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 I have mentioned, a critical plank of the stabilisation agenda will be to continue to deliver the pay awards that our health and social care staff deserve. That extends to staff working in the independent adult social care sector. My ambition is to make that sector a real-living-wage sector. I am determined not to be found wanting in that regard, especially given the importance that that has for our ability to successfully recruit and retain sufficient levels of staff. <BR /> <BR />Progress on the reform agenda continues. Despite the pandemic and the difficult budgetary environment, we have made tangible progress across multiple areas. There is, of course, much more to do, and the plan published today sets out my reform ambitions. It is important to be clear that reform is not a silver bullet that will solve everything.”
“I advise the Assembly that I will be meeting unions later today as part of ongoing work to secure pay settlements for the 2024-25 financial year. I go into those discussions committed to stabilisation, to getting a good deal over the line and to fair and equal pay, which, I hope, remains the policy position of the entire Executive. <BR /> <BR />With progress on that important issue, I turn to the detail of the plan. It is structured around commitments in the three key areas of stabilisation, reform and delivery. With the incredibly challenging budget position, stabilisation is inevitably a strong immediate focus, not least in minimising the impacts of the £200 million-plus of savings that have been delivered by trusts this year.”
“<BR /> <BR />Before I go into the detail of the three-year plan, I want to acknowledge the fantastic effort and commitment of our staff. They really are our health and social care service. Without the excellent care that they provide on a daily basis, we would not have a service at all, nor could we bring about the changes that we need to improve services for the benefit of all. That is why I have remained fully and absolutely committed to resolving the pay award for this year. Stabilisation is one of the key pillars of my three-year plan, and central to that will be ensuring that staff are properly recognised and rewarded for the great work that they do. I shall retain a major focus on the recruitment and retention of our staff.”
“We continue to face many interconnected challenges, which have been widely rehearsed, not least during the Bengoa event in October. Our waiting lists are simply unacceptable, and we continue to experience high and persistent levels of health inequalities. I have been clear on many occasions that it is for everybody, including my Department, the health and social care system, the Executive and the wider public sector to support people to stay well and live healthy lives. That is because our population’s health is, to a large degree, impacted on by factors such as housing, education, employment and the broader socio-economic environment. Of course, behaviours and health and social care interventions also play a part, but these issues need a robust cross-government approach.”
“Mr Speaker, thank you for the opportunity to make a statement today on the publication of the health and social care three-year plan. <BR /> <BR />When Professor Bengoa visited Northern Ireland in October, I was clear that I intended to publish a plan setting out my ambitions until the end of this mandate. The publication today of the strategic three-year plan does exactly that. I recognise that our health and social care system continues to be under severe pressure, and, with the onset of winter, the coming weeks and months will not be easy. Despite that challenging context, I believe that it is important to rise above the day-to-day and embrace the opportunity for reform.”
“I am not aware of its being advised not to take the handover. I think that there was a contractual board that advised the contractor and the Belfast Trust and that the advice was, figuratively speaking, to accept the keys. It was only afterwards, when the trust went into the solid state of water testing, which applies as if the hospital were fully operational, that the issue arose.”
“I will more than happily take that away, and I ask the Member to write to me on it. As a matter of broad principle, we follow the National Institute for Health and Care Excellence (NICE) guidelines. If NICE has approved something, we will certainly check its applicability in Northern Ireland. If NICE has not approved it, we tend not to do that, although it can be done through an individual referral pathway.”
“I thank the Member for her question. She has got me. I am not aware of that condition or of what we are doing, if anything, in that regard.”
“On the first point, I am not aware that that is the case. I have a sense that demand for the service is growing, but I will take that away, check it out and get back to the Member. <BR /> <BR />On the second part of the question, I have no vires over the productivity of the private sector.”
“I sympathise with the Member and his constituents. I am afraid that it is a question of resource. That is a technical medical procedure and is carried out at the Royal Belfast Hospital for Sick Children. There is a validation: in other words, a consultant goes through the list to make sure that people are in the right order according to the priority of their clinical need. There is, I believe, a plan to introduce another list in the Royal Belfast Hospital for Sick Children. We are also looking to the South Eastern Trust and specifically to the Ulster Hospital to see whether training can be introduced that may allow for those percutaneous endoscopic gastrostomy (PEG) tube insertions to be carried out outside the children's hospital.”
“As I said to the Member, I do not condone anything that is considered illegal, but we have free speech in this country. We have no contractual arrangement with the organisation that he referenced on its communications, marketing, advertising or website.”
“The Department of Health has no vires over what organisations place on their websites. In my experience, the Rainbow Project delivers valuable services to the LGBTQ+ community. I do not condone illegal activities in any way. The Member may wish to write to the Rainbow Project to highlight the issues that he has raised.”
“I thank the Member for his follow-up question. That is an area of detail that I want to take away. I will make a general comment: moving from the National Health Service or Health and Social Care (HSC) to the private sector and coming back again poses problems across the board, as far as I can see. The Member mentioned specifics, and I invite him to write to me in order to allow me to take them away and give his question the detailed response that it deserves.”
“<BR /> <BR />Any decision on the commissioning of adult services has to be based on an assessment of demand and made in the context of budgetary availability. Officials in my Department are well advanced in commissioning research to inform a future ADHD service by scoping out the level of demand. I am keen, as are the officials, that the research be completed before the end of the financial year.”
“I thank the Member for his question. As he is aware, there are no commissioned ADHD services in Northern Ireland, but services are being made available by the geographic trusts. Provision has grown across those trusts in response to population demand. That means that a level of provision is available, but that has also led to inconsistencies, which I want to see ended. As I said, in my mind, I look at the five geographic trusts as one trust, and I am saying to them, "In certain geographical areas, you will find pockets of best practice. Let's identify those areas of best practice and roll them out so that they become common practice across Northern Ireland". I include adult ADHD as part of that.”
“I thank the Member for his follow-up question. It is always dangerous to make up policy on the hoof, but I am on record at an event in the Long Gallery as saying that it is public health issue. I am happy to concur with the Member.”
“I have no difficulty in saying that I agree. I know that Mr McGuigan has a particular interest in that area. There has been a tripartite approach from the Northern Ireland Executive, involving the Minister for Communities, the Minister of Education and me, to try to get more resource from the UK Government to tackle the problem in Northern Ireland. I hope that that will bear fruit in due course.”
“Physical infrastructure is required. No one in the House would say that Health has been anything other than underfunded over a significant period. As a result, those things, sadly, will take time to fix.”
“As the Member is aware, we have been recruiting, I think, 48 new paramedics to join the Northern Ireland Ambulance Service (NIAS). NIAS has reviewed the data, so the Member will know that, in his area, it has come to the conclusion that it can adjust their rotas. The number of crews on duty between, say, 2.00 am and 6.00 am was overcapacity to meet the demand, so NIAS has decided that it would be better to reallocate some of that resource to late afternoon, when demand is at its highest. It is not as though nothing is being done, but the statistics that the Member has cited are absolutely shocking. They are not acceptable, and we need to do more. <BR /> <BR />The Member will know that, in order to make a positive difference, not just funds but appropriately trained and committed staff and other resources are needed.”
“I agree with the Member. A lot of work is being done to try to be more efficient. The Member is aware of that, because he rightly highlights the time that ambulance crews spend outside and in emergency departments waiting to discharge their patients. The same goes for the Police Service of Northern Ireland. The Member will be aware that the Chief Constable is keen on introducing the Right Care, Right Person approach, which will recalibrate how the Police Service engages with mental health patients in emergency departments and deals with other questions in that area. <BR /> <BR />I agree with the Member that that is a shocking statistic to have in a First World country. It is not something that anyone is trying to ignore or brush away.”
“When those charities come together, have an internal conversation and then come to the Department and say, "This is how, we think, you can get the best bang for your buck", that is co-design in action. I would encourage that kind of collaborative working in the community and voluntary sector. I am always open to meeting them — indeed, I am eager to meet them — to discuss the way forward. <BR /> <BR />I emphasise that I sometimes feel that some people look on those charities as the cheap alternative: I do not. They have expertise and reach that we cannot replicate. I go back to my days as a victims' commissioner. Those charities know individuals, families and communities much better than a Department can ever hope to do.”
“I thank the Member for his question. As he is aware, there are many, many charitable organisations and organisations in the community and voluntary sector involved in health delivery, whether for physical or mental health. <BR /> <BR />As I said, I have engaged through the umbrella body, NICVA. I could not tell you how many times I have met individual charities and groups from the community and voluntary sector. I applaud the many cancer charities that have come together as an umbrella organisation. That is a really sensible way forward, because, when there are limited funds and maybe 12 charities, such as cancer charities, all in the same area, it is sometimes difficult to decide how to allocate those funds.”
“However, I assure the Member that, as I said in the House in my first remarks in this role, my core priorities include mental health, and so it remains.”
“I thank the Member for his question. He will know that I have campaigned on the issue of mental health and well-being since coming to the House in 2011. In October monitoring, there was no provision for nor any invitation to make specific bids. While I rejoice in the fact that we have a mental health champion in Professor Siobhán O'Neill, who does really good work in raising awareness, and while we have a mental health strategy for the 10 years from 2021 to 2031, we do not have the funds that I would like to see devoted to this very important area. As the Member will know, there are so many demands on the Department of Health's budget that it is very difficult to squeeze out a little bit of extra money here and there.”
“Certainly, however, voluntary and community sector groups want to get themselves involved in a very simple regime where they can access government funds, support and resources to do the job that they are there to do. They are focused on helping people. They are not focused on being bureaucrats, human resource managers or accountants: their primary ambition is to help people in the community. I would like to simplify how we engage with them and enable them to do what they want to do.”
“I thank the Member for her follow-up question. As I think I have already made clear, I have been working with the Northern Ireland Council for Voluntary Action (NICVA) on the specific of the core-grant scheme in order to make sure that it is opened up for the first time in some 20 years and, therefore, is available to community and voluntary sector groups that have formed in that period. I would like to enhance the pot of money that is available to that fund. <BR /> <BR />On a more general point, I say to the Member that, in my six months in post, I have rapidly come to the conclusion that we have really over-complicated delivery of healthcare. I have not got to the bottom of why that is, and I am still grappling with the challenge of how to simplify it.”
“The mental health strategy envisages the community and voluntary sector as true partners that are fully integrated in ensuring improved outcomes for the population, and the sector being fully included in the planning, development and delivery of mental health services.”
“The mental health strategy for 2021-2031 recognises that effective delivery of mental health services is not possible without full integration of the community and voluntary sector, with that sector having an important role to play in supporting mental health promotion, prevention and early intervention and statutory mental health services. <BR /> <BR />To support delivery of action 17 of the mental health strategy, a review of the scope, scale and capacity of the community and voluntary sector will be undertaken in this financial year. Harnessing the skills and experience that exist in that sector is of utmost importance.”
“A total of around £130 million of funding is provided to the trusts through the mental health programme of care route for the provision of front-line services in mental health. That does not include the funding for the important role provided by the primary care sector. In addition, mental health strategy funding of £5·9 million has been allocated this year, most of which is being used for front-line service provision in CAMHS, crisis, specialist interventions and early intervention and prevention initiatives. <BR />Each trust is required to submit to the strategic planning and performance group (SPPG) monthly performance figures on commissioned activity. Where additional funding is allocated, robust mechanisms are in place to monitor service delivery, including post-project evaluations.”
“I thank the Member for his question. I am more than happy to engage with the Minister of Education on that specific. I have engaged with the Minister of Education on a number of specifics. Most recently, we met four principals of special schools to discuss the health — the physical and mental well-being — of pupils, and we are advancing well on the improvement of services in special schools. I, alongside the Chief Nursing Officer, intend to visit some special schools as part of the preparation for the next phase of meetings with the Minister and those principals. I can certainly incorporate the Member's recommendation in our discussions.”
“Then there is the Attach project, which focuses on trauma-informed practice (TAP) and the importance of relationships for looked-after children and provides training and support for staff who, in turn, support the child.”
“The aim is to provide intervention at the earliest opportunity to ensure that schools are aware of the appropriate pathways for support in their local area and, indeed, in the child and adolescent mental health services (CAMHS). Additional initiatives include a school nursing pilot. The Public Health Agency-led pilot is currently operating in five post-primary schools across Northern Ireland with a school nurse located in those schools. There is also the Text-a-Nurse service, which is a secure and confidential text messaging service for young people between the ages of 11 and 19 that provides them with access to a school nurse for advice and support.”
“I thank the Member for his question. I have not taken a position on that, but the THRIVE programme delivers very positive results. I am more than happy to take that recommendation back to the Department and contact the Member in due course with a response.”
“The project has supported small groups and provided whole-class support to 242 schools in the 2023-24 financial year.”
“<BR /> <BR />The resilience in education, assisting change to happen (REACH) programme has engaged approximately 8,000 pupils across more than 100 schools. REACH is an Education Authority Youth Service programme for six- to 19-year-olds to develop positive emotional health, increase their readiness for learning and build their resilience. The Being Well Doing Well programme supports schools with their current policies and practice to embed emotional health and well-being in them. In 2023-24, a total of 132 schools participated, with 160 schools projected to participate in 2024-25. Furthermore, a regional integrated support for education (RISE), Health-led, multi-professional early intervention team has been established for primary pupils up to primary 7. It aims to support younger children with their emotional health and well-being needs.”
“The children and young people's emotional health and well-being in education framework was launched in 2021. It is funded jointly by my Department and the Department of Education. A number of important projects and pilots have been taken forward through the framework, collectively providing help and support to children and young people in relation to their emotional and mental health. Those include the emotional well-being teams in schools project, the objective of which is to ensure that post-primary schools are aware of appropriate pathways for support. That project commenced in the financial year 2023-24. In the current academic year — 2024-25 — it will engage with no fewer than 50,000 children in 68 post-primary schools across the region. That is an increase from 46 schools in 2023-24.”
“On the first point, I can only sign what comes on to my desk. I am more than open to a direct approach, if things are not happening at the pace that they are supposed to happen. I can write to the Member to try to establish a pathway for her constituents within the Western Trust, because, if they are in need of meals on wheels, they should get it, and they should get it promptly to avoid malnutrition.”
“The cost to the individual is £1·50 per meal. The Western Trust subsidises those meals. The cost per meal to the trust varies from £2·99 to £9·48 per meal, and that depends on location and delivery costs.”
“The Southern Trust does not commission the service, but there are other options available for those who are unable to make their own meals, such as shop-purchased ready meals or the order and delivery of cooked meals from other organisations. The Southern Trust will provide home care services to heat those meals if the service user is assessed as requiring that support. <BR /> <BR />The Western Health and Social Care Trust does provide meals on wheels to service users. Within the Fermanagh area, six people currently receive a meal delivered to their home. There are also four day centres in that area in which a person can receive a cooked meal from the meals on wheels service. Those day centres include Kesh, Killadeas, Drumahaw and Tir Navar, and the number of people who attend the day centres can vary between 20 and 80.”
“In Northern Ireland, meals on wheels or cooked chilled meals are provided or arranged by trusts for vulnerable people where an individual needs assessment shows that a person is unable to obtain a nutritious cooked meal and would be at risk of malnutrition if such a meal service was not provided. The inability to prepare a meal may be assessed as a temporary or a long-term inability, and the meal can be provided directly by the trust or by the independent sector within the person’s own home, in the form of a cooked, frozen or chilled meal, or in a day care setting. There is a criterion for entitlement to meals on wheels and a small charge to the person in receipt of them. <BR /> <BR />The south Tyrone area sits within the Southern Health and Social Care Trust.”
“I say this to the Member: yes, Live Better is very much on course for delivery in 2025.”
“I have asked officials to bring forward the Live Better initiative to begin to address the situation. It will be demonstrated in two areas: one in west Belfast and one in Derry/Londonderry. I hope that, from that, we get the empirical evidence that we can make a difference. Then I will bring it back to Executive colleagues, because tackling these things is an all-Executive challenge. We believe that it is 20% health, but 40% socio-economic,10% environment and 30% behaviours. Behaviours include such things as smoking, so the Tobacco and Vapes Bill that is going through Westminster will help. Behaviours also include the abuse of substances, including alcohol, and that is why I would like Executive colleagues to support the introduction of minimum unit pricing for alcohol.”
“In a First World country, a quarter of the way into the 21st century, that simply should not be countenanced.”
“I can certainly give Mr Chambers that assurance; in fact, I will be having a meeting this week to look at the latest stage in the development of the Live Better initiative. It is worth putting it on record that that initiative is about tackling health inequalities. I always go to one particular statistic: two girls can be born on the same day in a maternity unit in Belfast and can grow up a mile apart, but, if one is in an area of the greatest deprivation and the other lives in an area of the least deprivation, their healthy life expectation will vary by 14·2 years.”
“I thank the Member for the point, but I am not aware of the specifics. I encourage the Member to write to me. I am more than willing to take a look to see how we can achieve and maintain a better balance.”
“I am determined to get to pre-COVID levels as soon as possible and then to exceed them, because it is important that productivity is what it should be. I can say to the Member that we did put the trusts on notice about their productivity some time ago. For the first time — certainly the first time that I am aware of — we are now beginning to claw back money from the trusts for elective procedures that have not taken place but which were scheduled.”
“I thank the Member for his follow-up question. I am sympathetic to the point that he makes, because, on a constituency basis, ever since the pandemic hit its peak, I have constituents, as, I am sure, the Member has, who come in and talk about the number of times they have to phone before they can get through to their GP. <BR /> <BR />I certainly look at the productivity in the five geographic health trusts, particularly in terms of elective surgery. It is not back to pre-COVID-19 levels, and I have yet to get what I consider to be a logical and reasonable explanation why. While I cannot answer the Member's question in the detail that I would like to, I hope that I can assure him that it is on my radar.”
“The pandemic also led to a significant emphasis on preparedness and response planning for future health crises. We are learning from experience and focusing on building resilient health systems capable of responding to pandemics or public health emergencies. That includes investment in public health infrastructure and workforce training.”
“I expect that it will inform the priorities for the Department into the future. For now, significant efforts are under way across a range of areas to drive forward progress on a range of public health priorities. We continue to work across government to deliver Making Life Better, which is the overarching strategic framework for public health, through which the Executive committed to creating the conditions for individuals, families and communities to take greater control over their lives and be enabled and supported to lead healthy lives. <BR /> <BR />Existing health inequalities were exacerbated by the pandemic. Recently, I launched the Live Better initiative, which looks at how we better align our existing resources and services with the aim of improving access and outcomes for those most in need.”
“The impact of the pandemic was felt keenly right across Northern Ireland in every household and every sphere of life. As a result, work was paused in a number of areas across public health policy. Where possible, however, key issues were focused on, such as the development of the new substance use strategy and the introduction of legislation on smoking in cars where children or young people under the age of 18 were present. <BR /> <BR />In the Public Health Agency (PHA), around 80% of resources were directed to COVID-19, with the remaining resource focused on issues such as rebuilding public health programmes, including screening and other interventional work on smoking. The majority of ongoing PHA work relating to COVID-19 has now been absorbed into business-as-usual mode. <BR /> <BR />The COVID inquiry is ongoing.”