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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“The GIRFT team has also been involved as external advisers on work to improve and standardise same-day emergency care (SDEC) services, which were commissioned and expanded through the No More Silos programme. I welcome the ongoing support and challenge provided by the team. <BR /> <BR />Although some progress has been made in delivering changes to services to meet the needs of patients and service users, I am afraid that there is no quick fix, and addressing the current situation will require sustained, long-term effort, additional recurrent funding and support across the political spectrum.”
“Following the completion of that report, commissioned by Robin Swann, my Department considered its recommendations and produced an improvement plan. My Department has also worked with trusts to address specific issues highlighted in that report. I know that there is interest among some in the House in having sight of the GIRFT report on emergency medicine and the associated implementation plan. That is why I will publish both on my Department's website tomorrow. I am pleased to be able to assure Members that the GIRFT implementation plan is on track for delivery. <BR /> <BR />Since the completion of that review, the GIRFT team has continued to work with my officials and the trusts on their improvement plans and played a key role in the development of the trusts' local winter plans for 2024-25.”
“Like elsewhere in the United Kingdom, the pressures across our system are immense, meaning that the long-term vision that I have articulated — improving services and the service that you experience by making it easier to access the most appropriate services at the right time — remains essential. <BR /> <BR />We published the urgent and emergency care review in 2022 with strategic priorities, including the roll-out of urgent care centres across all trusts, greater use of rapid-access clinics and ambulatory care, the introduction of local and, ultimately, regional Phone First services and improving intermediate care to treat patients in their home as an alternative to hospital admission. An additional recommendation from the review was the initiation of the Getting It Right First Time — GIRFT — review of emergency medicine.”
“<BR /> <BR />One of the key messages from the visit was that, for the protocol to work, there is a need for a whole-system approach and that emergency departments and the Ambulance Service, on their own, cannot bring about the changes without the support of the rest of the system. It will require leadership, ownership and cultural change, which are at the heart of the planning workshops that I have been facilitating with leaders across HSC. I am pleased that everybody seems to be up for the challenge. <BR /> <BR />More broadly, my vision remains to keep emergency departments for emergency cases. That is why I have continued to implement the recommendations set out in the urgent and emergency care review.”
“<BR /> <BR />Improving those times and response times in the community is a key focus, and, as part of work to explore new methods of working, my officials and the trusts have engaged with the London Ambulance Service to understand better its scheme for releasing ambulances no later than 45 minutes after arrival. We know that that scheme has resulted in significant improvements in handover times across the London area. My officials, alongside clinicians and management from trusts, visited the King George Hospital in London with the London Ambulance Service on 10 March to discuss the adoption of a robust protocol for the escalation of ambulance handovers that exceed the 15-minute target. Those discussions continue at pace with trusts on how the learning can be used to improve handover at our hospitals.”
“That is why I initiated a series of winter planning workshops aimed at identifying new, innovative solutions to the system-flow issues that we face collectively. I attended the first of those events on 4 March and was encouraged by the engagement and enthusiasm from HSC leaders from across the system. The workshop was attended by a wide range of stakeholders from across HSC, including the royal colleges, clinicians and other front-line services. Our system leaders are all involved. There will be three more workshops over the coming months, with the final workshop in June. That will inform a sharper, more focused plan for next year. I expect to see better outcomes in advance of winter, including improvements to ambulance handover times.”
“This year, an external evaluation will be carried out by the Public Health Agency to inform plans for further expansion of the service. <BR /> <BR />I have previously rehearsed my concerns about the pressure on NIAS staff, who must deal with the welfare and distress of their patients and their carers on a daily basis. Those concerns remain with me. Nevertheless, NIAS is making great strides in supporting staff back to work, improving their long-term absence rates and increasing the available workforce. It is right that the improved absence rate was acknowledged in the Audit Office report, and I hope to see that trend continue. <BR /> <BR />I remain determined to find better ways for the system to work to tackle the complex issues that we face.”
“Learning from the Scottish Ambulance Service, which has integrated mental health professionals into its control room, the integrated clinical hub contains mental health professionals from the South Eastern Health and Social Care Trust who work at weekends to provide expertise that supports patients in accessing alternative pathways for mental health issues. The service currently operates Friday to Sunday from 6.00 pm to 2.00 am. Early data from NIAS shows a 40% reduction in conveyance to emergency departments among patients who are experiencing mental health crises. That has led to much-improved patient experiences. Western Health and Social Care Trust staff are finalising training to work with the NIAS control room, which will enhance their service even further. Funding for the scheme is being provided until the end of March 2026.”
“It also provides advice to support crews, enabling referrals to a range of other pathways, including Hospital at Home and the falls, epilepsy and diabetes pathways.”
“<BR /> <BR />In 2023-24, NIAS established a new integrated clinical hub, which incorporates senior clinicians. NIAS subsequently changed clinical practices in the integrated clinical hub team to support the management of patients in the community where possible, thus reducing conveyances to EDs while ensuring that patient safety is maintained during extended response times. The integrated clinical hub's highly skilled senior clinicians can identify alternative pathways for patients through the increased use of Hear and Treat and See and Treat pathways, which can be managed through an urgent care liaison desk. That enhanced clinical team provides increasing numbers of patients with advice in order to reduce conveyances to our emergency departments.”
“I thank the Member for her comment. I have absolutely no difficulty in agreeing to that meeting. <BR /> <BR />Work to address the wider system pressures has to be prioritised. That does not mean that NIAS has been sitting idle, waiting for issues to be resolved elsewhere. Flow and discharge issues are key aggravating factors, but there is much that NIAS can do and, indeed, is already doing. My Department is actively engaged in developing a 10-year workforce plan with NIAS to further develop capacity, capability and the utilisation of the right skills mix. That will allow the Ambulance Service to better meet the needs of our communities by developing the enhanced paramedic role, innovative care pathways and strategic collaborations across the health system.”
“The work involves the extension of the early review team pilot model, which reviews needs and ultimately allows additional capacity to be recycled into the system. It also involves digital interventions, such as CareLineLive and the care home availability app, using technology to help ease pressures. <BR /> <BR />The work involves direct payments and emergency direct payments to enable packages of care to be provided through the employment of a personal assistant. That will improve flow and discharge transitions. The work also involves the extension of the trusted adviser model to a seven-day model across all hospital sites, promoting safe and timely discharges from hospitals.”
“My Department is taking a number of steps to minimise the challenges in coordinating those delays. To support the adult social care reform programme, we have established a social care collaborative forum. That provides vision and strategic advice and guidance on the delivery of social care. The forum will take forward agreed action across a number of work streams to support improvement and transformation in adult social care. <BR /> <BR />That work will include a comprehensive review of the regional care home contract and specification, with a revised contract expected to be in place by June of this year. It also means taking forward my commitment to end minimum wage jobs in social care, ensuring that all staff are paid at least the real living wage.”
“Patients are waiting for far too long in ambulances outside our EDs, and that is a direct consequence of poor flow in our hospitals and social care constraints, as Members noted. I also recognise the risk of harm to patients who are delayed at handover on arrival at EDs and the impact of that delay on NIAS's capacity to respond to the next emergency call in the community. <BR /> <BR />Reducing ambulance handover delays has been and remains one of my key areas of focus, but it is important to reiterate that, while pressures manifest at the emergency department, flow through the system and getting people medically fit for discharge into the community remain significant issues. It has been widely referenced in recent weeks and months that hospital flow is hampered by delays in discharging individuals who are deemed to be medically fit.”
“They have worked too hard for too long in a system that does not deliver the type of care that their commitment and resolve deserve. I suggest that, as political representatives, we owe it to them to do better and to relieve them of that moral distress. That is why I welcome the Northern Ireland Audit Office report on ambulance handovers. As we know, it was published on 11 March, and it underlines the seriousness and scale of the pressures facing HSC services. Alongside key officials, I will carefully consider the report's recommendations. I have already noted the recognition of the fact that the root cause of delayed ambulance handovers is wider severe HSC whole-system pressure and hospital discharge delays.”
“Thank you, Madam Principal Deputy Speaker. I must say that I am heartened to note the near-universal acceptance of the fact that the issue is not just about the Ambulance Service but about a whole-system response to the pressures faced and about the flow through our hospitals. If I have time, I hope to return to some of the comments that the Member who moved the motion and the Members who moved the two amendments made. <BR /> <BR />When we were here in January to discuss ambulance waiting times, I commended the hard-working and dedicated staff of the Northern Ireland Ambulance Service, and I make no apology for my doing so again. The staff — those working on the front line and those working in support of them— are, like all staff across Health and Social Care, the lifeblood of the system.”
“Congratulations. I do not know how long you have been a Daideo, but I am sure that you are enjoying it.”
“I am committed to working alongside health visitors, local communities and all relevant stakeholders to achieve that. <BR /> <BR />Finally, Deputy Speaker, I address Mr McGuigan, the Chair of the Health Committee. Every day is a learning day: is it Daideo?”
“I thank the Member for his intervention and understand his concern in that area. I will double-check, but I do not have any concerns that anybody who needs to access healthcare in our HSC system, who lives in Northern Ireland and who does not have English as their first language, experiences any difficulty in getting translation services. However, as I say, I am more than happy to check that. <BR /> <BR />We owe it to our children to give them the best possible start in life, and that means ensuring that every child, regardless of where they live, receives the support that they need in those critical early years. By strengthening our health visiting services and addressing those regional inequalities, we can and should build a healthier, more equitable future for all our children.”
“<BR /> <BR />The health and well-being of our children must be a high priority, and the year 1 health review is not just a tick-box exercise but a crucial opportunity to support child development and family health. I am committed to working with all health and social care trusts to ensure that every child in Northern Ireland receives that vital health review within the accepted time frame. The refreshed Healthy Child, Healthy Future framework will play a key role in that.”
“Improving the emotional health and well-being of our schoolchildren through helping to build resilience and encouragement in the development of healthy lifestyles, together with the promotion of health literacy, is fundamental in improving outcomes for children and young people. <BR /> <BR />As Members have noted, I have also launched a Live Better initiative, which has one strand and a sole focus on starting well. While not solely focused on the year 1 review, the Live Better initiative presents a unique opportunity to work collaboratively to improve access to early years healthcare in communities experiencing deprivation, and it should also help inform future collaborative work more generally.”
“I am pleased to be able to confirm that a refreshed framework is nearing completion, and I expect to publish it in May of this year. The refreshed framework will bring increased focus on providing additional support in the first two years of life, from conception to age two, and on tackling inequalities by focusing on families at risk of marginalisation and social exclusion. <BR /> <BR />As the number of children requiring additional support in schools is rising, the framework will have an increased focus on early identification and support, and this should enable children to be school-ready and ready to learn. Improving health outcomes for our school-aged population is a key principle of the refreshed school nursing programme.”
“<BR /> <BR />I absolutely agree with the motion's call to end regional inequalities. The early years are critical to a child's lifelong health and well-being, and every child in Northern Ireland therefore deserves the best possible start. It is our responsibility to ensure that health and social care services are equitable, effective and accessible to all. Members will be aware that Healthy Child, Healthy Future is the framework for the universal child health promotion programme in Northern Ireland. The framework outlines the core health visiting and school nursing reviews that all families with children aged from nought to 19 can expect to receive. It is recognised as being central to improving child health across a range of issues and giving every child and young person the best start in life.”
“<BR /> <BR />The House will be aware of the wider workforce challenges that we face. The health visitor workforce has, like many other parts of our health and social care system, been under strain. Health visitors are working with and managing much higher levels of complexity in our society, and the recruitment and retention of health visitors has been challenging, which will inevitably impact on service delivery. <BR /> <BR />Work continues across all trusts to address those challenges through workforce planning and recruitment exercises and the prioritisation of health visiting contacts as appropriate. I reassure the House that any decision to stand down any element of core health visiting reviews, as defined in the existing Healthy Child, Healthy Future framework, will be subject to a risk assessment by the trust in question.”
“The Southern Trust has worked to increase recruitment to its complement of health visitors to allow it to deliver the services that are required. My Department has supported that increase in recruitment by funding significant training opportunities for nurses and midwives who wish to specialise in health visiting. I am pleased that the trust has been able to resume full provision of the Healthy Child, Healthy Future programme, and I have been assured that, based on current internal monitoring processes, uptake has improved significantly. Throughout that period, the trust took action to assess, manage and mitigate the risks involved. It has also reviewed its health visiting caseload and provided assurance that, in any case in which the year 1 review was not completed, an appropriate review has now taken place.”
“The year 1 health review is one of a number of important health contacts in a child's development, allowing us to identify and address potential health issues and ensuring optimal growth and development. <BR /> <BR />The Northern Ireland-wide figures highlighted in the motion relate to 2023-24. Regrettably, during that period, health visiting services in some of our trusts faced significant workforce challenges with a large number of unfilled vacancies. Those issues were particularly critical in the Southern Trust, which experienced significant workforce challenges with a large number of unfilled vacancies that impacted on its ability to fully deliver year 1 reviews as recommended in the Healthy Child, Healthy Future policy.”
“Their expertise in child health, child development and family well-being is crucial, and their work is fundamental to ensuring that our children have that best possible start. <BR /> <BR />I recognise the concerns raised by the motion and the statistics that it highlights on year 1 reviews in Northern Ireland generally and the Southern Trust specifically. The fact that 15% of children here did not receive their year 1 review in the financial year 2023-24 is more than concerning to me. The regional disparity due to the position of the Southern Trust in the same period is also troubling. The figures are unacceptable. Every child in Northern Ireland deserves equal access to healthcare, regardless of postcode.”
“They are integral to supporting families in the first few years of life; they are a vital part of the health and social care ecosystem; and they are instrumental in identifying developmental concerns. They provide advice that is often critical to parents, particularly new parents who are wondering how they are going to manage, and they ensure that families have the support that they need to provide the best start in life for their children. <BR /> <BR />As Members have acknowledged, I have a commitment to addressing health inequalities, which, I am glad to say, is also reflected in the Executive's Programme for Government. The work of health visitors is key in helping to address health inequalities by promoting early intervention, ensuring the health of our children and ensuring that future generations have the best start.”
“If we want to afford every child the best possible start in life, surely our first base is to deliver on our commitments. If the commitment is to an assessment for every child in the first year, the only acceptable percentage has to be 100%. Every time that we drop below that, we need to ask why. Sometimes there may be legitimate explanations, but 100% has to be the target. <BR /> <BR />I thank Peter Martin for pointing out that these assessments are entirely consistent with my desire to shift left. Absolutely; healthcare should be delivered at home or as close to home as possible, and that should include prevention and early intervention to give the child and the family the best possible start. I acknowledge the crucial work that our health visitors deliver daily.”
“Thank you very much, Mr Deputy Speaker. I thank the proposer of the motion and the proposer of the amendment for bringing this important issue forward for debate today. <BR /> <BR />One of the first Committees that I sat on when I was first elected was the Education Committee, and I became a fanboy of the late Professor Ken Robinson, who talked about the "element" that is in a pupil. It reminded me that, as a school governor, I used to talk about "the spark". Inside every child, without exception, there is a spark of ability, creativity and talent, and it is our duty as a society to create the environment where they can find out what that spark is and fan it out into a great forest fire of passion for learning and for life.”
“If there is more money coming, we will look at all the options. If there is a lot of money coming, it could be difficult to spend it in a timely manner. That is why we need a cocktail. I will certainly look at that. The cross-border scheme is the one to go with.”
“I will respond very quickly. The answer to that is no, there is not. However, we are tending, because of the pressures on the budget, to work hand to mouth and day to day and to live in the day, and we need to try to lift our heads up, difficult as it is, and start thinking a little bit more strategically.”
“The £135 million was to start reducing waiting lists, and, as I have said before, we would need to spend that £135 million five times. It is over five years. I am not at all confident that the £135 million will become available during the financial year 2025-26. I am seeking clarity on how much I can expect to get, and I am also seeking clarity on when that money may start to flow, but I am instinctively thinking that what I should do is proceed at risk. That means thinking about a cocktail of new initiatives: talking to the trusts; talking, whether Members like it or not, to the independent sector; and thinking about reintroducing the cross-border scheme.”
“I thank the Member for the question. The cross-border reimbursement scheme remains enduringly popular, certainly judging by the correspondence that I get from Members of the House, among others. Personally, I would very much like to reintroduce it. The Member talks about the Programme for Government commitment. I have to say that that commitment is qualified, because if you read what it says about waiting lists, you will see that it says, "with Executive support", we will get some money. It also says "up to £135m". It does not say that it will be £135 million. Therefore, I am hoping that the other £80 million, which is there to make sure that the waiting lists do not get any longer, will be forthcoming, because the key is to try to stabilise those waiting lists and not allow them to become any bigger.”
“I can certainly promise the Member that I am determined that all of us involved in health and social care delivery learn the lessons. The Member has given us a long list — a very long list, to my mind — of where things have gone wrong, and I certainly do not want that list to be added to on my watch. I gently say that a specific duty of candour on an individual basis, with criminal sanctions, may have a deep chilling effect on the recruitment and retention of essential health and social care staff. Again, I ask the House to reflect on that. We are all constituency MLAs. In every constituency, we have allied health professionals, nurses and doctors. Speak to them. Listen to them. Ask them what they think the impact of that individual duty of candour, with criminal sanctions, might be on healthcare delivery in the future.”
“There is quite a complex picture developing, and I assure the Member that we have a real focus on this and are liaising constantly with the UK Government about their proposals, which will be released in a short number of weeks. Remember that the Prime Minister promised to publish a Bill before the next anniversary of the Hillsborough disaster.”
“I thank the Member for the question. We have had significant and ongoing engagement with the UK Government over the Hillsborough law and it falls into a broader set of policy considerations that are under way. The Member may be aware that we are consulting on a Being Open framework. I have also made a commitment to look, during this mandate, at the possibility of a duty of candour on an organisational basis. I know that a significant number of Members of the House would also like to see a duty of candour on an individual basis, with criminal sanctions, and I have to say again that I think that that is a very negative way in which to phrase the concept. The Hillsborough law will play into that.”
“I thank the Member for his supplementary question. I absolutely agree. We have to start from a position of respecting everybody as an individual. Every individual has rights and views and should be listened to respectfully. That is the case in this, as with anything else that we deal with in the Chamber. <BR /> <BR />I think back to 1998 and the very first commitment in the Belfast/Good Friday Agreement, which was a fresh start in developing relationships. We are going to have to develop relationships with people and make sure that we offer them the best that we can possibly offer. On this specific, part of the way forward may involve the development of single-use and stand-alone facilities that can be used on an individual basis, regardless of gender, regardless of that view, but it is to be done with privacy and respect.”
“<BR /> <BR />I understand the argument for single-sex spaces in certain circumstances, but I also want the health and social care system to be a welcoming and supportive place for everybody who works there, regardless of class, creed, race or identity. I understand that gender identity policies are under review at a number of the trusts, and that is an important process. I will seek more information on that and what else may need to be done to provide greater clarity and protection.”
“I thank the Member for his question. Media coverage today relates to existing gender identity and expression policies in the health and social care trusts. In relation to changing and toilet facilities, the policies refer to putting in place arrangements that everybody is comfortable with and which respect everybody's dignity. That is, of course, the ideal; achieving it is probably easier said than done and will be a challenge. We are dealing with conflicting rights in some cases. More widely, the whole issue of trans rights has become wrapped up in quite a toxic online culture war, where any notions of sensitivity and respect have been totally abandoned.”
“I cannot give the Member an absolute guarantee that there will be no further delays, because I cannot look into the future. I am not aware of and have not been briefed about any potential hiccups or banana skins between now and the completion and commissioning of the urgent care centre. It is a positive move. It will be open seven days a week for 12 hours a day. It is adjacent to the emergency department. Let us not forget that it is on the site of an acute hospital, so scans and X-rays and all the other facilities that might be needed will be within arm's reach. It is a positive development. <BR /> <BR />Some people resisted the move from Ards to the Ulster Hospital, but it is 4·6 miles on a dual carriageway, so I do not think that it puts enormous pressure on people to ask them to travel that short distance for better care.”
“I thank the Member for his question. As he is aware, the minor injury units (MIU) at Ards and Bangor are making way for the urgent care centre, which will be within the curtilage of the Ulster Hospital; indeed, it will be adjacent to the new emergency department. I had the pleasure of visiting it some months ago. It is under construction. The current date for completion is March of this year. There will then be a short commissioning process, and the centre should be fully operational by June.”
“Yes. There is a cocktail of reasons why there were 500 to 600 people — certainly that was the figure in the early days of January — in beds in our acute hospitals who were fit for discharge. If you delve into those reasons, you will see that beds, step-down beds, care beds and domiciliary packages are at the top of the list. That is why, together with colleagues, I am putting a focus on those things as we look towards the winter of 2025.”
“I thank the Member for his question. He will be aware that, over the winter, the flow through our hospitals was not as it should have been. Although the focus was on emergency departments, that was only where the problem manifested itself. The problem was at the back door, in getting patients who were medically fit for discharge a care home bed or a domiciliary care package. On Tuesday of last week, we had a successful, well-attended opening session to look ahead to the winter of 2025. There were about 120 people in the room, all professionals with things to say, and there was a waiting list. We will work on that in the next few weeks. To try to make the profession more attractive, I have committed to introducing the real living wage for social workers in this calendar year.”
“I guarantee that I will look at that and engage at official level with NIPSA. I am more than happy to meet the Member to discuss it one-to-one.”
“I thank the Member for a very detailed question that I am not in a position to answer, as he may well have suspected. I am sure that he thought, "The Minister is waiting for a question about ambulance services and W45"; you have got me.”
“I thank the Member for his question. A lot of work has been undertaken in partnership with key charities and with families who have been affected by bereavement. That is because we want to ensure that arrangements are as sensitive and dignified as possible, so we have been listening. Thorough oversight continues to ensure that any baby or child who requires a hospital-consented post-mortem, as well as their family, is treated with the utmost care, respect and compassion.”
“It seems to me that it is just not a particularly attractive line of work in healthcare.”
“I thank the Member for her supplementary question. I believe that it is just not proving to be an attractive profession. As I said, this is not just for us; I think that two paediatric pathologists retired in recent years. We have made several efforts at recruitment, unsuccessfully. As part of our research into that, it has been made clear to us that it is not a Northern Ireland problem and is not even a UK problem; it is a global problem. Everybody is tending to specialise. Alder Hey is being asked to absorb more work from elsewhere — from beyond the north-west, which is the Liverpool area. It is content to continue with us. Our deal lasts well into 2027. Hopefully, that will be enough time for us to work with the Government of Ireland to see whether we can bring in a new service.”
“Even if we decide that that is the way to go, and I really hope that we go for the all-island solution, the biggest issue is the recruitment of a sufficient number of pathologists to service the whole island. In fact, getting enough to service one jurisdiction will be a challenge. Doing both will not just double the challenge but will probably treble or quadruple it.”