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 am very much of the opinion that tackling health inequalities is not just for the Department of Health to tackle. Socio-economic issues are also involved, so the Department for the Economy is involved. It is about the environment and people's behaviour. Equally, we can look at educational underperformance and not just look to the Minister of Education to do something about that. We know that healthier children do better in school, so that is down to me. If we look at our shocking rates of economic inactivity, with 27% of people of working age neither in work nor seeking work, once again, when we look at the contributing factors, we see that it is not just about affordable and accessible healthcare but about poor mental and physical health. All those things need a whole-system, all-Executive approach.”
“Given the focus that I have had, since being elected in 2011, on mental health and well-being and, since I took up post as Minister, on health inequalities, I will try to be a bit more specific about a range of actions that, at low or no additional cost, will potentially help alleviate pressures in the psychiatric workforce. We are doing an analysis of sick absence rates, an analysis of locum use, an assessment of the impact of existing and emerging workforce challenges, an assessment of the impact of reinstating mental health officers and an assessment of how best to promote Northern Ireland as a region in which to work. That is what we are doing as regards the workforce. <BR /> <BR />The issues that people face in the Member's constituency, particularly in areas of deprivation, are well known, and those things overlap.”
“As part of a significant package of training expansions, I announced in May an additional 26 new medical specialty training posts, including six in core psychiatry.”
“I am acutely aware of the workforce challenges in consultant psychiatry in the Western Trust and, indeed, across the region. A number of actions are being progressed. In response to action 32 of the mental health strategy, a mental health workforce review report was published in July 2023 that set out 18 recommendations to address workforce challenges across statutory mental health services. Work is currently being progressed to deliver a number of key recommendations on costing the proposed future workforce profile and on the development of a future recruitment and training plan. <BR /> <BR />In parallel, my Department has established a psychiatric workforce task and finish group to identify a range of actions to help alleviate the pressures in the psychiatry workforce in the short to medium term.”
“It has cost an awful lot from the public purse and, more important, has delayed the opening of that maternity hospital, which is badly needed for the women of this country.”
“On the first point, absolutely we want to get to the bottom of it and understand what happened, why it happened and who was responsible. However, I am not going to jump the gun. I assure the Member that, when we find out who is responsible, we will take the appropriate action. <BR /> <BR />As to the second part of the Member's question, it is my understanding — I await a formal briefing on it — that a couple of the workforce in the Belfast Trust were perhaps not as forthcoming as we might have expected them to be in their engagement in that review process. I await a formal briefing, and then I will make my decision. I assure the Member that it is not acceptable to me if a member of the workforce of the Belfast Trust or, indeed, of the Department of Health is not fully engaging in any review or investigation into what has gone wrong.”
“I am not aware of whether we have looked at the model in Portugal, but I assure Mr Carroll that we will certainly take that away. It may be of interest, as a bit of a tangent, that I was at a four-nations ministerial meeting on substance use last week, and the question of whether Portugal was leading the way in permissiveness in the use of drugs came up. The answer was that it was, but, because it is no longer putting resources into helping people who are taking drugs, those problems are re-emerging. I find that interesting.”
“However, I recognise the importance of clinical education and the need to listen to women in this area and ensure that appropriate referrals are made and treatment decisions are taken that best meet the needs of those individuals.”
“In a recent response to a question for written answer from the Member on the same topic, I welcomed the report by the UK Parliament's Women and Equalities Committee on women's reproductive health conditions. It highlighted the fact that women often find that their pain is normalised or dismissed when they seek medical help from the NHS in England. I am aware, through qualitative feedback received by my Department, that some women in Northern Ireland have had similar experiences. Others have reported having a positive experience when discussing issues with their healthcare provider. I fully acknowledge the range of experiences. However, to the question of whether an impact assessment has been made, unfortunately you cannot readily assess something that is not well defined and measurable.”
“I thank the Member for his question. It is the first time that I have had the opportunity to welcome him onto the Floor of the Chamber. <BR /> <BR />My number one for men's health is suicide. It is a major risk factor for men. Suicide is a major cause of death, particularly for men under the age of 50. Cardiovascular disease is also a contributory factor to poor men's health. Many conditions, such as heart disease, are preventable, as I know from my experience. There is the potential to do more on male cancers with early detection through the screening of testicular and prostate cancers. Men are also disproportionately affected by type 2 diabetes. Those are all critical areas where, as Minister, I want to put a focus.”
“I am aware of that research, and my Department has been looking at it. However, I will have to write to the Member with the detail because I do not have that off the top of my head.”
“I thank the Member for his supplementary question, because it takes me to my Live Better initiative. When I took up post, one of the most shocking reports that I saw was on health inequalities. This year's health inequalities report is out. It confirms that the difference in healthy life expectancy between people living in the areas of most deprivation and those in the areas of least deprivation can be as much as 14 years. I find that shocking, given that we are a quarter of the way into the 21st century and in a First-World country, and I do not understand why we have tolerated it for so long. Live Better bundles together services that already exist, takes them into areas of deprivation and tries to get them as close to people's front door as possible, because all the empirical evidence suggests that, if you do that, uptake goes up.”
“While there is no current plan to develop a men's health strategy or action plan for Northern Ireland, given the existing resource constraints, I want to ensure that, in the development of health-promoting strategies and plans, relevant actions target men and are included where there is a difference in behaviours or outcomes between the genders.”
“Evidence suggests that men are disproportionately affected by certain conditions, such as some types of heart disease, and smoking; indeed, more men than women die by suicide. The inequalities in men's health are stark. On average, those in more deprived areas are much more likely to die early than those in the least deprived areas. The gap in life expectancy and healthy life expectancy at birth between men and women increases in line with greater levels of deprivation. <BR /> <BR />The Public Health Agency (PHA) supports a wide range of men's health initiatives.”
“The answer to your question is, as I outlined, the £5 million of additional moneys through the elective care framework implementation plan. I acknowledge that there are explanations — not excuses — for what happened. For example, it was over the summer, and the workforce was challenged because people need their summer holidays. A number of factors play into it. I stress this: explanations and excuses are different things. That is only an explanation; it does not make it right.”
“I absolutely agree with the Member. He will be aware that, during my time as Minister of Health, one of my objectives is to ensure that, whatever the condition or process or entry point for a patient or service user into our Health and Social Care (HSC) system anywhere in Northern Ireland, the patient receives a standardised, regionalised service. That is the ambition across the board.”
“An eight-, nine-, 10- or 11-week wait is not acceptable to me, patients or their families: I get it. However, the postcode lottery that was in place before I introduced the regional booking service was equally unacceptable. You could have been living a mile away from a trust that was seeing all or nearly all its patients within the 14-day target, while your trust satisfied only 10% of the demand. That was clearly inequitable and unfair, and we have successfully moved to do away with the postcode lottery. We now have to drive down the waiting times and meet the 14-day target. It is a big ask but one that those patients deserve to see delivered.”
“As I said to the Member, £5 million has been allocated through the elective care framework implementation plan. That will strengthen long-term resilience and reduce reliance on temporary measures. We must get rid of temporary measures and install resilience. On my actions to deal with the immediate pressures, the trusts have been instructed to prioritise red-flag referrals in the existing core capacity to ensure timely access for the most clinically urgent cases. The strategic planning and performance group (SPPG) is working with trusts on a plan to provide regular additional waiting list initiative clinics and mega-clinics. The independent sector will also supplement capacity in the short term.”
“<BR /> <BR />We have allocated £5 million in recurrent funding through the elective care framework. That will support additional waiting list initiatives and the expanded use of the independent sector, while we work to increase clinical capacity in the trusts. A comprehensive review of breast services, meanwhile, is under way. I want to ensure sustainability and resilience in the years to come.”
“I am most exercised by the fact that, for far too long, patients have faced unequal access to timely breast cancer assessments. In one geographic part of the country, we were consistently meeting the 14-day target, while, in others, fewer than 10% of patients were seen within that time frame. The regional system was designed to eliminate disparities by pooling referrals into a single waiting list and offering patients the earliest available appointment, regardless of their home trust. We have taken a deliberate step towards fairness and consistency, and therefore the system is delivering on the promise of equalised access but is not delivering on the challenge of meeting the 14-day target. The current average wait is simply not acceptable. I have told officials that it is not acceptable to me and that I expect to see improvements.”
“I will finish by welcoming all the people who have come up from Fermanagh. I applaud you for your continued interest and your determination to do what, you think, is right for yourselves and your community. I promise that I will try to do my best for you. Thank you for coming up. I welcome you here and wish you a safe journey home.”
“<BR /> <BR />Mr McCrossan kindly said that I am a man of plain speaking: he is about to become a victim of that. He said that it is a brand new hospital and that it is shocking that we are discussing its future. We are not talking about whether it has a future: it does. We are discussing only one service, albeit a very important one. I want any patient who goes to the SWAH to get safe and timely attention and treatment and to be allowed the basic courtesies that are absent in our emergency departments in particular of holding on to your privacy and dignity.”
“I am sorry; I have a lot to get through. I want to give some responses. <BR /> <BR />Mrs Dodds normally asks me about 5,000 questions: I will answer four of them. I have done Altnagelvin. She talked about an awareness of the implication of rural healthcare delivery. I assure Mrs Dodds that we do rural impact assessments as well as equality impact assessments. The SOAS road map is interesting. I think that she wondered what my view of it was. It would not be appropriate for me to give my view. I do not want to be confused for the chair or the chief executive of the Western Trust. They have to make that decision, not me. I will be the person who signs off or does not sign off on the decision that they come to, but that is that. We are looking at the two uncommissioned theatres and wards as part of our waiting list initiatives.”
“I have made the point about the network that we have to realise that not every hospital will offer every procedure. If the procedure that you need is being performed by your nearest hospital once a week but, 20 or 30 miles away, the next hospital is doing it 10 times a day, five days a week, where will you go? Obviously, it will be safer to go to where it is done more frequently.”
“While most of those had been achieved, some remained outstanding and needed to be strengthened. The strategic planning and performance group, which is the performance management arm of my Department, works with the trust monthly to monitor progress and assure me that matters are being adequately addressed. <BR /> <BR />Mrs Dodds said that there was an issue at Altnagelvin because it, too, was under pressure. I say this to her: every hospital, facility and worker in the Health and Social Care network is under pressure. Our hospitals across the region face challenges and pressures. We are not an outlier — that is the position across the UK — but having a small population of 1·9 million means that specialist services are innately difficult to fund and maintain region-wide. You cannot put them in every hospital.”
“However, in lieu of the inability of the trust to stand up safe services and satisfy the clinical general surgery standards, the reconfigured Altnagelvin-led service remained in place. <BR /> <BR />Members have mentioned RQIA. In 2024, it was alerted to some concerns from clinicians in the trust that had to be listened to about the robustness of the pathways at Altnagelvin. The Department of Health team asked RQIA to conduct a robust investigation and report on their effectiveness and sustainability. We got that report in the spring of this year. The outcome was presented at the Health Committee by RQIA officers on 13 March, alongside a response from the Western Trust. Essentially, there were 10 recommendations for the short and medium term for the further refinement and improvement of the pathways.”
“In November 2022, the trust decided to temporarily suspend EGS for patient safety reasons due to staffing challenges. I understand the concern caused by the trust's decision. The protection of patients from adverse clinical outcomes has to be my most important duty; I have to make sure that patients are safe. The decision was taken at a time when there was no Minister in post. The trust stated that its ability to safely staff and operate an emergency 24/7 rota for surgical care was inadequate and unsafe. I stress that point to remind Members of the genesis of that decision. Subsequently, the trust ran a public consultation exercise on the temporary suspension, the findings of which were published in July 2023. The strength of local feeling and of opposition to the suspension was clear.”
“I often say that to deliver healthcare, you need buildings, beds, equipment and medicine, but all that counts for nothing if you do not have the right staff, qualified and motivated. That is where the problem began with this issue. We talked about the extra theatre and bed space. The hospital has the potential to do more, and I absolutely want to see it doing more. Let us remember — I think that Diana Armstrong made the point — that it has never been busier or more productive, and it has the potential to do even more because of those two non-commissioned theatres and beds. <BR /> <BR />I am keen to do more at the SWAH, but let me move to the specific of emergency general surgery.”
“<BR /> <BR />Moving to the debate, I will attempt to address some of the points raised. The South West Acute Hospital serves a significant portion of the Western Health and Social Care Trust population, which is approximately 300,000 people — a significant proportion of our people. The population of the Fermanagh and Omagh District Council area is estimated at 118,000 from the 2021 census. <BR /> <BR />Since taking office, I have had the pleasure of visiting the SWAH on various occasions. The most recent visit was a few weeks ago, when I talked to some patients and staff. I visit many hospitals and healthcare facilities. I always get a sense and a feel just walking in the door. Is it a good feeling, or is it maybe that the air is being sucked out of me? I always get a really good feeling in the SWAH, which is a great modern facility.”
“It is not sustainable because every pound that we spend in Health is a pound not spent by the other Departments on tackling the social determinants of health inequalities and ill health, so we all have to work together. <BR /> <BR />I was pleased that Mrs Dodds acknowledged that sometimes we rightly — it is our duty — put a focus on what is wrong and what goes wrong in health and social care delivery, but sometimes we do not put a focus on what goes right. Of course, in the majority of cases on a daily basis thousands of appointments, diagnoses and procedures go very well for people. I do not prescribe to or buy into the idea that the health service is broken, but I do know that many of the pathways to access health and social care are broken, and that is an important distinction.”
“I was also encouraged that everybody — I mean everybody — who came up to me said, "If you're going to make the big, difficult decisions, we will support you". That is not always the case once we get into the nuts and bolts and the specifics. <BR /> <BR />One of the things that I regret — it is something that I am encouraging people in Health and Social Care to fix — is that sometimes a change has been allowed to be perceived in the public consciousness not as delivering better outcomes but as a cost-saving measure. I am not interested in doing that, but I have to accept that, in recent years, Health's proportion of the overall Executive Budget has gone up from 46% to over 50%, and that direction of travel is not sustainable.”
“Mr Deputy Speaker, thank you very much, and thank you to Mrs Dodds for stepping in for Deborah. When Deborah arrived here, she very quickly established a reputation for being a respected and effective Member of the legislative Assembly, but tonight, of course, the focus is not on Deborah the politician. It is on Deborah the wife, and I offer her and her husband every good wish as they prepare to welcome their first child and start that family. <BR /> <BR />If I may, I will start with a general point, so please indulge me. When I first stood here, 15 months ago, as Minister of Health, I said that I wanted to be judged and I wanted to judge myself on whether my words and actions were delivering better outcomes for patients, service users and the 70,000-odd glorious staff who deliver health and social care.”
“<BR /> <BR />Mr McGrath said that the issue was one of housekeeping. For me, it is about ensuring that the house looks after its guests fairly and equitably and pays proper attention to their rights and dignity.”
“Thank you very much, Madam Principal Deputy Speaker. I thank the Members who contributed to the debate. Their thoughtful contributions gave me a sense of a collective commitment to safeguarding the rights and dignity of those with mental health conditions, learning disabilities or a diagnosis of autism. <BR /> <BR />I will not delay the House. Mr McGrath was the only Member who raised a question, which was about the costs. I can assure him that no direct costs are associated with the legislative consent motion and that there is no cost to the trusts. If we end up in a position in which there are private providers — that might be a matter of regret, because I would rather that it be done by Health and Social Care — there could be compliance costs, but that is not a matter for us.”
“My Department's screening shows no adverse equality or rural impacts but shows benefits for patients through enhanced private provider accountability. It is my assessment that the amendment promotes equality by extending European Convention rights and protections to mental health patients regardless of provider type. <BR /> <BR />Failure to support the motion would exclude Northern Ireland from the protections. Approving the motion will demonstrate our dedication to a rights-based mental health system, align with our legislative framework and uphold Bamford's vision. Furthermore, it will ensure, beyond doubt, that private providers that provide services on behalf of public authorities are accountable in the same way as public authorities are at present. I commend the legislative consent motion to the House and urge Members to support it.”
“<BR /> <BR />The UK Government's Department of Health and Social Care has worked closely with my Department to align the amendment with Northern Ireland's mental health framework, particularly its aftercare provisions, and I thank officials for their engagement. Consultation has been led by the Department of Health and Social Care. My Department has engaged the Northern Ireland Human Rights Commission and awaits its response. The amendment enjoyed cross-party support in Westminster, with no Northern Ireland-specific concerns having been raised in parliamentary debates. The Health Committee supports the legislative consent motion in principle, and its report has been shared with the Westminster Bill team.”
“Specifically, to remove any doubt on the matter following the Sammut ruling, the amendment designates private providers as exercising public functions under section 6(3)(b) of the Human Rights Act when providing aftercare services post detention and voluntary inpatient treatment or health assessments. As I mentioned, although no private inpatient providers currently operate in Northern Ireland, the amendment future-proofs us should private inpatient services of that type that are publicly funded or commissioned open here in the future. That will ensure that they are held to the same human rights standards as in other UK jurisdictions. That aligns with the Bamford principles by enhancing patients' rights and dignity while ensuring uniformity and accountability.”
“The amendment would ensure that private providers delivering certain mental health services, when funded or arranged by public bodies, are subject to Human Rights Act obligations. Although health and social care are devolved matters, the Assembly cannot directly amend the Human Rights Act, which is a reserved matter that requires the Assembly's consent for Northern Ireland application. Therefore, this legislative consent motion (LCM) is the only mechanism to extend the protections, and, without it, Northern Ireland risks disparities in human rights protections compared with the rest of the United Kingdom. <BR /> <BR />I will move to the detail of the amendment.”
“Thank you, Principal Deputy Speaker. <BR /> <BR />The Mental Health Bill introduced in the UK Parliament in November last year reforms the Mental Health Act 1983, which governs compulsory detention and treatment in England and Wales. That Act is the equivalent of our Mental Health (Northern Ireland) Order 1986. This Bill enhances patients' autonomy, tightens detention criteria, increases review frequency and removes prisons and police stations as places of safety. None of those measures will extend to Northern Ireland, but, today, we address an amendment extending specific provisions to this place. <BR /> <BR />That amendment seeks to address a gap in Human Rights Act 1998 protections for mental health patients following the 2024 England and Wales High Court ruling in the case of Sammut v Next Steps Mental Healthcare Ltd.”
“On a point of order, Mr Deputy Speaker. Mr Burrows made his maiden speech seven hours and 18 minutes after the first session that he was available to attend. Can you check with the Speaker's Office whether that is a new record?”
“Obviously, there will be recurrent costs. It is not a service that will last until the end of the financial year or for a single financial year. With no disrespect to the Member, I think that making that point is redundant. As to the other costs that he mentions, I am not aware of any costs for primary care or for general practitioners. They will refer into CAMHS as they do for a lot of other issues. If the Member has fact on that that I do not have, I am more than happy to look at it.”
“As with this, it does not delay moving to delivery, because I said to the trust, "You can go on with the design and continue to talk to consultants and experts about delivering your preferred option, and let us hope that that is where we end up". In the same way, the recruitment for the other posts that I have mentioned today and for those that I have not mentioned will continue, so bringing in Dr Cass and colleagues for a couple of days will not delay anything.”
“That is how we have got to where we are today, and it is not the first time in this role and certainly not the first time in life that I have been given advice and thought, "I would like to bring in a little independent expert advice for some quality assurance". <BR /> <BR />For example, I am reluctant to raise it, but, regarding the water issues at the maternity hospital, the Member will know that options were put to me with a recommendation for a specific option, and I refused to accept it. I said, "No, I want to bring in an independent expert to review and quality-assure what I'm being told, and then we will move forward".”
“I am afraid that I am at a loss to remember when I said "we" rather than "I", but, as a general rule, if I say "we", you can take it that I mean "I", because I am the Minister, and the buck stops with me. <BR /> <BR />Regarding the advice that you get, I am sure that your daughter's is first class. My advice has come from, for example, officials, CAMHS and the Knowing Our Identity service — people who are professional, expert and experienced in such things — and we have taken those ideas and consulted on them, as we should do. Maybe not in every debate or every day in the House, but that is a staple of how we deliver government services. We talk about co-design and co-production.”
“I will run through some of the costs. The Member's opening remarks take me back to this point: we do not decide who does and does not deserve to have access to medical health and social care services for what they need or believe that they need. We will not cherry-pick on that. A lot of the money will go on staffing and the workforce for the new service. There will be a psychologist, which comes in at over £100,000, and there will be a service manager, a practitioner, another lower-band psychologist, administrative support, a medical secretary, a nurse, a pharmacy technician — that sort of thing. The figures all add up.”
“Stakeholders were involved in the discussions that have led to this lifespan gender identity service. My officials have assured me that that has happened and that stakeholders are as happy as possible with what we propose. They also believe, as I do, that what we are doing is compliant with the Cass recommendations. When Dr Cass comes, she will do that short, sharp quality assurance that that is the case. There is no need for stakeholders to be involved in that, because the four people will be talking to the clinicians and the team who will deliver the service to make sure that everything is as we believe it should be. That is the nature of an independent review.”
“It will not be gender-affirming. If you mean that somebody is going to come in and say, "I believe I am a girl, not a boy", we will not simply say, "Right, we are going to make that happen for you".”
“If anybody is trying to say that we should deliver health and social care only for the people whom we approve of, then, once again, count me out.”
“Just before I respond to Mrs Dillon, I want to address something that I have not addressed, which is the idea that the plan was in the public domain before I briefed the Executive. I can confirm that that was the case because we did not make the announcement; it came via the Rainbow Project. <BR /> <BR />To Mrs Dillon, the beauty of the National Health Service — the glorious, glorious concept — is that it does not matter who you are. If you need health and social care, you get it for free. Yes, all of those groups — those vulnerable groups that were let down by people like us, people in authority, be they politicians or people who were running institutions or whatever — have been hurt and let down, and they all deserve our attention.”
“The stakeholders, including the Rainbow Project, were brought into discussions about the way forward. That is entirely consistent with co-design, so I do not get the implication in the question that, somehow, that was wrong. The matter of regret for me is that it asked for and was given permission to talk to the wider stakeholder group about what we were proposing. I do not believe that the media were stakeholders, but they became aware of it and published that information. It would have been much preferable if it had come, as is normal, through the Department of Health.”