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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“Let us find out where best practice is happening in any particular service and roll that out so that it is common practice across the five trusts.”
“I assure the Member that I am very focused on that. I see that she is wearing a Heart Failure Warriors badge, as I am, after visiting the group in the Long Gallery earlier. We heard the two sisters on Radio Ulster this morning. One is in the Southern Trust area, and one is in the Northern Trust area, and there is a very divergent set of experiences between the two. That leads me to the conclusion that, while it would be tempting to go from five geographic trusts to one, I am not sure that that would be any more than a divergence and a distraction. I want outcomes, so I have made clear to the chairs and chief executives of the five geographic trusts that I am looking, wherever possible, for regional services where they are collaborating and cooperating and not competing.”
“I give the Member that assurance. The important thing is to recognise that co-design means starting with as close as possible to a blank page and asking the service users, "What do you want, what obstacles are in your way and how can we overcome them?". We got to a point where residential care in particular was being knocked out by short breaks, because the two were incompatible in the same infrastructure. I want to be sure that we understand what the obstacles are, so that, as we go forward, we not only remove them but monitor the implementation.”
“One example will be to expand access to after-school clubs and youth clubs to provide families with additional support. <BR /> <BR />In the longer term, I want to work with parents of children with disabilities to co-design, because it is not about presenting a plan and asking what they think but about getting as close as possible to starting with a blank page and asking what they think at that point.”
“It is a tripartite approach, particularly for respite and residential care: we need not only infrastructure and funding but a workforce that is suitably qualified and, indeed, committed to that challenging role. An immediate priority is to reinstate and expand overnight residential short breaks for children with disabilities. I recognise that that is only one component of the continuum of support that those families need, so, in addition, I have asked the trusts to prioritise the continued development of short breaks, fostering or Share the Care services specifically for children with disabilities. Those services can include support from befriending right through to overnight breaks. We are also working with the voluntary and community sector to see how we can expand and extend some of the services already available.”
“I thank the Member for her question. As she will be aware, I was pleased recently to approve additional regional funding for children with disability services, despite the financial circumstances facing my Department. That funding allocation will enable up to £2 million to be spent over the rest of this financial year, and there will then be £13 million a year in multi-year funding to support families who have children with disabilities. <BR /> <BR />On the allocation of the funding, each trust is working intensively with my Department to agree what actions can be taken forward this financial year. I have been clear that the plans must improve family support, short breaks, residential care and behavioural support for families who have children with disabilities.”
“Again, I accept that as the Member's genuine belief. Ultimately, it will be a judgement call for the House. I will make my judgement call after we have consulted on our Being Open framework. We can all agree, however, that we have an opportunity here to end the years of frustration. At this point, we might not agree on the exact way forward: I propose that we go forward with an organisational duty of candour only, but maybe Mr Frew will introduce a private Member's Bill or try to amend the Bill that may come out of the Department. However, we have an opportunity to ensure that that sort of cover-up never happens again.”
“I am clear that there should never, ever be a cover-up by an individual, a group — such as a group who had maybe operated a procedure in a theatre in a single day — a trust or the health and social care system.”
“The final thing that we have not discussed around the chill factor is about applying for a job in health when a duty of candour with criminal sanctions for individuals applies only in Northern Ireland. We already have huge workforce issues: maybe we will lose more people to Sláintecare or to England, Scotland and Wales. <BR /> <BR />I will give way.”
“There is also the question of whether people who know what went wrong will be willing to speak out. When I spoke to a lot of the victims who lost loved ones to Dr Watt, they were clear in their minds that people around Dr Watt knew exactly what he was doing and the harm that he was creating but were afraid to speak out. The question is whether an individual duty of candour that is legally binding and has criminal sanctions will further enforce that chill factor or open things up.”
“I am optimistic about what we can achieve before the end of the Assembly mandate and the momentum that exists across the system on the issue. It is something that I very much welcome. I look forward to updating the Assembly again, following consideration of the Being Open framework consultation, on the next steps for that work and on the duty of candour issue more broadly in Northern Ireland. <BR /> <BR />As we move forward on an organisational duty of candour, it will also give us a further opportunity to involve key stakeholders in the development of the policy. I talk often about trying to avoid the chill factor. One Member pointed out that not all clinical decisions will have successful outcomes, and perhaps a chill factor would impact a clinician in deciding whether to perform a certain procedure.”
“I have also written to the First Minister and the deputy First Minister, as there will be implications across the public sector that we will need to be alert to. <BR /> <BR />While the duty of candour is under review throughout the UK, I am not content for Northern Ireland to remain an outlier on the organisational front. It is certainly important that I continue to take account of the experience and effectiveness of the duty in the rest of the United Kingdom over the coming months, but I do not want that to unduly delay progress. In principle, I repeat that I support the implementation of an organisational duty in Northern Ireland and expect to make a firmer commitment to its implementation following the outcome of the forthcoming consultation on the Being Open framework.”
“My officials continue to engage with colleagues in England to ensure that any future work in Northern Ireland is informed by the conclusions of that important review. <BR /> <BR />The Assembly will also have noted that the Prime Minister committed, in the King's Speech, to a duty of candour Bill to be introduced to Parliament before the next anniversary of the Hillsborough disaster, which is in April 2025. The Bill is expected to be much wider-ranging, taking into consideration all public bodies so that they all act in the public interest with transparency, candour and frankness. Again, my officials are engaging with colleagues in England, Scotland and Wales to consider those wider developments.”
“<BR /> <BR />It is important too to recognise the wider duty of candour policy context across the UK. England, Scotland and Wales already have an organisational duty of candour in place. The legislation in Wales was implemented recently, in fact, in 2023. It is also important to note that, in December 2023, in response to the release of the Hillsborough disaster report, the Department of Health and Social Care in London announced a review of the duty of candour in England. Its statutory duty has been in place for 10 years now, and the review is taking place to understand to what extent the duty is being honoured, monitored and enforced and to ensure that the initial policy objectives are being met. In ensuring that our legislation is as effective as possible, the evaluation of the English duty will be of significant benefit to us.”
“I thank the Member for her intervention, and I agree. I hear Members say that, even when individuals in HSC are willing to come forward and talk about what went wrong and why, they are sometimes discouraged — "discouraged" may be a light description — by their senior management or by people above them in their line of management. So, yes, it is important, and, that, I believe, links into the culture that has to go alongside any legislation. <BR /> <BR />Significant engagement has been carried out by the Department over the past number of months about the Being Open framework. It aims to ensure that individuals in our system are fully empowered to exercise candour and openness and that HSC organisations have in place the necessary support and the systems required to enable and nurture a truly open culture, as the Member referred to.”
“<BR /> <BR />The key question, then, becomes how to create a regime that minimises the chill factor that deters individuals from being candid and maximises their willingness and responsibility to engage in an honest review of what went wrong. I am happy to report to the Assembly that we have made significant progress on a regional Being Open framework in recent months, and I expect to consult on that towards the end of the calendar year. That work was initiated in the autumn of 2022, with Professor Peter McBride, an experienced associate member at the HSC Leadership Centre, commissioned by the Department to lead on that work.”
“The decision of my predecessor was to address, in the first instance, the cultural work that is critical to any successful legislation and, in parallel, to further consider the concerns expressed by some consultees around the impact of the proposed criminal sanctions. I am firmly of the view that new legislation, without also addressing the cultural issues that I have referred to, would not be particularly productive. However, I am aware of the time that has passed since the release of the hyponatraemia recommendations in 2018 and the frustrations that I have mentioned. I am on record as saying that I am in favour of every individual working in public service being honest and candid when people suffer unnecessary harm, whether that harm is physical, mental or psychological. That is my desired outcome in this important policy area.”
“<BR /> <BR />I am conscious that a duty of candour for HSC staff is nothing new or, indeed, novel. It appears throughout professional codes of conduct, and, in that sense, nothing new is being asked of staff when it comes to being open and honest when things go wrong. The proposals, as Members will know, are not to sanction mistakes but to sanction attempts to mislead or cover up when mistakes are made. It is clear that a lack of openness when things go wrong can be devastating for patients and for families and can significantly frustrate our efforts to keep patients safe going forward. <BR /> <BR />The Department's response to the consultation was outlined to the Assembly in October 2022, just days before the Assembly collapsed at the end of that month.”
“In fact, the consultation yielded 344 responses that the Department considered along with the hyponatraemia work stream structures that were established. Those structures included service users as well as the clinicians who provide them. While there was significant support for legislation to support a duty of candour, there was also a significant amount of concern and fear around the proposals. In the main, those concerns related to whether a culture of openness and candour is sufficiently present and supported in the systems that we currently have in place. There were also concerns around what the unintended consequences of an individual criminal sanction might be in Northern Ireland, when such a sanction does not exist elsewhere in the United Kingdom.”
“As Members have made out, it would be remiss of me not to say that, in the vast majority of cases, openness and honesty as well as a relentless commitment to patients and their safety are evident in every ward and through every service in Northern Ireland. The staff in our health and social care sector continue to undertake some of the most difficult work in some of the most challenging environments. However, as is clear from the reports and reviews that I have referenced, much more needs to be done to ensure that, when things go wrong, there is openness and candour. <BR /> <BR />As mentioned, my Department consulted on organisational and individual duties of candour in 2021, and, understandably, there was a great deal of interest in the issues raised.”
“and that, specifically, Northern Ireland should introduce an organisational duty of candour, as we are the only part of the United Kingdom without such a sanction in place. I agree, and, if the legislative programme permits, it is my ambition that legislation will be introduced before the end of the mandate. It is a vital issue and one that must be addressed not only by my Department but by the Assembly and the health and social care sector at large. Our focus and the purpose of any legislative change need to be clear: to reduce patient harm and to support a culture where openness and honesty are at the centre of the services that we provide.”
“In recent times, I have met representatives of the Ladies with Letters and, I think, 29 family members who lost loved ones to Dr Watt. Some people say to me, "Those must be difficult things to listen to", but I think that they are difficult things for the survivors telling their stories to trust to somebody in authority. <BR /> <BR />We have seen recommendations for a duty of candour also arise from the urology inquiry and the UK-wide infected blood inquiry. That last one recommends that:”
“To begin with, I acknowledge not only the genuine passion with which Members have spoken but the frustration that nothing has been done in a long number of years. Members have alluded to the fact that the idea of a duty of candour has been around since the inquiry into hyponatraemia-related deaths and the conclusions of the chairman, Mr Justice O'Hara, that the arrangements to ensure the quality of service and the behaviour of certain individuals in the health service at the time were not acceptable. As Mr Frew pointed out, those failings led to the tragic deaths of five young children — Adam Strain; Claire Roberts; Lucy Crawford; Raychel Ferguson; and Conor Mitchell — who, along with their families, of course, were so badly let down. <BR /> <BR />Mention was made of other disasters.”
“She will be sadly missed. On behalf of the Ulster Unionist Party, I offer my condolences to her family and friends.”
“Anna became the bridge between young, nervous reporters like me and that formidable head of the BBC World Service in Belfast. <BR /> <BR />I think that "being a bridge", to a certain extent, summarises Anna's contribution to public life in Northern Ireland down the years. She was a fantastic character. She made a tremendous contribution. At all times, she was not just a public servant but public-spirited. She was very direct. I will never forget Anna coming straight up to me on one sunny March morning outside the famous Willard Hotel in Washington DC. I had made a statement the night before. She had obviously read it. She deconstructed it. She changed my mind, and she admonished me. In a way, that underlines the sense of respect that she commanded as a great person.”
“As we create this tapestry of tributes to Anna Lo, it is difficult, at times, to avoid repetition. However, repetition is not necessarily a bad thing; not when it focuses on Anna Lo's values and the great contribution that she made, not just in the Chamber but to society in general. <BR /> <BR />Before she was here, Anna spent some time working for BBC Northern Ireland, which is where I first came across her. She was working on the administrative side of the BBC's World Service operation in Belfast. For a young aspiring journalist, having, "Worked for the World Service" on your CV was very desirable at the time. The obstacle was the person who was head of the World Service. I will not name them — if you know, you know — but they were difficult.”
“I accept the points that the Member has made, and the inconsistency is something that I would like to see rectified. Again, let us identify what is best practice and where it is being rolled out and then roll it out to make it common practice across all five geographical trust areas. I was up at Altnagelvin a couple of months ago and met some family nurses who deal with young mothers. It is a tremendous support for those young mothers during pregnancy and then in the months and indeed years after delivery to help them deliver the best outcomes for their young children.”
“We have a workforce strategy 2026, so it would be wrong not to say that we are focused on the vacancies and on how we improve recruitment. It is not just about recruitment; you have to retain your staff, and there are a lot of competing and some new pressures. I have said before that we used to worry about nurses and doctors moving to Australia and we now worry about them moving to Athlone, such is the attractiveness of salaries in Sláintecare. Workforce planning is an issue, but we are well focused on it.”
“On the second point, I think that I have already addressed workforce issues during the question-and-answer session. <BR /> <BR />I stand over the decision to move maternity from the Causeway to Antrim Area Hospital. The Member will be aware that there is also a consultation live from the Northern Trust regarding general emergency surgery, again, potentially moving from Causeway to Antrim Area Hospital. Not every hospital will be able to deliver every service, and that is why we have to start looking at hospitals as a network. I accept that transportation will be an issue for some, and that is why it is a focus of mine in thinking about how we introduce a new regime where not every hospital delivers every service.”
“Yes, there is a proposal for a mother-and-baby unit, and we have looked at the potential location for it and identified Belfast City Hospital as the place where we would base it. The Belfast Trust has been asked to look at a business case. I understand that that business case is pretty well advanced. Once we get the business case, we will have to look at available funding. That, of course, will be a capital project rather than part of the resource departmental expenditure limit (DEL), and, from early discussions, I do not think that funding is going to be an insurmountable obstacle. We are making progress to deliver a mother-and-baby unit in due course.”
“That is all that I can say to the Member, except to repeat that if he were to ask me whether I am happy with the way in which the management of the Southern Trust has conducted business in that area over the past number of days and weeks, no, I am not.”
“I acknowledge the Member's continued passion for services at Daisy Hill Hospital. I can only repeat that I do not have the power to stop the Southern Trust if it decides to make a decision on a temporary reallocation, but I do not want it to happen. I can only repeat that, if there is going to be a reconfiguration of service deliveries between hospitals, it needs to be planned and managed, and people — the staff and the community — need to be brought with us. We need to explain why we are doing it. We are only going to do it on my watch if I am convinced that the outcome is better outcomes for people. I do not see better outcomes if there is a collapse of maternity services at Daisy Hill Hospital, and we are working to understand the problem and to try to identify solutions.”
“Work is ongoing in the area of antenatal screening for fetal abnormalities and inherited conditions. Once the information is collated, it will be considered by the Northern Ireland screening committee before informing a future policy decision. I hope that that addresses your questions in that area, but I am happy to engage.”
“I thank the Member for her question. I have outlined the eight areas of work that the professor wants to see, and which I will want to see enacted before we go to these community hubs. Communication of that, as with all policies, is a challenge, but I do not see it as a particularly difficult challenge. When somebody becomes pregnant, they engage with healthcare professionals, and we will ensure that the healthcare professionals alert them to all the options: home birth, birth at a community hub or birth in a hospital. I do not see it as being a particular issue.”
“What is the point of saying to people, "Here is a lovely, shiny strategy" and raising really high expectations when you do not have the funds to deliver on it? I will focus on an action plan that is deliverable in this financial year and in this Assembly mandate, and I will not raise expectations. Of course, in an ideal world, I would ask for a strategy, but I just do not see the value of it in the real world.”
“I thank the Member. I am afraid that I do not think that a strategy for women's health will happen in the immediate future, and the reason for that is the financial constraints and the absence of a long-term Budget in Northern Ireland. I am saying to my officials, "Let's talk about an action plan. Let's talk about what we can actually do with the resourcing and funding that we have available". The Member can shake her head, but I can tell her that I was very pleased when my predecessor brought forward a 10-year strategy on mental health. I was really, really pleased, yet I stand here knowing that we have, in the assessment of the mental health champion, one eighth of the budget that we need to deliver the action plan for this year's part of that 10-year plan.”
“Any loss is a tragedy, and it is, of course, personal to that woman and that family. Unfortunately, healthcare workers have to deal with that daily. I am not aware of any particular concerns, although you raised the fact that these things happen while others are celebrating a successful and healthy birth. Given the confines of space and budget, it is very difficult to do everything that you would want to do in separating people out. I am very happy to engage with the Member if she has ideas on how we can do that better.”
“To answer in reverse order, yes, I will keep a close eye on that because that is an extremely important area. Effectively, the trusts have been asked to ensure that, at all times, they are providing a safe, empathetic and professional service for people who are pregnant and those in the early weeks and months after delivery.”
“The Member will know that we are rolling out Encompass, and, in 2025, the Southern Trust will join the others that are currently online. Once we have Encompass in all five geographic trusts, we will certainly be in a unique position in the United Kingdom, and on these two islands, in having the ability to harvest data that will impact on population health.”
“Funding is a continuing issue. The Member will know, because she voted for the Budget, that we are under severe pressure when it comes to funding for this year. I do not anticipate that that will get better in the next financial year. I will consult the Department about timelines, and I might be able to write to you and give you something indicative on timelines.”
“Ticking all eight boxes will require time. At that point, I will be with the professor on the matter of the community hubs.”
“in those units. <BR /> <BR />The fourth requirement is:”
“I will focus, if I may, on the community aspect, because the professor suggested that we go for community midwifery hubs. I do not think that we are ready for that. It needs more work, particularly if we are talking about births in what the professor called "community hubs" or "midwifery-led units". She mentioned eight requirements for community midwifery hubs, which were free-standing midwifery-led units. It is worth defining those eight requirements, if the Principal Deputy Speaker will allow me the time to do so. They include:”
“I thank the Member. Did she mention community-based care?”
“That is something that flows into safe staffing legislation, and we are working on that. I recognise that some Members are perhaps a little frustrated about the pace of development in that area, but the document that we published today is very important in many areas. On the specific point that the Member raised, I guarantee that the report will input into our thinking on safe staffing legislation.”
“I understand that it is a genuine workforce issue, but the best way to resolve workforce issues is to bring your workforce with you.”
“I thank the Member. If she were a fly on the wall in the ministerial office in the Department, she would note that, over the past four and a half months, staff morale has been a particular interest of mine. I have very much picked up the impression that, of the various groups of professionals who deliver healthcare, morale is at its lowest among those who deliver maternity services, and midwives in particular. We need to improve that. <BR /> <BR />I hope that the Member has already picked up the impression that I am not happy with the way in which the management of the Southern Trust has been dealing with that issue.”
“I do not want to misspeak, so I will write to the Member about the RQIA's 23 recommendations. I am not confident that I am across every detail. <BR /> <BR />The Member will recognise that, when it comes to breast screening, I am looking more towards regional services, allowing for any idiosyncrasies or particular regional or subregional requirements. Yes, we have five geographic trusts, but the closer that they come to operating as a single Northern Ireland-wide trust, the better. That is where my focus is. I want to absorb what is in RQIA, what is in Renfrew and what the new group brings forward so that we can try to become the best. Our aspiration should not be confined to being the best in the United Kingdom; why not try to be a global front runner in maternity services?”
“In June of this year, the workforce data indicated an overall reduction in vacancies across the region, which, of course, is a good thing. The regional vacancy rate for registered midwifery roles is below the HSC average, sitting at 4·7%. Pre-registration midwifery places were increased from 90 to 115 for the three financial years 2020-21, 2021-22 and 2022-23 to address the shortfall in qualified midwives. The first cohort entered the workforce in September of last year. Training places returned to 90 in financial year 2023-24. That is both a sign of our commitment to the service and an indication that things are improving.”
“In discussions with the professor, we agreed that it is an opportunity for Northern Ireland to become the best region or nation of the United Kingdom for birthing and maternity services. That is my intention.”