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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“Yes, I have. I had some detailed discussions with the previous Minister for Health in the Government of Ireland, Stephen Donnelly, about the possibility of pitching to the Shared Island Fund for a single mother-and-baby unit that would service the whole island of Ireland. Without wishing to break any confidentiality, the response from the Shared Island unit, according to Minister Donnelly, was a hard no. That, perhaps, explains part of the delay, in that we were hoping to go down that route. That is over, however, and now we must press ahead at pace and get it done. My wife could have used that service 30 years ago.”
“The development of a service user leaflet to explain perinatal mental health is under way.”
“It has advised that, once it receives instruction on the number of beds required, it will take six weeks from then to finalise the business case. <BR /> <BR />While the development of a mother-and-baby unit remains a longer-term strategic objective, my Department has committed to strengthening existing provision in the interim through investment in community-based specialist perinatal mental health services; the upskilling of perinatal clinical staff; the implementation of the perinatal mental health care pathways and associated guidance; the implementation of crisis intervention pathways and out-of-hours support for women experiencing acute distress; and, finally, ongoing engagement with service users and advocacy groups to ensure that care remains person-centred and responsive to the needs of mothers and families.”
“An earlier independent review identified that the model of the proposed six- or seven-bedded mother-and-baby unit should be that recommended by the Royal College of Psychiatrists and that the location of the mother-and-baby unit should be the City Hospital site, which, of course, is in the Belfast Health and Social Care Trust. I have made clear to officials in my Department that I wish to see the issue progressed at pace — that would be a change — but, given the importance of the service, the latest position is that public health colleagues have been asked for their input to strengthen the case for a seven-bedded unit, which will help to make the unit future-proofed. Belfast Trust is at an advanced stage of developing a capital and revenue business case.”
“I understand that the Member is curious about that, as, indeed, am I. As I understand it, the trust is still trying to figure out exactly what has gone wrong with the pipework. We know that there was pseudomonas bacteria in the pipework. That was the main issue, but, since then, I understand that some valves that have seals are, perhaps, defective. There is now a question about where that responsibility lies. <BR /> <BR />The matter is commercially sensitive. I do not want to not be open and transparent, but I do not want to say anything in the Chamber that might prejudice anything that, the Belfast Trust feels, it needs to do in liaising with the contractors.”
“I am satisfied with the verbal assurance that I got as recently as yesterday that work is progressing on the children's hospital on time and to budget. That said, we are in the foothills of a long building works campaign. I am happy to report that the Falls Road has not collapsed, and I do not say that flippantly. Work has to be carried out in the first instance to ensure that the road is shored up, and that appears to have been done successfully.”
“However, I accept the point that it does nothing to restore public and political confidence in the Belfast Health and Social Care Trust.”
“As the Member said, this is a different issue. A fire safety audit was carried out at the Royal Victoria Hospital on 4 June by personnel from the Northern Ireland Fire and Rescue Service under the Fire and Rescue Services (Northern Ireland) Order 2006. The audit found a substantial risk at wards 4 and 7, with a score rating that falls within the enforcement notice category. A follow-up meeting took place on 11 June to assist the Belfast Trust in making the necessary improvements. Another meeting is arranged for this afternoon. <BR /> <BR />I appreciate the pragmatic approach that the Fire and Rescue Service takes to working with responsible persons at audited premises to mitigate risk. In this case, the Fire and Rescue Service inspection officers continue to work with Belfast Trust officials.”
“Therefore, I would like an external view about whether option b or 2 is the right one, whether it really should take 28 months and whether there are parts of the hospital that we can start using while we fix the water. The area of real danger, as you know, is the neonatal unit, where the most vulnerable children are. I also feel that I need to better understand from those who were against option b why that was the case. <BR /> <BR />I am far from finished on this. There is nothing good to say, except that it is a magnificent facility that is not in use.”
“First, no decision has been endorsed by me. There were three options, and I know that the trust is going for option b. That appears to have a timeline — I am sorry to say this — of 28 months. That is another two years and a bit and several million pounds. <BR /> <BR />As I said, I have met the relevant official. I have not accepted this. I cannot gild this lily; I cannot soften this. None of the three options can be guaranteed to solve the problem. The third option is to rip out all the water works and start again, and that will take even longer. <BR /> <BR />I have asked that we find an external expert because, when the multidisciplinary team looked at the three options, the majority went for option b or 2 but not everybody.”
“<BR /> <BR />The Belfast Trust has assured me that the safety of patients remains its highest priority in addressing the water safety issues in the new hospital. I support that position. In that regard, I can advise that the trust has confirmed that it will establish a robust flushing, management and testing regime for the water systems during and after the remediation works. The management of the regime to ensure patient safety will need to be closely monitored by a dedicated trust project water safety group.”
“I have already met the trust's director of strategic development to try to satisfy myself that everything possible is being undertaken by the trust to allow the maternity facility to become operational as soon as possible while ensuring patient safety. There are a number of issues with the report and proposed way forward on which my officials and I have tasked the trust to come forward with further information. <BR /> <BR />I can understand why there is a genuine desire from the Committee to receive the report, and, once the next steps are determined — hopefully that will be very soon — I assure members that the document will be shared and officials made available to brief the Committee as required.”
“The Belfast Trust recently completed the multidisciplinary review of the options for the remediation works required to address the water safety issues in the new maternity hospital at the Royal Victoria site. The review has been in the form of multidisciplinary risk assessment workshops held in April and May. The intent was to determine the route forward for the building and the level of remediation works required to give assurance of safety. A recommendation on the option to be implemented was discussed and accepted at trust board level on 5 June. The trust provided the Department with a briefing document only last Thursday. It outlines the proposed remediation works to be implemented, and it includes a programme for the remedial works and estimated costs for same. <BR /> <BR />My officials and I are reviewing the document.”
“On a point of order, Madam Principal Deputy Speaker. I understand that Mr Donnelly made a point of order earlier to the effect that the supporting document that I mentioned during my response to the question for urgent oral answer had not been received by members of the Health Committee. I understand that there was some sort of administrative error in processing that. However, I confirm to the House that the Clerk to the Committee for Health is now in possession of that document.”
“I am not in a position to do that yet, because we have not scoped out to what extent the behavioural and cultural issues that are now known about in the cardiac surgery unit are replicated elsewhere across the trust. Peter McBride will be doing that for me, so, until he gives his assessment of that, it is impossible to put a timeline on it. For me, it is all urgent, so I say as soon as possible. What that means, I cannot tell you in days, weeks or months.”
“I am not aware of that, but if the Member is and has details, I encourage him to take the responsible route and report it.”
“I can give the Member that exact assurance. Again, I have been asking what I think are pretty basic questions about the number of doctors who have been referred to the General Medical Council and the number of whistle-blowing cases and tribunals etc. If I may put it this way, perhaps the responses did not demonstrate a depth of knowledge that I might consider appropriate. That needs to change.”
“I see absolutely no reason not to forward the action plan to, for example, the Health Committee as soon as I get it.”
“Also, if the way to move from complaints is to go into whistle-blowing, how do we ensure that the maximum number of staff has appropriate confidence in that whistle-blowing process?”
“I give the Member that assurance; absolutely. We have two points here. When I had my 45-minute session with the chair the other Friday, we discussed the quality of the complaints process and how he and the trust quality-assure what their human resource team does when dealing with complaints. Reference was then made to the whistle-blowing process, which the trust has. I do not think that I am breaking the confidentiality of the discussion with the chairman when I say that I do not think that the level of staff confidence in the whistle-blowing process is as good as it needs to be. That is one of the areas that I will put in the terms of reference for Peter McBride. How do we quality-assure how complaints are handled? That includes the timeline.”
“<BR /> <BR />Even if it did not fall to Peter McBride to address such events because they were not directly associated with those behaviours and the culture, they should not be happening anyway. I certainly expect all trusts to work to deliver standardised regional services. The quality of that work would be measured by people's not being gowned up at the fifth time of asking and then being told, "I am sorry. It is not going to happen."”
“The answer to that depends on whether those postponements and delays are part of the toxic culture and to do with the behaviours of the surgeons in particular. If so, I absolutely expect Peter McBride to address that issue. <BR /> <BR />I should tell the House that we have not agreed the final terms of reference. One of the reasons for that is that, last week, I met the relevant unions and professional bodies and invited them to give me their thoughts on what they think the terms of reference should be, because it is important that those be genuinely co-designed and co-produced. There is a very little point in me saying, "I am satisfied with how we went about this and with the conclusions that we have come to", if the unions and others who deliver healthcare in the Belfast Trust are not.”
“As I just said, there is absolutely no evidence that the outcomes from the procedures carried out by the cardiac surgery unit in the Belfast Trust are anything other than first class. To rebuild public confidence, I am putting in place Peter McBride. I hope soon to be able to announce the name of the second person, who has expertise in good clinical teamwork. They are the right people to go into the trust and make sure that the trust board is fulfilling its duty, which is to tackle the issues and detoxify the toxic atmosphere.”
“It is incredibly serious where it is happening, but I do not believe for one millisecond that it is happening everywhere in Health and Social Care (HSC).”
“First, I understand why that constituent is extremely concerned. She is being asked to go through a very serious procedure, but there is no evidence — no evidence — of bad clinical outcomes from that cardiac surgery team. I hope that she will find some reassurance in the fact that the outcomes from such procedures are first class. The difficulty is the environment in which those first-class outcomes are being delivered. <BR /> <BR />If the problem is more widespread, I will take advice from Peter McBride, and, if necessary, others: the Chief Nursing Officer, the Chief Medical Officer and whomever else I need to speak to. We will tackle the issue and do so wherever it occurs. Again, for public confidence, I say that there is no evidence to suggest that the situation is endemic. We therefore need to keep it in proportion.”
“I have every confidence in Peter McBride. As I stated in my written ministerial statement, I have known him for some 17 years, since my time as a victims' commissioner, when he was chief executive of one of Northern Ireland's leading mental health charities. He has a lifetime's experience of organisational culture, so he has the right experience and the right skills. He certainly does not hide away from confronting issues when they arise, so I am convinced that he is the right person to do that job for me. <BR /> <BR />Let me emphasise once again to the Member and to the House that it is not for Peter McBride, the Department or me to do the implementation. Our job is to oversee the implementation and to satisfy ourselves that it is taking place and, ultimately, that it has taken place appropriately.”
“<BR /> <BR />The Member will be aware that I have not been particularly supportive of an individual duty of candour with criminal sanctions up to this point. I accept that the revelations about what is happening in the Belfast Trust will make my position a lot more difficult.”
“I am aware of reports — such reports are coming to me as well as to other MLAs, including the Member — that the cultural and behavioural issues are not necessarily confined to the Belfast Trust and may apply not just to the five geographically defined trusts but to all six trusts. The challenge is to sort out which are genuine grievances and reports, given the inevitability that some people will act in a more vexatious manner, and I am determined that we will address that. However, it will take time because we have only limited resources. We are starting with the Belfast Trust, but I hope that my saying that I do not think that we will finish with the Belfast Trust provides some assurance to the Member.”
“Peter McBride will go into the trust, and he will advise me whether the issues are widespread. He will advise where else I need to be looking and demand that the trust take action about the behaviours and cultures. <BR /> <BR />One of the joys of having a permanent secretary who has been embedded in healthcare delivery all his adult life is that he knows people who are good at certain things. He has identified a recently retired clinician who specialises in clinical teamwork. The permanent secretary is liaising to make this person available, so we will have a two-pronged approach. However, until those people report back to me, I cannot be definitive about the entirety of the next steps. I am trying to make the right official available to come to the Committee on Thursday.”
“I can only repeat what I said to Mr Donnelly: you have a copy of what levels 1 to 5 entail. As to the practicalities of that, Peter McBride will be available to me from the beginning of next week. He will, in effect, be my ears and eyes in the trust while it implements the recommendations of the independent report commissioned by the strategic planning and performance group (SPPG) and the Public Health Agency. <BR /> <BR />Let me stress that I am not the employer; the trust is the employer. It is primarily for the board of the Belfast Trust to sort out the issues, and not just in cardiac surgery. Throughout the trust, where there are behavioural and cultural issues, they must be addressed. That is why I made the level 5 intervention applicable to the entire trust and not just the cardiac surgery unit.”
“I understand that the postponement was over a short number of days, and I am not aware that any harm came to any of those patients. I believe that I would have been informed had that not been the case.”
“If I used the word "cancelled" that was inappropriate, because there was a postponement, not a cancellation.”
“I beg your pardon, Madam Principal Deputy Speaker: I advised that in a written ministerial statement rather than to the Committee. <BR /> <BR />My Department and the Public Health Agency (PHA) already had escalated oversight in place, which, given this report, has been reviewed and will now also include the Chief Nursing Officer and the Chief Medical Officer providing support. The accountability arrangements will ensure that pace and urgency are injected by the trust into appropriately managing all the issues involved.”
“Assigning an issue to my Department's support and intervention framework creates a focused request for improvement by that trust. Level 5 is the highest intervention level and brings with it external support and escalated oversight. The Member will be aware that, at the Health Committee meeting on 29 May, when I attended with the permanent secretary, I agreed to release copies of that support and intervention framework to the Committee. <BR /> <BR />The accountability arrangements for the level 5 escalation in relation to cardiac surgery services in the Belfast Trust include enhanced arrangements with suitable external, experienced support, which, as I advised the Committee, will come from Peter McBride, accompanied by another experienced individual.”
“Perhaps we can do more to make people wake up feeling good about life, feeling a bit more prosperous and feeling that using substances is not a valid way in which to feel good about getting through the day. <BR /> <BR />It is therefore about poverty and hope and about giving people's lives purpose. For me, that is the big challenge that the Executive and the Assembly need to face collectively. Let us give people some hope.”
“I thank the Member for the intervention. Yes, the Right Care, Right Person initiative is the right one, because the police are not generally trained to deal with the mental health issues that we sometimes ask them to deal with. <BR /> <BR />I will finish by referring to Mr Lyons's assertion that substance use is a refuge from trauma, because I agree with him. I absolutely agree. That is why it is important that we do more to understand the causes of the causes. Perhaps the Executive and the Assembly can inject a little more hope into the lives of those people who are using substances so that they do not feel that they have to inject them.”
“I will also consider what is appropriate under the wider legislative framework. <BR /> <BR />Finally, I acknowledge the stigma. It is still there. We need to remember that it is about our sons and daughters, our brothers and sisters and our neighbours and friends. It is vital that we do not discourage them from coming forward. It is vital that we acknowledge their issues and permit and encourage them to seek help so that we can make a real difference.”
“Naloxone was reportedly used 197 times to reverse an overdose in that same period. Recent legislative changes that I brought forward, which were supported by the House and my counterparts across the UK, mean that even more people can now supply naloxone without a prescription, which, of course, increases opportunities to save lives. <BR /> <BR />While I appreciate that there is an appetite amongst some Members to go further with harm reduction services, our decisions on which services to prioritise must be evidence-based. I am aware of the overdose prevention facilities that are being piloted in Glasgow and Dublin. While there are no proposals in the strategy for such facilities here at this time, I do not rule it out. We will continue to monitor evidence on the effectiveness of those facilities and other harm reduction interventions.”
“However, I also want to be clear that there is already extensive service provision across the region, including in East Antrim and the wider Northern Trust area. That includes services that are delivered in collaboration with the community and voluntary sector, such as youth engagement services in Ballymena, which are delivered by Start360; treatment services for adults who use substances, which are delivered by Extern; and needle and syringe exchange sites along with statutory addiction services, which are provided by the Northern Trust. That is to name but a few. It is important that people know that such help is available, should they need it. <BR /> <BR />We have made considerable progress in our efforts to reduce harm. By way of example, in financial year 2024-25, 1,533 take-home naloxone kits were dispensed.”
“The strategy also takes a harm reduction approach by seeking to meet people where they are on their journey, helping them into treatment and ensuring that recovery support is there in the longer term. <BR /> <BR />When it comes to delivery in Health, the HSC substance use strategic commissioning and implementation plan has been co-produced by the Public Health Agency and the strategic planning and performance group. It creates a new whole-system, outcomes-focused strategic service delivery plan. That covers all tiers of service provision for substance use for the next four years. The plan is part of our wider health reform agenda, which stresses the importance of using our existing services in better ways to meet the needs of our population.”
“I acknowledge the growing support for a public health approach to address the harms of substance use. That is very much at the heart of my approach. Of course, as Members have said, it is not just a matter for the Department of Health. As an Executive and an Assembly, we need to work together to address the wider social determinants that are associated with substance use and the harm that it brings. Those determinants have been well rehearsed, and mental health, housing, economic inactivity and trauma all play their part. <BR /> <BR />We have an Executive strategy, Preventing Harm, Empowering Recovery, which is led by my Department. We acknowledge that we require a joined-up, whole-system approach, not only in the health and social care system but across all other sectors.”
“Legislation clearly plays its part in deterring and penalising those who seek to profit from the supply of harmful substances in our communities, but it is vital that we address broader substance use in a holistic way, primarily as a medical and social issue that requires therapeutic interventions and support, rather than focusing simply on the criminal justice outcomes.”
“<BR /> <BR />As Members are aware, there is a mix of reserved and transferred responsibilities in relation to substance use. The legal frameworks for the use of drugs, including the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016, are reserved to the UK Government. Meanwhile, as has been acknowledged, our Justice and Health Departments work closely with other devolved nations, which work together as well, and with the UK Government on general substance-related issues. There are also established links with Ireland on substance use through the British-Irish Council, which has a specific group focusing on alcohol and other drugs, and through the North/South advisory group on alcohol policy, which was recently renewed.”
“We say that substance use can cause serious mental harm and serious physical harm, up to and including death, but we need to focus on the causes of the causes: in other words, what makes people want to use substances as they do in the first place. I may come back to that. <BR /> <BR />Although the conversation often turns to drugs, we should also remember the impact of alcohol. In 2023, there were 341 alcohol-specific deaths registered in Northern Ireland — 341. Rates of alcohol-related deaths here are amongst the highest in the UK, and rates in the most-deprived areas are almost four times higher than those in the least-deprived areas. That is why I think that minimum unit pricing would be a real step in the right direction.”
“Thank you, Mr Deputy Speaker. I thank Mr Donnelly and everybody who contributed to the debate. <BR /> <BR />The statistics have been rehearsed. We can all translate them into an understanding of the human cost of substance use. That human cost impacts on individuals, families and communities. I acknowledge that every life lost is one too many, and I affirm my commitment to doing what I can to tackle this scourge. <BR /> <BR />The rise in the deaths and the wider harm over the past 10 years has been driven by a whole range of factors, including the availability of new substances, the increased complexity of cases and poly-substance use, as Mr Donnelly said. Behind all that, however, you have a complex picture of determinants. Some are social, some are psychological and some are economic. Often, we talk about the causes of substance use.”
“I am not aware of what the Member means by "definitive". He will be aware that the chief executive stood down some months ago, so we are now in a period of transition, and I am working with the permanent secretary of the Department of Health to see how we can use that period to effect better outcomes, better organisation and better structures and avoid the prospect of my having to return to the House with yet more bad news about the Belfast Trust.”
“Let me assure the Member that, first, there is no question of trying to withhold or disguise information. I have agreed that we will publish the report of the independent body. It is not a question of not wanting to give you the information; it is a question of my not having it yet, and that is the purpose of the meeting with the chair of the trust. <BR /> <BR />As for the Member's other specifics, I am not aware of any particular negative impacts. There was a bad culture and a huge, almost catastrophic, breakdown in relationships — when I say "catastrophic", that relates to four people deciding to work from home — but I do not think that there were any catastrophic impacts on the outcomes of procedures that patients underwent.”
“That is all that I am here to do: to try to deliver better outcomes not only for patients and service users but for staff, as it is clear that they were not getting good outcomes from the culture of the unit.”
“I accept the Member's proposition that people are continuously losing trust in the Belfast Trust because of incident after incident and problem after problem being reported. My language underplays the situation: what has been going on is incredible, with, as the Member said, four consultants working from home. I find it hard to process how that delivers cardiac surgery. To what extent is it possible to deliver a full service while working from home? <BR /> <BR />We need to look at this. I think that I am right in saying that the Belfast Trust is the largest trust in the United Kingdom, and that may be cause to reflect on how we deliver better outcomes.”
“I am afraid that the Member misunderstood me when I said that I was blissfully unaware. I meant that I was blissfully unaware when I was a patient presenting for a pacemaker and a defibrillator. As the Minister, I am not blissfully unaware. <BR /> <BR />As for the other part of the question, that is something that I will take up with the chair of the trust as a matter of urgency.”