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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“Whilst beds are commissioned on a localised basis, I have repeatedly said to the trusts at the highest level — chief executives and chairs — that I expect them to collaborate and cooperate. In my mind, the five geographic trusts are one trust, and that is how I want them to navigate these issues. <BR /> <BR />Learning disability services now account for £500 million per year, supporting 9,000 adults and their families. Investment has increased significantly in recent years, but I do not see or hear that when I speak to carers and families. It is clear to me, as Health Minister, that we spend money in the wrong places. We respond to crises, placement breakdowns and delayed discharges. We need to rapidly recalibrate the service to provide greater support at an earlier stage and to better recognise the role of unpaid carers.”
“I am keen to see to what extent the voluntary and community sector can play an enhanced role. I look back at my time as a victims' commissioner, when we worked closely with the voluntary and community sector, which delivered a lot of services for victims of our conflict. Having said that, I do not think that they should be some sort of "cheap alternative" to statutory services. It is a question of getting a balance there, but I am keen to work with the Northern Ireland Council for Voluntary Action (NICVA) and others to try to see how we enhance those services and pay for them appropriately. <BR /> <BR />It can be a challenge when a family moves from one trust to another — again, that was raised by the second amendment — and it can result in a temporary loss of respite support.”
“Demand exceeds supply, and there are significant workforce challenges. Also, trusts have reported a growing complexity of children who have transitioned into adult services. That can reduce capacity in day care and in short breaks, while requiring higher levels of staff and support. On my mind on a daily basis is the idea of transition and how we do it better, because we do not do it well. <BR /> <BR />I am aware that there have been instances when short-break beds have been temporarily repurposed for emergency or residential purposes. For example, the Southern Health and Social Care Trust temporarily closed Woodlawn House at the end of last year for residential purposes, which cancelled a series of planned short breaks for several weeks.”
“Those carers have continuously stressed the importance of periodic, flexible and planned short breaks, and of the importance of recognising the fact that short breaks provide the person being supported with a break from the family home and offer different activities. Nobody could put it better than Kellie Armstrong did in her contribution, which I acknowledge and for which I thank her. <BR /> <BR />The services were significantly impacted on by the pandemic, as trusts balanced infection control with the practicalities of delivering a learning disability service. Members will be aware that my predecessor approved the pathway to remobilise services as we emerged from the pandemic, which enabled full restoration of day services and an ambition for short breaks. Today, the challenge is different.”
“That is a valid point, and one that I acknowledge. <BR /> <BR />Respite services for adults with learning disabilities account for approximately £25 million expenditure a year, which accounts for only 5% of the total learning disability spend. Trusts deliver and commission approximately 100 respite beds, which are used by thousands of families in Northern Ireland. There lies an obvious disparity; those are indicators that something is not quite right. <BR /> <BR />I acknowledge that respite provision is most certainly not a luxury, but that it is indeed a necessity for many unpaid carers in our society.”
“Following that consultation, the model will form the basis of regional and trust-level commissioning and investment plans for years to come.”
“<BR /> <BR />I was struck when Mr Robinson said to me that if separating emergency and elective or planned surgery makes sense, it makes equal sense to separate out residential and respite care. My Department has a draft plan, and my officials have engaged directly with several of my colleagues in the Chamber in order to provide assurances that we know what the problems are and, more importantly, that we have a clear vision for the way forward. <BR /> <BR />I will provide an update on the draft learning disability service model, which aims to recalibrate services to provide greater support in the community, including through the expansion of respite and short breaks. We engaged carers in the development of the model and we intend to do so on a greater scale through a public consultation in the coming months.”
“Without the love and dedication of unpaid carers, the current model of social care for learning disability would collapse overnight. Mr McGrath talked about signs of humanity. Is there any greater sign of humanity than the love of the parents of children with learning disabilities that we watched in the 'Spotlight' programme? <BR /> <BR />I accept that we need to address the lack of respite provision for children and adults. That will require immediate action but also forward planning and additional investment to grow and diversify the service in the coming years. It is important that funding for the service is ring-fenced and not used for residential and emergency purposes. To do that will require a comprehensive examination of the entire learning disability programme of care.”
“Thank you very much, Mr Deputy Speaker. I thank all Members who contributed to the debate. <BR /> <BR />I will start with a direct and clear response to the motion. The current provision for children and adults with learning disabilities is inadequate and has been for quite some time. I agree with the motion that respite is not a luxury; it is an essential and critical service for unpaid carers and their loved ones. The provision of respite gives recognition to the fact that most people with learning disabilities will remain in the family home throughout adulthood. <BR /> <BR />I fully recognise the hard work and dedication of staff who deliver respite services. I also take this opportunity to pay tribute to unpaid carers. They have been mentioned often in the debate.”
“I met some of the ladies from Ladies with Letters, and Diane Dodds was in the room at the time. Clearly, confidence is not there. Trevor Harbinson was in the room, not long after he had buried his wife, Erin, who should be alive today. She should be alive today, but she was failed by our system. That is my motivation. Let Erin Harbinson be the last. Let us change the system. Let us make it equitable, accessible and world class. That is my ambition.”
“I said that I want to tackle health inequalities. For me, that is short for three things: health inequalities, which are about outcomes; health inequities, which are about unequal access to services; and health literacy, which means people understanding how to access health and social care in Northern Ireland. On that theme, the rapid diagnostic centres will be very useful, but you need to know that they are there and how to access them. Even if you know how to access primary care and your GP, they need to be open and responsive when you reach out to them. <BR /> <BR />My final point is on the subject that Mr Buckley raised: confidence. Confidence is absolutely key. If we do not trust our doctors, nurses, clinicians and surgeons, how can the health service operate?”
“It is unacceptable that our cancer outcomes are not better than they are when compared with other countries, and that is why we need reform, a point that Mrs Dodds made.”
“Engagement with clinicians, people with lived experience of cancer and cancer charities will all be central to the review. My overriding priority is to secure better outcomes for patients, and the review will include examining options from consolidating the number of locations where assessment and surgery are provided. At the same time, it will consider how aftercare and chemotherapy are provided, and those services should, I believe, be provided as close to home as possible. I am confident that patients are prepared to travel for specialist assessment and treatment, but they want follow-up and continuing care to be as close to their dwellings as possible. <BR /> <BR />A few other areas were mentioned during the discussion.”
“That will enable patients from across Northern Ireland to access the earliest appointment available to them, wherever that might be. I want to deliver equitable access to breast services. I want to end the unacceptably long waits. I want our staff to have a more resilient service. The patients of the Upper Bann region have been highlighted here today. To me, it is unthinkable that somebody from that area who might wait for weeks for a breast assessment could, if they lived just a few miles up the road, wait for only days. That regional inequity in access to breast cancer services will end. <BR /> <BR />More challenges need to be addressed to deliver a service that meets the needs of all who require it. For that reason, I have asked for a wider review of services to be undertaken at pace.”
“Regionally, we have never met our 14-day target for all red-flag assessments. According to the latest cancer waiting time statistics, between April and June of this year, just 31% of patients were assessed within 14 days of their red-flag referral. The target is 100%. Only 36% of patients started treatment within 62 days of their referral. That target is 95%. Conversely, 91% of patients started treatment within 31 days of diagnosis. It is a clear indication that addressing the wait for assessment is a priority issue, and, once a diagnosis is provided and a decision to treat has been made, the service should be much timelier. <BR /> <BR />That is why I recently announced that single regional waiting lists for breast assessments will be implemented in the coming months.”
“However, with any major change in the way that we work, it takes a little time to adjust, and that impacts on service delivery. As happened in other areas of the UK where a similar system was introduced, there has been an expected downturn in capacity in the South Eastern and Belfast Trusts, and that is expected to be the case when the Northern Trust goes live on 7 November and when the Southern and Western Trusts go live in 2025. <BR /> <BR />Departmental officials and trust staff have worked tirelessly to provide short-term interventions to address the waiting times and backlog. That has included inter-trust transfers, increased waiting list initiative funding for red-flag patients and the coordination of mega clinics on evenings and weekends. We are all aware that breast services here have been under severe pressure for some time.”
“Therefore, if even one staff member is on leave, falls ill or suffers a bereavement, it can have a catastrophic impact on the trust's performance. Over the past 12 months, staff shortages have had just that effect on many occasions. Mr O'Dowd asked whether a third consultant had been appointed in the Southern Trust, and I can tell him that it is the case. To some extent, that has helped to stabilise the service, but there is still a waiting list backlog, and workforce issues remain: one GP with a special interest has, I believe, gone to another trust, there has been maternity leave, and other issues have affected that small team disproportionately. <BR /> <BR />Members will also be aware of the introduction of Encompass to our health and social care services. It is a major step forward and an exciting innovation.”
“Staff have made an enormous contribution; I wholly endorse that idea. The issues with the services do not sit with the staff who deliver them. The issues that need to be addressed are systemic, and I intend to address them. <BR /> <BR />I wish to deliver a more equitable, sustainable and timely service to deliver better outcomes for patients and more resilience for our staffing complement throughout the region. The particular concern of the Member who secured the debate is the waiting times in Upper Bann. The key hindrance to the breast service's performance in the Southern Trust and a contributory factor to long waiting times is the ongoing challenge of staff availability. In the current delivery model, each trust relies on a small team to deliver its breast services.”
“Deputy Speaker, thank you. I thank Diane Dodds for securing today's Adjournment debate. I welcome the opportunity to recognise the situation that so many people living with breast cancer find themselves in. <BR /> <BR />Naturally, much of the discussion about our breast services focuses on performance, and quite rightly so. Since becoming Health Minister, I have had the opportunity to meet a number of people who are living with breast cancer or, indeed, supporting those who are doing so. A key takeaway for me from those discussions is that our breast services in their current format are not performing as they should, hence my desire for reform. I want to be clear that that is by no means a reflection on the dedication and commitment of the staff who work day in, day out to deliver those services.”
“I commend the trusts, which have made unprecedented savings in excess of £200 million this year.”
“We received £122 million in June monitoring, which was very welcome. It has made a good contribution to the deficit. However, following an additional push for savings from our arm's-length bodies, the gap is now a reduced but still significant £130 million to £135 million.”
“I am not sure whether it was the practice manager or one of the doctors in the Castle Practice who felt that East Antrim had been knocked out of its place in the pecking order. The next three proposed federations for MDT are North Belfast, the South West, which is Fermanagh and Omagh, and, indeed, East Antrim. All are hugely deserving of the programme, and it is my firm hope that, if the transformation bid is successful, we can move at pace with the East Antrim roll-out. It is something that the Member will have heard GPs raise on more than one occasion as being important for their area.”
“If the bid is successful, it is proposed that the roll-out will progress in two tranches during the five-year window of the fund's existence.”
“I very much enjoyed the visit with the Member to Carrickfergus and East Antrim, and I thank him for the invitation. It was useful to see at first hand the convincing case that the Castle Practice has made for an investment in its premises. The pharmacy is among the top three busiest in the whole of Northern Ireland. <BR /> <BR />I am fully committed to the further roll-out of the MDT programme. Of any transformation that has taken place since the Bengoa report in 2016, MDTs may be the shining example of a successful initiative. A bid for funding for the wider roll-out of MDTs across primary care has been submitted by my Department to the Northern Ireland Executive's transformation fund. There is a question about whether that will be successful, given that the fund is £47 million per annum but is across every Department.”
“Those are the principles that I want to apply, and that filters down through officials in the Department, who are doing the day-to-day engagement. I am always more than happy to engage directly with unions and other stakeholders.”
“Meetings, particularly between officials and stakeholders, including the unions, happen all the time. I am more than happy to engage when appropriate. I want to see a workforce in which there are no vacancies and where people are as content as possible in their role because they feel that they are being cherished and well rewarded. I came to this role from the Economy Committee, where the Member's colleague Conor Murphy talked about good jobs. We had several debates in that Committee about what a "good job" is. You might say that a good job is being a consultant or surgeon and not a hospital porter, but we need hospital porters. A good job must embrace hospital porters, and that means that they wake up in the morning looking forward to going on a shift and feel that they are well rewarded, respected and honoured for doing their work.”
“Carál Ní Chuilín made the point in last week's debate on social care in north and west Belfast that people are burnt out. The job is not attractive; there is no work-life balance. If you do not have a good work-life balance, you do not have a good workforce and you have problems in your workforce. The Member is identifying issues that we are aware of but do not have easy solutions to.”
“Pay and workforce challenges are among our most pressing, difficult and intractable issues. I acknowledged previously, for example, that, with pay rates in Health and Social Care (HSC), it is difficult, if not impossible, to compete with Sláintecare, particularly in the border areas. The Western Trust and Southern Trust have particular problems because it is now so easy, with the road network transport arrangements, for people to base themselves here but work for Sláintecare. <BR /> <BR />We have many vacancies across the Health and Social Care workforce. All I can say to the Member is that we are very aware of that and we do what we can. Part of the challenge, because we cannot necessarily compete on salary, is to put together a package that is attractive to people.”
“One of the challenges for us is to say to people that the proposed move under option 7, as the Member calls it, of general emergency services from Coleraine to Antrim is only half the story. That half of the story is taking something away from people who access the Causeway Hospital, but the other half is that we are going to put something in. We will make the Causeway Hospital an elective overnight stay centre. That means that a lot more efficiency will be delivered, as elective procedures will not have to be cancelled because of emergencies. Better outcomes will be delivered, with the proviso that we will carefully assess any potential patient risks in moving services from one hospital to another.”
“I know how they arrived at option 7, and that was by listening to the clinicians. I visited the Causeway Hospital and Antrim Area Hospital one day a few weeks ago, and I met some clinicians who were involved. I have to say to the Member that their view was that that option was not, as the trust put it, their "preferred option"; in the view of the clinicians, it was the only and the essential option, otherwise services would be closer to the danger of collapse. <BR /> <BR />I understand that, for everybody, healthcare is personal and local and that, in an ideal world, everybody would like an acute hospital at the end of every street, but we cannot do that. We have to reconfigure how we deliver our services. I have acknowledged in the House that there will obviously be a tension between clinical opinion and community opinion.”
“I assure the Member that, before any final decisions are taken about moving any services from one hospital to another, the safety of patients will be the priority concern.”
“<BR /> <BR />It just makes sense logically, wherever possible, to separate emergency surgery from elective or planned surgery. It is deeply frustrating, if you are on a list — it does not matter whether you have been waiting for a month, a year or five years — to wake up at 6.00 am on the day of your procedure only to get a phone call or message to say that the procedure has to be postponed because emergency surgery is taking place in the theatre that you were supposed to go to. How deeply frustrating is that? To achieve the productivity and efficiency that I seek from the trust, it makes sense, as a matter of course, to separate emergency and elective surgery, but it has to be done in a safe way.”
“I thank the Member. I acknowledge that there are legitimate concerns when you move services from one place to another. Yes, the Northern Trust is consulting on removing emergency general surgery from the Causeway Hospital in Coleraine to Antrim Area Hospital in Antrim town. That is a live consultation, and it is only when we get to the end of that process that the trust will present the Department with an outline business case. <BR /> <BR />The emergency department will stay at the Causeway. If somebody is in a bad way, the important thing is to stabilise them. That is the absolute priority. I am seeking and, to some extent, getting assurances that, once that is done, it is not life-threatening to move that patient to Antrim Area Hospital for the emergency procedure that they need.”
“I thank the Member for his question. We do not have plans in that area, and the reason is that we are following Great Britain on the advice and roll-out of that vaccination.”
“<BR /> <BR />I have to say to the Member that a draft equality screening, a draft assessment of disability duties and a draft human rights assessment were published alongside the Bill.”
“No Bill has been written, and the Bill's composition will be dictated to an extent by the public's reaction to that consultation process. However, it will also be up to the Assembly and the Committee for Health to decide the shape of the Bill. Again, I do not feel that I am the only person making decisions here. <BR /> <BR />I shall use the consultation to try to shape the Bill. You know that I am personally not in favour of forced vaccinations, but it happens. During COVID, for example, over-50s in Italy were subjected to forced or compulsory vaccinations. I will shape the Bill as I feel best, but I will bring it to the Chamber and to the Committee, and I will ask you to help me to shape it so that we get the right balance between protecting population health and upholding human rights and personal liberties.”
“<BR /> <BR />I point out to those who think that some proposals are draconian that the 1967 Act already provides for a magistrate's order that a person suffering from a notifiable disease that presents a serious risk to others can be removed or detained in hospital for a specific period. It empowers authorised officers to "do all acts necessary" to give effect to that order. That is in sections 3A(1) and (2) of Part I of the Public Health Act (Northern Ireland) 1967.”
“I thank the Member for his question. This is, of course, a very important area that we are discussing. I have not yet had a briefing on the number of responses, so I am not even aware of that, never mind whether they are positive or negative. I am aware of the strong campaign against some of the proposals. I re-emphasise that, because we are moving from the 1967 Act, which gave cover only for a number of infectious diseases, to all-hazards protection, which includes biological, chemical and radiological hazards, I felt that it was important to put all the options on the table for a public consultation. It is not for me to decide in advance that I will rule out any option. Indeed, had I not included some of those options, there might have been another campaign to ask why I had not done so.”
“I am sorry: I did not quite catch that. I acknowledge that the SAI procedure, as currently constituted, is not fit for purpose. I am determined that we bring one forward that is efficient, fast and patient-centred.”
“OK. The redesign of the current serious adverse incident (SAI) procedure is important and one of my Department's priorities. We are undertaking extensive engagement with a broad range of stakeholders. That includes the Patient and Client Council engagement platform, which comprises five individuals with lived experience of the SAI procedure. <BR /> <BR />I will give way to the Member for a follow-up, if that is possible.”
“Professor Bengoa made clear that every country, particularly every country in Europe, is seeing its budget for healthcare rising. The challenge is to decelerate that increase as much as possible. Primary care and GPs play a crucial role in delivering that.”
“I thank the Member for his question. Absolutely: I have talked often about a "shift left" for healthcare delivery. By that I mean getting healthcare out of hospitals and into the community and primary care practices. The primary care elective service is hugely important in providing five key pathways in dermatology, gynaecology, vasectomy, minor surgery and musculoskeletal health. More important than that, however, it is about prevention and early intervention. Only if we do that will we be able to transform how we deliver healthcare. If we do not transform, as Professor Bengoa warned us last week, by the year 2040, Health will require the entire Executive Budget: 100% of it. There will be nothing left for schools, roads or anything else. It is imperative that we get on with that transformation.”
“The Member's use of the term "sleight of hand" will be deeply resented by officials in the Department of Health. I encourage you to eyeball them and make that accusation. There was a very frank, honest and robust discussion this morning on the issue. My officials are absolutely certain in their position, and I have seen no evidence to make me doubt that. If the Member wants to use language like that, I encourage him to eyeball the officials, put it to them and let them respond.”
“It is my understanding that there was a negotiation, not just about the money that would go into the general medical services contract but about the work that that would cover. There was a rejigging of the services that were to be commissioned. It is not necessarily accepted by all, but my officials are very clear that money was ring-fenced — £5 million — for the indemnity of GPs. It is fair to say that it is pretty well known outside the Chamber that GPs are not on the same page as me on that. I have proposed an independent arbitration process to look at the contracts and tell us who is right and who is wrong. If we are wrong, we are at fault, but we are confident, as are the GPs on the other side, that any independent assessment will find in our favour.”
“My officials were keen to say that, by the end of calendar year, if not well before then, they hope to be in a position to sit down with Dr O'Hagan and colleagues and present what, we hope, will be an acceptable long-term solution to the issue. As the Member said, GPs here feel exposed in a way that GPs in other areas of the United Kingdom do not. That is clearly a problem, with the sort of potential consequences that the Member has outlined.”
“I thank the Member for his supplementary question. It is a very important issue. Having spoken to Dr O'Hagan and some of her colleagues this morning, it is clear that there is at least a misunderstanding or misinterpretation of the current arrangements, which is causing some disquiet among general practice doctors. That needs to be resolved at pace. <BR /> <BR />It is, however, at least as important to note that we are discussing an interim measure and that we need to move to a solid-state, long-term solution to the question of indemnity. During the discussions, we talked about several issues that might help to resolve it.”
“<BR /> <BR />Looking at the longer term, a number of possible indemnity options have been identified, ranging from the current model to state intervention, which includes a number of state-backed model options.”
“That was an interim measure, pending identification of the long-term model of indemnity. <BR /> <BR />Documentation outlining the detail of the contract agreement set out how reallocation of funds to the GMS envelope would work. Further clarification on those arrangements was issued to all GP practices on 18 September. I am aware, however, of the issues raised by the Northern Ireland General Practitioners Committee in relation to the outworkings of the 2024-25 GMS contract, including the funding for indemnity. Indeed, I met the chair of the General Practitioners Committee, Dr Frances O'Hagan, this morning. We discussed those concerns and explored options for moving forward. We will continue to engage with the committee representatives on that issue.”
“I thank the Member. I recognise that arrangements for clinical negligence indemnity are a matter of concern for GPs locally. In the financial year 2023-24, £1 million of funding was reallocated from other areas of the general practice budget on a one-off, non-recurrent basis to support GPs with indemnity costs. As part of the 2024-25 general medical services (GMS) contract, which was agreed with the Northern Ireland General Practitioners Committee in May this year, £38·9 million of funding was released for repurposing as a result of the incorporation of the quality and outcomes framework and specified enhanced services into the core contract, and with funding for clinical waste also moving into the core funding. Of that, £5 million was allocated to GP practices on a per capita basis for indemnity costs.”
“I thank the Member. On foot of the pseudomonas issue that arose at the maternity hospital at the Royal Victoria Hospital, we are reviewing how every trust monitors the water supply in all their facilities.”