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.”
The complete record
Every one of 5,312 lines we hold for Mike Nesbitt, in date order, each linked to its source. Free to read, in full, without an account. Page 3 of 107.
“I want to know all those things, and then I will come to conclusions.”
“That very issue is a focus for me, and it begins later today when I will meet the chair and the chief executive of the Belfast Trust. I am not interested in letting anybody off the hook. I am absolutely convinced about the guilt here and about the evil that was perpetrated. It was not simply about nurses wandering around the hospital site but about oversight. I have said it before that the board was not curious enough. It was satisfied when it was told that a process was in place. It should, however, have gone on to say, "Yes, but what is it achieving?". <BR /> <BR />How many instances were there of peer-on-peer abuse? How many instances were there of abuse by patients against staff and vice versa? All those things need to be analysed. Why were they not analysed? What was the motivation behind management's not analysing them?”
“The Member mentioned how impactful the report is to read for families, never mind us. Again, one question that I want to ask the families is this: in reading the report, were they shocked, or were they just affirmed by seeing what they knew all along in black and white in a report by an official body, such as a public inquiry? Does that justify and affirm what they have been saying all along, particularly given the fact that they started from a position where the authorities said, "We do not believe you"? Scandalous.”
“On the second point, I understand that all but one of the patients have now been allocated a new set of living circumstances. I am also assured that one reason for it having taken longer than it was first anticipated to close Muckamore Abbey Hospital is that such considerable care has been taken in trying to meet the patients' individual needs. I certainly want to test that when I engage with the families.”
“My focus is not really on the volume but on the tone and attitude and the fact that Mr Kark said that it was adversarial. A public inquiry is not an adversarial platform. I need to better understand why he came to that conclusion and why the trust felt that need. In my view of life, if you get it wrong, put your hand up and fix it; do not try to justify it. We all know that the cover-up is always worse than what happened in the first place.”
“On the latter point, we are talking about the support and intervention framework, which is commonly known as "special measures". I put the Belfast Trust into level 5, which is the highest level. I have brought the trust out of that, because I felt that we were getting somewhere with the leadership. As I have said on a couple of occasions, I am meeting the leadership — the chief executive and the chair — today. I do not rule anything out around further interventions, because it is incredibly serious. <BR /> <BR />I was quite surprised to read in the report that, after the warning letters went out, there was a response from the trust that ran to well over 400 pages. On reflection, it is a very detailed and complex issue, and we, as a Department, have responded to some queries from the inquiry with a great deal of volume.”
“The Member also mentioned funding. In my mind, I have divided the 106 recommendations into three categories, one of which is consideration for the funding, but he is talking about funding for the implementation of the Adult Protection Bill. It may be that the publication of the report and the focus on the evil that was perpetrated at Muckamore will ease the purse strings when it comes to how we allocate budget to the Adult Protection Bill as we implement it as an Act.”
“First of all, we will need time to assess not just the recommendations in their own right but how they will interact with the adult safeguarding Bill. I cannot give you definitive answers to that now. We will need more time than we have had since the publication of the report on 18 June.”
“Yes, that will happen. I will do everything that I can to make sure that the right voices are heard in the right places at the right time.”
“It was shameful, so we have to do everything humanly possible to make sure that it never happens again. <BR /> <BR />There are 106 recommendations. I will not go through them all, but I will take the first and the last. Recommendation 106 is about a small working group to discuss redress. That includes patients, families and service users: I will absolutely do that. Recommendation 1 is:”
“Anybody working in Health and Social Care from me down through the trust boards and down to individuals delivering care in the community and in hospital settings needs to be curious; needs to feel empowered to speak up; and needs to speak up. What happened in Muckamore was that people walked on by. People sat and observed. I am a bit cautious about using emotional language, but, frankly, healthcare workers turned abuse into a spectator sport.”
“Clearly, the primary harm that that evil has done has been on the patients at Muckamore, their families and their friends. That, rightly, is our primary focus today. However, the Member makes a valid point about the ripples of uncertainty and, potentially, fear, particularly for vulnerable people and their families in the community. Those ripples are out there, and one of the things that that does is undermine trust. Some 75,000 or 76,000 people, I believe, deliver health and social care in this country. The vast majority are entirely trustworthy and are to be commended for what they do. I reassure them that I am with them and do not consider them to be in the same category as the number who perpetrated the evil of Muckamore or, indeed, those who should have identified that evil early and stopped it early.”
“I thank the Member for pointing out that there are families in the Gallery: I was unaware of that. I have said that I want to meet them, hopefully this week. If they have time after the session, I would like to come up, say hello and start that conversation. <BR /> <BR />Yes, there are people working in HSC who lived through the scandal. When it comes to the Belfast Trust, I will repeat that I have a meeting scheduled with the chair and the chief exec later today. That will be the start of trying to come to a determination about whether the trust that I have put in them remains as solid as I have said it is and whether that is a valid position to take.”
“Of course, there are a couple that I cannot commit to implementing: recommendation 88 is for the PSNI and recommendation 89 is for the Department of Justice. Another one, recommendation 101, will involve the Housing Executive and the Department for Communities. That leaves 103 recommendations for the Health and Social Care system. We will press ahead, as a matter of urgency, with an open mind and a positive attitude towards implementation. That is how I intend to try to give the assurance that the Member seeks.”
“I am unaware of the statement and very much regret that it has not landed well with the people — the group — to whom the Member refers. <BR /> <BR />When it comes to ensuring that it never happens again, I think that Mr Kark has tried to give us the road map with those 106 recommendations. We will not take six months to decide whether we implement them. Over the weekend, I went through those recommendations, and I have now categorised them across three columns. There are some — in fact, around 66 — that we can action very quickly. There are others where I feel that I need to consult officials to better understand the implications should we go ahead with implementation. Then there are ones that will need exploring because they will require resource and funding. That is not an impediment; it is simply a challenge.”
“We have to have systems and structures in place to make sure that we nip it in the bud.”
“<BR /> <BR />When it comes to how we want to do things differently, we will listen to what the report says, and, rather than review abuse on a case-by-case basis, we will look for trends to see whether the issue is systemic and, if it is, do something about it. I have mentioned the two things that we are doing: the patient safety and quality committees that are being set up in each of the trusts; and the adult safeguarding Bill that is going through the House. We will learn lessons and adjust the Bill accordingly. <BR /> <BR />All I can say to the Member is that I promise a renewed and more laser-like focus on abuse, not just on a case-by-case basis but on how it is being perpetrated on a systematic basis. I hope that that has stopped, but we cannot rely on hope.”
“I agree with the Member that those are the right asks, and I will work tirelessly to try to implement them. I was struck by how Mr Kark makes a conclusion that the trust was about the business of assurance rather than reassurance. In other words, at board level, they were asking the question, "Is there are a process in place?", but, when they were told, "Yes, there is", they effectively moved on to the next agenda item rather than saying, "What is that process delivering? What outcomes are we getting? Is it working to protect people?". There was a lack of curiosity, frankly, and Mr Kark refers to a lack of curiosity in the report.”
“However, there was nothing to defend about Muckamore: it was evil. Evil was perpetrated by healthcare workers who were there to look after the people whom they were attacking. <BR /> <BR />There is a big deal of work to be done in trying to restore public confidence, and I get that. I am also conscious that we are talking about a system that has 75,000 or 76,000 people in it, so we face a massive challenge to make sure that not one of them ever does anything that they should not do.”
“I very much agree with a lot of the sentiment that the Member has expressed. It should not have happened. I think that we all agree that families should have been listened to. I also think that we all agree that the Department of Health, the Belfast Trust or any other trust, the Regulation and Quality Improvement Authority (RQIA), the Patient and Client Council (PCC) and any of the bodies delivering across the Health and Social Care system exist for the benefit of patients, service users and our society. <BR /> <BR />I am particularly disturbed to read the stinging criticism from the chair about the adversarial nature of the Belfast Trust's response. To my mind, it is acceptable to protect the integrity and reputation of an organisation when it is under unfair attack — unfair attack.”
“At the summit, I will set out my vision and expectations for our collective responsibility as an HSC system to strengthen patient safety, culture, governance and accountability. <BR /> <BR />I shall bring Members further details and updates on progress against the recommendations as my Department and the wider HSC system work through the report. I commend the statement to the House.”
“I commit to Members that the Department will consider the implications of the inquiry's recommendations on the proposals in the Bill and will ensure that any necessary adjustments are made without delay. <BR /> <BR />Finally, while the inquiry's report helps us understand the failings of the past and provides a road map for the work needed to address those issues, it is vital that we now move forward as a health and social care system and, importantly, as a society into a safer, more inclusive and accepting future for those who are most vulnerable. To that end, I am convening a summit at the end of June that will bring together Health and Social Care leaders, including trust chairs and chief executives, as well as the chairs of the newly established patient safety and quality committees.”
“Work is also ongoing to implement the recommendations set out in the ‘Equity of Access and Outcome’ report, which examined the future role of registered nurses in learning disability in supporting people with learning disabilities. <BR /> <BR />Let me re-emphasise: the safeguarding of those who are most vulnerable in our society is a key focus. That has been demonstrated by the adult safeguarding Bill that is progressing through the Assembly. Members will be aware that the Bill's progress was paused earlier in the year to enable the findings from the inquiry to be published and considered in conjunction with the Bill. The work will now restart.”
“The first is on an organisational duty of candour for Northern Ireland that will place a legal duty on the HSC to be open and honest in defined circumstances where harm has occurred. Secondly, we are participating in the UK-wide Public Office (Accountability) Bill or Hillsborough law, which will place individual statutory duties on all public officials, including those in the HSC, to act in the public interest. Work is also under way in other areas, such as the implementation of the new learning disability service model, which will provide a lifetime model of responsive services for those with learning disabilities.”
“I shall set up a small consultative working group to discuss redress once I have met some of the families, which I shall do as soon as we agree dates. <BR /> <BR />We have started work on the recommendations, and we shall continue at pace. Some have financial implications and will need detailed consideration. Our considerations will include identifying interfaces or alignment between the inquiry's recommendations and other work already being progressed by my Department. For example, work is progressing on the introduction of a duty of candour. At its core, the work is focused on strengthening a culture of openness and honesty, and work is being taken forward on two separate pieces of legislation.”
“On Thursday, I reacted to recommendation 2 of the report, which allows the Department of Health up to six months to make public whether it accepts the report's recommendations or explain why it does not. I want to do much better than that because we owe it to those who suffered, their families and friends and to the future of public confidence in the delivery of health and social care. I have observed significant cynicism suggesting that lip service will be given to the 106 recommendations in the report and that the report will be left to gather dust on the shelf: that is not my style. I am determined that it will not be an open-ended process, and I give Members my commitment that my Department will move swiftly to respond to the recommendations, starting with accepting No 106.”
“That is not what I would have expected, or wanted, to be the position that the trust adopted. <BR /> <BR />Given the trust's central role, I can inform Members that I am already scheduled to meet trust representatives later this afternoon. I expect them not only to provide an initial assessment of the report but to account specifically for the inquiry's stinging criticism of the trust's approach to the inquiry.”
“It has not been without cost to them, and, in some cases, a very considerable cost, but their engagement was vital. I also thank those from outside our health system who assisted the inquiry with its work. Many findings, conclusions and comments in the report made for uncomfortable reading. One such suggestion was that the Belfast Health and Social Care Trust did not consider that evidence from families and patients should have been given equal weight to its own records. Equally, I was concerned to read in the report:”
“<BR /> <BR />I pay tribute to the bravery and perseverance of all the families who have made sure that their loved ones have had their voice heard, starting when the initial allegations of abuse were raised in August 2017 and continuing through the work of the inquiry to the current day. I do not underestimate the toll that that has taken on you and the personal cost incurred from your being required to relive experiences so publicly through your engagement with the inquiry. I can only hope that the publication of the final report, with its 106 recommendations, in some way vindicates your efforts and determination. <BR /> <BR />I also acknowledge the health and social care staff, past and present, who engaged positively with the inquiry.”
“You were let down, and you were failed. You were then not believed — not believed — when you sounded the alarm. <BR /> <BR />Mr Speaker, we should all be human. If it were you or one of your loved ones in Muckamore, how would you want to be treated? Humanely, I suggest. That it has taken a public inquiry to get to the bottom of issues that were raised over a number of years, when they could and should have been addressed at the time, is so, so wrong. For that, I am truly sorry. I am sorry that families had to fight so hard and for so long to have their concerns taken seriously. I am sorry that they had to relive painful experiences so openly and in public in order to make the system understand. I am sorry that the services that they should have been able to trust, without a moment's hesitation or second thought, so badly let them down.”
“It is unforgivable to let down those who rightly expected the health system to look after their loved ones. They placed their trust in the system to keep their loved ones safe and to provide them with the care and compassion that they needed. Again, I can only say sorry. <BR /> <BR />What happened has been devastating. It has devastated trust, devastated confidence in healthcare and, above all, devastated lives. I am struck by the report's identifying families as feeling guilty when they saw the devastating CCTV footage. They felt guilty because they felt that they had failed their loved ones. I say this to those families: your emotions are natural, because you are decent, caring human beings, but it was not your fault. Rather, it was the fault of healthcare professionals who did not share your caring, loving values.”
“That is a true scandal, and, for that, I offer an abject apology from me and on behalf of the entire health and social care (HSC) system. That apology means little on its own, and the 106 recommendations in the inquiry's report are a testament to that. I thank the inquiry chair, Tom Kark KC, and his colleagues for the report and for the care and diligence that they took in conducting their inquiry. The amount of evidential material provided was considerable, as was and the number of witnesses who spoke to the inquiry, and I thank all who helped uncover the scandal. <BR /> <BR />As I said in my initial response on Thursday, the report must be a watershed moment for the treatment and care of the most vulnerable in our society. Anything less is unacceptable.”
“I begin with an unconditional apology for the evil that was perpetrated in Muckamore Abbey Hospital, as confirmed by the inquiry report, which was published last week, on 18 June. <BR /> <BR />I thank the leader of the Opposition. Today is Opposition day, and, when I asked him whether he would make way for the statement, he agreed without hesitation. Thank you, Mr O'Toole. I believe that that is the definition of a responsible Opposition. <BR /> <BR />I invite Members to reflect on the words "Muckamore Abbey Hospital": "Muckamore", a location; "Abbey", a place of Christian values and practice and a sanctuary for visitors; and "Hospital", a place for care and compassion. The words "Muckamore Abbey Hospital" therefore suggest the perfect home for the vulnerable, but, for far too many, for far too long, it was anything but.”
“Mechanisms, procedures and protocols are therefore in place to try to ensure that we continually focus on the safety of our staff and workforce.”
“All trusts have fora for engagement with staff. All trusts recognise the relevant trade unions, which are another channel for expressing concerns or discussing how we might better support all staff and not just international colleagues, although it is clear that international colleagues have concerns at this time. I fear that those concerns will remain valid and that racism is not going to go away. It may have left our streets and may stay off our streets, and I certainly hope that it does, but there are fundamentals underlying that. <BR /> <BR />Domiciliary care and community capacity are a bit more difficult, because a lot of it is managed by private care providers. The Regulation and Quality Improvement Authority will undertake inspection and speak to everybody in Health and Social Care who provides care.”
“They do their best to get you to a better place because they have commitment, and that is magnificent, even though they will probably never see you again. I thank you for sharing.”
“I thank the Member. That was a very difficult intervention but a very important one because it proves something that is absolutely fundamental, which is that all healthcare is personal. It is as personal as it gets. They have done wonders for you. I get really fed up when people say that the health and social care system is broken: it is not. The pathways in are badly damaged because we have long waiting lists, but, once you get there, the service that you get is world class. I am so pleased that you and your baby got world-class treatment. It does not matter whether they were international colleagues or indigenous workers; they are meeting a stranger who is having problems — in the Member's case, with a pregnancy — and they pull out all the stops.”
“I can tell them that 100%. They are essential, welcome and valued, and they bring compassion and expertise. They bring something else that I should mention. I see it once a year when they have an annual conference at Stranmillis University College; in fact, it is not just there that I see it. As well as that compassion and professionalism, do you know what else they bring? They bring joy to Health and Social Care. If you are lying in a bed, sick and worried about your future, a nurse tending you with joy is so important, and I thank them for it.”
“The driver of that procedure is one consultant: he is a Muslim. He is not from these parts, but I tell you this: he is so dedicated to this place, and he is so committed to the Health and Social Care system. He is a star, yet the people on the streets last week would send him back.”
“I am shocked; I was not aware. I will follow up on that incident in Whiteabbey. Good God. <BR /> <BR />If we do not have our international colleagues, the health service collapses. Let us be straight about that. We simply do not have the capacity without them. We have to continue to recruit. Over the two years in which I have been in post, I have been to Altnagelvin, where there is a centre for acclimatisation for international colleagues; I have been in Daisy Hill, where I have met international doctors from India who are working at Daisy Hill and Craigavon — in the Southern Trust, effectively; and, last week, I was at the day procedure unit in Omagh, which is doing fabulous work. There is one procedure for which, not long ago, the waiting list was over four years. It is now coming down to less than 26 weeks.”
“As yet, I have not. I have been making it my business to be across the impact of that unacceptable week of violence on the health and social care system. I have engaged with a number of representative bodies in the past, and I will continue to do so on foot of what happened last week. I will also take what I consider to be an appropriate interest in a case. As a Minister, I should not be getting involved in individual cases, but I wish to make an exception and take an interest in Mr Ogilvie's ongoing healthcare requirements.”
“I will be asking that question over the course of this week. We talk a lot about being candid, being open, being this and being that. The phrase that I like for Health and Social Care is, "Be human". If it were you, what would you want us as a health and social care service to do for you?”
“First, on the Executive, I am glad that the First Minister and deputy First Minister joined me at the Mater to show solidarity. That was a very important image to send out. Giving staff additional time off to rebuild will be a matter for the trusts. I would be extremely disappointed if they did not make that facility available to people. I was making the point yesterday that the BBC showed a montage of trouble, and I think that we all saw the family that was bundled into the back of a police Land Rover. I am told that the mother is a nurse. I do not want to go further than that, but she is a nurse and they were having to leave because the house next door had been set fire to. <BR /> <BR />As for what sort of compensation arrangements are put in place, I am not aware of that, but I say to the Member that I am keen to be told of that.”
“I spoke to a young nurse in Altnagelvin a while ago who had been badly physically abused. She was making the point that she had to get a solicitor if she wanted to take action against that person, because the law currently does not permit the trust to take action on her behalf. Maybe, in that Bill, there is an opportunity to change that and bring the full force of the Health and Social Care system, not the force of one young person, against the abusers.”
“Yes, I will expect to receive reports from the trusts, first of all, if there are any resignations. That is a hard number that they should be able to provide easily. Also, I would like a more qualitative response from the trusts on their assessment of morale and who is thinking of leaving and who is really upset. <BR /> <BR />In terms of the attacks, there is an issue that, if you are a health worker and are attacked, it is currently up to you to take action through the courts. I have spoken to the Justice Minister, who is bringing a victims and witnesses of crime Bill. Through officials in both Departments, we are scoping out whether there is a potential to put in an amendment that would give powers to employers to further support their staff in taking action against anybody who abuses Health and Social Care staff.”
“Yet those wonderful 75,000 or 76,000 people who make up the workforce keep turning up for work. They keep going to strangers and saving their lives, knowing that they will probably never see them again. There is a magnificent combination of professionalism based on their training and their experience and compassion based on their empathy and their humanity. Those are not traits that I saw on the streets of east Belfast last week.”
“Yes. Staff at the Ballyclare advice centre said that they were the target of misinformation. Somebody asked them, "Are you sheltering boat people?". Misinformation has always existed. The Nazis specialised in misinformation, but they did not have social media. This the problem with the modern world. There is an old expression that the lie is halfway around the world before the truth gets its boots on. That is happening in spades in the modern world. There was misinformation about that. <BR /> <BR />Yes, all attacks are wrong, and, as I said a little earlier, thousands of attacks on Health and Social Care workers have happened in our hospitals, and not necessarily because of race. They are happening for a variety of reasons, and not one of them is justifiable.”
“If you think about it, a mob of rioters intent on burning a building will of course try to stop the Fire Service, because it is intent on putting that fire out. Thankfully, I do not think that the Ambulance Service got it as hard, but it was doing things that nobody should have to do in a First World country a quarter of the way into the 21st century.”
“I expect risk assessments to be done on a case-by-case basis. I am aware of one care home — I do not want to identify it — where the workforce is 85% international colleagues. They were extremely worried, and there was a question about whether that would impact on service delivery in that home. <BR /> <BR />On Tuesday night, I received an early alert from the Mater Hospital; it was concerned about staffing in the emergency department dropping below safe levels. Thankfully, that did not happen, but there was a risk that the emergency department of the Mater Hospital would have to close on Tuesday night, leaving the entire Belfast Health and Social Care Trust with one emergency department for the capital city. <BR /> <BR />The Fire Service was impeded from attending fires, and some firefighters were physically attacked.”
“<BR /> <BR />Firefighters put themselves in harm's way daily to save lives. I urge the Health Committee to visit firefighters again, just to reassure them.”