Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“I thank the Member for the supplementary question. That is perhaps a sixty-four thousand dollar question to which I do not think there is an answer. However, I can tell you that I have been working recently with officials in my Department on how we will develop the all-island model. They are particularly keen to look at modern developments, which would include non-invasive procedures. The first thing that we want to do is make sure that the thinking of officials in my Department aligns with that of officials in the Department of Health in Dublin, because this goes beyond post-mortems into a broader sense of paediatric pathology. These things, as the Member will know, can take time.”
“In the meantime, as those services move to more and more centralised models nationally and in the absence of any viable alternative at this time, my priority remains to ensure that bereaved parents continue to have access to a high-quality post-mortem service that provides the medical answers as well as the care and support that families need and deserve. Access has therefore been secured by a further extension of the arrangements with Alder Hey in Liverpool.”
“I remain very keen on exploring the feasibility of an all-island approach to those services in the longer term. That might mitigate the need for infant remains to be transported overseas. <BR /> <BR />I had a number of conversations with Minister Donnelly about the possibility of future cooperation with the Government of Ireland on the issue. I recently raised it with the new Irish Health Minister, Jennifer Carroll MacNeill TD. While it is at the early stages of consideration, the conversations, I can report, have been positive. The Minister reiterated her agreement to take the matter forward, which will allow the feasibility of an all-island approach to be considered, but I must say that any post-mortem service is likely to take time to develop even if it is feasible.”
“It is important for any parent going through the terrible experience of losing a child to have the option of a post-mortem examination to help to provide answers about their loss and that, if they decide to proceed, they are fully supported at all stages of the process. Members will be aware that the current service for hospital-consented post-mortems for families in Northern Ireland is provided by Alder Hey Children’s Hospital in Liverpool, and that has been the case since 3 January 2019. My first preference would be the restoration of a dedicated paediatric pathology service for Northern Ireland, but that remains incredibly challenging, I am afraid, as those services are under pressure not just across the UK but globally due to a shortage of paediatric pathologists.”
“I thank the Member for his question, which I will answer much more generally. As we walk through a very complex health and social care system, the number of doctors, nurses and consultants in just about every walk of life is probably not adequate. We need more. Yes, we need buildings. Yes, we need equipment. Yes, we need medicine. Yes, we need funds. However, if we do not have an appropriately sized, qualified and motivated workforce, the rest is as nothing.”
“I thank the Member for pointing out that disparity. To my mind, that is an inequity and a potential health inequality. Therefore, as I have said previously, it is something that I will wish to tackle. On my watch, we will always, I believe, have five geographic trusts, rightly or wrongly. Those five trusts should deliver standardised, region-wide services, and the Member has pointed out an area where that is not happening. I would like to see that addressed. Once again, I will take that away from today's sitting.”
“I thank the Member for his interest. I am absolutely prepared to go away and make a further push. It is important because the services are important. The range of services will be, more or less, as before, but it will be reconfigured differently in the temporary accommodation. At the moment, service delivery is via the mobile health bus, hostel facilities and day shelters. A GP and out-of-hours service is operating on the Crumlin Road, but I agree with the Member that we want to see a new permanent home.”
“It is necessary to get their input on the optimum location for the service. <BR /> <BR />The trust has also actively viewed a number of properties. Recently, one was identified as potentially suitable. Trust representatives are engaging with the relevant landlord to discuss a potential lease of the property, including any specific refurbishment work that would need to be completed before it could be agreed. Given that the talks are ongoing, I am not in a position to provide the Member with a definitive timescale for when the inclusion health service will be relocated to a new centre, but I can assure him that it will be done as soon as is practicable.”
“I recognise the vital work that the Belfast Inclusion Health Service offers to individuals who are homeless and need access to timely health and social care provision. I, like many in the Chamber, was shocked by the series of events that necessitated the relocation of that vital service to a new temporary location in Belfast. In that context, it is vital that the new permanent location be safe for those accessing and delivering services. To assist with that, Belfast Health and Social Care Trust is actively looking for suitable permanent premises. The work has involved engaging with a range of key stakeholders, including Belfast City Council, the Northern Ireland Housing Executive, community and voluntary groups and Land and Property Services (LPS), as well as with the staff and users of the inclusion health service.”
“I have had a conversation with Ema Cubitt about support. The sort of things that she was looking for to get up and running were simple things like a website, business cards and access to information and research. I have subsequently had a report back that she is satisfied with the level of cooperation that she is getting from the Department of Health and, to be fair, from the Department of Education. She is satisfied with the interplay there, as well.”
“I am sorry: did the Member ask what support the autism reviewer is being given?”
“I take the admonishment from the Member: that was loose and inappropriate language; I apologise for my use of it. <BR /> <BR />The Education Minister and I have met the principals of a number of special schools in this Building. We had a discussion on the issues that they face. On foot of that, the Chief Nursing Officer and I have visited at least two special schools to see for ourselves the sort of health requirements that some of the pupils who present with pretty severe learning difficulties experience. I believe that community children's nurses have a role to play. I have asked the Chief Nursing Officer to look at the way forward and to bring forward proposals at pace.”
“Once again, it would be up to the trust to put in place the sort of facilities that the Member refers to. The strategy is supported by increased collaborative working across sectors. We have a two-year delivery plan, which contains a range of actions across Health, Education, Communities, Economy and a range of statutory and independent sector delivery partners, so it is a cocktail. A cross-departmental monitoring and funding approach is necessary. A report was published recently, setting out progress including the outcomes that have been achieved and how they have been measured. The report also captured, where possible, funding that has been allocated to support and deliver the commitments of the strategy. Good work is being done, on that cross-departmental and cross-sectoral platform, to try to deliver better outcomes.”
“I thank the Member for her supplementary. As she may be aware, following the additional winter pressures, after Christmas, I visited seven of our emergency departments. One of the takeaways for me was that bright light and excessive noise are two things that, if you suffer from autism, are extremely off-putting. I believe that work is ongoing to try to create a much more appropriate environment for those who suffer from autism and have to present at hospital, particularly an emergency department.”
“It is also important to stress that input from the independent autism reviewer, Ema Cubitt, will be crucial to informing the next three-year delivery plan, work on which is due to commence shortly.”
“It sets out progress and achievements across government, including the development of guidance for employers, in collaboration with the Equality Commission; over 600 staff trained in autism awareness in the Northern Ireland Housing Executive (NIHE); several actions taken forward via the special educational needs (SEN) reform programme to better respond to the needs of autistic pupils, including continued collaboration with the Middletown Centre for Autism; the launch of GP training videos to improve equity of access and outcomes; and two significant reviews undertaken by the HSC Leadership Centre. The outputs from that work, wider year-1 progress and the next monitoring report, for 2024-25, will inform the development of actions and measurable targets for the remaining years of the strategy.”
“My Department has taken a leading role in preparing the cross-departmental strategy to address long-standing inequalities across our public services. Despite a very challenging financial and political context, my Department continues to develop the new cross-departmental autism strategy for 2023-28, which was published in late 2023, and to align it with legislative requirements. My Department continues to deliver against the duties set out in the legislation to develop, implement and monitor the autism strategy. <BR /> <BR />Along with the autism strategy for 2023-2028, a two-year delivery plan for 2023-25 was published that focuses on the implementation of the requirements in the Autism (Amendment) Act (Northern Ireland) 2022. My Department recently published a monitoring report for the first year of implementation.”
“Those decisions are taken by the trusts. I will certainly look at what appears to be a disparity in the Southern Trust. As a matter of principle, I would like to see the five geographical trusts move to having standardised regional services so that there is no question of a postcode lottery in dentistry or in any other part of the Health and Social Care system. The Member raises an interesting point, and I am prepared to take it away with me.”
“As I have said, dentists are independent practitioners. It is up to them to decide whether they want to take on new patients and register them for health service work. I am afraid that the Department's position is that we will provide a list of local dentists to anybody who approaches it seeking to be registered with an HSC dentist. I am afraid that it is for individuals to phone around to see whether they can get registered. It would place an enormous administrative burden on the Department if we were to do that for every individual and every family who contacted us with that problem.”
“I thank the Member for his follow-up question. I regularly meet representative bodies of the various branches of Health and Social Care, all of which have concerns. They have concerns about their budget, about the cost of services and about the amount of money that we can devote to them. In fairness, all of them are determined to deliver better outcomes. <BR /> <BR />One agreement that I came to at the meeting was that we would undertake a cost-of-service survey, because I do not think that any of us around that table was particularly aware of what it costs to deliver dental services in Northern Ireland in 2025. That will be the fundamental research that will give us the evidence base on which to move forward.”
“<BR /> <BR />Efforts to improve access for all patients will continue to be the short-term focus as dental reform is progressed. I met the British Dental Association last month to discuss the issues facing the industry. Officials held a follow-up meeting on investment options for the 2025-26 financial year, and that is targeted at improving access.”
“<BR /> <BR />Access to health service dentistry remains a focus for me and my Department. We are specifically targeting investment this year at improving access for priority groups. An investment package of £9·2 million has supported general dental services in the current financial year. That includes £1 million for newly registered child patients, through the re-establishment of the enhanced child examination scheme; £4·3 million to fund a 30% enhancement to fees paid to dentists for priority treatments; and £3·9 million for the treatment of high-priority unregistered patients through a dental access scheme. Currently, 30 practices are participating in that access scheme, seven of which are in the Southern Trust area, with two in Newry itself.”
“With your permission, Madam Principal Deputy Speaker, I will answer questions 2 and 12 together. <BR /> <BR />I acknowledge the challenges facing many patients, particularly those not registered with a dental practice, in accessing dental care when they need it. One of the underlying reasons for that is that general dental practitioners are spending less time treating health service patients and more time meeting the strong demand for private work, and, as independent contractors, they are able to do that. As independent contractors, dental practitioners are under no obligation to register new health service patients, and nor does the Department have a role in deciding the location of new practices; that is a business decision made by the practice owners.”
“I thank the Member for her supplementary question. As I said, there is an EAP, but it is available only from one of the 23 participating so-called NorthStar clinical centres in the United Kingdom. That programme is a clinical network of UK-wide healthcare professionals who are focusing on the best clinical management of DMD. <BR /> <BR />As I said, the Belfast Trust is the regional provider of paediatric neuromuscular services here, so it is the only clinical centre eligible to participate in the NorthStar programme. Provision of givinostat EAP is being offered by the drug manufacturer only through the Belfast Trust in Northern Ireland. It has said that, because of the follow-up and the monitoring required, it is not prepared to do it. I cannot intervene.”
“I hope that that gives the Member some idea of the attention that is paid to young people who, unfortunately, suffer from Duchenne muscular dystrophy.”
“I am aware of the young boy whom the Member has mentioned, and my sympathies lie with him. However, I have to progress within the rules and recommendations and do so safely. The Belfast Trust provides a regional paediatric neuromuscular service through the Royal Belfast Hospital for Sick Children, and that would include the boy to whom the Member has referred. <BR /> <BR />While there is currently no cure for DMD, a variety of treatments can help to manage the condition. Treatment and intervention are provided in the Royal Belfast Hospital for Sick Children through a multidisciplinary team (MDT) approach, and that includes specialist clinicians from neurology, cardiology, respiratory and endocrinology. Physiotherapists are also involved with the patients' care.”
“First of all, I was entirely unaware of your brother. I pass on my condolences to you. <BR /> <BR />I do not want to provide false hope. It is up to NICE to decide whether it is safe to administer or recommend givinostat. NICE is a non-departmental public body (NDPB). It is sponsored by the Department of Health and Social Care (DHSC) in London. It produces national guidance on the promotion of good health and the prevention and treatment of ill health. It makes its recommendations independently. As I have said previously, it would be entirely inappropriate of me to intervene with the Belfast Trust to try to expedite the matter, unfortunately.”
“<BR /> <BR />It would be inappropriate for me or my Department to intervene in the trust's decision, as that risks undermining our well-established processes with NICE that ensure that our population has access to new medicines that have been demonstrated to be clinically effective and cost-effective. Should NICE recommend givinostat, my Department will consider it under the usual processes and endeavour to make the drug available as quickly as possible.”
“However, when monitoring is required, which is the case for givinostat, clinical centres need additional resources — for example, to carry out blood tests and hold additional clinics — to undertake the monitoring safely and sustainably. Although medicines under EAPs are typically provided for free, additional implementation costs will fall to the relevant trust, which is, in this case, the Belfast Trust. Having considered the resource required to administer givinostat safely and efficiently, the trust has advised that it is not able to facilitate this early intervention. Members will be aware of the huge budgetary pressures and saving targets facing all trusts at this time.”
“One of my duties is to ensure that Northern Ireland has timely access to clinically effective and cost-effective medicines. We do that through a formal link with the National Institute for Health and Care Excellence (NICE). As givinostat is a new treatment, routine access in the Health and Social Care (HSC) system is based on the outcome of considerations from NICE. NICE is currently evaluating givinostat. Final guidance is not expected until July. <BR /> <BR />There is a route through an early access programme (EAP) ahead of NICE decisions, but responsibility for participation in those EAPs lies with the trusts. A compassionate use scheme such as that works well for therapies and conditions in which no close monitoring of patients is required.”
“During the debate, however, nobody has yet suggested what I should deprioritise in order to make that happen. Should I deprioritise the building of the children's hospital at the Royal so that we have the capital for the centre in the north-west? Should I deprioritise nurses' pay so that we have the resource to fund the operation of a centre annually? That is part of the problem. If we are to do this, we need capital and resource, and I do not see them becoming available. I therefore reaffirm my commitment to doing what I can to help those who are subject to substance use and abuse, but we have to be realistic about what is possible.”
“I thank the Member for his intervention. The fact that the law dates from 1971 suggests that it may well be fit for review. The Member is taking me into the area of a different debate, and it is a debate that I would very much welcome the House having, including our debating taking a position on whether we are in the right place, and have been since the early 1970s, or whether it is time to look at taking a different approach. Again, for me, the fundamental is to look at the causes of the causes and how we address them. <BR /> <BR />Without wishing to stir things up or to divide the House, I gently say that I note that the motion and, indeed, the two amendments call on me:”
“I thank the Member for his intervention. I understand his position. My position is that, if we can tackle the causes of the causes, the need for prosecutions will go away. I know that he does not think that there is a need for prosecution now. Others take a different view, however. Let us therefore tackle the causes of the causes so that the issue does not arise at all.”
“Yes, poverty is absolutely a key factor, and that is why I say to the House that tackling this is not just an issue for the Department of Health: we need an all-Executive, all-systems approach to tackling it.”
“<BR /> <BR />We need no reminder that those impacted on by drugs and alcohol use are our sons and daughters, our brothers and sisters, our mothers and fathers and our friends and colleagues. Almost everybody in this region has been or knows somebody who has been affected by substance use, so it is an issue that touches us all. Please let me take this opportunity to once again restate my commitment to making a positive impact in relation to substance use across this region. <BR /> <BR />One comment that I want to reply to is that of Mr Carroll. It is about the causes of the causes. It is not enough just to say, "Alcohol use or substance use causes ill health". What causes people to abuse substances in the first place?”
“<BR /> <BR />Funding has been provided to Addiction Recovery Coaching, a community-based, not-for-profit addiction recovery organisation in Derry/Londonderry. To Members who have mentioned ARC, I say that I have visited it and been inspired by the leader, Gary Rutherford. I have not just visited; I have invested in that service. It is led by people with lived experience of substance use and addiction, as well as by mental health professionals and accredited therapists. Their work promotes an understanding of the recovery pathway and a reduction in the stigma associated with addiction. That support is provided through access to physical activity, professional support and reconnection with community. It complements and supports the work of other community and statutory services.”
“<BR /> <BR />Service providers in the north-west area will therefore develop enhanced and comprehensive community care for those with problematic alcohol use, with the primary objective of mitigating the harmful effects of alcohol on individuals, families and communities, while addressing the socio-economic issues that continue to undermine the health and well-being of our population. That will be achieved by supporting adults in safely detoxing at home or in a community space rather than within residential services. <BR /> <BR />My Department is currently funding a pilot project in the north-west, the aim of which is to improve the physical and mental health of individuals directly and indirectly impacted on by problematic substance use.”
“The implementation of the recommendations made in the assessment are being considered in the Western Drug and Alcohol Coordination Team, with the support of the PHA, the SPPG and the Western Health and Social Care Trust. <BR /> <BR />I am also pleased to note the recent announcement of PEACE PLUS funding of €8 million for an innovative community detox-plus project in Northern Ireland, and that is namely in the Western and Southern Health and Social Care Trust areas and the border counties of Ireland. That funding has been secured through the collaborative health and social care addiction services investment area's PEACE PLUS healthy and inclusive communities theme, and it will contribute towards the more efficient delivery of health and social care services relating to addictions.”
“That needs assessment was commissioned by the PHA and the SPPG to better understand the needs of the population in the north-west area and to identify gaps in services. It identified the wide-ranging impact of substance use in the Western Trust area. It requires a comprehensive, whole-system response to the development and improvement of services and support in order to bring about lasting change for the population. It further identifies the need to support the development of recovery communities across the Western Trust area and to increase the use of data and performance information to ensure that future commissioning decisions are informed by an understanding of what works and take cognisance of changing trends.”
“The report's recommendations will most notably impact on current residential rehabilitation provision, with the recommendation that such services should be subject to a regional procurement exercise. It is intended that, by taking a procurement exercise regionally for residential rehabilitation services, there will be a beneficial impact for people requiring those services, with consistency and equity of access to services on an evidence-based approach. <BR /> <BR />The recommendations of the regional independent review also concur with the findings of the local population-based needs assessment for the Western Health and Social Care Trust area in relation to substance use.”
“Such services include community detoxification services, community addiction teams and community mental health teams, early intervention and prevention services and primary care inpatient detoxification services and residential rehabilitation.”
“Subject to further analysis of the consultation responses and the required departmental approvals, the recommendations will be prioritised for implementation by the SPPG and the Public Health Agency this year and going forward. It is important to note that the review does not recommend that a new dedicated treatment and recovery centre be developed in the north-west but instead that joined-up working be improved and better pathways developed between existing services.”
“The review is in draft and has been subject to a 12-week public consultation that closed on 19 February. The review makes 20 recommendations to support the development of a regional specialist assessment, treatment and recovery network. This will enable people to receive the right assessment, the right treatment and the right support at the right time, in the right place and from the right people. <BR /> <BR />The consultation on the review received 55 responses, of which 66% came from the Derry City and Strabane District Council area. Early analysis of the responses indicates a high level of agreement with all 20 recommendations, ranging from 85% to 99% support for the proposals.”
“The plan addresses various levels of need relating to substance use in our population, and it encompasses service provision ranging from early intervention and preventative services to specialist inpatient detoxification and residential rehabilitation services. The plan is part of our wider health reform agenda, which stresses the importance of using our existing services in better ways to meet the needs of the population. <BR /> <BR />As part of that reform agenda, an independent review of tier 4 addiction services has been commissioned by the SPPG as an accelerated work stream within the commissioning and implementation plan. The aim of the independent review is to scope the needs of our population relative to current hospital inpatient detoxification and residential rehabilitation services for substance use issues.”
“Substance use is also an issue that knows no borders, and my Department works closely with colleagues in Ireland and across the UK through the British-Irish Council and four nations ministerial meetings on the topic. On delivery in Health, Members may be aware that I launched the HSC substance use strategic commissioning and implementation plan in November of last year. The plan has been co-produced by the Public Health Agency and the strategic planning and performance group (SPPG). It creates a new whole-system, outcomes-focused strategic service delivery plan that covers all tiers of service provision for substance use, and it will last for the next four years.”
“Our strategy, Preventing Harm, Empowering Recovery, therefore acknowledged that we require a revised, joined-up, whole-system approach to our services in Health and Social Care (HSC) and across other Departments. <BR /> <BR />The motion helpfully recognises the links between substance use, mental health, housing and economic inactivity. While the substance use strategy is Health-led, it rightly recognises that a whole-system approach is required to address not just the causes of substance use but the causes of the causes. All those sectors are part of the strategy's implementation and of the programme board that oversees delivery.”
“While the conversation often turns to drugs, we should also remember the impact of alcohol. In 2023, 68 people in the Western Trust area died from alcohol-specific causes. That is simply unacceptable, and I am therefore committed to taking action. We also know of the cost to the health service and to Northern Ireland. It is estimated that substance-related harm costs us up to £1·5 billion a year. Again, however, I emphasise that we should primarily focus on the human cost. <BR /> <BR />Despite some positive progress, such as a reduction in the number of young people drinking alcohol or using substances, the level of harm has been increasing. That is driven by a range of factors, including the availability of new substances, increased complexity of cases and polysubstance use.”
“Principal Deputy Speaker, thank you very much. I thank also the proposer of the motion and the Members who moved the two amendments. I do not think that we can ever spend too much time raising awareness of the harms of substance use and putting a focus on all that we can do collectively to try to address this topic. <BR /> <BR />As Members will be aware and as has been stated in the debate, tackling health inequalities has become a passion of mine, and, currently, the largest inequalities in health relate to substance use. In the most deprived areas, for example, drug-related deaths are almost six times higher than in the least-deprived areas. In the Western Trust area in 2022, there were 26 drug-related deaths, each with a devastating impact on family, friends and community.”
“When it comes to moving into areas of deprivation to tackle the issues and disparities, particularly those in healthy life expectancy, who has done more to put a focus on that than I have?”
“The first step will be to continue to try to persuade her that she made a big mistake in voting for the 2024-25 Budget. Áine Murphy made the point that a lot of dentists were no longer providing NHS dental treatment because it is no longer economically viable for them to do so: I agree. What is the solution? We need to find more money. Where do we find more money? We find more money in the Budget, but you voted for a Budget that, you were warned, was not adequate to meet the health and social care needs of our population. <BR /> <BR />The other point and the other irony klaxon is about health inequalities. I ask Members this: which Health Minister in recent years has put more of a focus on tackling health inequalities than I have?”