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 keen that we have a new funding model that will enable the shift left: you cannot do that without a new funding model. The underpinning rationale for enabling hub-and-spoke dispensing between different pharmacy businesses, should they choose to do so, is to allow for more efficient dispensing and the freeing up of pharmacists to provide more clinical services. In turn, that could help to alleviate pressures across an already stretched system. <BR /> <BR />To finish, I turn to the unexpected controversy of when the Committee first dealt with this issue. I believe that I said that it was Thursday 29 May, but the Chair seems to think that it was Wednesday 28 May. I am happy to give way if he wants to clarify.”
“Madam Principal Deputy Speaker, thank you. I also thank the Chair and the Deputy Chair of the Committee and Mr McGrath for his comments. In the current challenging healthcare climate, all policy options that improve efficiency and potentially increase the level of service to patients are to be welcomed. I believe that these legislative amendments will ensure that local pharmacies will continue to have access to the same commercial model — I stress commercial model — as their counterparts in England, Scotland and Wales. <BR /> <BR />Mr Donnelly talked about shifting left, and Mr McGrath talked about the importance of community pharmacists. If we are to achieve the shift left in my vision, it will not just be about GP surgeries; community pharmacies will have a key role to play.”
“The timescale will allow the PSNI, working in tandem with the General Pharmaceutical Council in Great Britain, to consider how best to ensure that any additional professional guidance is available in time to support safe and compliant implementation of the potential new legal framework. <BR /> <BR />I am pleased to inform Members that the Health Committee considered the policy intent of the statutory instrument (SI) at its meeting on 28 May, confirming that it was content that the SI be laid in draft form in the Business Office. When the SI was laid in draft, the Committee considered it at its meeting on 12 June and, again, indicated that it was content. It is therefore with the Committee's support that I bring the statutory instrument before the wider Assembly today. I commend the motion to the Assembly.”
“<BR /> <BR />The legislation will not come into operation until 1 October of this year. That helps to provide certainty to the sector and gives time for the Department to consult community pharmacy representatives on any further requirements, which could include guidance or further legislative amendments that may be required to the terms of service and the contractual arrangements for community pharmacists, as set out in the Pharmaceutical Services Regulations (Northern Ireland) 1997. <BR /> <BR />Hub and spoke pharmacies will operate as registered pharmacies under the regulatory oversight and standards of the Pharmaceutical Society of Northern Ireland (PSNI), as they currently do.”
“Secondly, the spoke must sell, supply or dispense the medicine to the patient, the hub having assembled or part-assembled it under the arrangements. Third, the dispensed medicine must be labelled with the spoke's name and address plus the date on which the hub assembled or part-assembled the medicine, along with the standard information that is required on any dispensing label. <BR /> <BR />Next, the sharing of patient data between the hub and spoke without the explicit consent of a patient is permitted through an information gateway that requires the spoke to display an appropriate notice to patients and staff at the spoke and the hub to maintain the confidentiality of the patient data. Finally, with the aim of providing full transparency to patients, the spoke is required to display a notice on its premises and its internet presence.”
“<BR /> <BR />The revised proposals will mean the introduction of model 1 only at this stage, with a view to introducing model 2, subject to public consultation, if there is sufficient stakeholder interest once model 1 has bedded in. To ensure patient safety, having taken into consideration the consultation responses, the legislation seeks, through several measures, to enhance the governance, transparency and accountability to patients of participating pharmacies. <BR /> <BR />First, hub pharmacies and spoke pharmacies will be mandated to enter into written arrangements with one another when adopting that dispensing model. The written arrangements will be a comprehensive agreement on the responsibilities of each pharmacy for the shared dispensing process.”
“<BR /> <BR />Responses to the consultation proposals raised a number of significant concerns about model 2: its potential to undermine the relationship between pharmacy and patient; risks posed by the sharing of accountability for the supply of medicines; and risks to patient safety. Following further re-engagement with key stakeholders, including the Chief Pharmaceutical Officers of the devolved Administrations and community pharmacy representative organisations, the UK Government propose to proceed with the introduction of hub-and-spoke reforms with amendments that take account of those key stakeholders' views.”
“A UK-wide public consultation on the proposed changes to the Medicines Act 1968 and the HMRs ran from 16 March to 8 June 2022. The consultation included proposals on two models of hub-and-spoke dispensing. In model 1, the patient presents a prescription to the spoke, and the spoke sends the relevant information to the hub so that it can carry out its agreed dispensing actions. The hub then returns the dispensed medicines to the spoke, which may have further responsibilities to perform, such as providing the patient with advice on the medicine before ultimately supplying it to them. In model 2, a similar pathway is followed whereby a patient presents a prescription to the spoke that is sent to the hub. After the hub assembles and prepares the medicine, the completed order is supplied directly to the patient.”
“The legislative changes, along with other changes such as previous amendments to the Human Medicines Regulations, which provided flexibilities to pharmacists for the dispensing of medicines in their original pack, will help community pharmacies to streamline how they manage the dispensing workload and release capacity in pharmacy teams to undertake more patient-centred services that align with Health and Social Care (HSC) priorities.”
“The legislation will also make it possible for dispensing doctors to act as a spoke, giving them access to the knowledge provided by pharmacists in the hub. <BR /> <BR />Hub-and-spoke arrangements will not be mandatory. Enabling all pharmacies to avail themselves of hub-and-spoke dispensing arrangements, should they choose to do so, aligns with a strategic priority in my Department's community pharmacy strategic plan 2030, which aims to modernise systems for the safe and reliable supply of medicines and professional advice from community pharmacies.”
“The concept is that the simple, routine aspects of assembling prescriptions can take place on a large scale in a hub that usually makes use of automated processes. Meanwhile, the relationship that patients have with their pharmacist continues at the spoke pharmacies. <BR /> <BR />Under current legislation, the medicine dispensed in one pharmacy can be sold or supplied only by that pharmacy or another within the same legal entity. The proposed legislative amendments will enable pharmacies belonging to different legal entities to set up hub-and-spoke arrangements. That will unlock the hub-and-spoke dispensing model for smaller pharmacy businesses and level the playing field so that all pharmacy businesses can avail themselves of the model, should they choose to do so.”
“Thank you, Madam Principal Deputy Speaker. I seek the Assembly's approval of the draft statutory instrument (SI), which will amend the Medicines Act 1968 and the Human Medicines Regulations 2012 — the "HMRs". The amendments are aimed at enabling all community pharmacies to access hub-and-spoke dispensing of human medicines, should they so wish. <BR /> <BR />Hub-and-spoke dispensing is a pharmacy model whereby some routine parts of the dispensing process, such as assembling prescriptions, are done in a central hub pharmacy, while patient interactions and final supply occur at spoke pharmacies, allowing staff in those pharmacies to focus on delivering patient-centred services. Typically, there are many spoke pharmacies to one hub.”
“I beg to introduce the Adult Protection Bill [NIA 16/22-27], which is a Bill to make provision for the purposes of protecting adults from harm; and for connected purposes.”
“I will say it again: I want to see a shift left — a shift to primary, community and social care — to take the emphasis off the acute hospitals and try to make sure that they do not have to do as many high-cost procedures. Doing so will start a funding flow towards GP services.”
“As the Member will know, the BMA GP Committee did not like the contract offer that was put to it this year; it wanted another £80 million, as well as to look at things such as indemnity and National Insurance contribution hikes and the rest. I was disappointed that we were not able to discuss access arrangements in any great detail. <BR /> <BR />As the Member is aware, we put some relatively modest proposals to it that could be implemented at no cost. We are not getting into a big, detailed discussion on that at this stage, but we are moving on to discuss with that committee a new model for the delivery of primary care. That opens up all sorts of potential in primary services, not just for further investment.”
“I want to focus on those things to try to make those roles as attractive as possible and, therefore, attract people to and, importantly, retain them in HSC.”
“There are a number of factors that inhibit the filling of all those vacancies. One is location. I think that it is well understood that some consultants are unwilling to travel to some of the points furthest away from Belfast. Belfast becomes a kind of Mecca or magnetic centre point for the delivery of healthcare. In some respects, it has to be that way, because the Belfast Trust delivers so many regional services for the whole of Northern Ireland. <BR /> <BR />We used to worry about consultants, nurses and allied health professionals going to Australia, for example; now, we have to worry about them going to Athlone, because the rates of pay under Sláintecare are much more attractive. If we cannot compete on salary, we have to look at other terms and conditions, such as working conditions and work-life balance.”
“As I said earlier in the session, although you need buildings, beds, equipment and medicines to deliver healthcare, all of that is as nothing, if you do not have the right workforce. The Member has identified just one of the many areas in which we have too many vacancies, to the point where the delivery of better outcomes for the patients who need them is not there. We have a workforce directorate, whose responsibility it is to take the necessary steps, in conjunction with the trusts, to improve those rates of vacancy. I do not want people not receiving timely and proper attention when they need it.”
“The answer to that is, "Yes but not by the Department, by the trusts". I assure the Member that, last year, the trusts had protocols in place to help international colleagues with practical things. Some international colleagues were afraid to use public transport to get to and from work for fear of intimidation and potential physical attack. There are practical processes in place and reporting mechanisms so that individual members of our international community can alert trusts to the fact that they are concerned or fearful or that they feel intimidated. I have no particular concerns about that not being treated with the utmost seriousness by the five geographically defined trusts. Those processes are in place.”
“Let me be clear: it is extremely well accepted in healthcare delivery that, if we do not have our international colleagues, the healthcare system collapses — I repeat: collapses.”
“I thank the Member for the question. I have been public about this. While we have received no evidence to date that any of the people who were subject to the racist attacks are international colleagues working in delivering healthcare in the Health and Social Care system, I am aware that, last year, several valued members of the international community in the HSC system came under attack. I think particularly of a nurse in Antrim, but that was one of several attacks. <BR /> <BR />Regardless of whether any member of the Health and Social Care community has been attacked, it is beyond logic that international colleagues will be feeling the fear and the intimidation and wondering, "Are we next?".”
“For the avoidance of doubt, I declare an interest, as my sister is a custody visitor. She gives me a narrative of her experiences sometimes. <BR /> <BR />The bottom line is that I thought that Health and the PSNI were getting a lot better at understanding where people should be placed. For example, people with severe mental health issues should not necessarily be put in a holding cell in a police station. The Member is taking it to a different level where there seems to be some sort of division of labour and people are refusing to offer appropriate medical support and intervention. I will most certainly take a look at that.”
“I understand the angle that the Chair of the Justice Committee is coming from. It is not an area that has been a focus of mine, so I am more than happy to take it away and listen to whatever the Member has to say by way of follow-up.”
“I thank the Member for her question. I express my condolences to Mr Blair on his loss. <BR /> <BR />Neurology was one of the areas where we were looking at a really bad situation. I need to write to the Member because I do not want to misspeak on such a serious issue.”
“I say yes to the Member. I said that I would intervene on a number of levels. Peter McBride going in to look at the culture and behaviours and where they are wrong is number 1. Number 2 will involve putting in someone external who has expertise in what I call "clinical teamwork", which is a direct reference to the cardiac surgery unit. My permanent secretary, Mike Farrar, is on top of that. One of the great advantages of having somebody steeped in healthcare delivery across the UK is that he knows names, so I have left him to liaise on that. There is a third intervention that I am working on but am not in a position to reveal. However, I assure you that the House and the Committee will be the first to know.”
“I want to be assured that people feel that, if they whistle-blow, they will be heard properly and will not feel that they are putting themselves at risk of some sort of reprisal from management. I have no idea whether that is the case. However, if you judge it by the reported level of confidence in that system, there is certainly a problem, and, where there is a problem, there needs to be a fix.”
“I think that I can say yes to that, but I want to be specific about it; in fact, after the sitting, before the day is out, I will meet Peter McBride. The Member knows that I have asked him to be my eyes and ears in assessing the adverse cultural and behavioural issues not just in the cardiac surgery unit but across the Belfast Trust. I have some draft terms of reference for him. I want to consult the unions again — I have already spoken to them and to the professional bodies — to make sure that they are content with the terms of reference. Obviously, I want Peter to be content. <BR /> <BR />One of the specifics is the whistle-blowing policy, because it is my understanding that staff confidence in that whistle-blowing policy is low.”
“The public consultation on the proposed eligibility criteria for passporting universal credit recipients closed on 10 March. I welcome the openness, feedback and engagement from all who participated in the consultation. Officials are currently analysing the responses and compiling a consultation summary report that will be published on the departmental website in the coming weeks. <BR /> <BR />In the context of the extremely difficult financial environment, implementing the existing GB thresholds remains the preferred option. That will preserve parity with the rest of the UK. It is also the most affordable to the Health budget and will ensure continuity of eligibility for the most vulnerable.”
“I assure the Member that work on the proposed changes to the legislation remains a key focus for my Department and that I am committed to ensuring that that work is completed without undue delay.”
“I do not have a definitive timeline for that work. It falls into a broader category. Indeed, yesterday I was with representatives from Belfast City Council talking about their Complex Lives proposals, which seem to work extremely well. I have agreed that I will try to get a multi-departmental meeting with the council on that alongside the Department of Justice and the Department for Communities. I want to place that work in a broader societal context.”
“However, the exact requirements for that should be informed by the review. <BR /> <BR />Subject to the completion of the DAMIS review, the resulting recommendations and securing the necessary funding, it may be appropriate to consider whether other potential suppliers should be invited to put forward proposals in that area.”
“<BR /> <BR />It is important to note that the drug and alcohol monitoring and information system, which is operated by the PHA but overseen by a cross-departmental steering group, continues to provide up-to-date information on substances that are of concern to service users and those who are likely to come into contact with potentially harmful substances. Under DAMIS, through partnership working with the PSNI and Forensic Science Northern Ireland, we have the ability to proactively seek the rapid testing of substances that are seen to be causing harm. That information is used to inform related advice and give alerts to service users, vulnerable groups and those who are in key services. It does not, however, provide for the ongoing testing of a wider range of substances, and it is acknowledged that enhancement in that space may be useful.”
“I am aware of the outline proposal that Queen's University Belfast put forward to trial a rapid drug-testing model in Northern Ireland. Following recent conversations with interested parties, including Queen's, the PSNI and the Public Health Agency, the intention is that enhanced testing possibilities will be fully considered as part of a wider anticipated review of the current drug and alcohol monitoring and information system (DAMIS). <BR /> <BR />While the extremely challenging financial situation remains, funding for any enhanced testing service is unlikely to be available in the near future. However, we will continue to monitor the position and will seek to identify other potential funding sources should the review of the information system indicate that that type of approach would be helpful locally.”
“I thank the Member for her question. As far as I understand it, there are ongoing discussions about the future of that service. All those services have been shown to be of benefit to patients, particularly vulnerable patients and those patients who perhaps do not know how to navigate a hospital such as the Royal Victoria particularly well. However, funding is always an issue. The best thing that I can say to the Member is that, while no definitive answer is forthcoming today, negotiations are under way with a view to trying to maintain that service.”
“I do not want to see a hiatus in which there is nobody around to try to deal with vulnerable people who have severe mental health and well-being issues and could be a danger to themselves and others.”
“The Member mentioned that there are PSNI officers in the Mater Hospital, as there are in the EDs of all our acute hospitals. The Member will be aware that the Chief Constable, Mr Boutcher, is planning to move the PSNI to the Right Care, Right Person model, following an approach that is under way in other parts of the United Kingdom. He will argue quite rightly that the reason for that is because PSNI officers are not trained to deal with many mental health issues, so the Department of Health has been working with the Department of Justice and the PSNI. I understand that the direction of travel is the one that we need to pursue. My only concern is transition.”
“That is where my primary focus is, and we need to do more to deliver those services for people who are incredibly vulnerable because of their mental conditions.”
“Without wishing to scare people, the question, "Will things be adequately resourced?", tends to end up with the answer, "It could be much better resourced", although that is not to say that there are not good resources out there. The Member will know that I have campaigned on mental ill health and well-being since I was elected back in 2011. It is no longer the Cinderella service that it was back then, but there are two issues: awareness and action. We have done a lot more on awareness than we have on action. To do more on action, we need more funding and resourcing, but we also need workforce. I say again that to deliver healthcare, you need buildings, beds, equipment and medicine, but all that says nothing if you do not have the right workforce in numbers, skills and commitment.”
“<BR /> <BR />While some individuals who are experiencing a mental health crisis require their needs to be assessed and met within an emergency department, others may not. As an alternative to ED attendance, two initiatives were piloted for individuals who have mental health needs but do not require acute physical care. There is the multi-agency triage team (MATT), which is currently only operational in two trust areas, and the Northern Ireland Ambulance Service's pilot initiative Hear and Treat, which is operating in the South Eastern Health and Social Care Trust area and includes mental health professionals in the control rooms.”
“Implementing the new regional mental health crisis service is a commitment in actions 12 and 27 of the mental health strategy 2021-2031. My departmental officials and the Public Health Agency (PHA) are working in partnership to deliver on both those actions, with the hope of developing a regional mental health crisis service for all the citizens of this place. <BR /> <BR />Future state work has commenced across lifespan services, including a scoping of what a good service would look like. As part of the development of the regional mental health crisis service, my departmental officials are keeping national developments, such as specialist crisis centres in NHS England, under review.”
“Although Mr Dickson validly points out that there is an issue that needs to be addressed, the one that I really want to address next is electronic prescriptions.”
“I see that as being part of the next phase. As has been said, £360 million is a lot of money. To roll out Encompass fully across primary care is beyond our financial reach. I say to the Member, however, that the next thing that I want to see is e-prescriptions. I want to see GPs being able to prescribe over the internet. I take five tablets every day. I go to my chemist, and the pharmacists tell me that they have to walk up the hill to the GP practice, physically collect the docket, come back and process it. If we were able to do such things electronically in primary care — GP surgeries and pharmacies — it would be transformational. Yet, I am told that it will be 2032 — seven more years — before that will happen. That does not equate with my seeking urgency in healthcare delivery and asking how we are doing things at pace.”
“It is not about the money, however, but about the ability to deliver public health through understanding much better where the problems are, particularly problems with health inequalities, in order to be able to analyse where those health inequalities occur and then tackle them proactively.”
“As the Member may know, I have been out and about a lot. I have visited a lot of sites, particularly hospitals where Encompass is in use, and I do get a mixed reaction when I ask people what they think of it. I have heard some extremely negative comments, which I will not repeat in the Chamber. I have also received some particularly encouraging responses, however. The encouragement tends to come more from clinicians and consultants than from people who are, as you put it, moving from paperwork to data work. <BR /> <BR />Yes, £360 million is a lot of money. We reckon that Encompass's cash-releasing benefits will be £29·6 million over the next number of years. That is in cash terms. Non-cash-releasing benefits, I have been told, will be to the value of £514 million.”
“As the Member will know, GPs do not have full access to Encompass, but it is my understanding, from talking to the officials who were in charge of it, that they have sufficient and appropriate access to it. Where we go in the longer term is something that I am very much open to discussing, but, at the moment, I am satisfied that GPs have appropriate access to the information that they need, which is now being held on Encompass.”
“The fact is that rolling out Encompass is one of the biggest changes to patient record-keeping that the health and social care workforce has ever had to face. Encompass needs a period in which to bed in and a period for validation, so, as frustrating as that may be, there have been times, and there continue to be times, particularly in the Southern Trust and the Western Trust, which are the latest trusts to adopt and go live with Encompass, when the information and data that we are getting is not fully validated. That is just part of the process. I say again that it is frustrating, but think of the prize when we get it fully embedded, operational and validated. Its impact on our ability to deliver public healthcare is unmatched, so we are in a really good position.”
“Key integrations include systems for routing letters, imaging and lab results to GPs; ambulance booking and arrival management services; regional radiology and digital pathology services; and the Northern Ireland pathology information management system for laboratories. <BR /> <BR />Encompass continues to collaborate with senior trust information risk owners, the Information Governance Advisory Council (IGAC), the Information Commissioner's Office and other key stakeholders to ensure that benefits are being realised across the region within the framework of continuity of care, patient safety, information governance and cybersecurity.”
“With the system now operational across Northern Ireland, all patients and service users will be able to securely access a subset of their health record, such as clinical letters, medication details and some test results via the My Care patient portal. They can also view appointments and track the progress of their treatment. My Care is already providing secure access to personal health information for over 150,000 users. <BR /> <BR />The Encompass system also offers the seamless sharing of patient and service user data with authorised colleagues across the Health and Social Care (HSC) network.”
“Encompass successfully went live in the Southern Trust and the Western Trust on 8 May. This is the first time in the history of Northern Ireland that all five geographically defined trusts have been integrated into one digital system. It is a major transformational change that will empower patients and improve access to care. Used properly, Encompass will deliver improvements to care quality and productivity. It will ensure that staff have timely access to health information, while supporting safer and more effective care delivery. <BR /> <BR />Encompass is Europe’s most comprehensive digital care record, comprising acute, community and social care, social work and mental health care.”
“I will check once again with officials whether a temporary solution is possible. As I just said to the Member who asked the original question, it is now over 30 years ago that my wife had an episode of antenatal depression. What happened when my son was born was so far from ideal that it has stuck with us 30 years on. <BR /> <BR />Until we get the mother-and-baby unit, we will not be in the position that we need to be in. Temporary solutions sound good, but then you get into the practicalities. I will ask, however, and I will get back to the Member.”