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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“As Members will be aware, significant reductions will be required in my Department to contain existing resource expenditure, and funding pressures will need to be considered and prioritised alongside other demand pressures for available funding. <BR /> <BR />Funding for gambling harm services should be clearly seen as new or additional funding that does not, in any way, disadvantage core mental health and addiction services and their service users. As part of the scoping work, my officials have had some sight of potential high-level indicative treatment models for Northern Ireland that could be considered, taking into consideration the issues that I have outlined as well as training requirements for those who may be delivering the services.”
“In line with the usual process for commissioning services, any decision to commission bespoke gambling treatment services will need to be based on an assessment of the level of demand for services in order to create a fuller understanding of the population need here and in the context of future budget availability. I am hopeful that the work that was discussed earlier in that space will allow us to review that from a more informed position. <BR /> <BR />It is clear that funding for new services that are aimed at the prevention and/or treatment of gambling harm must not come from core health and social care funding. Mental health and addiction services are already challenged by the adequacy of the resources that are available to respond to the needs of the population.”
“On the motion and the current lack of statutory services that are dedicated to supporting those with problem gambling or gambling addiction needs, while I would like to say that support may be available through existing pathways for those with coexisting substance use or mental health needs, I note that we have some way to go to match the current gambling-specific treatment models that are available in some neighbouring jurisdictions. I also note the support that is offered through our community and voluntary sector to which our statutory service will signpost. That valuable work does not go unnoticed and it is greatly appreciated. <BR /> <BR />That said, if we are adopting a public health approach to gambling, my Department will have a role in the commissioning of gambling support and treatment services in Northern Ireland.”
“In the letter, we also raised a concern about Northern Ireland's exclusion from a share of the funds raised through the proposed statutory GB levy, to which many Members have referred. <BR /> <BR />Following a response from Baroness Twycross, the Minister for Gambling, we were assured that any actions taken would consider the implications for Northern Ireland, including engagement with Ministers as necessary. Cross-departmental officials have recently engaged with relevant colleagues in the Department for Culture, Media and Sport (DCMS) to further discuss and explore the issues, including the levy, and how collaborative working between the nations can be maximised with a view to improving outcomes for those who need them.”
“Therefore, last September, the Minister for Communities, the Minister of Education and I sent a joint letter to the new Secretary of State for Culture, Media and Sport. We noted the lack of a recommendation in the published UK Government White Paper of an outright ban on gambling advertising. We further sought engagement and involvement in any potential consideration of a change of direction in that approach following the general election. We are keen to have closer and stronger collaboration on enforcing gambling advertising regulation between, first, the relevant statutory bodies in Northern Ireland and, secondly, the Advertising Standards Authority (ASA) and the Gambling Commission in GB.”
“We intend to review policy options following the latest inquiry's recommendations. I hope that that work, alongside the updated data and evidence work that is being undertaken, will put us in a position where my cross-departmental colleagues and I can make decisions that will lead to the start of real progress in the area, learning from previous approaches taken in similar areas where there is harm to health, such as tobacco and alcohol, as mentioned in the motion. <BR /> <BR />I note the issue that the motion raises about gambling-related marketing. As Members know, the regulation of gambling advertising is a reserved matter. I feel, however, that we must continue to address the correlation between advertising and gambling-related harms.”
“<BR /> <BR />Our approach to gambling-related harm must continue to be collaborative, departmentally and across the sector, and to engage key stakeholders to ensure that, moving forward, our decision and policymaking will have the right outcomes for those who need them most. My officials will continue to do that, facilitated by the cross-departmental working group on tackling gambling harms, and they will remain engaged. <BR /> <BR />As I said at the beginning of my remarks, I thank the Members who tabled the motion and, more widely, the members of the APG for their recent inquiry report and its recommendations, which I welcome. My officials carried out scoping work following the recommendations contained in the first inquiry report, 'The Future Regulation of Gambling in Northern Ireland'.”
“My Department continues to work collaboratively with cross-departmental colleagues to address that. The questions on gambling that were included for the first time in the young person's behaviour and attitudes survey and the Northern Ireland health survey will help, and the results of the latter are expected imminently. I have been informed that the Department for Communities has commissioned an updated gambling prevalence survey, the first of its kind since 2016. I hope that those results and the ongoing programme of work will help us to fully understand the extent of gambling in our population and the harms associated with it. That will allow us to make informed decisions about potential policy progression and/or treatments in that area.”
“While evidence demonstrates a clear link between problem gambling and mental ill health, the relationship can be complex, with studies showing that gambling can be a coping response to pre-existing mental health problems. <BR /> <BR />At this point, I thank the Minister for Communities and his officials for their efforts thus far and their continued work on legislative reform in Northern Ireland. It is widely documented that gambling legislation here is outdated and does not effectively address the growing issue of the online market. My officials remain engaged with and supportive of their DFC colleagues as that work progresses. <BR /> <BR />That said, the deficit in up-to-date data and evidence on gambling prevalence and associated harms here is well documented.”
“<BR /> <BR />It is clear from the evidence available that problem gambling and gambling addiction are harmful to health. Those harms can be widespread, and they manifest in a number of ways, including mental health issues, substance use, addiction, financial problems, relationship issues, emotional or psychological distress or, indeed, criminal activity. I note the stark findings in Public Health England's 'Gambling-related harms evidence <BR />review' in 2021, which said:”
“I thank all the Members who have spoken in the debate. I pay particular thanks to members of the all-party group, not just for the work that they have done on the latest inquiry into public health approaches to tackling gambling but for all the work that they have done since the APG was formed. Previous inquiry reports, numerous evidence sessions and an all-round determination to tackle the harms have been of much support and interest to my Department and to me personally. <BR /> <BR />The first thing that you need to do, if you want to address a problem, is to name it, whether it is cancer, suicide or gambling harms. As other Members have done, I commend Mr McGuigan, because he has named it and so publicly owned his experience.”
“Subject to the necessary approvals, the Department will focus, in the immediate term, on the introduction of that legislation, including the bringing forward of regulations under the powers in the Bill. It will then identify the remaining challenges, which will be the focus of a new tobacco control strategy for Northern Ireland.”
“I am very supportive of the UK Tobacco and Vapes Bill. I thank the Member for his question. As he will know, smoking is the number-one preventable cause of death, disability and ill health in the UK. In Northern Ireland, it kills 2,000 people every year. <BR /> <BR />The Assembly agreed to Northern Ireland's inclusion in the previous Tobacco and Vapes Bill under the previous Government. That Bill fell due to the election in July. I hope that Members will continue their support for the new Bill, which is largely the same but with a few extra protections. I am hopeful that a legislative consent motion will be laid before the Assembly in a fortnight's time.”
“I agree that it is a public health issue. As a constituency MLA, I have visited houses that have damp and mould and are home to very young children. However, in legislating, I do not think that it falls primarily to the Department of Health. Certainly, on a personal and party level, we are supportive of the sort of legislation that the Member suggests.”
“I do not. If the Member wants to write to me, I will give it due consideration.”
“As former members of the Policing Board, we know the impact of body-worn video on the police's ability to do their job and bring wrongdoers to the right place.”
“I thank the Member for the question. I believe that the trusts are giving active consideration to that and, obviously, they are working with the PSNI. Another issue that I think will lend itself to the use of body-worn video is the introduction, which is forthcoming, as the Member will know, of the Right Care, Right Person policy by the Police Service of Northern Ireland, which is particular in how the police react to people who have mental health issues. I have no fundamental objection to the policy. My concern, as the Chief Constable and others know, is that we roll it out in a way that we do not create a hiatus: we do not do it so quickly that the police stop responding but the health service is not ready to fill the gap. <BR /> <BR />We are working with the police in the thinking around body-worn video.”
“The Member will agree with me that, in recent weeks and months, we have heard some very disturbing stories about activities within the curtilage of emergency departments. Threats to staff are high on that list. Drug abuse and drug use is another issue. Nurses and doctors in EDs are well used to people coming in with alcohol issues, but some of those developments are worthy of being defined as "developments". Personally, I support the consultation. I would like to know what the public thinks, and I would like to think that they will back us. We always recognise their support for healthcare workers.”
“<BR /> <BR />As the Member says, community pharmacies have a really important part to play in my desire to shift left because, along with GP surgeries, they provide so many vital services, and increasingly more, such as the sore throat initiative, over this winter.”
“I have written to Wes Streeting, the Secretary of State for Health and Social Care in London. I have also engaged with our Finance Minister, Caoimhe Archibald, to make her aware of the issues, and she is making representations to Treasury. The Member may agree with me that the relatively new Government in London have done some surprising things since taking power on 4 July, and when I say "surprising things", I mean not in a good way. Certainly this rise in National Insurance contributions, and who it is being targeted at, is not going to help healthcare delivery in the short to medium term.”
“I thank the Member for his question. It is certainly an issue that exercises me, as, I am sure, it does community pharmacists. I am not sure that I have any confidence that the Government in London are going to step up to the mark and provide help. I think that, for direct employees of Health and Social Care, we will get assistance with the additional demand for National Insurance, but I have no confidence that that is coming for GP surgeries, community pharmacies and hospices. The cost will be in the tens of millions of pounds, and it is another unwelcome additional pressure on major and extremely important areas of HSC delivery.”
“Some 171,000 people have accessed the full multidisciplinary team services, and 300,000 additional consultations have taken place because of multidisciplinary teams. My concern is that people in some areas have access to a full MDT team, but, in some areas, it is a partial one and, in some areas, none at all. That is an issue for the delivery of health equity, and it can be addressed only through additional funding, such as that coming from the transformation fund.”
“I thank the Member. I will take the second part of the question first. Yes. My view is that we must shift left into primary and community care. We must talk about prevention and early intervention rather than waiting for people to become acutely ill and end up in our major hospitals. Of all the reforms that have happened since Bengoa, multidisciplinary teams in primary care are probably the most successful example of transformation, and we have talked about elective overnight stay centres, day procedure centres, mega clinics, rapid diagnostic centres, which are all in secondary care. <BR /> <BR />I will give the Member some statistics. Multidisciplinary teams have seen over 751,000 patients and offered physiotherapy, social work, mental healthcare and the rest, and that is across 116 GP surgeries.”
“The interim board has done the first sift, and I am glad to say that our bid for money for multidisciplinary teams is through round one and into round two. I can only hope that we will come through successfully at the conclusion of its deliberations and that that will happen as quickly as possible.”
“I thank the Member. I very much enjoyed my visit to the practice in East Antrim with the Member. Sometimes, you walk into a health or social care facility and are immediately hit with the positive energy and a good feeling, and that was certainly the case on that day. <BR /> <BR />Multidisciplinary teams are currently in seven of our 17 GP federations. If I could click my fingers or had a magic wand, they would be in all 17 by the close of business today. Unfortunately, that is not the case. East Antrim is far from being in the worst position of the remaining GP federations because it is third on our list for a roll-out, but that roll-out is dependent on funding being secured from the transformation fund. The transformation fund has not yet come to any of its conclusions.”
“With respect, the Member's comment is entirely inconsistent. On the one hand he says, "This is a long-term problem that needs a long-term solution", and, on the other he thumps the desk and says, "Do something now". Does the Member really think that, if I could pull a lever that would help, even in a minor way, today and tomorrow, I would not pull it? Does he really think that anybody is sitting back and saying, "There is a partial solution, today and tomorrow, that will make a partial positive difference", and we are not doing it? If the Member does think that, come and see me afterwards and tell me what it is.”
“The Member will be aware of the regional control centre at Knockbracken. I visited it a few weeks ago for the daily 12.00 noon call, when staff try to coordinate the trusts. Collaboration is building. The trusts need to trust one another. You do not want one trust saying, "We will take some of your patients and take some of the load off you", unless it can be absolutely confident that the other trust is not simply saying, "We do not need to try any harder. We can just rely on our colleagues across the trust border". <BR /> <BR />It is stark to look at the screens in the regional control centre and see that ambulances are waiting 12, 14 or 16 hours. Often, the patient is in their 70s or 80s or even their 90s.”
“I thank the Member for his point. It is entirely regrettable that that is one of the symptoms of the blockage in the flow through our acute hospitals, and I am determined to address it. The answer is not simply in more staff or more ambulances. The answer is not just in bigger EDs with more staff, and it is not about more beds in acute hospitals. It is about the flow, and, as the Member knows, the biggest obstacle this winter has been the lack of community care, whether that is in care homes or through domiciliary packages. We have to work hard on that. Like nurses, doctors and allied health professionals in EDs, ambulance crews did not sign up to sit with, often, an elderly patient in their vehicle outside an emergency department, potentially overnight. <BR /> <BR />Things are being done to improve the service.”
“<BR /> <BR />The net effect of the Department, stakeholders and the HSC trusts working together over the past two years has been the trusts’ complete cessation of agency social worker usage, the direct recruitment of 160 former agency social workers into HSC contracts and the recruitment of almost 430 newly qualified social workers into HSC vacancies.”
“In collaboration with the trusts, the Department decided to end agency usage for HSC social workers by the end of June 2023. Some 160 former recruitment agency social workers were then recruited into HSC posts. I repeat: 160. The five trusts have confirmed to the Department that, between September 2023 and the present day, no recruitment agency social workers have been employed in HSC services. I am pleased to report that, between July and October 2023, 204 newly qualified social workers were appointed to vacant posts, the majority of which were in services relating to children and families. That exercise was repeated in the summer of 2024, and, again, I am glad to report that a further 221 newly qualified social workers have successfully completed their social work training and taken up permanent employment in the trusts.”
“The majority of those agency social workers were located in children's services, which is a sector that was also experiencing high levels of vacancies.”
“For a number of years, the Department has been working collaboratively with the trusts and other stakeholders in an effort to stabilise the social work workforce. It has been a key focus for my predecessor and for me. In early 2023, over 200 social workers were employed by recruitment agencies. They were delivering Health and Social Care services.”
“When we fill it in, a lot of the stuff that we already know is bound to go in there, but let us try to be imaginative, and, above all, let us include everybody from the get-go. That clearly did not happen last time. That is not a criticism of the Department; it is a critique of what happened last time and of how we might improve things next time.”
“I am very happy to confirm that they will be. To be fair to them, departmental officials were very professional in their approach when they started, in March 2024, to plan for this winter. From looking at the plans, however, it is clear to me that some of those organisations were represented directly at the table, some were represented second-hand by a broader organisational group and some were perhaps not even at the table at all. <BR /> <BR />My view is that we get every stakeholder around the table for the initial meeting, where the page is blank. I have some ideas, but, if I start to say them, I will be filling in the page before they get to have their input. Let us start with a blank page.”
“By the way, they said that the big problem was treating mental health patients, because, in the old ED at the Ulster Hospital, there was only one side room for mental health patients, so, when a second one presented, there was nowhere to put that patient. <BR /> <BR />When I was there, a guy came in a bit after midnight by ambulance. He was drunk. He had a lot of alcohol on board. He was found a chair. At around 2.00 am, the chair was empty. I asked, "Have you dealt with that patient?". I was told, "No, he has disappeared". At around 3.30 am, a second ambulance brought the same patient back. What had happened in the meantime? He had got a taxi home to get a drink. That is what ED staff have to deal with.”
“I thank the Member for his follow-up question. Before I became Minister — in fact, we are talking about maybe three or four years ago — I was made aware that Monday nights are the nights when EDs are under the most pressure. As a constituency MLA, I asked to spend the night observing a night shift in the ED at the Ulster Hospital. I brought up the issue of people coming in after excessive drinking and asked whether it caused problems and created pressure. The nurses said, very clearly, "Absolutely not. We have been dealing with that for decades. It is not a new issue. We are well used to dealing with it".”
“Trusts also plan to include the development of pathways that provide direct access for ambulance services to services as an alternative to conveyance to emergency departments, which will reduce pressures on those EDs. <BR /> <BR />If I may be so bold, Mr Speaker, maybe I can ask the Member a question. Does he support me in my drive to get the Executive to agree to introduce minimum unit pricing for alcohol, which has been proven to decrease demand on the NHS in Scotland?”
“Hospital attendances are coded to reflect the primary reason for a patient attending the emergency department, but that will not necessarily reflect the fact that alcohol was a contributory factor. It is therefore not possible to provide a reliable assessment of the impact of excessive alcohol consumption on visits to emergency facilities over Christmas and the new year. <BR /> <BR />We know that our EDs faced increased pressures over the festive period. That is why my Department asked the trusts and the Ambulance Service to develop improved plans to maximise capacity and improve flow through our hospitals. That is all part of the winter preparedness arrangements.”
“I thank the Member. I recognise that, like elsewhere in the UK, our Health and Social Care (HSC) system as a whole is under sustained and significant pressure. Too many people wait too long to access urgent and emergency care, which falls short of the service that we all strive to provide. <BR /> <BR />My Department recognises the risk of possible harm to patients who experience long waiting times in an emergency department. Some patients will present with a range of issues where alcohol may have been a factor — for example, a fracture or head injury due to a fall — or they may present with symptoms of liver disease.”
“Yes. Maybe I should have made it clear that my officials are liaising not just with the Department for Communities here but with the Department for Work and Pensions in London. As I said, it is a complex area, and we intend to get the best possible fit for people in Northern Ireland. That involves knowing exactly what DWP is doing, including the restrictions, because, as I said, not everybody automatically passports from universal credit to get this help. We want to get the best of both worlds.”
“I will confirm it in writing to the Member, but I believe that those are regulations coming out of the UK Government and are UK-wide.”
“<BR /> <BR />The third point was on whether I will investigate whether there has been an undue delay. I assure the Member that I will do that, but let us get the thing fixed first.”
“The Member now brings up three things. First, let us make it happen. To my mind, the most important thing is that we look after those vulnerable people and make sure that they get the help, resources and funding support that they need. <BR /> <BR />I am taking it in reverse order. Secondly, yes, there has been ongoing consultation between officials from my Department and the Department for Communities. The two Departments work well together. Indeed, what has been happening since last week's storm is evidence of good cooperation, from ministerial level down, between the Minister for Communities and me. I will digress just for a moment: a lot of the vulnerabilities are not with people in hospitals or care homes but with the vulnerable in the community.”
“The consultation will run for six weeks, with the associated legislative process commencing thereafter. It is intended that the legislative process will be completed by this summer. My aim is to ensure that those most in need automatically receive help to access those very important health services.”
“I thank the Member. I assure him that work on the proposed changes to the legislation is a key focus for my Department and that I am committed to ensuring that the work is completed without undue delay. The Member may well come back to me and say that there has already been undue delay. He can make that argument, which I am more than happy to listen to. However, in defence of the Department, it is a complex area. It is not the case that, in GB, all universal credit recipients are automatically eligible for help with health costs. That needs to be looked at and is part of the delay. <BR /> <BR />I am pleased to tell the Member that I am announcing that the public consultation on the proposed eligibility criteria for passporting UC recipients has launched today.”
“I do not know whether that will be the outcome or whether a better outcome is being proposed by colleagues in the Executive or elsewhere. How can anybody who has listened to the history of those major projects over recent years have any confidence that the next project will not run over in time and cost?”
“I thank the Member for his question, and I agree with the sentiment of it, although I caveat that by saying that there are things that are beyond our control. The rise in building costs and in building materials has been much higher than anybody — any economist, any politician or any Chancellor of the Exchequer — could have predicted over the past number of years. <BR /> <BR />That said, we have to think again, because there are so many examples, as I have just said, not just in health provision, where the costs and the timelines are exceeded quite starkly. I think that it was the Audit Office that recommended that we have an Executive-wide body to look at all such major projects. That is the right way to go, and I had written to the First Minister and deputy First Minister in those terms. It is an issue that, to my mind, is unresolved.”
“I have come to the conclusion that we are certainly not top of the class or best in class when it comes to major infrastructure works, and this is part of a bigger problem that needs to be analysed, because those figures, on the face of it, are surprisingly high. It is incumbent on me as the Minister of Health to look at whether it can be fully justified or whether there are areas where there are learnings and where we can say that we should not have run up such a big bill.”
“I thank the Member for her supplementary question, and I acknowledge, of course, the time that she spent in previous years in the maternity hospital. I will not endorse the thought of those fees being excessive, because I think that, to reach that conclusion, we need to break them down and analyse them line by line. I have asked for that to be done, because, like the Member, I find the amount to be surprising, if I may use that phrase. I find it surprisingly high, but they are major works that have gone on over a long time. <BR /> <BR />I have said in the House previously it is not just the construction of new build in Health and Social Care that should be an issue for the House and for the Executive. You think of things such as the additional costs of Ulster University's development in north Belfast and Casement Park.”
“The incorporation of learning from the maternity hospital and other learning from recent major schemes in the NHS and, indeed, in Dublin into the design and commissioning arrangements for the children’s project will be essential. That has included the definition of more detailed criteria for the water safety standards. We will also see the engagement of independent subject matter experts for all the critical systems. That includes high-voltage and low-voltage electricity, water, fire, medical gas and ventilation. The introduction of building information management and a contract management software system with common data environment for use by all parties will improve project collaboration and coordination. Finally, the introduction of a new change control protocol for the children’s hospital project should be reassuring.”