The trust is very aware, as are the other trusts, of my opinion on how we need to leave no stone unturned in trying to address waiting lists in those EDs. That is well understood. In the short term, the scope is limited by geography and budget, but that is not to say that we do not do everything that we can. To my mind, it is not just about the patients. While that is critical, it is also about the nurses and doctors and the moral injury that they feel because they are not permitted to make the best decisions that they know they can make.”
“It is partly to do with the environment in which people are working. Two of the seven emergency departments that I visited — the Ulster Hospital in Dundonald and the Royal Victoria Hospital in Belfast — were very modern. When I go to a really busy ED where the waits are measured in days rather than hours, I notice that nurses, doctors, clinicians and healthcare professionals know the right thing to do for a patient, but they end up having to decide on the least worst option so that they can move on to look after the next person. It is partly the environment and partly the demand. It is a cocktail of reasons. Again, that is to explain it without justifying it. I want to see it fixed.”
“Yes, I can commit to saying that we will not cut the budget. I do not wish to cut that budget, but one of the frustrations is that, every week — maybe not every day but certainly multiple times a week — people come to me and make the argument, "If you invest a bit of money in this, you will get a great saving", like the one that the Member has detailed regarding the independent living fund. However, the money to pump-prime it does not exist. As an Executive, we have to sit down and think about this a bit more, because if we do not take those steps to save the money — there are big savings and better outcomes to be derived for patients and service users — we will continue to be in a financially challenging position and will not take the logical steps to get ourselves out of the mess.”
“In an ideal world, absolutely. In the current world, with a £614 million gap in funding, it is simply not possible. I have had to stop going to my permanent secretary and saying, "What do you think about reopening this or putting a bit more into that?", because the answer is, "I am the permanent secretary and the accounting officer. If you tell me to do that, I will have to write back to you and say that we cannot make any argument under 'Managing Public Money Northern Ireland', which is the keynote strategy, to justify that". I have to live with the cloth that I have been cut, I am afraid.”
“We need to look particularly at promotion from band 5 to bands 6 and 7, because you can qualify as a band 5 nurse, have a long and very successful career and retire as a band 5 nurse. We have to look at ways of promoting nurses from band 5 through to bands 6 and 7. There is a whole basket of issues beyond money. It is about job satisfaction.”
“As I said, we are at the point where we can say that we do not use agency nurses. We are now addressing locums, because using them is a very expensive way to do business. That is not to say that locums do not have their place — of course they do — but we have become over-reliant on locums and are not using them for the original purpose for which they were intended. <BR /> <BR />When it comes to what I am trying to do to make the nursing role more attractive, the first thing was to give them the 3·6% pay rise that was recommended by the independent body that made the recommendation for Agenda for Change staff, which includes nurses. However, I acknowledge that nurses would, perhaps, like to negotiate separately from the other Agenda for Change categories.”
“I am sorry, the Member might be confusing me for a walking encyclopedia. Those are statistics that I do not have to hand. There are many statistics on health and social care. Those are important ones, and all I can say to the Member is that I will find that out and write to him.”
“As I said, we are trying to drive down the waiting times and handover times for all ambulances going to acute hospitals. For some time, there has been a cross-departmental working group that involves the Department for Infrastructure, the Department of Agriculture, Environment and Rural Affairs and my Department. We escalated it to a ministerial meeting just a few weeks ago because I certainly — I think that my colleagues agreed with me — felt that we were, perhaps, not getting the sort of outputs that we were looking for. We therefore asked them to refocus on their work, and we expect them to do just that and get back to us in short order with some actual proposals for how we can use community transport and other initiatives to improve delivery.”
“I understand that the Member is geographically wedded to the South Eastern Trust. My focus, of course, has to more broad and on the whole of Northern Ireland. Yes, we are absolutely looking at ambulance waiting times. One of the other things that we are doing though — I am doing it with the Minister of Agriculture, Environment and Rural Affairs and the Minister for Infrastructure, across the three Departments — is looking at alternative ways of getting non-emergency patients to and from hospital, such as by community transport.”
“Its chief executive, Nicola Ranger, had flown in from London, and she made it very clear that nurses had had enough. She also made it clear that they felt that they were too soft the last time that they went on strike, and that their message did not land properly. The Royal College is balloting its members on strike action — not industrial action but strike action specifically — and have said that, if nurses go out on strike again, there will be no derogations and no mitigations this time. I am afraid that, unless something changes, we have to anticipate nurses on the streets by mid-November. For the waiting-list initiative in the Programme for Government and the delivery of health and social care, that is just massive.”
“I will diverge from the Member's assessment and analysis of where we are. I understand that, as a spokesman for the Opposition, he comes at it from that angle. I do not see a fix for this outside the Executive working collaboratively, so I am not in the business of pointing a finger at any other Minister. I have made the point repeatedly that I understand that every Minister and every Department is suffering huge financial pressures. I believe that the pressures on Health are absolutely unprecedented: we are talking about a funding gap of around £614 million, and there is a question about whether is it unmanageable. Of that amount, £200 million is for nurses' pay. <BR /> <BR />After the last Executive meeting, I happened to have a meeting with the Royal College of Nursing.”
“It is also important to recognise that not every job offer made to recent graduates will be accepted by them. Individuals may choose to refuse the offer of a post based on a number of factors, including location, working pattern and the clinical environment.”
“Health and social care trusts are responsible for staffing. The regional recruitment of newly qualified nurses is therefore led by the trusts, in partnership with the Business Services Organisation (BSO). It takes place twice per annum. The most recent regional recruitment exercise for newly qualified nurses received more than 700 applications for band 5 posts across the five geographical trusts. Those applications are ongoing. The availability of posts during any one exercise is based on current vacancies and anticipated staff turnover. That can change almost daily.”
“That has been very obvious, even over the summer. Here we are in mid-September. I have no doubt that, if we took ourselves to Derry/Londonderry and visited the ED at Altnagelvin, we would see a very unbecoming sight.”
“On that point, when I visited the Royal Victoria Hospital, more than one person in the urgent care unit — it is on the first floor, from memory — had a flask and packed lunch with them. I asked if they had been sent by their GP, and they said, "No, we didn't bother trying to phone our GP. We came straight here". They knew that they would be there for a number of hours, so they brought their food, drink and podcast and were happy to wait for a while. <BR /> <BR />These issues have been growing for a very, very long time. I absolutely agree with the Member that it is not about just winter pressures. In fact, going through last winter, I said to colleagues in the Department, "Please stop talking about winter pressures. We should be talking about additional winter pressures, because, sadly, the pressures on our emergency departments are 365".”
“I visited those seven EDs in January and talked to people who were in the same chair, waiting for treatment, for four days. Please do not think that making steps towards making things better is anything but a real area of focus for me.”
“As stated, I hope to be publishing that winter preparedness plan in the next two to three weeks. Certainly, the four sessions are over. I was very pleased with how the Chief Medical Officer and Chief Nursing Officer went about their business. I was extremely pleased with the appetite among stakeholders to attend those briefings; in fact, there were waiting lists for some of those sessions. I will not list the seven areas, but top was identifying elderly people with frailty issues. Clearly, if we can keep them out of an emergency department, we should be doing that. The Member is a nurse: he will know the pressures and how difficult it is. There are also vulnerable people for whom the noise and lighting in the EDs are not suitable.”
“However, until you get a new ED, which is several years away, nothing is going to be perfect. We are only going to be doing continuous improvement.”
“I cannot say to anybody that things will be perfect, but I believe that the four sessions that we had — we called them the "big conversation" — which will lead to the plan for winter preparedness for 2025-26, will help. The urgent care offer at Altnagelvin has helped, and the respiratory offer has helped — we are increasing the availability and accessibility to the respiratory offer. Those things mean that you have pathways by which you can avoid having to go to ED. <BR /> <BR />I visited EDs last January. Of the seven that I visited, it is the visit to Altnagelvin that sticks. It is the oldest of the type 1 EDs in Northern Ireland, and you can tell that it is, but things are being done. The trust is doing things, even with seating accommodation, to try to ease the pressures.”
“That includes improving the use of advance clinical care planning and enhancing pathways for patients, ensuring that the right care is delivered in the right place the first time. <BR /> <BR />I hope to publish my winter preparedness plan in the next couple of weeks and, as in previous years, will again call on the public to do everything that is possible to help protect our system, including utilising community services where available and getting vaccinated if eligible.”
“Earlier this year, under the leadership of the Chief Medical Officer and the Chief Nursing Officer, we brought together senior leaders from across the health and social care system to learn from last winter and plan for winter 2025-26. I was clear that I wanted a blank sheet and a whole-system approach to look at what could be achieved in advance of the winter and in the longer term. <BR /> <BR />That process identified the need for a particular focus on interventions to improve the care of older people who are living with frailty, who have been identified as some of the most vulnerable to the risks that are associated with the winter period. Seven improvement projects have been established. They focus on reducing hospital demand by supporting older people to stay well and receive appropriate care in the community.”
“<BR /> <BR />We in the Department remain committed to supporting equitable access to mental health services, and we continue to assess and respond to workforce pressures in collaboration with the trusts and our other stakeholders.”
“Following a formal application from the Western Trust, in August 2024, the Department approved a 10% recruitment and retention premium as an incentive in consultant psychiatry posts. Despite ongoing recruitment campaigns, no appointments, I regret to say, have been made to date. <BR /> <BR />In response, the trust submitted a further application seeking an enhanced rate of up to 20% for a mental health liaison team, crisis mental health services, including for inpatients, psychiatry of learning disability and community recovery teams. The Department approved that application on 22 August last. That agreed rate is up to 20% of a consultant's starting salary as a recruitment incentive, and, as I say the trust requested it.”
“Obviously, if you need psychiatric help and it is not there for you, that can have a potentially devastating impact on your health. The number of psychiatrists in each trust will be determined by the population in the trust area and assessment of need, but the Member may find it very interesting to hear the number of vacancies across the five trusts. As of 30 June, there were 33 consultant psychiatrist vacancies across Northern Ireland. The Southern Health and Social Care Trust had the highest level of psychiatrist vacancies with 14, but the Western Trust was right behind with 13. The Northern Health and Social Care Trust had four vacancies, Belfast Health and Social Care Trust had two, and the South Eastern Health and Social Care Trust had none. There is another massive postcode lottery.”
“Absolutely. I will not quote figures to the Member, but we started with nursing and have reduced our reliance on agency nurses. Actually, we have cut it out. The focus now is on locums, who are very expensive, as the Member will be aware. We have asked one of the chief executives of the five geographic health and social care trusts to lead an investigation into ways in which to deliver a plan for doing the same with locums as we did with agency nurses.”