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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“Are you telling me that that level of resource can be diverted without a potential impact on business as normal elsewhere — on road traffic collisions, house fires and all the rest that the Fire and Rescue Service cannot predict? Are you telling me that those firefighters could look at me and say, with 100% certainty, "This does not put other areas at risk"? No, they could not. <BR /> <BR />Then they saw on social media that long list of houses in multiple occupation (HMOs). I saw in the eyes of the senior leadership of the Fire and Rescue Service not fear but recognition that, if the attacks on those homes were widespread, they would not be able to handle them. They would not have had the numbers of trucks or personnel to handle that level of attack and lives would have been at risk.”
“Yes, I absolutely give that assurance. The last point that the Member made about the entire workforce in Health and Social Care is important to me. On Wednesday night, I was in Lisburn, in the Northern Ireland Fire and Rescue Service's command and control centre. The previous night, it had received more than 300 phone calls. That is the highest number that anybody in that room could remember, and some of them have been in the Fire and Rescue Service for over 20 years. They said that it was much worse than the Eleventh night bonfires. <BR /> <BR />There were 31 fire trucks in Belfast last Tuesday night, 21 of which did not belong in Belfast. They had come from fire stations here, there and everywhere. That was a third of the entire fleet.”
“<BR /> <BR />We have to take the matter as seriously as anything that has happened during the mandate. I have been attacked many times on social media because yesterday, on television, I said that what had happened was a stain on this country locally, nationally and internationally. I stand by that statement, despite what people say. People ask, "Why are we bringing people in? Why are we not training up more local people?". We are training up more local people than ever, but we cannot get enough of them to ensure that the system does not collapse without our international colleagues.”
“I assure the Member that their concerns are being heard. I hope that I demonstrate that by visiting not just hospitals but places such as the one in Ballyclare that I mentioned. I will continue to do that. For the past two years, I have been out every week, at least once a week, visiting Health and Social Care settings. I would like to think that the Health and Social Care workforce understand that I am interested and am listening. <BR /> <BR />When it comes to what is happening outside of Health and Social Care settings, the police clearly have a role. When the children of international colleagues are afraid to go to school, that stretches beyond what the Department of Health can do, apart from speaking in their support and liaising with the Police Service of Northern Ireland, in particular, as well as social services where appropriate.”
“Those workers put themselves potentially in harm's way, yet we reward them with racist attacks. Seriously?”
“On the Member's second question, all the trusts have protocols in place to provide physical and psychological support to anybody who works in our Health and Social Care (HSC) system who is under attack or under threat. I have not had a report on the number of staff who have left. If people are leaving, I expect to be told, but I have not had any reports of anybody having left. Once again, however, if people are leaving, no one in the House could blame them for doing so. <BR /> <BR />It is not just in our hospitals. It happens to people working in domiciliary care — home care — delivery. Remember that, when you knock on somebody's front door, you do not know what to expect. You know that you are tending to a service user or a patient, but you do not know who else is in the house. You do not know who is lurking round the back.”
“Down the street, a community domiciliary care team comprised largely of international colleagues were frightened to go about their business. They work across Northern Ireland and are frightened to go to help people. <BR /> <BR />Mr Ogilvie was tended to by healthcare workers. I do not know who was on that team, but I would be surprised if there were not international colleagues who helped that man. <BR /> <BR />The people who are out rioting, who are racists, do not care. That is appalling. Let us remember that healthcare workers are attacked daily in our emergency departments and in our hospitals by indigenous people from this part of planet earth. The last thing that those workers need is a layer of racism on top.”
“I do not have those statistics to hand. It is hard to measure in a statistical way the impact on morale, on people feeling safe or on the number of our international colleagues who now feel that the situation has become so dire that they are no longer prepared to stay with us. I tell them that they are welcome, that they are treasured and that we want them to stay. I would not, however, encourage a single person to stay if they felt that they were putting themselves at risk physically or at risk of psychological torture. I will be clear that that is what has been happening. <BR /> <BR />It is not just about the hospitals. I was in Ballyclare last week, where I visited an advice centre for international colleagues working in healthcare. It had been attacked, and the windows were cracked.”
“I thank the Member for his question and for the interest that he has shown. I was in the Mater Hospital last week, where I heard a number of horrendous stories. I will not share them with the House, because the narratives would identify specific nurses and put them back at risk of injury or abuse. I heard, however, of one young nurse who had to negotiate her way through the rioters and the barricades at Carlisle Circus. That is not right. It is not right at all. That was the subject of one of the communications that I had with the Chief Constable. I assure the Member that Mr Boutcher took the issue very seriously indeed.”
“That resulted in an observable increase in police presence in the vicinity and on the site of the Mater and in the emergency department, with police liaising with staff on the ground. Trust security staff and duty managers also provide a range of interventions to support staff that will be deployed, going forward, when required.”
“I was in direct communication with the Chief Constable a number of times last week, and that contact will continue. Many of the issues with gaining access that were faced by staff last week related to disturbances in the surrounding areas rather than on the campuses themselves. <BR /> <BR />The safety of staff is paramount. A range of security measures are in place. Dedicated security teams are available 24 hours a day across our main sites. They are trained in the prevention and management of violence and aggression. They carry out regular patrols, monitor CCTV and liaise with the PSNI. <BR /> <BR />The disturbances largely centred on the Belfast area, particularly the Mater Hospital. The Belfast Health and Social Care Trust engaged regularly with the PSNI, including at a meeting with the Deputy Chief Constable on 11 June.”
“The appalling events of last week — I include those on Monday night — have left a mark on healthcare staff, particularly our international colleagues, some of whom have endured horrendous experiences. As I have stated many times, not only do we benefit from our international colleagues, but some staff groups depend on them. Without their commitment and skills, parts of our health service would simply collapse. That is a simple matter of fact; one that, I suspect, that the individuals responsible for some of last week's outrageous events either do not appreciate or perhaps chose to ignore. <BR /> <BR />Trust security responsibilities extend to hospital premises and grounds. Security issues beyond the perimeter of trust sites are a matter for the PSNI.”
“I had to reduce those delays. As the Member knows, the protocol was implemented on 27 April. She has identified the downside of it. As we have discussed already in Question Time, it is not just about what happens at the front door but about the whole flow through the hospital and out the back door and into the community, where we need more health and social care capacity. I had a couple of meetings with clinicians, hospital administrators and trade unions. I felt that it was going to take a long time to implement. However, initial responses about ambulance handover times at hospitals since 27 April are really good. I commend everybody involved because it is not just the ambulance crews but the intake staff, the nurses, the clinicians and the administrators. Release to rescue is only part of the solution to a bigger problem.”
“I am not sure that I agree, but I will certainly look into that. Common sense should apply, and I am not sure that we are comparing like with like when it comes to reading a biblical passage, one to one, to a patient in hospital and what happened out on the streets.”
“If I am asked to issue guidance, I certainly shall. I was not aware that there was any uncertainty until the Member spoke just then. Perhaps he could elaborate on that, and that will inform a decision on whether we go with renewed or fresh guidance.”
“If the federations support pay parity with Agenda for Change, they should just do it.”
“GP federations are not health and social care bodies. Pharmacists in the GP federations are employed by the GP federations, so it is up to the federations to determine their pay and conditions. We have no locus there, but we did provide an uplift for staff costs to federations in respect of their pharmacists on the basis of the pay award agreed by the Review Body on Doctors’ and Dentists’ Remuneration. We have done that for last year and are committed to doing it for this year, if and when we get a Budget.”
“I do not accept that. I am trying to remember. As we know, the Southern Trust did not follow the standard procedure of one full review and one quick review. It went for two full reviews. Of course, the trust did that with the best of intentions, but it meant that we could not benchmark against other services, and that was one of the big problems for the trust. From memory, when it comes to the Western Trust, the level at which it pressed the warning light was different. I will refresh myself on that and meet the people whom Sinéad McLaughlin wants to bring to me. We will see where that takes us.”
“The focus that I inherited was entirely on the Southern Trust, so that is why we pursued that to its conclusion. Well, it may not be the conclusion; obviously, the Ladies with Letters and others are considering potential next steps, and that is, of course, their right. I am aware that there are women in the Western Trust area who also had issues. I will refresh myself on those situations, because I believe that there is no direct read-across to what happened in the Southern Trust. Sinéad McLaughlin wrote to me to ask whether I will meet some of those women, and I signed off on that today, so we will find a diary date to make that happen.”
“That is how we must work in these constrained financial times. We must gather up pots of money to enable the shift left to the neighbourhood model.”
“It says two things to me. First, it speaks to the confidence that the National Lottery has in the Together for Families project, because that £30 million is an unprecedented investment in a project of that scale in Northern Ireland. Even if the funding had been only £1 million, I am convinced that the National Lottery would still have done its due diligence and sweated the proposals in order to be assured that the plan was solid and robust. <BR /> <BR />Secondly, it tells us about the value of partnerships. As we try to shift left, we will look to others to come in and help us with funding and other resources. The Member will be aware of our cancer charities fund, which is relatively new. We put in £1 million, and Macmillan Cancer Support matched it with another £1 million, so we got £2 million.”
“The funding is absolutely transformational, and it is a once-in-a-lifetime opportunity to switch how we intervene for families with young people who have real issues. It is an opportunity to keep them out of care and get away from reactive, statutory interventions to early, community-based support. That is entirely consistent with my desire for the health and social care system to shift left to the neighbourhood model. I am very grateful to the transformation fund for the funding, which is just shy of £30 million, and I promise that it will be well used.”
“What I will not do is encourage the Member to speak to his colleague, because I know that the Minister of Finance wants to bring forward budgets for resource and capital spending. I cannot make a commitment without a capital budget, however. I need to know what my budget will be, after which I will have to look at the priorities. I am not particularly optimistic that that venue will be high up the list, because there are a lot of demands on my budget. In an ideal world, of course, I would give that commitment here and now, but I am not in a position to do so. I regret that.”
“I do not carry that level of detail or set of statistics in my head, and I do not have them on file. I am more than happy to get back to the Member on it. The Executive or, more likely, the next Executive will need to do a lot of work in that area and legislate to make life better for those who need those services.”
“I will check. I am not sure that I signed off on it; it is not striking a bell with me. The arm's-length bodies have certain autonomy. As the Member said, it was the Public Health Agency that posted it. I will certainly check and write to the member.”
“For example, I was at a four-nations meeting on drug use last year in Scotland, where they are so concerned about people injecting a certain class A drug that, in one 12-month period, they gave out 400,000 pieces of foil to encourage people to smoke the drug rather than inject it in oder to avoid blood-borne disease. I support that as a practical step, rather than saying that it is possible to stop the illegal use of drugs.”
“I take a rather practical view of the use of banned or illegal substances: they have been with us for a long time and will be with us for a long time to come. I know that some people, including those in the Member's party, say that the only acceptable message is, "Do not take illegal drugs". That position is perfectly valid, and I acknowledge it, but I do not think that it is practical. People take those drugs, and a concert is one of the occasions when they are probably most likely to take them. I am into mitigating the damage.”
“I have no vires over the Department of Agriculture, Environment and Rural Affairs, but I would ask that people respect the role of firefighters in the Northern Ireland Fire and Rescue Service and accept that, at times, they put themselves in harm's way physically and mentally to keep the public safe. I would therefore ask that everybody who is in a position of responsibility or authority make sure that they do all that they can to keep our firefighters safe, and, when those firefighters have to put themselves in harm's way, that everything is done to make sure that the environment is as amenable as possible.”
“I have not had any direct contact with the Fire and Rescue Service on those two specific fires. Today, however, I signed off on the responses to three questions for written answer from you on that issue: the numbers for waste-management sites and other areas.”
“My Department has held a series of round-table meetings with key stakeholders from across the sector. The purpose was to explore and learn from good practice in each of the trusts and to review any additional measures that could be taken.”
“Responsibility for ensuring equitable access to domiciliary care rests with each trust. At a regional level, the Department works closely with the trusts through the social care collaborative reform board and its implementation groups. My Department has developed a 10-year strategic plan together with a three-year delivery plan to implement a reform agenda. Domiciliary care is an important element of that, and one of the social care collaborative reform board subgroups has been tasked with developing a sustainable adult social care system that can meet the future needs of people who require care and support. <BR /> <BR />The work includes establishing a new regional model for domiciliary care, including an updated domiciliary care contract.”
“The issue has been under active review since concerns first emerged. The trust has been progressing a careful, clinically led look-back process, in line with established guidance. During that time, the priority has been to ensure that the information is validated and that patients are contacted in a structured and supportive way rather than causing unnecessary alarm. I make this broader point to the Member: any time that something goes wrong, as the Minister, I expect an early alert. In other words, I expect to be alerted in real time about a problem or potential problem. Such, arguably, lengthy delays in problems coming into the public domain are not acceptable to me.”
“<BR /> <BR />In addition, a dedicated patient advice line has been established. It provides patients with a direct and accessible point of contact. I should stress that that support is not limited solely to those who have received a recall notification. Any patient who has concerns about their device, whether or not they have received correspondence, is encouraged to contact the advice line for clarification and support.”
“I fully recognise that receiving a recall letter about a cardiac therapy device can give rise to understandable anxiety and distress not only for patients but for their families and friends. It is therefore essential that appropriate support, reassurance and timely clinical assessment be in place throughout the process. The Belfast Trust is treating the matter with the utmost seriousness, as am I. A structured and carefully managed phased approach is being undertaken, with affected patients being contacted and reviewed. The trust is working to ensure that individuals who receive a recall letter are offered an appointment that is aimed at minimising any prolonged period of uncertainty and ensuring that patients receive appropriate clinical advice and, where necessary, timely intervention.”
“There are always robust governance arrangements in place, whether we do it in the health and social care system or use the independent sector. That applies to all the work that we do.”
“Sorry, I am not sure whether I understood the Member correctly. Did she ask how the independent sector will do that?”
“I am always happy to meet advocates for particular conditions.”
“Formal guidance issued by the British Society of Gastroenterology in 2014 specified that a robust diagnosis of coeliac disease should involve an endoscopy procedure and an accompanying biopsy. That was followed by interim guidance in 2020 on a no-biopsy protocol that was intended to support timely diagnosis during the COVID-19 pandemic when our endoscopy capacity was significantly reduced. The pathway allowed diagnosis based on blood tests alone under specific conditions. To date, the guidance issued in 2014 remains the formal guidance. It limits the scope to adopt no-biopsy pathways at scale. Broad adoption would require updated formal guidance from the British Society of Gastroenterology, followed by the issue of clear referral guidelines, based on that guidance, to primary care.”
“Yes. I have been clear about my commitment to implement the real living wage across the social care workforce, and I have set that out directly to the key stakeholders. I wrote to trade unions to confirm the pathway to delivering the real living wage through Agenda for Change arrangements from 2026-27. I then wrote to members of the social care fair work forum to reaffirm my commitment to implementing the real living wage for independent-sector adult social care staff from, again, 2026-27, with any uplift to be backdated to 1 April. Taken together, those actions demonstrate a clear intention to deliver the real living wage across the statutory and independent sectors, subject, of course, to the availability of funding and final budget decisions.”
“I am sure that it is very bad for morale. I understand the disappointment, and I have acknowledged that my decision was counter-strategic, but, given the financial constraints that I face, it was unavoidable. Social care staff make an essential contribution — absolutely — and, if we had more of them, they could do more. I share the ambition to establish the sector as a real living wage sector as soon as finances allow. That is a very important step towards improving the flow out of the back door, but there is more to be done, and mileage allowance, terms and conditions and work-life balance are all in the mix.”
“I agree with the Member that the problem is community capacity in domiciliary care workers and packages and care homes and care home beds. Where is the money to do that? Yes, we spend a lot of money on bank and agency staff, but, if we divert that flow of money to create more community capacity, hospitals become unsafe. If the health service is a train, we are running it on a track that we do not want it to run on; we want to build a different track and run it on that. We can barely afford to run it on the track that we are on, never mind creating the track that we all know that we need to create. I do not have the solution, because I do not have the money. We know what to do and how to do it; the frustration is that we do not have the cash to make it happen.”
“The Member is right to talk about the money that is spent on agency workers. Agency workers are used to make sure that we deliver safe services. We use agency nurses, for example, only if the pool of bank nurses has been exhausted. We have had, I believe, 100% success in no longer using agency social care workers. We are now looking at nursing and at locums. There is an acceptable and necessary level of agency and locum work to keep delivering safe services, but we are way beyond that, and we need to crunch it down.”
“Notwithstanding those constraints, I have made clear repeatedly that the real living wage remains a priority. It will be implemented at the earliest point that it becomes affordable. Importantly, once introduced, the uplift will be backdated to 1 April 2026, reflecting my commitment to that workforce.”
“I fully acknowledge the essential role played by domiciliary and home care staff in supporting people to remain safely in their own homes and thus alleviating pressure on our acute services. Home care workers provide far more than just practical or personal care and support; they provide reassurance, continuity and human connection at moments of vulnerability. I remain fully committed to implementation of the real living wage for home care workers in recognition of the vital front-line role that they play in supporting vulnerable individuals to live independently at home. I am not in a position at this stage, however, to confirm a definitive timeline for implementation. That is due to my Department not yet having a confirmed budget settlement. We continue to face significant financial pressures, as I have already alluded to.”
“That approach enables proportionate monitoring while ensuring that dementia training is being embedded consistently across the system.”
“My Department monitors uptake across different sectors through a combination of established governance, reporting and workforce oversight arrangements. Trusts are required to track and report on staff participation and completion rates as part of their existing training and performance management processes. In the independent and voluntary sectors, the Department works with relevant commissioning, regulatory and partnership mechanisms to promote uptake and gather assurance on training activity. That includes engagement with providers to ensure alignment of agreed standards and expectations. Regional oversight is provided through the regional dementia project board, which reviews progress, identifies gaps and supports continuous improvement.”
“I am afraid that I do not have an update to hand on the psychiatry workforce. I am more than happy to write to the Member. As the Member knows, in the Department of Health and in Health and Social Care, we live in a world of statistics, and it is very hard to retain the numbers that I would need to retain to be able to answer all the questions that Members legitimately ask at Question Time.”
“The best thing that the Department can do is to ensure that dementia training remains current and aligned with best practice. We do that through collaboration, not least with academia but with clinical experts, and alongside established governance structures. The prevalence of dementia is so high, however, that I would be very surprised if anybody in the health and social care workforce who comes into contact with people with the condition is not keen to keep themselves trained and aware of and up to date with developments in how best to look after those people. It is a massive problem, but there are many areas where the workforce has to be trained up. That is why it is impossible to say that it has to be statutory. However, it is important for many people that staff keep themselves up to speed.”
“At present, there is no statutory requirement, as the Member knows, to mandate dementia awareness training across the system. I strongly endorse the importance of such training as a key element of workforce development, but — the Member will not like this — it is not proposed to introduce a compulsory requirement at this time. <BR /> <BR />The Department operates within an enabling framework where employers retain responsibility under existing employment and professional regulatory arrangements to ensure that their staff are appropriately trained and competent to carry out their roles. That approach allows for proportionate implementation while supporting organisations to embed dementia awareness within their broader training and their governance structures.”
“There will be an online version of that, and it will be accessible to all stakeholders and easily navigated, with signposting to relevant training and resources.”