Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“I rise to pay a particularly fond farewell to my friend and my former colleague. Ken bore his health issues with typical fortitude and concern for others. Numerous times, I asked him, "How are you?", and he quickly switched to talk about the wonderful healthcare that he was receiving from the nurses, doctors and allied health professionals. He was blown away by their relentless professionalism and compassion. <BR /> <BR />Ken spent his early years in journalism as a dedicated newspaper man. In fact, broadcasting came almost by accident. One day at UTV, we needed to interview somebody in Cork, where Ken was based. I phoned him and asked him whether he would be the reporter. He said yes, but on two conditions: that he did not appear on camera and that we cut out his questions.”
“I asked the Ladies with Letters to consider the amount of pressure that they would put on themselves as participants in a public inquiry, because public inquiries are not easy for groups like Ladies with Letters. I am not ruling it out, but I want to get the answers that a public inquiry will provide. If it turns out that a public inquiry is the only way to get them, I will certainly look at that positively.”
“I thank the Member. At this stage, my priority is waiting to be given the report on the cervical cytology review and the two reports that I mentioned in my previous answer and examining those. <BR /> <BR />A statutory public inquiry asks a number of questions: "What happened? Why it did it happen, and who was responsible? What can be done either to ensure that it never happens again or to minimise the risk of it happening again?". I want answers to all those questions, and I want the Ladies with Letters to be satisfied that they have got honest, appropriate answers to them all. If that can be achieved by another route that is not a public inquiry but gets us to where we need to be more efficiently and quickly, that is the route that I will take.”
“The Belfast Health and Social Care Trust is now the provider of the regional laboratory service for cervical screening programmes. That service model is necessary to ensure that the performance standards and minimum requirements for screening and reporting staff are maintained.”
“I thank the Member for her question. Yes, I think that the review is due to be completed shortly. A report will set out its factual findings. A further report will set out the facts on the invasive cervical cancer audits. Those two reports will be produced by the Public Health Agency (PHA) in the Southern Trust, and a detailed analysis will follow that will be supported by the appropriate independent experts. It is important that I say that, as we await the outcomes and analysis, those reports will determine the next steps. <BR /> <BR />As Health Minister, I remain committed to finding the most appropriate method to understand what happened, learn lessons and ensure that our screening programmes deliver on behalf of our population.”
“I think that the Member is aware that, where money is available, it is being targeted towards red-flag referrals. I met the Member and a group of women from her constituency, and some of the narratives were truly shocking, not least those on the waits. For some people, the wait was being measured not in months but in years. It was not one, two or three years; I think that I am right in recollecting that, in one case, the wait had been seven years. Is that acceptable? No, it is not.”
“I thank the Member for her question. I will certainly take that away, because, as a general point, we are looking at the productivity and efficiency of the health service, particularly in regard to elective or scheduled procedures. There is more to be done to deliver those in a more efficient, effective and timely manner. The area that the Member identified could well be at the top of that list.”
“There is a mix that needs to be put together to make consultants and everybody working in Health and Social Care understand that HSC in Northern Ireland is a good place to work and offers fair rewards and opportunities to develop in a personal and professional capacity.”
“There are a couple of points to make on that. Some people think that consultants work for specific hospitals, such as Craigavon or Daisy Hill. Contracts should be with a trust, and consultants should be told that they are expected to travel as demand dictates. We have had some successful forays abroad to attract international colleagues, who have helped to close the gaps. To my mind, it is about not just pay but making the job attractive. The Member's colleague the Minister for the Economy has a focus on a definition of what a good job is. I have rehearsed my views in the Chamber before.”
“The private sector, to a certain extent, can become something of a Trojan Horse, in that you could lose some of your best workers to it. They could start at one day a week, but they could decide, "Well, this is such a nice place to work that I'll do two days a week".”
“I thank the Member for the question. It is a very important point. I am sure that, from his former role, he is aware that the Department looked at the significant cost that it was incurring from the use of agency nurses. A decision was made to stop, and that was successful. I am told that there was a bit of scepticism when that proposal was first made, but it was delivered. The same focus will now be brought to bear on this issue. <BR /> <BR />While I understand why we sometimes go to the independent sector, particularly to tackle waiting lists, it makes me very nervous. If you go to somewhere such as Kingsbridge Private Hospital on the Lisburn Road and you put in one day a week as, say, a surgeon or consultant, you are in a very fine and enjoyable working environment.”
“The exact quantum is still under discussion as we firm up the elements that will go into the plan.”
“I thank the Member for his question, but I do not have a specific answer. Some people think that I am not in favour of a women's health strategy: I am, in principle, but it is not right to present a strategy that you cannot afford to deliver on. The Member may be aware that I have campaigned on mental health since I came here many years ago. When Robin Swann became Health Minister, I was delighted that he appointed a mental health champion and brought forward a 10-year mental health strategy. However, the mental health champion, Professor O'Neill, will tell you that the Department has only about one eighth of the budget required for this year's action points, which means that you are raising expectations only to disappoint. That is why I want to go for a costed action plan as a first step towards delivering the strategy.”
“I further recognise the need for improved education and information on a wide range of women's health issues and risk factors. I want to support women and healthcare professionals in the identification, management and treatment of conditions, including cardiovascular disease, which is one of the leading causes of death among women. That work will form part of the women's health action plan that my Department is developing.”
“I thank the Member for his question. Like me, he may have been in Long Gallery for the meeting on heart failure earlier today. Mr Speaker, I do not know whether it requires a declaration of interest, but that is the very condition that I was diagnosed with in 2016, so I declare that I have two stents, a pacemaker and a defibrillator. I suspect that you might think it kind of greedy of me. <BR /> <BR />Last week, I met the British Heart Foundation prior to the launch of the 'Bias and Biology' report on the heart attack gender gap. I welcome the report. It highlights issues of unawareness, under-diagnosis and under-treatment of cardiovascular disease among women and provides helpful policy recommendations that my Department will now consider.”
“In January, yes. The point, to me, is that it is delivered in this financial year. If it happens to slip, that is a matter of regret, but it is not as big a regret as not being able to deliver it at all. I am determined to deliver it, even if it slips into the 2025 calendar year.”
“I thank the Member, but, if I heard him correctly, he seemed to suggest that part of this year's pay award will be delivered in the next financial year.”
“Since last Monday's Executive meeting, I think that there is now a real collective will to do that, not just for healthcare but for all public-sector pay.”
“The Department of Finance and, I think, the Executive generally are extremely keen that we all balance the books, because, if the Executive do not, the Treasury may want to recoup a £559 million loan that it is otherwise prepared to write off. I do not want to be the man responsible for that £559 million coming out of next year's Executive Budget. <BR /> <BR />At the same time, I want to deliver pay parity. It is in the public domain that I have said that I can use the £220 million that is left to me from October monitoring to deliver that pay parity for eight of the 12 months. I am now working at pace with Executive colleagues to close the gap that exists from 1 April 2024 to 31 July 2024.”
“I thank the Member for his question. A number of pay parity awards are under consideration. He will be aware that, last week, I met Agenda for Change unions and the British Medical Association (BMA) to discuss the situation. On Saturday, I was at a GP conference in the centre of Belfast discussing the same issues. It is a matter of regret for me that part of what I am calling the "plan" has been leaked into the public domain. That has led to a degree of misunderstanding in Health and Social Care and among the broader public. <BR /> <BR />The situation is that the Department of Finance was well aware ahead of October monitoring that I needed £130 million to balance the budget and £320 million to deliver pay parity awards; in other words, £450 million in total. I got £350 million, so there is a gap of £100 million.”
“<BR /> <BR />My Department will be running a number of engagement events from January, listening to women and further informing the development of the action plan. The pace and extent of delivery will be determined by our available capacity and resources, which remain under extreme pressure, which is well documented. <BR /> <BR />With regard to the budget required, clearly what is desirable exceeds what is available for the foreseeable future. However, many initiatives are under way that have received investment or that can be delivered at low cost or at no additional cost within current budgets: for example, in 2024, the introduction of primary HPV screening for cervical cancer and the delivery of menopause training to many healthcare professionals.”
“The purpose of the plan is to highlight the wide range of policy and service development initiatives that are in progress and outline the actions and improvements that can be delivered over the next three years to improve health outcomes for women. At this stage, the focus is on mapping the work that is already under way across the health and social care system, including, for example, improving maternity, gynae and menopause services, cervical screening and breast cancer services and planning for a mother-and-baby unit, as well as identifying areas where further action is needed, for example, improving public health awareness around women's health; providing more training and education for healthcare professionals on those issues; and promoting healthy lifestyles and tackling health inequalities.”
“I thank the Member. I am personally not aware of the spike that she referred to, but I assure her that the Department, in all its actions, is keen, eager and determined to look at rural impacts. That runs across all the activities of Health and Social Care.”
“Finally, work is under way to commission a review of the scope, scale and capacity of the community and voluntary sector to ensure that it is fully integrated into the delivery of mental health services, building on the previous report on the community and voluntary sector's collective voice. <BR /> <BR />In the current year, our priorities are a continued focus on early intervention; developing a plan to maximise the role of the community and voluntary sector; the continued development of the regional mental health service; and stabilising and growing the workforce.”
“Work is ongoing to embed a mental health outcomes framework within Encompass, as it is rolled out. There is the development of a three-year early intervention and prevention action plan and the completion and publication of an independent mental health workforce review, with work under way to begin planning the implementation of key recommendations. <BR /> <BR />Additional investment of £2 million in child and adolescent mental health services (CAMHS) to enhance existing provision and alleviate pressures is under way, as is work to scope and develop a digital mental health service action plan.”
“Delivery of the mental health strategy has been taking place within an extremely challenging financial context, using existing limited resources to take forward actions. As a result, the strategy is being implemented through annual delivery plans that set year-on-year priorities and actions. While the number of actions that can be taken forward is limited due to the funding position, good progress has been made in taking forward a number of areas, including implementation of the community perinatal mental health service across the region — teams are now in place in all trusts — and establishing the regional mental health service, including the appointment of the head of the service and a service user consultant as well as preparatory work for the formation of a regional collaborative board.”
“I agree with the point, which is well made. My objective is to deliver better outcomes for patients, service users and the population generally as well as for those who deliver healthcare. Sometimes, slight adjustments are all that is required. Sometimes, a relatively small investment will have a disproportionately positive result. <BR /> <BR />Of course, it is important to monitor and measure outcomes, and the project is monitored quarterly against agreed targets by the Department of Health's strategic planning and performance group (SPPG). The case studies provided to SPPG in monitoring reports also demonstrate outcomes at a service-user level. The service will continue to be tested for value for money against other community care initiatives, such as acute care at home, that may cover some of the same areas.”
“That funding will enable IMPACTAgewell to continue its vital work of delivering integrated support and services for older individuals, particularly those facing challenges with isolation, long-term health conditions or limited access to community resources.”
“<BR /> <BR />IMPACTAgewell has reported that, since its inception, as well as improving outcomes for older people, it has saved approximately £6·1 million by avoiding unscheduled care costs to the health service in this area over the past seven years. I see it as an example of best practice that I would like to see rolled out across Northern Ireland to become common practice in how we deliver healthcare and support to an ageing population. <BR /> <BR />I recently visited the Mid and East Antrim Agewell Partnership premises and confirmed a two-year funding extension. That reaffirms the Department's commitment to supporting innovative, community-based solutions that address the health and well-being of ageing populations.”
“I thank the Member. The IMPACTAgewell project delivered by the Mid and East Antrim Agewell Partnership is an integrated community development approach to improving the health and well-being of older people. The approach brings together those involved with the care and support of an older person: the GP, community pharmacists, social care workers and the practice manager of a locality hub. IMPACTAgewell is continually developing to meet the needs of local older people and recently commenced work in Inver rehabilitation ward, with officers being involved at the very start of the rehab admission to ensure that, when the older person is ready for discharge, everything is in place for them to return home, including food packs, meals on wheels, key safes and referrals to occupational therapy and so on.”
“I am not aware of any discussions that are ongoing between my Department and the UK Government on the theme that the Member mentions.”
“I am more happy to engage with the Member on the detail of the individual case. <BR /> <BR />As a more general rule of thumb, the North/South reimbursement scheme, which was successful, no longer operates, because there is no budget for it. A bid was made in the previous financial year for budget to allow that scheme to be reintroduced, but that bid was unsuccessful. That is the position that we find ourselves in. Should that position change, as I have said in the House before, I am more than open to and would welcome sensible North/South cooperation.”
“<BR /> <BR />The trusts' CDS teams provided the following information on the current estimated average waiting times from the time of initial referral. For the Northern Health and Social Care Trust, it is six to 12 months for paediatric dental extraction lists and eight months for patients with additional needs requiring comprehensive treatment. For the Western Trust, it is one to two months for paediatric dental extractions and one to two months for patients with additional needs requiring comprehensive treatment.”
“<BR /> <BR />The majority of children receive all their dental care, including extractions, under local anaesthetic in general dental services. Extractions under general anaesthetic are indicated in children who are too young to tolerate the treatment under local anaesthetic, need multiple extractions or display disproportionate anxiety. General anaesthetic may also be required for patients with additional needs who are otherwise unable to cope with invasive dental procedures. Some patients may require all or most of their dental care to be under general anaesthetic. That waiting list is separate from the paediatric extraction waiting list. Children with additional needs may be placed on either list, depending on their individual needs.”
“Community dental services (CDS) in health and social care trusts provide dental care to patients who, for various reasons, are not suitable for treatment in the primary care setting. For young children or those with additional needs or in particularly complex cases, it may be necessary for the treatment to be taken under general anaesthetic. To ensure that the most urgent cases are treated as quickly as possible, community dental services teams operate a strict triage and prioritisation process for general anaesthetic that is based on clinical need. That means that, for patients whose cases are considered to be acute or urgent, waiting times can be relatively short, but, for those in the routine category, waiting times can be significantly longer.”
“I thank the Member for his follow-up question. With his permission, I will go away and test the question of policy. Certainly, from my point of view, sending somebody out of the jurisdiction would have to be an act of absolute last resort. I hope that the availability from 1 April of a new £13 million fund for this area will go a long way towards making sure that that never happens again. The fact that it does not happen would be my number-one objective in providing that sort of care.”
“There is a specific task and finish group, which is considering the introduction of multisite children's homes. By that, I mean an arrangement where children are cared for across a number of buildings that are collectively registered as a single children's home. Both of those work streams will conclude their specific pieces of work by March 2025.”
“The commissioning and contracting work stream is taking forward the review of the regional care homes contract and specification, which will include provision for respite places in the care home setting. The maximising capacity work stream is working to make most effective use of the available regional care home resource. <BR /> <BR />In children's social care services, short breaks can be provided through hospitals, children's homes and specialist foster care settings. My Department is leading on the children's social care reform programme established in response to Professor Ray Jones's review. The reform programme contains a specific work stream in relation to residential care of children, including the provision of short breaks.”
“Members will be aware that the health and social care trusts have responsibility for commissioning and delivering services for children and adults, aligned to assessed needs. Respite or short-break care is defined as the provision of regular, occasional or emergency but time-limited breaks to those who are caring for others. <BR /> <BR />Statutory and independent-sector care homes facilitate planned and emergency short breaks for adults. In addition, short breaks are provided through the Shared Lives service. Currently, in adult services, there are a number of multi-use sites containing short-term respite and residential or nursing beds. That model has been utilised in order to expand the provision of respite services. My Department is leading on the reform of adult social care under the auspices of the social care collaborative forum.”
“I have not had any particular engagement with that organisation on the question of Lynch syndrome, which, I understand, is a genetic issue. Early discussions are under way, however, to test the feasibility for the establishment of a Northern Ireland Lynch register, and those discussions are taking place between my officials, the Northern Ireland Cancer Registry at Queen's University Belfast and Health and Social Care (HSC) staff.”
“It is question of resource, it is a question of funding and it is a question of capacity. There are many things, on a daily basis, that people come to me about and ask, "Why do you not do this? If you invest in this, you will save money there. You will deliver the better outcomes that you talk about delivering." However, you need the infrastructure, funding and workforce, and when those three do not align, you cannot make the sort of improvements that I would like to see.”
“It is important to note that screening programmes are a pathway and not just a test. As such, where a screening programme makes changes to its eligibility, it is important that associated infrastructure, including diagnostic capacity and any treatments that may be required, is aligned accordingly.”
“The United Kingdom National Screening Committee recommends that bowel cancer screening be offered to individuals aged between 50 and 74. Currently, in Northern Ireland, anybody aged 60 to 74 who is registered with a GP is eligible for bowel cancer screening. Action 7 of the cancer strategy for Northern Ireland 2022-32 is a commitment to reducing the sensitivity levels used in the fecal immunochemical test (FIT) and lowering the age range in the bowel screening programme in line with the UK National Screening Committee recommendation. Our work to meet the commitments to lower the age range and further reduce the sensitivity level is ongoing. However, it must be viewed in the context of the wider financial and capacity challenges within the supporting services.”
“I like to get out and about every week. I have been to the SWAH. I have been to most hospitals in Northern Ireland over the course of the months that I have been in charge. I meet not just managers but people who are delivering services, including those overnight services. However, as regards a strategic review, that is carried out by officials.”
“The two issues are the quantum of the budget and the fact that it is a single-year budget. I have said before that I am optimistic that, if we do not get to multi-year budgets for 2025-26, I see no reason why we cannot get there for 2026-27, not least because the Labour Government will have embedded themselves both in Downing Street and the Treasury. Those are the two issues that play into workforce. Workforce is always a challenge. There are so many moving parts in delivering healthcare, particularly at an acute hospital like the South West. When one part falls down, it has a huge impact. In fact, it makes the whole thing grind to a halt. Workforce is a priority focus for me.”
“Thank you so much, Mr Speaker. I am going to have to get back to the Member, but I will say that there are successes in the transformation programme that we have undertaken since Professor Bengoa was first here in 2016. The elective overnight stay centres and the day procedure centres are a part of that. Primary care multidisciplinary teams are the shining example. Within all that, yes, I would like to see Daisy Hill being enhanced as an elective care centre.”
“'Hospitals — Creating a Network for Better Outcomes' clearly states that it is about the reconfiguration of the network of acute hospitals, of which the South West Acute Hospital is and remains a part. The proposed designation of SWAH as a general hospital refers to the tier at which it sits in the network and is not a reflection of its being downgraded from acute hospital status. In fact, the hospital network document does not contain any proposed reconfigurations. It simply sets a strategic context for future reconfiguration decisions.”
“I am pleased to confirm that the South West Acute Hospital is now delivering more elective activity than it has at any point in its history. While I am very aware of some ongoing local concerns regarding the future of the hospital, I assure all — that means its patients, staff and the wider community in the Fermanagh and west Tyrone area — that I see the hospital continuing to play a very important and long-standing role. In particular, initiatives such as the elective overnight stay centre at the SWAH are and will remain critical in helping to tackle our lengthy waits for elective surgery. Members will be aware that I recently encouraged people to view our hospitals as a network and to recognise the fact that not every hospital will deliver every procedure. There is a place for the SWAH in that network.”
“It is all going very well here. The South West Acute Hospital is a very important asset in the Northern Ireland health service estate. I have had the pleasure of visiting the hospital on a number of occasions in recent months. Indeed, I visited it most recently with the Member. I saw again how accessible and modern the facilities are. The hospital is commissioned for an average of 15·3 elective theatre sessions per week across gynaecology, general surgery, paediatric surgery and dental. The number of patients who are treated will vary slightly each week, and that will depend on the case mix. Whilst there had been a period of under-delivery, following a recent recruitment exercise, the trust has successfully appointed four new consultants. That has had a positive impact on theatre scheduling.”
“It is intended that the additional funding will assist with increasing short-break capacity and expanding family, therapeutic and behavioural supports in the community right across all five geographic trusts. It is very important to recognise that overnight residential short breaks are only one part of the continuum of services that are needed for children with disabilities and their parents and carers. We must look at opportunities to expand the support services that we can provide in the community. Those are under active consideration as we look towards a £13 million additional spend in the next financial year.”