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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“It is aimed at improving staff understanding and delivery of person-centred care. <BR /> <BR />In addition, the Department has endorsed the regional roll-out of online dementia-related pain management training known as DOTS. It has been developed and researched by Ulster University. That evidence-based programme supports staff to better recognise and manage pain in people who are living with dementia, thereby contributing to improved outcomes. The work stream is also updating the dementia learning and development framework from 2016. That sets out the core knowledge and skills required by health and social care staff to enable them to interact appropriately and respond sensitively to the needs of people living with dementia, as well as their families and their carers.”
“Aligned with the regional dementia care pathway, my Department remains firmly committed to strengthening and enhancing dementia training, and I very much accept the Member's long-term interest in that area. The regional dementia project board plays a central role in that work, with a dedicated work stream focusing on education, training and research specifically. Through the work stream, significant progress continues to be made developing and expanding high-quality dementia training. That includes building on existing programmes and introducing more specialised learning opportunities such as the development of Dementia Relationships, which is a rights-based approach to training, alongside Queen's University. That is available online through LearnHSCNI. The initiative has been supported through funding from the Department of Health.”
“I am aware of that, and, again, I have discussed it with the digital team. Apparently, there were two fail-safes that failed, so, by definition, they are not fail-safes. The only assurance that I can give people is that, while it is unacceptable that that happened, those were referrals that were rejected by consultants. So, no physical harm was done. Obviously, if you are waiting for the result of your referral, and it is assumed that your GP has that information, that is not an acceptable situation. Work is ongoing to investigate the matter, but there were failures in the process. I accept that and apologise for it.”
“I have been in discussions with our digital team, and we have come up with a warning that will appear on a person's home screen every time that they log into Encompass to tell them that inappropriate accessing of information could result in disciplinary action or even criminal prosecution.”
“If I understand the Member correctly, she is talking about adding a layer of protection and security to a system whose essence is that everybody in Health and Social Care can access it. That is part of the beauty of Encompass. If a patient is being transferred from one hospital to another in an ambulance, the receiving consultant and their team do not have to wait to receive the paper file that comes with the patient. Instead, they can go on Encompass and prepare themselves. The difficulty is with whether people who have access to Encompass will use it in a prurient or voyeuristic way.”
“As I understand it, although it was always accepted that the roll-out of Encompass would slow down procedures while people transferred from paper, its long-term benefits very much outweighed any short-term hiccup from that. <BR /> <BR />As yet, there has not, to my knowledge, been a review, because Encompass is still being rolled out. As I have said before — I have expressed it as a form of frustration — it can apparently take up to two years after Encompass has been installed for it to become fully operational. As the Member will know, it was rolled out across the final one of the five trusts in only May of last year.”
“Encompass reduces duplication and supports faster decision-making, with improvements expected to grow as optimisation continues. Patients and service users are also benefiting from increased transparency and digital access through the My Care portal. Over 300,000 people have already signed up to the My Care app.”
“Encompass is now fully live across all five geographical health and social care trusts. It provides a single digital health and care record that supports safer, more joined-up care for people right across Northern Ireland. It is a major, once-in-a-generation modernisation. It is also an essential foundation of service reform. Independent assurance has been used as part of our oversight toolkit at key milestones. A recent review described the regional solution as being robust and assessed delivery as being feasible, while also being explicit about the issues that continue to require active management attention. <BR /> <BR />The benefits are increasingly becoming tangible. Staff now have far better access to timely information.”
“I am not aware of specific plans. The Member is right, however. When I took up post, everybody was focusing on the issues at the front door, such as delayed handovers for ambulances and overcrowding in the ED, but the Member is right: the problem is the flow out of the back door. We have to build community capacity. Otherwise, we will not get the flow right. Where are the resources in order to do that, however? The Department currently sits without a budget, but, based on the draft Budget, we have a shortfall of £760 million. That is unprecedented and unmanageable. It means that we cannot do what the Member and I know needs to be done.”
“The Member makes a pertinent point. There was a tragedy in the ED at the Royal just a few weeks ago. If I needed convincing, that convinced me that, often, an emergency department is the last place that a patient with mental health issues should go to and wait in. <BR /> <BR />I visited the Mater Hospital a few days ago. It has PATH, a psychiatric assessment and treatment hub, which is a separate room on the first floor that is designed to be an alternative place for mental health patients to go to avoid the ED. The hospital wants to expand that provision, and I would love to see it expanded around all the acute hospitals. I cannot give you the detail on that, but, in my mind, that is the ideal direction of travel.”
“I am aware that the numbers are way beyond what the capacity and the build were intended to meet. We are trying to create alternative pathways, such as urgent care, and to make sure that only people who really need the emergency department present there. I am aware that Altnagelvin is the oldest of the big emergency departments in the region. I have visited it when it has been extremely busy. It is nowhere near where we want it to be, not just for the patients but for the staff. I say again that they make decisions that are not the best decisions that they have been trained to provide but the least worst ones, because that is the environment in which they operate.”
“My ability to commit funding will depend on the Department's capital allocation from the Budget process and the identification of sufficient recurrent funding to meet any additional resource costs associated with the facility. If sufficient capital and revenue funding is available, the trust will have to update and submit its outline business case to the Department for approval.”
“With your permission, Mr Speaker, I will answer questions 1 and 4 together. <BR /> <BR />The Department undertook an information-gathering exercise in mid 2025 to inform the Executive's consideration of a multi-year Budget for financial year 2026-27 and the subsequent three financial years. In recognition of the importance of progressing the new emergency department (ED) facility at Altnagelvin as quickly as possible, the Western Health and Social Care Trust submitted proposals in July of last year to re-phase an original project plan. The budget cost for the initial phase is £73 million. The information provided by the trust to the Department was included in the capital budget bid submitted to the Department of Finance.”
“Finally, with the single key worker or a lead practitioner under Together for Families, we will see more consistency and a lead operator coordinating across a range of Departments and agencies to deliver better outcomes.”
“It has been successful in securing £30 million from the transformation fund, and that has been matched by £30 million from the National Lottery community fund, which is an unprecedented intervention in Northern Ireland from that fund. On inconsistencies or postcode lotteries, Members will know that I am looking right across the board for consistent regional services. Work is already under way on Together for Families, with new practices being identified. I want best practices to be rolled out and for them to become common practice right across Northern Ireland. Work is already under way, and, now that the funds have been confirmed, we will firm up the structures to support it.”
“The model is built around 17 integrated neighbourhood teams acting as provider alliances. <BR /> <BR />The second is moving child social care services away from the skew towards child-protection activities and towards greater support, including very practical support for families at an earlier stage. That was, of course, a key message coming from Professor Ray Jones during his independent review of children's social care services in Northern Ireland. <BR /> <BR />Finally, I want to mention the Together for Families model announced today. It is a new transformational model of supporting children and families. Developed under the reform programme, it marks a decisive shift towards earlier intervention, stronger family support and more joined-up working. I welcome the confirmation today of the funding.”
“Of the work that is being taken forward by my Department to improve collaborative support, I want to mention two particular areas of focus. First, there is the neighbourhood model of health and well-being. That will see community pharmacies, GPs, GP Federations, voluntary and community organisations, the trusts, independent providers, other statutory bodies and local government working together in formal partnership to provide integrated care. It places local communities at the heart of how services are planned and delivered, and it focuses on designing care pathways that meet more needs earlier, before people reach a crisis point or need care in hospital. It is about shift left, prevention and early intervention, getting health and social care as close to your front door as possible.”
“If, across Departments and sectors, we can continue to improve our multi-agency response, there is strong evidence to demonstrate that supporting families early leads to substantial economic savings as well as improved outcomes.”
“It works with families with a child aged up to 17 on an outreach basis, providing practical support with a wide range of presenting challenges. Home-Start Causeway provides practical and emotional support to families across the Causeway Coast and Glens area. Trained volunteers and staff provide weekly home-visiting support and group support to families with at least one child under five. A range of other organisations with more specific referral criteria provide support in the area, including the drug and alcohol intervention service for youth (DAISY), the young carers' service, Autism NI, Triangle Housing Association, Sure Start, the child bereavement service, Women's Aid and Safe Families.”
“It provides one-to-one outreach support to young people aged 10 to 17 and their parents or caregivers. The service seeks to provide support around a range of issues, including mental health and emotional well-being, and managing behaviours presenting at home, in school and in the community. Barnardo's early intervention family support service works across the Northern Trust, providing one-to-one outreach support to children between eight and 13 years of age and their parents. The service seeks to provide support in respect of a range of issues that present at home, in school and in the community. <BR /> <BR />The northern early intervention support service, which is led by the Public Health Agency, covers Ballymena.”
“The trust, of course, works in partnership with the Police Service of Northern Ireland, the Youth Justice Agency, schools, voluntary and community organisations, and other statutory agencies to ensure that there is a coordinated response to children who are displaying offending behaviours. Children who come to the attention of statutory services in that context are treated as children in need, in line with the Children (Northern Ireland) Order 1995. We have five family support hubs covering the Northern Trust area, each one made up of community and voluntary sector and statutory agencies. They all deliver early intervention services to those under 18 and their families. <BR /> <BR />Action for Children's Choices family support service works across the Northern Trust area.”
“This is done through group interventions, addressing problems such as anxiety, low mood and emotional regulation, as well as individual work, including behavioural therapy and family support. It is all aimed at reducing the impact of problems and preventing their escalation. The regional integrated support for education (RISE) service provides support to children in the Northern Trust area. RISE takes a holistic approach to social, emotional and behavioural needs in the school setting, with a team that includes behavioural therapists, clinical psychologists and other professionals. The service helps to address the behavioural difficulties at school that can be precursors to disengagement and offending.”
“A key part of its role involves supporting children who are at high risk of offending, working with parents to help to prevent their children from becoming involved in crime, and helping them to address emerging patterns of challenging or problematic behaviour. The Links team offers services to children who engage in harmful sexual behaviour, helping them to make positive changes within an overarching trauma-informed approach. The project covers the whole of the trust area. It is based at Antrim Family Centre. It works with children, young people and their parents or carers where there are concerns that the child or young person has engaged in sexually harmful behaviour. <BR /> <BR />The Children's Early Intervention Service provides support to young people experiencing mild to moderate emotional and behavioural difficulties.”
“In the Northern Trust specifically, a number of teams are providing services that are aimed at addressing the identified needs of children and young people when it comes to support and, where required, safeguarding, protection and corporate parenting. The Gateway social work service has already been discussed. The trust maintains statutory family support and a looked-after children's team. It works alongside our justice system to support children and young people who come before the courts. The aim is to ensure that their welfare needs are represented and that appropriate social care interventions are put in place alongside any legal proceedings. <BR /> <BR />The intensive family support team works with children aged 10 to 18 in the Northern Trust area.”
“Supported services provided under the Children Order include practical support and advice; befriending schemes; childcare provision; play facilities; specialist services; counselling; parenting programmes; respite care; provision of accommodation for longer periods; and financial support. In putting those packages together, trusts should take account of the excellent range of services provided by our colleagues across the community and voluntary sector as well as by the other Departments or their agencies. We recognise that effective family support often requires that collaborative multi-agency approach. <BR /> <BR />I will give Members a sense of the range of interventions that are currently supporting children, young people and families in North Antrim.”
“of support services. The concept of need is deliberately wide in order to reinforce the emphasis on preventative support and services for families. Given the range of challenges that children, young people and their families face today, it is more important than ever that we respond effectively. We must ensure that all children and young people are given the opportunity to develop their full potential. <BR /> <BR />In assessing individual need in families, trusts assess the existing strengths and skills of family members and put in place a plan to help them overcome identified difficulties and enhance those strengths. Sometimes the needs will be found to be intrinsic to the child; at other times, it may be that the parenting skills and resources are depleted or underdeveloped and thus threaten the child's well-being.”
“OK. Thank you, Deputy Speaker, and thank you to everybody who contributed to the debate. Thanks also to the Members who recognised that family support is not down to any single Department and is a multi-departmental challenge. For the Health Department, it is not an optional offering but a statutory requirement set out in the Children (Northern Ireland) Order 1995. Article 18 of the Order places a duty on the trusts to provide a range of social care services to children in need and their families. The aim is to safeguard and promote the welfare of those children and support them to be raised in a family home. On that basis, today's announcement of Together for Families is very welcome. <BR /> <BR />A child in need is any child in Northern Ireland who is:”
“Finally, Mr McGrath said, "Let's get it going by September 2026", and a couple of Members said that that was, to paraphrase, ambitious. I think it is, but there are only 311 days left before purdah. You are looking at a man and a Minister in a rush to get things done, so let us be ambitious.”
“I did not hear Mr McGrath mention that in his speech, but I emphasise that my door is open.”
“I am committed to bringing forward system and service reforms that are practical, deliverable and aligned with our wider reset agenda, subject, of course, to the necessary funding's being made available. <BR /> <BR />Mr McGrath raised a couple of points. The Department is a bit nervous about your cost estimate. It has looked at the systems in Scotland and Wales and wants to look a bit more deeply, but it fears that it may be a bit more expensive than £6 million. Having said that, with a shortfall estimated at £760 million, it will be challenging, to say the least, to get the permanent secretary to agree that any new service is affordable. However, it is well worth continuing to look at that. I read the SDLP's news release about the proposals. It included a promise to ask to meet me.”
“<BR /> <BR />I absolutely agree that social care workers must be appropriately paid, in recognition of the work that they do to support some of the most vulnerable people in our society. I wanted to do that last September. I remain committed to doing so. Given current financial pressures, it will be a priority in planning for the 2026-27 Budget, which, as we know, the Executive have yet to agree. <BR /> <BR />I reiterate the fact that there is no quick or easy fix to the challenges that are faced in our emergency departments. Achieving the improvements required will involve a complex interplay of services in and across the wider HSC system. I recognise and support the ambition regarding a regional 111 service, as set out in the motion.”
“Early review teams continue to demonstrate tangible benefits, such as releasing home care capacity, with a significant proportion of individuals requiring reduced or no ongoing packages of care following review. The introduction of regional protection for home care packages on hospital admission further supports timely discharge once patients are medically fit. Digital enablers have been progressed to improve transparency and efficiency across social care pathways. CareLineLive has been implemented across all the trusts, delivering measurable efficiencies in home care hours, although I accept that some Members have concerns about the squeezing of the time that is devoted to service users at home. I recognise the core importance of community capacity, which requires a long-term solution.”
“<BR /> <BR />The motion rightly highlights the shift-left agenda. It is about prevention, early intervention and strengthening care as close to home as possible. As my permanent secretary said to the Health Committee on 7 May, although work is in its early stages, Northern Ireland can be a "trailblazer" when it comes to implementing the neighbourhood model. I fully endorse that view. We are a small country with a strong ethos of collaboration across professions, organisations and sectors. We can support patients in accessing the care that they need in the most appropriate setting. <BR /> <BR />I have already said that the solution to reducing ED pressures requires a whole-hospital, whole-system approach. It is not just about the front door but about the back door, including, as I have said, timely discharge.”
“I thank the Member for the intervention. Release to Rescue is going into its fourth week. I believe that it has been, by and large, successful. It has by-products and consequences, such as the one that the Member mentioned. I intend to make a statement much more specifically about Release to Rescue in the coming days, so, if the Member will forgive me, I will stand by for that. I think that I have already told the House that, in the first four days of operation, the number of ambulances that had to wait for over two hours and breach Release to Rescue was eight. That is a phenomenally good number, but I think that everybody in HSC is a bit nervous about going too fast too soon and saying, "This is a success story". The early indications are pretty good, with the proviso of the additional pressures within the confines of hospital settings.”
“The protocol is designed to ensure that ambulance crews are able to hand over patients into the clinical care of ED staff within two hours of arrival at hospital so that those crews are available to respond to further calls.”
“Progress will depend on taking a whole-hospital, whole-system approach that provides appropriate alternatives to emergency departments, addresses capacity and demand issues in them and supports patient flow through timely, appropriate discharge of patients to free up beds for those who need them. My Department continues to act to improve hospital flow, reduce ED congestion and ensure that patients receive timely, safe and effective care. Urgent care centres, minor injury units, Phone First and GP out-of-hours services are fully operational across the region, helping to divert appropriate demand away from EDs. <BR /> <BR />In relation to the Ambulance Service, we are strengthening Hear and Treat and See and Treat pathways. Members will also be aware that the Ambulance Service implemented its Release to Rescue protocol on 27 April.”
“While I recognise that Phone First is not the same as a regional HSC 111 service, statistics indicate that it plays an important part in diverting people from ED services towards services that are more appropriate for their needs. I encourage everyone who needs it to make use of the current Phone First service. In addition, our GPs and the services that they provide for their communities, in and out of hours, are critical in supporting patients. Community pharmacies also play a key role in supporting patients with minor illnesses and reducing unnecessary demand on GP and emergency services. <BR /> <BR />No single lever will fix ED waits, and no individual reform, service or policy can, on its own, eliminate overcrowding, delays and corridor care.”
“Members have already made that point. It could ultimately increase, rather than relieve, pressure on front-line services. <BR /> <BR />I do not need to repeat the funding pressures that face my Department. They are well known and well documented, but, put simply, the development of a 111 service requires resources that I do not currently have. However, in the absence of a confirmed Budget, we are not standing still. As a system, we are continually focused on strengthening, better integrating and enhancing existing services and pathways, and on improving patient flow within the existing resources. <BR /> <BR />I must emphasise that people who need access to advice or urgent care can continue to contact their local Phone First services, which are already in place in all geographic trusts.”
“It would help us move away from a system that is overly reliant on hospital-based care and towards one that prioritises prevention, early intervention and the provision of care closer to home. <BR /> <BR />To be clear, however, establishing a fully operational regional 111 service is a major system change. It would require not just a telephone platform but workforce, clinical governance, pathway development and supporting digital infrastructure. That requires detailed planning and sustained investment. In my three-year plan, I made clear that the delivery of a 111 service was not possible without resources and a plan. Without that plan, a programme of work and investment, there is a real risk that we could create a substandard service that generates additional demand without the proper tools to meet it.”
“<BR /> <BR />I agree with Mr McGrath that a 111 service has the potential to play a significant and enabling role in transforming how people access their urgent care. That is why I included it in my three-year plan in 2024. A 111 service would provide a single, simple point of access — a front door, if you like — through which patients could receive consistent advice and be directed quickly to the right care in the right place. It is not a replacement for existing services; it is a coordinating layer, supporting better navigation by triaging patients and, crucially, directing them, where possible, away from EDs to where their needs can be met more appropriately, be it through primary care, community care or urgent care services. In doing so, a 111 service aligns directly with the shift-left agenda, as many Members pointed out.”
“I am referring to the rising demand for healthcare generally. Claire Sugden just made the point that other sections of Health and Social Care (HSC) tend to push people towards emergency departments, but I do not contest what the Royal College of Emergency Medicine is saying. <BR /> <BR />That constrained community capacity is where I would wave my magic wand, if I had one, because until we deal with the fact that the DTAs — decisions to admit — are heavily outnumbered by the number of patients who are in hospital beds despite being deemed medically fit for discharge, we are not addressing the fundamental problem. Everything else is just around the edges. It is important that we deal with those things as well, but that is fundamental.”
“Thank you, Mr Deputy Speaker. I thank Mr McGrath for proposing the motion and all who have contributed to the debate. We all agree that the situation in our emergency departments is symptomatic of wider pressures, rising demand, more complex patient needs and constrained social care or community capacity. If I had a magic wand, that is where I would be waving it, because —.”
“I expect everyone delivering health and social care to be human and to look at their patients and service users and say, "What if it were my relative? If that were me, what sort of treatment would I expect?".”
“I am not sure what the Member is referring to as "cold and insensitive". I absolutely regret what happened, particularly the two losses of life. They should not have happened. Anybody accessing healthcare has a reasonable expectation that they will be seen professionally and compassionately, that their screening or diagnosis will be accurate and that their outcomes will be positive, wherever possible. That clearly was not the case. I regret that very much. I have tried to engage with the Ladies with Letters and some of the other families who were included in serious adverse incident reports, and some of those meetings were shockingly insensitive. <BR /> <BR />I turn to the Regulation and Quality Improvement Authority (RQIA), which has a policy of being human.”
“We made it clear to the Belfast Trust that the PHA will make extremely clear what it expects in respect of quality control in the system. We will monitor that closely. I assure the public that we will move as quickly as possible to secure that external quality assurance.”
“That is clearly a party political point. Some time ago, the Ulster Unionist Party made a determination to take politics out of the delivery of health and social care in Northern Ireland. One of the outworkings of that is that Members are more than clear to go and do their constituency work, and, if that involves representing the wishes of their constituents, that is perfectly fine by me. That leaves me clear to pursue the evidence and take evidence-based decisions. In this case, the evidence was so complex clinically that I decided that I needed an expert to advise me; hence I brought in Sir Frank Atherton to do that for me. I did not have to put into the terms of reference advice on whether we should call a public inquiry, but I did.”
“When I met the Ladies with Letters and the other families at Oxford Island, I said that I think that the most appropriate and best legacy, not least for the two women who so sadly lost their lives, would be to ensure that the HPV screening currently being undertaken by the Belfast Trust is world class.”
“I share that concern and have said many times that I will bring forward a women's health action plan, but I would like to see a strategy come forward in the next session. When I bring forward the action plan, I hope to be in a position to mention something else that is a significant first for any Department in terms of gender.”
“<BR /> <BR />I have been open and transparent. However, the bottom line from Sir Frank is that a statutory public inquiry is highly unlikely to advance matters.”
“As I said, when I saw the list of attendees at Oxford Island on Thursday, it was pointed out to me that they were bringing a lawyer. I was asked whether I would like to effectively block that and refuse access to that lawyer. I said no, because I want to be open and transparent. I was presented with six reports that pulled in different directions. To use the word that Sir Frank used on Thursday, those six reports were "dissident". They clash with each other. I do not have the clinical expertise to knit those reports together into a coherent whole: that is why I asked Sir Frank to do it. When the Ladies with Letters said that those six reports did not necessarily include all the information that is pertinent to the case, I asked Sir Frank whether he would meet them. He met them, and he met others who were involved.”