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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“<BR /> <BR />There is not a different approach to implementation in Northern Ireland. I emphasise to Members that the proposed framework will apply across the United Kingdom, and there is no difference in the approach to implementation here. In practice, there are currently no point-of-care manufacturing sites in Northern Ireland, as point-of-care products have not moved past the clinical trial phase. While it may take some years before point-of-care products become widely available, the plan is to implement the new framework pre-emptively in order to provide certainty for the industry about the regulatory requirements that they will be required to meet and to promote the UK as a great place to invest in clinical trials and product development.”
“<BR /> <BR />The diligence of the control site in overseeing the manufacturing locations will be scrutinised at routine MHRA inspections, and arrangements for oversight will be examined as part of the licensing process. Several manufacturing spoke locations will also be sampled and subject to inspections to ensure that the oversight claimed by the control site can be independently supported by inspection findings. The new framework is a modified form of the current regulatory system for the evaluation of regulatory compliance at manufacturing sites and safety monitoring. There will be no change in the expected standards that must be met for the safety, quality and efficacy of the product. There will not be an increased risk to patient safety, with the MHRA retaining regulatory oversight.”
“I will set out how the MHRA will ensure that point-of-care and modular manufacture products meet the necessary standards of safety, effectiveness and quality that are expected of all medicines. <BR /> <BR />The new framework is centred on a hub-and-spoke model, with a single control site as the hub for each product overseeing all aspects of the point-of-care and modular manufacturing systems, including the spokes: the individual manufacturing locations and their activities. The control site will be the only named manufacturing site on the manufacturing licence and on the clinical trial and marketing authorisation applications. The holder of the control site will, as the name signifies, be responsible for ensuring product quality across all manufacturing sites and for notifying the MHRA of reportable issues.”
“Secondly, healthcare professionals will benefit from the ability to provide a greater range of more effective treatment options, thus improving patients' response to treatment and delivering better outcomes. Lastly, innovators in industry will benefit from clear regulatory expectations and the enabling of speedier product development. The new framework will remove regulatory barriers that are not suited to novel manufacturing methods. That benefit will be seen across companies of all sizes, be they large, medium or small enterprises. <BR /> <BR />It is vital that the medicines regulatory framework is flexible for new innovations but does not compromise patient safety.”
“<BR /> <BR />The objective of the instrument is therefore to provide an enabling framework to allow the safe and efficient manufacture and supply of those emerging medicines, which are still in the early stages of development, and provide the regulatory clarity necessary to encourage the development of those new products and approaches. The benefits of that approach will extend to patients and carers, who will benefit from access to new and more personalised medicines in a timely and more convenient manner with the potential, as I said, for some patients to be treated with medicines manufactured at their home. It will help to move care from hospitals to communities, which is, of course, consistent with my direction of travel for health and social care delivery.”
“Point-of-care and modular manufacture products may be manufactured at multiple sites across the country. Some of the products are developed to meet the unique needs of each patient when the patient needs them and are often derived from the patient's cells or blood; indeed, some products must be administered within an hour or, in some cases, even minutes of being manufactured. That creates an urgency and a specific demand that traditional manufacturing cannot easily accommodate. It would be extremely challenging for those innovative products to be regulated in accordance with the current regulations, and that results in significant regulatory and financial hurdles.”
“Modular manufacture can support early-stage vaccine deployment, allowing vaccines to be locally filled and finished and ensuring efficient supply to mass vaccination centres. <BR /> <BR />The amendments are needed as, with advancing health technology, innovative medicines are increasingly being developed that will need to be manufactured close to patients and healthcare settings. The traditional approach by the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), therefore needs to adapt to support the development of the new technologies. Current arrangements are suited to centralised factory-based manufacture, with a small number of fixed manufacturing sites named on manufacturing licences and on marketing authorisations.”
“<BR /> <BR />The introduction of the framework is intended to proactively support the development of new medical advances on the cutting edge of technology and new means of medicine manufacturing, facilitating the development of highly specialised medicines where they are most needed for patients, whether that be on hospital wards or in operating theatres, community health centres or even patients' homes. The products are in the early stages of development, but one example of the type of innovative treatment that may be enabled by the new framework is a diabetic foot ulcer treatment that uses blood-derived products obtained from the patient and manufactured at their bedside.”
“Thank you, Madam Principal Deputy Speaker. I seek the Assembly's approval for the making of the draft statutory instrument (SI), which will amend the Human Medicines Regulations 2012 — the "HMRs", as they are known — and the Medicines for Human Use (Clinical Trials) Regulations 2004. That will enable the introduction of a new, tailored regulatory framework to support point-of-care (POC) and modular manufacturing (MM). In turn, that will decentralise methods of medicine manufacturing and move innovative medicines closer to the patient while maintaining robust regulatory standards and ensuring patient safety.”
“I thank the Member for his comments. He will be aware that the Live Better initiative, which will come on stream very soon, has two demonstration areas, one of which is in West Belfast. When we spoke with people in that area about the services that they want, their feedback put dentistry on the list. That will be important, because if we can get better results and show empirically that the Live Better initiative in West Belfast has delivered better dentistry outcomes, we can use that evidence to roll it out further across Northern Ireland. Ultimately, it comes back to this: can we reform in a way that encourages dentists to do more work in the health and social care system rather than to use their time to offer private services, as is the trend at the moment?”
“There is an opportunity to be open and to have a Being Open framework, which I am about to publish for consultation. It is about looking at a duty of candour that might be placed on all public servants, not just those who are in the health service. Part of that is recognising that, if there is a serious adverse incident and something goes wrong, you and your family deserve to be told at pace what went wrong, why it went wrong and what we are doing to try to ensure that it never happens again. Yesterday, I met a family who lost a loved one to cervical cancer in the Southern Trust. This is my duty, and it is a privilege that those families feel that they can share their experiences with me. I say this to the Member: I would like to get to the position where I never have to meet another family in that situation.”
“I thank the Member for bringing up a very important issue. The serious adverse incident process is supposed to be a learning process. It is far too slow and is not fit for purpose. That is why it is under review. It will be reviewed within the broader context of the introduction of a duty of candour. <BR /> <BR />The House has debated whether the duty of candour should be organisational or individual and organisational, and, if it is to be individual, whether there should be criminal sanctions where people have not been open and candid. The proposed Hillsborough law that will come from the UK Government will also play into that. They are promising that legislation before the next anniversary of the Hillsborough disaster, so by April 2025, which is ambitious. <BR /> <BR />Here are the opportunities as I see them.”
“Let us say that a GP assesses that a patient has respiratory problems and there is a respiratory unit that is probably approximate to where the ED is geographically. The GP will refer the patient straight to the unit. That is how you take a bit of pressure off EDs, as well as, of course, trying to make people healthier and keep them healthier for longer.”
“The reason for the lack of detail on winter preparedness in the plan is that a statement on winter preparedness has already been issued. <BR /> <BR />On the substantive issue, one thing that we are trying to do is provide alternative pathways to EDs. For example, there are ambulatory services in many of our acute hospitals and specific respiratory areas to which people can be signposted without having to go through the ED. There is the same for cardiac services. We are trying to get to a point where a GP who would currently assess a patient and refer them straight to the ED might be able to refer them so that they do not have to go through the ED and have a second assessment if that assessment is not needed.”
“I thank the Member for the question. Yes, I am satisfied. I meet periodically with the chairs of the geographic trusts — in fact, the chairs of all the arm's-length bodies, including the Ambulance Service. I do not think that anybody in that group is unaware of the need for reform. Part of the measure of success of reform will be increased efficiency and productivity.”
“I acknowledged to Mr McNulty that the broader workforce challenge is a daily one for us. Although it is up to the trusts to manage those workforce challenges daily, it is up to us, as the Department, to look at a five- and 10-year plan, to anticipate what the needs are going to be, and to make sure that the training place numbers are right and that the universities and the other teaching areas have the facilities and the courses that we need to ensure that we have a workforce for the future and that we future-proof our workforce as much as we can.”
“I thank the Member for his question. There will be an analysis. Let us say that there is an elective list that is scheduled for this afternoon. If, for reasons beyond the trust's control, a key member of the workforce, such as the anaesthetist or the surgeon, is unable to attend — perhaps they have been involved in a road traffic collision — it would be unfair to penalise the trust for that situation. However, there are other situations in which the trust has some control. For example, it may have a week's notice that the anaesthetist will not be available next Tuesday. We would expect the trust to take action to try to make sure that that list goes ahead and is completed. We are going to take a very practical and reasonable approach to those things.”
“I am entirely unaware of what the Member is stating, but clearly it is something that, if true, is very serious. I will take it away immediately after this session and ask the appropriate questions.”
“I thank the Member. Of course, any review will look at the financing. We are very aware of the pressures, and not just in dentistry. We used to worry about nurses or doctors going off to Australia; now we worry about their going to Athlone, because, if you are talking about just salaries, it is very difficult to compete with Sláintecare. However, I gently say this to the Member: your party voted for the Budget. The Budget is a key factor in how much money we are able to devote to dentistry, GPs, rolling out multidisciplinary teams and all the rest.”
“I thank the Member for his question. The most appropriate thing that I can do is take that away and get you the sort of detail that you are looking for, rather than trying to recall it on the hoof. I take your point: what you quoted from the plan is a generalisation; you want the specifics. I accept that, and you have a right to request them.”
“It was a very emotive start, and I certainly join the Member in expressing sympathy for the loss of Jody Gormley. When we think about the dignity of Sir Chris Hoy, who now faces a terminal illness, it is remarkable how some of our sportspeople give examples to all of us to follow. <BR /> <BR />As to the Member's substantive point, he should not imagine for one second that the workforce is not an extreme focus. Although we have more doctors and nurses than ever before, we have severe workforce challenges. I assure the Member, however, that, by and large, every day, when somebody has to go to hospital and stay as an inpatient, they are well looked after. I am not sure that what was actually a rant advances anything.”
“I thank the Member for raising that point, which is an area of some frustration for me. You detailed the long and, to some extent, winding road that we have been on. We should be at the point where we are making ultimate decisions on the reform of where stroke services are delivered and which hospitals will become areas of specialism. I will certainly take that away. If it can be done without consultation, it should be, because speed is now the critical factor.”
“With a multi-year — let us say a three-year — Budget, a lot more is possible, not just around stabilisation but in producing the reform that we need. We should bear in mind that, in October, Professor Bengoa warned that if we do not reform, Health will absorb the entire Northern Ireland block grant by 2040, which is not that far away. That would be the opposite of sustainable.”
“It has certainly been a remarkable year for in-year shifts. We started the year by voting against the Budget because we anticipated the problems that were going to arise. I acknowledge that there have been two major investments through the June and October monitoring rounds, but we are still left with a very challenging position for the rest of the financial year, and that is having an impact on the speed with which we can try to settle the outstanding pay parity issues. <BR /> <BR />Everybody around the Executive table would very much welcome a multi-year Budget, and I believe that we are going to get there, not in the next financial year but in 2026-27. We are, of course, dependent on the UK Government taking a lead in that regard, but I feel confident that that is what is going to happen.”
“When I go to the trusts, I am very aware that I am asking them to do two things at once: save me a lot of money and be a lot more efficient and productive. In the next financial year, I hope that the focus will be on being efficient and productive. As I said, we are looking at the funding model. If we are doing the equivalent of ordering 10 items online and only seven arrive, we will only pay for seven. Currently, we are paying for 10, so that has to change. Addressing that will help with the waiting lists.”
“Some of the waiting times have improved. I emphasise again that, overall, the picture is not acceptable and needs a lot more work. However, when we talk about specific numbers and we say that the total number of people who are waiting for an appointment is x, that is not necessarily accurate, in that I could be on three different waiting lists. Disaggregating that might make a difference, but it might only be marginal, so I only mention it in passing. Some of the lists are getting better. <BR /> <BR />Our direction of travel includes rapid diagnostic centres, mega-clinics and the separating of elective and emergency care. Those are all going to help. However, we still need to have a laser-like focus on efficiency and productivity.”
“The reform therefore has to be something really fundamental that encourages that shift to reverse so that there are more dentists and more time being spent on NHS dental work. The detail remains to be worked out. I am simply identifying the issue as a large challenge that has to be tackled, because so many people need the service to change.”
“I thank the Member for bringing up the subject, because it is raised with me daily, not least by Members on behalf of their constituents. She will be aware that my predecessor, Robin Swann, put several million pounds into dental treatment, but we still have a problem with dentists deciding that they will focus on private work. The issue is therefore becoming very challenging and extremely difficult. <BR /> <BR />When I talk about reform, I do not want to scare the horses, but we may need to do something radical, because dentists have a lot of power within their grasp to decide whether to do NHS work or private work. We can presume that the private work is very profitable and agreeable to them.”
“That is where the detail will be. I hope that that action plan will eventually inform the creation of a women's health strategy. I know that we are not doing one at the moment, but is a strategy that does not have the funding to back it up really worth anything, if we cannot deliver on it? We are starting with a action plan, but I support, in principle, the development of a strategy in future times.”
“I thank the Member for the questions that she poses. Is having a single authority a product of that? To an extent, yes, it is. As the Member alluded to, it is very important that, among women, we restore confidence in the service and in its ability to deliver. She will be aware that there has been a move from cytology to HPV screening, which is a much more robust assessment. <BR /> <BR />Having that kind of single authority sits with my idea that, although we have five geographic trusts regionally, I look at them as one. I am looking for regional excellence by taking best practice wherever we find it and making it common practice so that we have that kind of consistency and get away from a postcode lottery. <BR /> <BR />On women's health, the Member will be aware that we are bringing forward a women's action plan.”
“I thank the Member for his question. I am meeting unions later today. We have had previous discussions about how I would hope to honour the national pay parity awards, and it was made clear to me by the unions that my language, which included such words as "ambition" and such phrases as "using best endeavours", was not acceptable. When I meet them later today, my language, I hope, will be more pleasing, or agreeable — let me put it that way. <BR /> <BR />The Member referred to future activity. It is my ambition — rather, it is my intent — that, all things being equal, when the pay bodies make their pay recommendations for the 2025-26 financial year, I will accept them and begin implementing the awards with immediate effect.”
“That means investing more in GP surgeries, Community Pharmacy and community health initiatives such as my Live Better initiative. That has always been my ambition and where I want to shift to, but that does not mean that we will be closing acute hospitals because we do not need them. I just hope that we would need them less and that people would stay healthier for longer. <BR /> <BR />On health inequalities, look at the difference between two women growing up maybe a mile apart in this city — one in the area of least deprivation and one in the area of most deprivation. Their healthy life expectancy varies by 14·2 years. Those are my ambitions; that is where I am trying to get to.”
“I thank the Member for her question and comments, but I see no contradiction. You need to do both. As I said in my first comments here as Health Minister, if you took a blank map of Northern Ireland and asked yourself, "Do you want to design a health and social care system?", the answer would, I think, be yes, but then you get into judgement calls about whether it is about prevention or cure. Of course, it has to be both, because, no matter how good you are at prevention and early intervention, people will still get sick. Therefore, you still need your acute hospitals and the screening programmes that she referred to. <BR /> <BR />My ambition is clear: it is that shift left and getting care away from acute hospitals and delivering healthcare in the home, ideally, or, if not in the home, as close to it as possible.”
“If the Department of Health is paying for and commissioning services, those services either get delivered or we take the money back and use it for some other service. A pound wasted in one area is a pound that could be devoted somewhere else, not just within Health. It could be devoted to tackling the social determinants of bad health in education, housing and all the rest.”
“That is a broad ambition, and the outworkings are still to be developed. What you will see in the coming weeks and months will be detailed annual plans, the first of which should be published shortly after the Budget for 2025-26 is agreed. <BR /> <BR />I will make a more general point, if I may, on something that I alluded to in Question Time yesterday, I think: challenging the trusts. We have commissioned scheduled lists of surgery in our acute hospitals, and we are monitoring those. A few months ago, I put the trusts on notice that I wanted to see them make a strenuous effort to achieve 100% delivery. As of a couple of days ago, we have, for the first time, told trusts that we are taking money back for elective surgeries that were on the lists but not performed. To my mind, that is the vision of the future over the rest of the mandate.”
“I hope that my officials and I can continue to work with the Committee through some of that detail, because we are listening and you have that statutory ability to assist and advise the Department and me in our work. I hope that we can continue to do that in delivering on the plan.”
“First, I join in offering condolences to the friends of Jody Gormley, who, as you say, has tragically passed away in the past 24 hours. <BR /> <BR />Full funding is one of the major challenges that we face. You have heard me say it before on the mental health strategy: we have about one eighth of the money that, we thought, we would require to implement the action plan for this year. Red flag and critical is where we are, and where we are is talking about sustainability, because the budget is not where we would like it to be. <BR /> <BR />I welcome the fact that you think that it is an ambitious plan, but it is also a realistic plan.”
“I thank the spokesman for the Opposition for his comment. He is clearly living in the ideal world. I live in the practical world, where we have a four-party mandatory coalition. I am doing what I can. <BR /> <BR />As for definites, you will notice that I said that I have set a target of an additional 46,000 outpatient assessments and 11,000 treatments by 2027, so there is some concrete, time-bound detail in the plan. Of course I would like more — everybody would like more — but this is the real world.”
“The three-year plan is realistic and ambitious. Of course, the pace of progress will depend on future Budget settlements and, indeed, on successful partnership working in the Executive. If we all work together, we can meaningfully improve population health, support people to live healthy lives and provide the conditions for our health and social care system to thrive. I commend the three-year plan to the Assembly.”
“I am determined to advance proposals for an organisational duty of candour as well as considering proposals for an individual duty of candour in the coming months. Being open and honest is critical to safe and effective healthcare. We want to create a culture in which our health service staff feel safe, supported and empowered to speak up when things go wrong in the certainty that their concerns will be listened to and acted on. We want to create a culture in which the public can have confidence that, if mistakes are made, they will be informed quickly and accurately about what has happened. The Being Open framework seeks to put in place the necessary support and systems to enable and nurture a truly open culture and help to prevent patient harm. I encourage the public to get involved and have their say.”
“Those will include bringing forward a consultation on replacing the current serious adverse incident process, and that will happen early in the new year. <BR /> <BR />Today, I am pleased to launch a 14-week consultation — slightly extended to take account of the Christmas break — on a new Being Open framework, and on the issue of duty of candour in Northern Ireland.”
“I am determined that the health and social care system maximises the benefits that can be had from digital reform. That will include making full use of the rich data that will be available to us. <BR /> <BR />I anticipate reform of neurology and stroke services, the outcome of which will be subject to consultation and funding availability. There is a need to reform pathology services, and I intend to have a single management structure for all pathology and blood transfusion services. I also intend to deliver a regional imaging academy to increase the supply of suitably trained clinicians. <BR /> <BR />I will continue with the important implementation of the urgent and emergency care review, and I will move ahead with strategic initiatives on quality and safety.”
“The reviews will inform how those services should be delivered in the future, allowing equity of access for all patients across the region. <BR /> <BR />The actions identified in the next phase of cancer strategy implementation, which is for the period 2025-28, provide a real opportunity to deliver positive change and service outcomes that everybody expects and deserves. That, along with the actions emerging from the strategic service reviews, will provide the basis for cancer service transformation. I am confident that that will provide a more sustainable approach for the delivery of cancer services and ensure that the early detection and treatment of cancer are at the core of our future response. <BR /> <BR />The implementation of the Encompass programme should help to enable those improvements in productivity.”
“We must deliver new and innovative ways of preventing cancer, supporting early diagnosis and delivering better care for cancer patients. Over the past two years, we have seen good progress on the delivery of a wide range of key cancer strategy actions. Key examples of progress to date include the development of services to provide genomic testing for cancer patients, investment in an oncology and hematology implementation plan and work to review patient pathways. Also, we have established minimum standards for adolescent and young adult cancer services. The rapid diagnostic centre model will ensure quicker access to red-flag services, and it will increase the survival chances of those patients. I have commissioned strategic reviews of breast cancer and radiotherapy services.”
“<BR /> <BR />As I have said, reform is necessary, but it is not sufficient to address the many deep-seated issues that are impacting on our health and social care services. Therefore, in addition to significant additional funding, we need a relentless focus on performance and productivity. To that end, I have challenged the health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by 2027. <BR /> <BR />One in two of us will receive a cancer diagnosis in our lifetime. That is the harsh reality that we face today. Currently, cancer services cannot meet that level of need, and the cancer strategy clearly outlines the need to transform the way in which we deliver cancer services for people throughout our community.”
“<BR /> <BR />The most recent published statistical information, as of 30 September 2024, for inpatient or day-case treatment waiting lists across the Northern, Southern and Western Trusts shows that there has been a 20% decrease in numbers waiting since the same month last year. That is 12,115 cases in real terms. Taking into account the data available for the Belfast and South Eastern Trusts, that represents a decrease of 5·5% in the number waiting since the same month last year. However, whilst there are some areas of improvement, I am mindful that, overall, our waiting times remain unacceptable. There are still far too many people waiting for far too long for outpatient assessment, for example.”
“Good progress has been made on implementation of the elective care framework with the roll-out of elective care centres and rapid diagnostic centres. Whilst the day procedure centres and elective overnight stay centres have had a positive impact on waiting times, as a result of our wholly intolerable waiting-time position, it is essential that we drive through further improvements in productivity levels to maximise the number of patients being cared for. The Department has been driving forward targeted measures to ensure that trusts are delivering 100% of all commission sessions and that efficiency and productivity across the elective care centres are maximised.”
“<BR /> <BR />Secondly, again subject to funding, I am keen to invest a further £15 million in our community and GP pharmacy services and an additional £17 million in our mental health services to support greater integration with the voluntary and community sector. Thirdly, I plan to implement within this mandate — again, as far as funding allows — new models for delivery of home or domiciliary care services, learning disability services and children’s social care services and a regionally consistent contract for care home placements. Finally, I want to see reform of dental services progressing in the coming years. <BR /> <BR />Turning to hospital services, I have launched a public consultation on a new network approach, and I look forward to seeing the outcome of that consultation next year.”
“First, by April of next year, I will publish a plan for the completion of implementation of the multidisciplinary team model across all areas of Northern Ireland. Subject to additional funding being secured, we will be much closer to that objective by April 2027. By that point, phased implementation will be under way, with anticipated investment of £19 million to expand the model to a further five new GP federation areas with a combined population of 670,000 people. That will mean that approximately 50% of the population will be covered, compared with about 30% today. The rest will follow as a priority.”
“It is, however, what is needed to give our staff and the public hope that there is a bright future for our health and social care service. I am determined to support people to live healthier lives and to tackle health inequalities. That is why I intend to embed the Live Better initiative into our mainstream way of working; develop a new obesity strategic framework; implement the Northern Ireland provisions in the Tobacco and Vapes Bill; and introduce proposals for minimum unit pricing for alcohol. Subject to funding, I also intend to put in place a new lung screening programme and an expanded bowel screening programme. <BR /> <BR />A lot has been said about the "shift left", meaning to provide services closer to people's homes. A number of measures in the three-year plan will support that shift.”