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 also want the appointment of a new director of strategic development in the trust to carry out the role of senior responsible owner for the children’s hospital. Much of their workload will be attributable to the project.”
“I thank the Member for her question. I have asked my officials to identify the key lessons from the new maternity hospital project and ensure that they are applied ahead of signing any contract for the new children's hospital on the Royal Victoria site. My officials are working closely with all parties involved in the delivery of the new children's hospital, including the Belfast Health and Social Care Trust, the design team and the contractor. We want them to consider a range of improvements to the management of that construction project, which the Member and I agree is absolutely crucial. <BR /> <BR />At the minimum, I am looking for the use of a new engineering contract (NEC), which is a new form of construction contract that contains contractual requirements demanding timely decision-making with collaborative, agreed outcomes.”
“We have also sought to better promote social care as a valuable career choice. We have delivered the Social Care — Making a Difference promotional campaign, which showcases the value and diversity of social care.”
“I thank the Member. A range of initiatives are under way to help to build and sustain that workforce: the social care workforce strategy, which I have already mentioned and which will be key to addressing recruitment and retention in the sector; the launch of the new level 2 safe and effective care practice certificate; a new care and practice framework, which includes career pathways; and a continuous learning framework. Those will all support the career progression of social care practitioners and should enable them to use their practice experience, knowledge and skills to better support service users. I have mentioned the establishment of the fair work forum to make an evidence-based case for improving pay, terms and conditions. Furthermore, I recently announced my intention to make the sector a real living wage sector.”
“I thank the Member for the point. I am not aware of that individual constituent's contractual relationship with her employer. It may well be a private-sector matter, in which case the Department is, probably, limited in the extent to which it can intervene. However, if the Member wants to provide me with the details, I am more than happy to look at the particulars; as Shakespeare said, from the particular comes the general.”
“I think that the Member will recognise that I have set a direction of travel, which is to shift left in order to try to take the emphasis off curing people who, in many cases, have become acutely ill and need an acute hospital, and to put the emphasis on community, primary and social care, and on prevention and early intervention. It is about making sure that people do not need to go to an acute hospital, unless that need is absolutely acute.”
“I agree with the Member that listening is absolutely important. As Minister of Health, I listen to people, not just those in the Department. I listen to anecdotes, but, more importantly, I like to listen to people who are at — to use an old-fashioned phrase — the coalface. I do that all the time. I was in a care home on Christmas morning, listening to some of the staff talking about the challenges that they have in delivering for their service users. It is really important to listen. It is also important to set a direction of travel.”
“I am very glad to listen to representatives from the voluntary and community sector, who operate in rural areas, for me to fully understand the issues and to listen to imaginative ideas for how to address them.”
“I thank the Chair of the Committee, who is speaking in her personal capacity as an MLA. Yes, that is an issue but it is one in a range of issues that we have to look at. We have to think outside the box and have that blank-page start and ask, first of all, "What are the issues?", and there are specific, rural issues with healthcare delivery. Absolutely. We then have to ask ourselves, "What are our resources and what is our ability to meet the challenges that we have?" <BR /> <BR />I am more than happy to work with the Member on an individual basis, and I am more than happy to work with the Committee. I will be working with officials.”
“<BR /> <BR />With that blank-sheet approach to pressures in our EDs — not just winter pressures, which I now call "additional winter pressures" — I hope that we will look at the consequences and how we improve, going forward.”
“Yes, I can assure the Member that there will be an immediate consequence in what I am calling "blank-sheet planning" for next winter — and, indeed, earlier than that. As she correctly identifies, the issue has been the flow, which can be blocked at any point between a patient arriving in an ambulance at an acute hospital and being fit for discharge at the so-called back door. The Member is also aware that, this year, the biggest problem that has manifested itself in emergency departments is not the emergency department but the community capacity. I am determined to work at that over the course of the coming calendar and financial year. Hopefully, introducing the real living wage should make working in that area much more attractive, certainly more attractive. That is a major step.”
“<BR /> <BR />A new social care workforce strategy was launched on 12 December. Among other things, it sets out how we will attract, grow, retain and develop the skilled staff necessary to deliver high-quality social care. To deliver that stronger, strategic vision, a whole-system approach to design and delivery will be required.”
“I also made available additional funding in the financial year 2024-25 to help stabilise and maintain independent sector provision. The implementation of CareLineLive in three of the health trusts is enabling the better utilisation and deployment of the trusts' home-care services. They do this by creating greater line of sight of home-care capacity on specific schedules and quickly identifying areas where there are capacity issues and where recruitment activity needs to be focused. <BR /> <BR />The completion of a review of the impact of trusts' early review teams resulted in 2,884 strategic planning and performance group-funded hours per week being recycled into the system between October 2023 and September 2024. It is intended to roll out reviews across all programmes of care in the next financial year.”
“I thank the Member for her question. Following the publication of the consultation report, the social care collaborative forum was established with the intention of working with my Department to implement the proposed reforms. The forum provides the cross-sectoral leadership that will be critical to adult social care reform. While it is expected that full reform of the scale necessary will only be deliverable in the longer term, we are also trying to make progress in a number of key areas. Achievements to date include the establishment of the social care fair work forum, which aims to gather evidence to support additional investment in the sector, and the commitment to make it a real living wage sector, which is a policy that the Member will be aware that I announced earlier this month.”
“He said that he needed every square yard — I imagine that he said "yard", because he is not a European and would not have gone for "every square metre". We need every square yard or square metre of all the facilities. It is about how we reconfigure them, and that is why I have gone out to consultation on the idea of having a network of hospitals. We really need to embed that idea in the minds of the population.”
“I was recently in Downe Hospital. The urgent care centre was one of the areas that I visited. It is a magnificent development. Indeed, the consultants and nurses in that urgent care centre made the point that, in the past, people who lived in the vicinity of that hospital would have made their way to the Ulster Hospital emergency department to be triaged and would then have been referred back to Downe Hospital. The direction of travel that I want to see, which is now emerging, is having direct referrals, preferably made by GPs who have done a triage assessment, and then being able to contact an urgent care centre directly, bypassing EDs and unnecessary trips to other hospitals. <BR /> <BR />More broadly, I am absolutely with my predecessor Robin Swann when it comes to maximising the capacity of those hospitals.”
“I thank the Member for that follow-up question. We have been increasing the number over recent years. Would I like to increase it yet further? Yes, of course I would. Would I like to provide a timescale? Yes, I would, but the fact is that the budget does not permit me to start detailing that sort of plan to the Member. As we move into next year, the draft 2025-26 Budget leaves the Department of Health with a funding gap of around £400 million. I remind the Member that I am working hard to deliver the pay parity awards that nurses and doctors deserve. I do not want to sound the irony klaxon just yet, but the challenges of increasing staffing, workforce and resource cannot be met without an appropriate accompanying budget.”
“<BR /> <BR />The Member will know that, in order to provide a new service, such as a step-down service or an emergency service, we need four things: the building, the equipment, the medicines and the workforce. Of course, the workforce is the most important element. If you do not have the right workforce, it does not matter what buildings, equipment capacity or range of medicines you have. Given the timescales, it was not possible to consider Bangor Community Hospital in the way that the Member has suggested.”
“I thank the Member for his question. Given the logistics involved, no consideration has been given to asking the South Eastern Health and Social Care Trust to reopen the inpatient ward or minor injuries unit at Bangor Community Hospital. I believe that the Member is aware that that service, along with the associated resources, transferred to the Ulster Hospital as early as September 2023, following extensive consultation. As detailed in the consultation report, the stand-alone minor injuries services at Bangor Community Hospital were not sustainable. I believe that there has been a physical reconfiguration of that area in Bangor Community Hospital since then.”
“Let us address them urgently, but let us not use language that might have the effect of putting people off visiting EDs when that is where they really need to be in order to get the healthcare that they require.”
“I accept that. <BR /> <BR />Sinéad McLaughlin mentioned equity and regional balance. I am very keen on that. She will be aware of the fact that my Live Better initiative to tackle health inequalities has two demonstration areas, which are coming soon, and one of those is the Moor district electoral area in her city. I am very optimistic that it will start a process. One of our measures has to be healthy life expectancy. Since devolution came back in 1998, we have not shifted the dial in the right direction. <BR /> <BR />Thank you for the debate. It has been very helpful for me. Let us be aware of and absolutely honest about the issues.”
“<BR /> <BR />At one point, I think that Mr Delargy compared staffing levels at Altnagelvin with the levels in the Belfast Trust. With respect, that is not really comparing like with like. We can compare the Western Trust, which has more than one hospital, with the Belfast Trust, which has more than one hospital, but comparing one hospital with a whole trust does not really do it for me.”
“I agree, but: it is a, "Yes, but", from me, because, even if you doubled the size of the ED at Altnagelvin, with the appropriate staff, you would not cure the problem. The problem emerges and is evident in EDs, but the problem is not the EDs. It is the flow. Over this winter, the biggest block has been at the back door, not the front door. It has been the lack of community capacity by way of domiciliary or home care packages and care home beds. Those issues cannot be fixed very readily, but I am determined to work on them. Mr Delargy acknowledged that I have decided to give the real living wage to people who work in domiciliary care. It is important to make that sector more attractive. The salaries and the daily rate simply are not attractive at the moment.”
“By April 2027, subject to additional funding, which is a big question, we will further reform urgent and emergency care through exploring and, subject to analysis, developing a regional 111 urgent care service. Through investment in Hospital at Home and immediate care services, we will offer better and more appropriate alternatives, where appropriate, to emergency departments. <BR /> <BR />I turn now to some of the remarks that were made by Members. I very much welcome Mr Delargy saying that he and, I believe, everybody in the Chamber wants to work with me and the Department. However, with respect, we need some common agreements. Mr Delargy suggests that faster processing times would help ambulances.”
“We certainly do not want to see it repeated. Nuala also talked about not doing these things piecemeal. That is why, in October 2024, I launched the consultation, 'Hospitals — Creating a Network for Better Outcomes'. We have to view Altnagelvin and all the hospitals, including SWAH, in the other geographic trusts, as an network. Not every hospital will do everything. The result should be that we develop hospitals that have specialisms. I want to see best practice rolled out across Northern Ireland. That does not mean in every hospital, but every service should be best practice. As well as that consultation, I published the three-year strategic plan, in December. It sets out a path for the future, based on three pillars: stabilisation; reform; and delivery.”
“Again, we are moving to the point where GPs make the direct referral, so that second, unnecessary assessment, which comes at the cost of sitting for hours or, perhaps, days in chairs or standing in the ED, is done away with. There is a respiratory hub at Altnagelvin — it was established in September 2021. I have been in it. It is a really good facility. There is also a cardiology assessment hub. That was initiated as a result of COVID-19. Patients are triaged there and assessed by an experienced cardiac nurse. Those things are happening. <BR /> <BR />It is important to ensure that the proposed solution for the new ED delivers the benefits that are needed and represents value for money. Nuala McAllister made the point about what has been happening in Belfast. I do not think that anybody can stand over that.”
“I do not want people to think that nothing is happening. A couple of Members mentioned the relatively new minor injuries unit, which opened on 25 March 2024. The direction of travel here is that it is often not required. If you go to the GP, get a diagnosis and are told by the GP, "You need to go to an acute hospital", you go and sit for those 300-plus minutes, waiting for a second assessment. The second assessment is redundant — it is not required — in some cases. Therefore, a referral directly to a minor injuries unit would take some pressure off. It is also a much better pathway for the patient. Some settings have dedicated areas, such as respiratory and cardiac units.”
“I have been told not to suggest that getting it through to final business case and then to construction will be done in fewer than five years.”
“<BR /> <BR />Returning to the specific issue of Altnagelvin, the current space is not adequate to support current or future numbers. As Mr Delargy said, it was built to support approximately 35,000 patients per annum. It is probably receiving double or just over double that number. We will get a new ED at Altnagelvin. If I am being realistic, I think that five years is the quickest time in which it could be done. Mr Durkan mentioned the fact that we have been at this for a while. The first business case was for multiple facilities, and the decision of the Department was that it would be more realistic, practical and achievable to break it up into single units. That is why there has been a second outline business case, specifically for an emergency department.”
“What you have to do is make a decision, not on the best option but on the least worst option. You are going to have to move a patient out of resus who is not ready to be moved because there is a patient who is worse off and needs in. <BR /> <BR />We talk about winter pressures, but I have stopped talking about them. I now talk about "additional winter pressures" in recognition of the fact that the pressures on EDs are now happening 365 days a year. I will say to the House what I have said in all those EDs to members of staff: I understand that we cannot continue endlessly to try to run healthcare, and particularly emergency departments, on goodwill, because goodwill is finite. It will run out at a certain point. That point will be different for different people, but everybody has a limit to their goodwill.”
“Patients who check in are not just asked for their health and care number: far too many of them are also asked to surrender their dignity and their right to privacy. When I was in Altnagelvin, I talked to the wife of a patient. The two of them had been in chairs for four days. Four days. That is not right, and it is not fair on the staff — the nurses and doctors — who are suffering moral injury, because they know what they can do. <BR /> <BR />That is not just the case in Altnagelvin; it is happening in the six EDs that I have recently visited. Generally, in the resuscitation area — the resus area — of an ED, there will be clinicians and nurses. However, if the resus area has five bays and there are six or seven patients who need resus, how do you square that circle? How do you riddle that?”
“Thank you, Mr Deputy Speaker. I thank Pádraig Delargy for securing the Adjournment debate. It is an important issue, and I very much accept that. <BR /> <BR />Let me start with a very important positive. I am fully supportive — fully supportive — of the need for a new emergency department at Altnagelvin Hospital. I am aware of the depth of concern and feeling that surrounds the issue. I was there recently. I have been to six EDs since Christmas. I will be in the South West Acute Hospital — the SWAH — tomorrow. While they are all different — Altnagelvin, as we have acknowledged, is the oldest, which presents its own infrastructure problems — there is a commonality that I have picked up from all six.”
“I thank the Member for giving way. I just want to address Mr Carroll's concerns. He might be aware that a new policy is coming forward called Right Care, Right Person, which is a collaboration between the PSNI, the Department of Health and the Department of Justice, and it will address that very concern.”
“I want to deliver anti-stigma and anti-discrimination public awareness and education campaigns. Where collaboration with other Departments or community and voluntary sector partners can achieve that, we must take those opportunities. Again, I stress the incredibly valuable role played by community and voluntary sector organisations. I close as I began by thanking the Member for moving the motion.”
“Discussions are under way with my departmental digital mental health forum to identify potential avenues to take all that forward. If we genuinely want to achieve the required improvements in our mental health services and ensure that the services that we provide can meet current and future demands, mental health services need real and sustained funding to ensure full delivery of the mental health strategy. As I said yesterday, for this year's action plan, we should have £42 million: we have £5·9 million. <BR /> <BR />I will begin to conclude by encouraging all Members to support my efforts to achieve that outcome. In answer to the motion, I am open to all discussions, ideas and proposals that enable us to provide better mental health services for people across Northern Ireland.”
“I thank the Member. In trying to transform the laws of defamation, I tried to address issues with the internet, though not necessarily the specifics to which he refers. We all know about people searching what is commonly known as "Dr Google" — other search engines are available. That can lead to bad outcomes. Then there is the pressure, not least peer pressure, particularly for young people, on the internet. As politicians, not just here but in London and, indeed, probably globally, we are always playing catch-up with the advances in technology that necessarily include significant downsides that may pose significant health risks, particularly but not exclusively to young people. <BR /> <BR />I am looking for a strong partnership approach, but it will need significant funding to progress all these plans.”
“It provided an analysis of the current digital landscape for mental health promotion and early intervention. It outlines a road map for the phased development of a collaborative mental well-being platform.”
“There are many aspects to stigma, and therefore measuring it is complex. A multisectoral subgroup has been developed to progress work on communications and public awareness. Currently, it is focused on three key areas: research, best practice and targeting brand and digital campaigns. <BR /> <BR />The Public Health Agency carried out a digital discovery exercise in April and May last year. The aim was to explore the role of digital tools in supporting mental health promotion, early intervention and prevention across Northern Ireland. More than 110 stakeholders engaged in that process through one-to-one interviews, focus groups and workshops. Reports from the digital discovery exercise have been shared with contributors and stakeholders.”
“I wonder whether it may be a false economy to save money by not advertising on specific issues. I have not come to a conclusion on that. I am aware of a successful businessman, who might have been a Fortune 500 chief executive. Many years ago, he famously said, "I spend millions every year on advertising and marketing, and I know that 50% of it is wasted. If I can ever find out which 50% that is, I will cut it out". Again, it is a very complex issue. <BR /> <BR />I turn to public attitudes to mental health. An exploration was undertaken through the mental health survey to inform future work to address stigma and public awareness-raising activities. Mrs Dodds gave a definition of stigma. It is a complex, multifaceted phenomenon for which there is no universally agreed definition in health.”
“It is a very complex area, as the Member will acknowledge. I believe that, if we achieve the shift left, it will take a lot of pressure off the acute hospitals, which is where the very expensive stuff takes place. It is incredibly complex, and we have seen that in the pressures on EDs over the winter. It is about the flow. There can be a blockage in the flow at any point from leaving the home to being discharged from the acute hospital. <BR /> <BR />I wanted to make a point about public awareness campaigns. There has been something of a moratorium on advertising by the Department. I am exercised by that. I wonder, had we been doing the sort of advertising that we would normally do to promote vaccines, particularly the flu vaccine, whether the uptake would have been better and to what extent?”
“I will make a point that I have made before: independent analysis, not least that by the Fiscal Council, says that, for every £100 that NHS England spends, we need between £104 and £107 to deliver the same services. If we include social care, the figure would be £109. Under next year's Budget, it will be £101·50. There is a problem with the funding.”
“They are for only a few hours and, again, do not make you a counsellor, but they give you the confidence to engage with people whom you think are behaving in a way that is worrying. You know the right questions to ask, and you know how to signpost them to help. Again, that safeTALK group and the people whom we were talking with in the housing areas in Newtownards were not talking about stigma any more. They were talking about how we could practically help people who were in trouble. <BR /> <BR />Somebody said that I would mention funding, and, of course, it is an issue. I will say something gently to Mr Donnelly. He said, quite rightly, that the percentage of spend here on mental health issues is not as high as that in England, Scotland and Wales. Let us remember that percentages are not absolutes. Look at the absolute budgets.”
“When Lynda had her clinical depression, she was working for the BBC in London. She came home for a couple of days one time, and I knew that she was not right. I decided to phone her editor — I would love to name him, but I will not — to try to engage him and tell him that Lynda was not well. His response was, "Pour her a large Bushmills and make sure she catches up on her sleep". That was the advice. <BR /> <BR />There are things that we can do, as MLAs and elected representatives. Some years ago, in my constituency, I started the Ards Suicide Awareness Group, because of people in the constituency who had lost loved ones to suicide. We raised some money and, with it, started commissioning safeTALK programmes in the big housing areas in Newtownards.”
“We work on the emotional well-being of pupils, but, some years ago, I read research from the Department of Education that stated that the majority of pupils surveyed said that they would be reluctant to discuss, or have some degree of difficulty in discussing, their mental ill health with a teacher or member of the non-teaching staff, and that they would be much more likely to engage with their peers. It is not a question of teaching and empowering a school-aged boy or girl to be a counsellor; it is about empowering them to know how to engage with a friend of theirs who they can see is clearly not quite right, and, potentially, signposting them to where help is available. <BR /> <BR />We can also do it in the workplace. Mrs Dodds made the point about so many women being told that they should get over themselves and get on with it.”
“I saw that at first hand in their dealing with victims of our conflict. There is no stigma with those groups when people who have poor mental health come to them, because it is so common; it is probably the most toxic legacy of our Troubles. They understand it, they name the problem and they embrace it. They are role models for us and, yes, we can do more, working with them, to address the stigma. <BR /> <BR />Where else should we be tackling the stigma? In schools.”
“Because of her experience, Lynda decided to talk about it and to confront that stigma. She gave many interviews in the media; she did many, many talks for community and mental health groups; and she was the face of the first Public Health Agency (PHA) campaign on mental health. On more than one occasion — not a huge number, but on more than one occasion — somebody has told me that they had read what my wife had to say about mental health, or that they had attended one of her talks, and then said, "I believe she saved my life". We do stuff, but we can never do enough. As is the case with suicide, the only acceptable number is zero. <BR /> <BR />Another experience that I have had of mental ill health was as a victims' commissioner. Mention has been made of the great work that is done by community and voluntary groups.”
“<BR /> <BR />It is well documented that my main experience of mental ill health was with my wife, Lynda Bryans, who, 30 years ago, was diagnosed with clinical depression. It turned out to be antenatal depression. She was bearing our first son. Mr Deputy Speaker, if you do not mind, he turns 30 on Monday, so, if I say in advance, "Many happy returns, Peter J Nesbitt", I guarantee that he will not speak to me for at least another month.”
“Thank you, Mr Deputy Speaker. I begin by acknowledging and thanking the mover of the motion. I have known and worked with Órlaithí Flynn for long enough to know of her genuine passion for the area of mental ill health and of her willingness to set aside party politics to get consensus. We will see that at the end of the debate, because the House will not divide on the motion. I thank her for that. I thank my officials. As always, they have provided a comprehensive speaking note, but, on this occasion, because we are focusing so much on stigma, I will, with no disrespect to those who authored the speaking note, speak slightly differently. I also acknowledge the loss of loved ones, particularly of Mr Durkan and Ms Hunter.”
“<BR /> <BR />In closing, many Members have asked me for certain actions, including those to, for example, fulfil commitments that were made under section 2 of the Autism (Amendment) Act 2022 and that would deliver Mr McHugh's utopian vision. There is a reason why the three-year plan that I published recently for the rest of the mandate talks about stabilisation before reform and delivery. There is no magic bullet, and decisive action can come only when there is a budget. When we have £5·9 million against £42 million, we have a big problem.”
“The funding plan that was published alongside the mental health strategy in June 2021 identified a requirement of an additional £1·2 billion over the life of the strategy to fully deliver those 35 actions. This year, £5·9 million has been allocated towards the delivery of the mental health strategy actions for 2024-25, but that is against an estimated requirement of some £42 million for this year. That is £5·9 million versus £42 million. If we genuinely want to realise vital improvements in our mental health services to meet the needs of those with an autism diagnosis and, indeed, of the whole population, mental health services need real and sustained additional funding to ensure the full delivery of the strategy.”