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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“<BR /> <BR />Across all the geographic trusts, overnight short breaks for children with disabilities have been significantly reduced due to the limited availability of residential provision. Much of that provision is now being used for medium- to long-term care placements. The stark impact was laid bare in last year's 'Spotlight' programme, which so many Members have referred to and which featured the lived experience of five families. It also had input from the Children's Law Centre and the National Autistic Society. The accounts were powerful and touching and impossible to ignore. As a former broadcast journalist, I repeat my admiration for Tara Mills for that powerful piece of journalism. It acted as an accelerant rather than a wake-up call for my Department.”
“Thank you, Mr Deputy Speaker. In the 10 months or so that I have been in post, I have found this issue to be unique in that money is not the primary issue. I have been able to find some money. We have not been able to spend it all, and that is indicative of the fact that the issues are primarily buildings, beds and workforce. <BR /> <BR />I will immediately address the point from Mr McGrath about the numbers. The South Eastern Trust has the worst vacancy rates for social workers in children's disability teams. That speaks to what you addressed. <BR /> <BR />Some of the issues are particular to the South Eastern Trust, but others just reflect broader systemic issues that impact on families across Northern Ireland. It is not confined to one trust or area; it is a regional challenge that I want to see responded to with a regional response.”
“Like the people who are on a waiting list, I am pretty impatient to get that done.”
“I am more than happy to share the paper with the Committee at the appropriate time. The paper is coming to me to facilitate a meeting next week; I am not sure which day of the week. I cannot really say, because I have not seen it yet, whether I will just say, "That's perfect. Let's sign it off", or whether I will ask officials to go away and do a bit more work on it. I would rather that it comes to the Committee as a pretty definitive plan so that I can say, "Here is our plan. What do Committee members think of that? Can you advise and assist me on how we might make it better?". We want to proceed at pace. If we start next week, I am told that it may be another six to eight weeks before we can put the cross-border scheme in place and start the machinery rocking. That is getting well into this financial year.”
“There is an equity issue there that I am concerned about, and I want to see what can be done, with no guarantees, to try to mitigate the fact that there may be those who cannot afford or do not have the means to find the money for the upfront payment. However, perhaps we can deal with them through one of the other pathways that we will create.”
“To tackle the waiting lists in this financial year, there has to be a cocktail of actions. First, work will be carried out by the health and social care trusts. We will do that in the HSC system. Secondly, we will have to look to independent providers. Thirdly, we will look to reinstate the cross-border scheme. We will do all that at pace. I will meet officials in the coming days to look at an options paper that they are preparing for me in that regard. I put in this proviso: I know that many Members like the cross-border scheme — it is very popular — but remember that patients have to pay up front and then be reimbursed by the Department.”
“Tackling waiting lists is an Executive priority. I have no difficulty with that, because I agree with it. I will get another £50 million in June monitoring if I can provide the right plan, and I accept that I need to be able to justify that spend.”
“I most certainly have, yes. There is £215 million, which is broken into three pots of money. There is £85 million for red-flag cancer and urgent and £80 million to stop the waiting lists growing any larger, effectively. That is £165 million of the £215 million. That is coming out of my budget; it is being ring-fenced by the Executive.”
“<BR /> <BR />Most of the facial palsy assessments and treatment are provided locally through the local hospitals' specialties, but the strategic planning and performance group sends most of the patients who require specialist surgical Botox treatment to the United Kingdom via an extra-contractual referral or "ECR". <BR /> <BR />If that does not answer the Member's question, I am more than happy to accept a follow-up in writing.”
“I can say to the Member that, on average, only three to five patients are assessed as being suitable for surgery every year in Northern Ireland. Those referrals are managed through the South Eastern Health and Social Care Trust as part of a network arrangement with a specialist provider in Great Britain. The activity represents a small component of the care pathway for facial palsy. The majority of patients are managed locally across the trusts. In-reach services are provided as part of the total commissioning arrangement for plastic surgery provided annually to the South Eastern Trust.”
“<BR /> <BR />A communication is being issued to each trust in the coming weeks that will inform them of the agreed pathway, and an information webinar will be delivered to GPs and emergency departments to aid with timely and appropriate referral. In addition, a new nidirect web page was established recently to assist patients who are experiencing facial palsy symptoms. It will signpost patients to helpful information while they wait for an assessment. A video has been produced by a service-user advocate. It is being used on social media platforms to promote the new nidirect web page.”
“I thank the Member for his question, and I note his contribution to that event in the Long Gallery, which I attended. <BR /> <BR />A new facial palsy regional planning group was established in September 2023. It has developed a pathway for local services for adults and children. It has been a complex process, with multiple services involved in the pathway development — the pathways need to be multiple — and multiple access points into the service across all trusts. Those standardised pathways will ensure appropriate treatment of patients and local services, as far as possible. They will also outline the appropriate referral pathway for those who require enhanced and specialist intervention.”
“The Member will be aware that tackling health inequalities is a key focus for me; it is something that I have communicated to officials and, more broadly, the Health and Social Care system, and it has been very well received. We are starting with two urban areas as demonstration areas for Live Better, but that is because that is the easiest way to trap the empirical evidence that will allow us to validate what I intend to do. We will then tackle the deeper challenge of making it work in rural areas. <BR /> <BR />I do not want to see a single community pharmacy close, and I do not want to see one more GP practice hand back its contract. That is a particular challenge in rural areas. I assure the Member that an appropriate focus is being put on that by departmental officials and the trusts.”
“I thank the Member for her question. I wrote to Wes Streeting, Secretary of State for Health and Social Care and communicated with the then Finance Minister, Caoimhe Archibald; indeed, the three devolved Administrations in Wales, Scotland and here have been liaising. I think that there is a concerted approach to make the Treasury aware of just how serious this is, particularly in primary and community care.”
“I am afraid that you have failed in your audition to become Health Minister, but that is the way that it goes. <BR /> <BR />I do not accept that at the moment, because it is just too early. We are still in the foothills of how we carve out the Health budget, because it is, after all, over £8·4 billion. Despite the fact that there is a £400 million gap — I do not wish to underestimate the severity of that — I tend to be a "glass half full" person. I will work with the new permanent secretary and senior officials in the Department to see what can be done. Certainly, trying to avoid individuals having to put their hands in their own pockets to cover those costs is a motivation for me.”
“I want to do everything that I can to close that gap on the additional costs of National Insurance before I do many other things.”
“I thank the Member for her question. I am sympathetic to that, because it is an unexpected and additional burden that has been placed on opticians, GPs, pharmacists and the rest. Within the Budget, the Minister of Finance has informed me that £3·5 million has been contributed to what, we think, will be a £36 million challenge. That is within the broader challenge, where we still believe that, despite the additional £50 million for waiting lists, the overall budget for the Department of Health is around £400 million short of what we need to deliver all services. That means that there will have to be priorities and that decisions will have to be made. Once again, I return to the fact that, without a workforce, everything else is as nothing.”
“That falls to you, Mr McGrath, as a member of the Opposition. However, I agree that it would be nice to see those things executed after all these years, and I have faith that the AERA Minister will do that.”
“I thank the Member for his follow-up. I am not sure that I agree that that has fuelled the fire, but I am sure that every Member would like to see a wildfire management plan and a wildfire management strategy. I know that the Minister of Agriculture, Environment and Rural Affairs shares that ambition and, I think, is pressing officials to bring forward proposals. He has had a particular difficulty in that nobody tendered to deliver the wildfire management plan. However, it is not as if nothing has happened. The Northern Ireland Environment Agency (NIEA) has new vehicles that have been helping to tackle the fires in the Mournes today. <BR /> <BR />You point out many times that there is disagreement between members of Executive parties in the Chamber. It is not my responsibility to criticise any other Executive member.”
“I very much welcome the opportunity to join the Member in paying tribute to members of the Northern Ireland Fire and Rescue Service, who have been tireless in recent days, manually beating down the fires in the Mournes. I will visit them: I want to show my appreciation and admiration of them, but, as the situation is still live, it would be inappropriate and would be a distraction if I were to go down in my ministerial capacity at this stage. However, that does not diminish my absolute gratitude for what they have done to protect life and to preserve that very important area of Northern Ireland.”
“I will need half a minute to get to the answer, Mr Speaker. <BR /> <BR />I thank the Member for her question. We have been engaging with the campaign group Hernia Mesh Awareness NI about the Hughes report and redress, and that includes surgical mesh for men. I assure the Member that not just is it on our agenda but action is being taken to scope out, understand and react appropriately to the men who have suffered in that area.”
“I thank the Member for her follow-up question and her concern, which I share. The numbers in Northern Ireland have to be determined. I am not hiding behind the fact that we are waiting for the Department of Health and Social Care in London to respond definitively to the Hughes report, but it is important that the devolved Administrations go forward together on the issue. If you start doing things differently, you potentially sow the seeds of division among the people who are suffering in England, Scotland, Wales and here. I am open to what the Member has suggested and will make that part of my consideration, but, I am afraid, the next step is to wait for the UK Government to respond to the Hughes report.”
“She recognises that any response by the UK Government is likely to have implications for the devolved Administrations, and she said that she is keen to work closely with officials right across the UK in considering the report's recommendations. She has provided assurance that my officials and I will be engaged in a timely manner and in advance of any UK Government response. The approach to redress in Northern Ireland will be informed by the UK Government position, and, as I say, that is not yet determined.”
“I very much regret that those who have been harmed by pelvic mesh implants and sodium valproate have had to wait so long for clarity on the way forward in response to that report. <BR /> <BR />I wrote to Baroness Merron, who is the Parliamentary Under-Secretary of State for Patient Safety, Women's Health and Mental Health at the DHSC, and requested an update on the consideration of the Hughes report recommendations. I have sought assurances that consultation with the devolved Administrations will take place in a timely manner and in advance of any UK Government decisions. Baroness Merron responded that the UK Government are carefully considering the report before coming to a decision.”
“The Patient Safety Commissioner for England, Dr Henrietta Hughes, made recommendations in the Hughes report on redress for those who were harmed by pelvic mesh implants and the medicine sodium valproate. The Hughes report was published on 7 February last year. Dr Hughes's remit was specifically for England, but it is acknowledged that patients from across the UK have been affected by these issues. The three devolved Administrations await consideration and assessment from the Department of Health and Social Care (DHSC) in London. However, the UK Government have not yet formally responded to the Hughes report, and a UK Government decision on redress has not been taken.”
“Timing will be dependent on a number of factors, as you can imagine, including site availability, ease of obtaining planning permission, tendered costs and everything being affordable within our capital budget. Therefore, I am not in a position to provide a cost estimate at this point. Definitive timings and definitive costs depend on the outcome of the engagement in the design process and confirmation of the availability of funding through our capital plan. The project will be subject to the usual business case approvals, and that will include any potential revenue costs as well as the capital. I would very much like to see a successful and speedy completion of the project.”
“I want to emphasise that I did go there in December. They are great people and very dedicated people, but they are working in a building that is long past being fit for purpose. They do not have enough space, rooms are too small, and they are just making do. You need buildings, equipment, medicines and workforce, and I always prioritise the workforce, but, in this case, the building is just not good enough. <BR /> <BR />We are at the very start of scoping the project, so I am afraid that it will be a number of years before the building will be delivered. Experience of similar schemes leads me to conclude that it could take in the region of three to five years.”
“It will be subject, of course, to the usual business case approvals. Timing will be dependent on the outcome of that process and, of course, approval of funding through the Department's overarching capital plan. I am keen that we move towards a new build for Carrickmore.”
“<BR /> <BR />Carrickmore is a large practice with five GPs, practice support staff and approximately 10,000 patients, but its growing size means that it now operates out of a space that is below its capacity requirements and, indeed, below the Department of Health's recommended schedules of accommodation for a practice of that size. Approximately £70,000 has been invested in the existing premises in the 2024-25 financial year, but that, of course, is only an interim solution to address immediate pressures. Work has also commenced to address the longer-term needs of the practice, and that is potentially in the form of a new build. Initial engagement commenced in October last year between my Department, the Western Trust and the Carrickmore practice, and they have begun to scope the project together.”
“I thank the Member for his ongoing interest. I am aware of the frustrations and concerns being raised locally, and he is getting those in his office. I met the GP partners and their staff at the health centre in Carrickmore on 4 December last year. <BR /> <BR />I fully recognise that there is a huge need to invest in primary care to support the reform agenda and stabilise primary care. Capital investment is required to modernise and maintain that service and ensure that the estate is fit for purpose to enable service delivery. Since financial year 2018-19, around £38 million of capital has been invested, through the primary care infrastructure development programme, in GP premises, including investment in accommodation for primary care and multidisciplinary team purposes.”
“Those groups have been on ceasefire for over 30 years, which means that they have been on ceasefire for longer than they were active — not that they should ever have been active — so this question remains: why do they still exist, 30 years after they declared ceasefires? They exist for a number of reasons. Some people are lining their pockets; other people are exercising coercive control over communities that I and many others in the House represent. It is time to stop it. We cannot over-exercise ourselves in what we do to give the people who live in towns such as Newtownards the ability to grow up, live, express themselves and enjoy themselves as freely as possible.”
“We have a number of strategies in play. If you are referring particularly to people who are suffering trauma and community coercive control by paramilitary groups — is that where you are? — yes, there is the tackling paramilitarism, criminality and organised crime programme. There is a lot happening. Justice leads on that, but it is a whole-Executive response. <BR /> <BR />I represent the town of Newtownards and am proud to do so. Fantastic people live in the town, but I have to accept that, if you go there and look at the murals, you will see every shade of loyalist paramilitarism represented. I am aware that coercive control by paramilitary groups is going on, particularly in the concentrated housing areas such as the West Winds estate and others.”
“I am suffering from trauma from your sense of humour.”
“I am very aware of that, and I will work hard to try to protect it, because it was my idea, and the idea was to work for the victims and survivors of the conflict.”
“I thank the Member for her question. I acknowledge her ongoing interest in the area and in the broad field of mental health and suicide prevention. As I said, April 2023 is the appropriate date to start the clock on phase 1, so April 2026 is when three years will be up. I go back to the fact that it is a period of at least three years, not of three years. Certainly, from talking to groups such as Relatives for Justice (RFJ), the Ely Centre and South East Fermanagh Federation (SEFF) — the six or seven groups that were always involved in the co-design of the network — I know that there is extreme concern. It is not over-egging it to say that there is extreme concern about opening it up, thereby diluting what it can do for their service users.”
“We may look at a graduated move towards opening it up, because, to get back to the Member's question, the capacity will always struggle to meet the demand.”
“That answers the Member's question, in that the capacity is not there to deal with every single victim and survivor who wants to ask for help with the trauma that they suffered, and continue to suffer, as a consequence of the conflict. Could that resource be put in place? I think that doing so would be just too big an ask. On top of that, at some point there has to be a phase 2, which will open up the RTN further in order to comply with what the officials were saying back in the day, which, as I said, was that one cannot have a National Health Service service that is limited to a specific group of the population. Phase 1, that period of at least three years, takes us to April of next year, so we are only 12 months away from a decision, but the decision does not have to be to just open it up to everybody.”
“As I was saying, the RTN was set up specifically for victims and survivors of the conflict. It was agreed during the Stormont House talks by Martin McGuinness, Peter Robinson and all the other party leaders who were involved. Then, however, officials made the point that the National Health Service has to be open to all. One cannot have an NHS service, or a Health and Social Care (HSC) service, that is limited to a specific number of people. The compromise was to have that first phase, which is to run for a minimum of three years, with phase 1 being specifically targeted at victims and survivors of the conflict. <BR /> <BR />The network has a waiting list.”
“<BR /> <BR />I am certainly open to discussions on a bereavement payment. I would not want to make policy on the hoof — I am sure that the Member will appreciate that — but that is certainly worth detailed and due consideration.”
“I thank the Member for his follow-up question. The Regional Trauma Network is as broad in its reach as it can be, and, of course, service users bring up bereavement daily. I am confident that the RTN has the capacity, skills and experience to deal with that. <BR /> <BR />The Member will be aware that the Regional Trauma Network was my big ask as I led the Ulster Unionist delegation into the Stormont House talks — my goodness — 10 or 11 years ago, so I am pleased to see it in place. The biggest toxic legacy of our conflict, which we so euphemistically call our "Troubles", is poor mental health and well-being not just at an individual level but at a family and community level. The RTN is making significant inroads in tackling that toxicity, and bereavement is a central part of that.”
“The service user experience captured has been positive. <BR /> <BR />Of major significance, in addition to direct referrals between statutory and community and voluntary sector organisations, is the fact that the RTN is taking forward additional work across a number of work streams, including training, research, monitoring and evaluation and children and young people, recognising the intergenerational impact of the conflict. The Regional Trauma Network also contributes to the overall ambition of the mental health strategy. Ultimately, the network and the service that it provides make a real difference to real people who have suffered physical and psychological harm. It offers a range of supports and interventions to address the long-term consequences of their traumatic experiences.”
“I am pleased to say that, since the beginning of the 2023-24 financial year, around 9,000 individuals have availed themselves of services in the Regional Trauma Network through the Victims and Survivors Service (VSS) and its 46 community and voluntary sector partner organisations. Around 600 individuals have availed themselves of services through the health and social care trusts' Regional Trauma Network teams. To date, the total number of cross-referrals has been low, but that is not unexpected at this stage, and numbers continue to grow. The latest figures, as of the end of December 2024, are 60 referrals from trusts to community and voluntary groups, with 123 referrals from community and voluntary groups to trust trauma teams. At present, there are 424 people in therapy across all trust trauma teams.”
“It is not an area where I have come to some definitive conclusion on why, while we are investing, they are not satisfied with that investment and still come back with genuinely held concerns. That will be an ongoing discussion until we get to a resolution where we are all happy that we have an agreed position.”
“I thank the Member for his question. He knows that I have the desire to shift left to primary and community care, and community pharmacies are key to that, as are general practitioners, dentists and so on. I continue to engage with Community Pharmacy NI. They come to me with what, I believe, are valid concerns. When they articulate where they are, they do not make things up. They say, "We have genuine concerns about the future of our ability and the sustainability of some of our community pharmacies". Yet, when I look at the statistics, I see that we have more community pharmacies per 100,000 people than anywhere else in the United Kingdom and that our investment in community pharmacies has gone up significantly, by millions of pounds.”
“People who were medically fit for discharge from acute beds were still in the beds because they did not have what they wanted, whether that was a bed in a care home or a domiciliary package. That is not easily fixed, because it requires a long-term recruitment and retention process to get the right workforce. We are working on it, and the real living wage is an important step in addressing the challenges.”
“I thank the Committee Chair for his comments and the question. Yes. The biggest single action that I can take is to introduce a real living wage for people who provide social care. That way, it will become a more attractive profession, and we can therefore grow that workforce. If we do not grow the workforce, the pressures will, by and large, remain. <BR /> <BR />We often say that, to deliver healthcare, you need buildings, equipment and medicines but, if you do not have a workforce, all that is as nothing. When winter pressures were manifesting themselves in the emergency departments, that was when we saw where the problem was. It was the flow, and the problem was at the back door.”
“I thank the Member for his follow-up question. There is a question in my mind about what percentage of people who attend an emergency department do so unnecessarily. Again, "Zero" would be the ideal answer to that question. We are trying to identify as early as possible in the patient journey the correct pathway for them. That may be an emergency department, but it may not. It might be to stick with primary care and their general practitioner. We also have urgent care centres being developed in our acute hospitals and other pathways such as respiratory areas and cardiac areas. We are looking at as many different pathways as possible to take the pressure off the emergency departments.”
“I attended the first of those in March and was encouraged by the engagement and enthusiasm from leaders right across the Health and Social Care (HSC) system; indeed, over 100 people turned up. The room was full, and we had a waiting list. The final workshop will be held in June, and that process will inform a sharper, more focused winter improvement plan for next year.”
“We had long waits and overcrowding, but we have learned from previous years that, overall, unscheduled care activity and acuity do not increase in winter; rather, it is the slowing of the flow through the system that creates those delays and additional pressures. Some of the flow issues are due to increased discharge delays to nursing homes and because domiciliary care demand has exceeded capacity. The situation is clearly not what I wish for for our patients or staff, and I apologised at the time to everybody affected. <BR /> <BR />I remain determined to find better ways to work as a system to tackle the complex issues that we face. That is why I initiated a series of winter planning workshops with the aim of identifying new and innovative solutions to our collective system flow issues.”
“I was clear last year that we expected a very difficult winter and that my Department's winter plan would not eliminate the pressures but, at best, serve to mitigate them. We know from previous years that people become sicker and sicker for longer over the winter months and that that brings additional pressures to a service that is already feeling strain and facing long-term financial challenges. That is why I no longer talk about winter pressures but about additional winter pressures, given the pressures that are on emergency departments (EDs) 365 days a year. <BR /> <BR />As expected, the huge pressures manifested themselves in those emergency departments over Christmas.”