Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“As the Speaker suggests, your question has very little relevance to the question posed by Ms Ní Chuilín. I gently say this to you: there were some workforce issues with midwives recently in the Southern Health and Social Care Trust, and the trust dealt with those as best as it possibly could handle them. I am not aware of any plans to dismantle maternity services at the Daisy Hill Hospital.”
“As the Member will know, the hospital has been subject to delay after delay for years, the consequence of which is that the cost of building it is now eye-watering. When I first saw the figure written down on a piece of paper, I thought that there had been a typographical error. It is phenomenally expensive. Spending the money to fix the PsA issue, particularly if the costs fall to the trust, will put even more pressure on an increasingly pressurised budget.”
“I thank the Member for her question. I stand to be corrected, but I do not believe that the Department played a specific role in the handover. The building was commissioned by the Belfast Trust, and there was a commercial relationship with a contractor. <BR /> <BR />My difficulty is one in a broader sense: the contractor ran some tests, and, based on how those contracts are managed, PsA levels were found to be acceptable. Those tests, however, did not replicate how the water systems would operate once the hospital had been commissioned and was fully operational. When the trust did further tests, we discovered that the levels of PsA were not acceptable. It is a very serious problem that may take a very long time to fix.”
“I acknowledge what the Member has said. The only potential confidentiality issue would be with who was responsible for PsA being in the water systems in the maternity hospital. There are ongoing discussions about that. The Member may be aware that there previously was an issue with the water systems in the critical care building on the Royal Victoria site, although I am assured that that was of a different origin and resulted from a different set of circumstances, which, as I understand it, led to a financial settlement with the contractor. The circumstances in this regard are very different, but openness and transparency, particularly to MLAs, is required, allowing for the fact that there may be some commercial sensitivity along the way.”
“The trust is currently commissioning an independent review of the water systems at the maternity hospital. The review will be undertaken by leading industry experts and will inform next steps for the trust under the relevant design and construction contracts. In tandem with that independent review, and subject to its final outcome, the trust is developing remediation options for the water systems. Remediation works could significantly impact on timescales for occupation of the building. Belfast Trust staff continue to provide excellent care to women and babies through the Royal Jubilee Maternity Service. I am told that service delivery has not been impacted on as a result of the delay, but, obviously, mothers and families are being denied access to the new maternity hospital.”
“The current issue involves the detection of PsA in the domestic water systems. The trust assures members of the public that it takes steps to prevent pseudomonas aeruginosa colonising in its plumbing network in order to protect the vulnerable patients in its care. That includes regularly testing the water systems.”
“I thank the Member. During construction of the new maternity hospital at the Royal Victoria, as part of routine monitoring, the contractor reported levels of pseudomonas aeruginosa (PsA) in the domestic water systems. Action was taken to remediate that. The contractor continued to test the water and provided a set of samples immediately prior to handover. The results of those samples were reviewed, and they met contractual obligations. <BR /> <BR />The building was then handed over in March of this year. Following that, the trust put the water systems in the building into operational mode and ran a period of steady state. During that period, the trust took samplings from all the water outlets in the building. PsA, I am afraid, was detected in a significant number of those outlets.”
“I thank the Member for his comments. Yes, I agree with everything that he said. It is a difficult challenge that does not easily lend itself to short-term fixes, but, as I said, hopefully this week and potentially tomorrow, we will start the process by looking at options. <BR /> <BR />I am pleased to see Ema Cubitt in place as the autism adviser. She has got off to a great start. I heard her on the radio not long after she was appointed, and she is clearly determined to be independent, which is exactly what she should be, holding people's feet to the fire, including those of the Department and mine.”
“I want to give a little hope and say, not least because of that devastating but brilliant documentary, 'I Am Not Okay', that it is very much on the radar of the Department and I am determined to do something about it.”
“I thank the Member for her question. When Professor Bengoa was here last week, in the morning we visited a residential social care site in north Belfast where the point was made to us that there were five beds in the unit but only two were being funded by the Belfast Health and Social Care Trust. It would be lovely to say that we can find the money to say that the trust could now fund all five, but the point was made that, even if that money was available, the staff are not available. That then becomes a workforce challenge on top of the financial challenge, and solving either of those is not something that can be done in the short term. <BR /> <BR />I want to be realistic, but I also want to be optimistic.”
“I can say that, this week — hopefully, as early as tomorrow — I will be presented with proposals by my officials, who are working tirelessly on the issue. If it is as early as tomorrow, that is something that we might be able to discuss at this week's meeting of the Health Committee, and I would welcome that very much.”
“There are two issues that we need to address. One is the physical infrastructure — the houses and residential places that we need — because we do not have enough. Professor Ray Jones has some thoughts about how we should reconfigure. There is also the appropriately trained staff. Even if we had the money and the physical infrastructure, do we have the staff to undertake a major increase in provision? The answer to that, I am afraid, is, "No, not in the immediate term". There will have to be training and recruitment. Also, we are concerned, as we are with all areas of the workforce, about the retention of staff. <BR /> <BR />Can I give the Member an answer to that? I am afraid that I cannot give you a timeline.”
“<BR /> <BR />I want to fully acknowledge that, in the very near future, active consideration will also need to be given to the medium- and long-term plans that each trust will need to consider to fully address the long-standing issues that have existed in the children with a disability service. It is important to recognise that overnight residential short breaks are only a part of the continuum of services needed for children with disabilities, and the opportunities to expand support services that can be provided in the community are also being actively considered.”
“The summit was also attended by senior representatives from each of the five geographic trusts and senior representatives from the Regulation and Quality Improvement Authority (RQIA). It was agreed at the meeting that each trust would develop a proposed children with a disability short-term action plan that it would submit to my Department for active consideration in terms of suggestions and estimated costings regarding what is needed to imminently attempt to alleviate some of the significant pressures experienced with children's access to overnight short breaks.”
“I thank the Member. I fully recognise that the current situation is unsustainable. I am determined to see urgent improvements in the area. I am aware that, unfortunately, a significant number of families are on waiting lists to access support services and an increasing number of children with disability are on the edge of care. I am also aware that, regionally, the limited availability of residential care for children with disability has resulted in a decimated residential short-break service, with a number of residential short-break units being repurposed to provide longer-term care to children with disability. <BR /> <BR />A children with disability summit was convened by my officials last month to consider potential options in respect of improving access.”
“<BR /> <BR />Officials have been engaging with counterparts in England and Scotland to get a better understanding of how services there operate, including the introduction of a mental health hub as part of any new service. That hub, if introduced, would provide mental health assessment and support, including signposting callers to other relevant mental health services.”
“I thank the Member. One of the strategic priorities of the urgent and emergency care review that was published two years ago was the introduction of local and, ultimately, regional Phone First services that would be akin to the 111 telephone services that operate in other parts of the United Kingdom. Local Phone First services are now available in all trust areas. They provide initial advice and triage for people who are considering attending urgent care services. My Department is also exploring the possibility of introducing a regional HSC 111 telephone triage service that will bring those local services under one, easy-to-remember telephone number, subject, of course, to business case development and funding availability.”
“When I started in the Department, one of the cost savings that were put to me, which I could not countenance, was cutting a significant number of hours of domiciliary care. If we were to do that, even more patients who are ready for discharge would be stuck in a bed, particularly in an acute hospital, and, if those beds are not vacant, the people in the ED who are trying to get into those beds would be stuck in ED and, therefore, the people in the ambulances would not get into the ED. It is all about the flow. I assure the Member that we are well focused on that in the Department.”
“I thank the Member. To address ambulance handover times, which are critical, my Department has taken steps to improve waiting times at emergency departments. Reducing those handover delays has been a key priority because of the impact that it has on the Ambulance Service's capacity to respond to calls in the community, particularly category 1 and category 2 emergency calls. A regional process has been issued by my Department to all the geographic trusts for the release of ambulances from outside EDs when the Ambulance Service has an outstanding category 1 or category 2 call. Trusts have been working with the Ambulance Service to introduce new care pathways for patients to provide alternatives to conveying all patients to an ED. <BR /> <BR />I would also say that it is about the flow, as the Member will be aware.”
“I thank the Member for his question. I visited Altnagelvin a few weeks ago. We looked at some of the new facilities, and I was updated on the fact that there is a plan for a new emergency department. I will have to write to the Member if he is looking for exact details of what stage that outline business case is at and the timeline for its completion.”
“The future of healthcare, moving from the past of healthcare, is a development towards having fewer generalists and many more specialists. That is the future. That is the direction of travel.”
“I thank the Member for that supplementary question. We are trying to remove the second assessment. A lot of people end up in a hospital because they start off with an assessment from their GP and are then sent to the emergency department of an acute hospital, where they are assessed for a second time. The future is to do away with that second assessment, wherever possible, so that the GP can refer the patient directly to a specialist service in the hospital. Some hospitals, as well as having emergency departments and minor injuries units, now have urgent care departments. That is what I am talking about: a situation where you can be referred by a GP directly to an urgent care department. The theory behind that is that you have more specialists.”
“Work between the trusts and care homes is helping to avoid admissions for residents, with plans in place to manage agreed conditions by care home providers. As well as redesigning seven general residential beds to increase capacity for patients with dementia, the trust will open a further 11 beds for dementia patients and eight general nursing beds to help improve flow through and discharge from Altnagelvin.”
“A consultant-led respiratory hub is also available, with clinics operating two and a half days a week and offering capacity for 1,200 patients each year, as well as providing seven-day respiratory consultation cover for the emergency department and inpatient referral. <BR /> <BR />The Western Health and Social Care Trust has established a control room in the hospital to proactively manage the flow of patients through the hospital site and into community services. A discharge coordination team is promoting earlier discharges and improved weekend discharge rates for patients who have been assessed as medically fit. In addition, the trust has engaged with GP practices to embed direct referral pathways from primary care to the "Hospital at Home" service.”
“I thank the Member for her question. My Department has taken a number of steps to improve patient flow at the Altnagelvin Area Hospital. An enhanced minor injury unit was opened in March this year. It is a Phone First-led service that operates from 8.00 am to 9.00 pm, seven days a week. It is my expectation that the unit will see some 20,000 minor injury patients a year, and thus 20,000 people will avoid the need to attend the emergency department (ED). <BR /> <BR />My Department has also commissioned an enhancement to the Altnagelvin ambulatory care unit, which operates from 9.00 am to 9.00 pm, seven days a week. It is expected that it will provide almost 20,000 bookable appointments a year.”
“Finally, Órlaithí Flynn said that it is important to have the debate because, in doing so, we send a message to society that we care and that it is an important issue for us. I do care. I care, but I do not have the magic wand. All that I can promise Members is that I will do what I can as soon as I can.”
“We cannot go on like that. It is my duty to bring forward the reforms that have been needed for so long, and I am determined to do so.”
“Professor Bengoa sat down last week with the First Minister, the deputy First Minister, the Minister of Agriculture, Environment and Rural Affairs and me; Ministers representing the four parties of the Executive. He made it clear that, if we do not reform, eventually — by about 2040 — the Department of Health will need the entire Budget — 100% — which will leave no money for education, roads and schools.”
“required by the Northern Ireland Children's Hospice. He also said that the current financial settlement is simply not sustainable. I tend to agree with him, but those statements could also be made about the budget of the Department of Health, and I could say that it is time for MLAs to step up and provide the quantum required by the Department and that the current financial settlement is simply not sustainable. The irony klaxon in the Department has sounded long and hard to those remarks. <BR /> <BR />I do not say that because I think that we can go on delivering health and social care by simply demanding more money, which is the way that we currently deliver it. We have to reform.”
“While I recognise the challenging financial context in which all hospices currently operate, I am conscious that many other health and social care and voluntary and community providers are grappling with their budgets. <BR /> <BR />Finally, on the issue of budgets, Mr Kingston said that the Department has to:”
“The Children's Hospice has advised that the annual cost of generating fundraising income has more than doubled, from £1·2 million to £2·6 million. The Children's Hospice anticipates that this year's operational costs will be in the region of £5·062 million. It has advised my Department that, to maintain financial stability, it requires an additional £860,000 or thereabouts that would need to be linked to future pay awards in order to ensure sustainability. Over the past number of months, my Department has engaged with the hospice to understand the operational costs of running the hospice, the cost of the services that my Department commissions and the extent of increased operational and fundraising costs.”
“<BR /> <BR />I understand that the Children's Hospice has faced financial sustainability issues that, it has advised my Department, are linked to increased operational costs and fundraising challenges. To move towards sustainability and a reduction in operational costs, the Children's Hospice advised staff of the need to reconfigure services to reduce the number of beds at weekends to manage costs related to special duty payments. I reiterate that there has been no reduction in recurrent core funding for services that are provided by the Northern Ireland Children's Hospice. <BR /> <BR />With regard to fundraising challenges, the hospice, like all charities that fundraise, has encountered an increase in the costs of doing so.”
“This year, my Department has provided funding of £1·7 million to commission the Children's Hospice to deliver bed nights in Horizon House, an inpatient unit that offers supported short breaks; a specialist community team, including a 24-hour on-call service; family support services, including bereavement support; the palliative and life-limited service, with nurses available to facilitate the transfer of children from hospital to non-hospital settings, which could be their home or the Northern Ireland Children's Hospice for step-down or step-up care or, where appropriate, end-of-life care; and the hospice at home service, which provides practical nursing care, support and short breaks to children in their home or community.”
“<BR /> <BR />Almost £195,000 has been made available annually for the provision of paediatric palliative care in Northern Ireland. That sits alongside £1·7 million for the Northern Ireland Hospice. As has been noted, my predecessor, Robin Swann, took steps in February of this year to stabilise the annual funding allocation to the Children's Hospice within the resources available at that time. I agree with Mr Kingston that the objective, as he said in his opening remarks, is to stabilise the Children's Hospice. <BR /> <BR />My Department has service level agreements in place with the Children's Hospice for the delivery of agreed commissioned services.”
“We have a mental health strategy, but, if you speak to the mental health champion, she will tell you that she has about one eighth of the budget required. The Department has about one eighth of the budget required to deliver this year's action plan rolling out from that strategy. I am not in the business of raising false expectations by promising a new strategy when I know there will not be the funding to make it happen. <BR /> <BR />Funding for a paediatric and life-limited nurse was made available by my Department. The nurse works in the Northern Ireland Children's Hospice and has a crucial role in delivering care for children right across Northern Ireland. The role was developed as a result of a need that was identified by clinicians and others involved in paediatric palliative care in Northern Ireland.”
“Those consultants work collaboratively across the health and social care trusts to lead paediatric palliative care in their trusts, ensuring that best practice is shared with colleagues in other trusts and, indeed, regionally. A regional paediatric palliative care consultant, who is based at the Royal Belfast Hospital for Sick Children, works across the region to assist children and clinicians to ensure optimum care for children. The consultant also acts in a leadership role across paediatric palliative care in Northern Ireland. <BR /> <BR />Mr Gaston raised the issue of a strategy. There are many strategies in the Department of Health. One that I am particularly focused on is the mental health strategy. I have campaigned for good mental health all of my time in this Building.”
“Secondly, the network acts as a vehicle for the region to identify areas of best practice and share clinical opinions on specific cases. To date, the network has developed antenatal care pathways, rapid discharge plans and advanced care plans, and agreed pathways for pain relief amongst other things. The network is also working on other key issues, including provision of 24/7 end-of-life care and examining how to best develop closer ties with colleagues in the Republic of Ireland. <BR /> <BR />To support the delivery of paediatric palliative care, each health and social care trust has a paediatric consultant clinical lead.”
“Regional meetings are held between local and regional specialists to ensure that high-quality care can be provided for children, irrespective of where they live in Northern Ireland. The network is made up of key clinical and nursing leads from each health and social care trust, as well as the Northern Ireland Children's Hospice. The network also includes representatives from Together for Short Lives. That UK-wide charity's aim is for children and young people with life-limiting and life-threatening conditions, and their families, to have as fulfilling lives as possible and the best care at the end of life. <BR /> <BR />The network works closely together in two main areas. First, it identifies the key priorities for delivering in line with the strategy and puts measures in place to deliver the same.”
“The strategy includes 23 ambitious objectives that cover the full range of issues in paediatric palliative care, from diagnosis of a palliative or life-limiting condition to bereavement support for families of children who have passed away. <BR /> <BR />Although the strategy was published in 2016, associated funding to support the implementation of the strategy was not secured until 2019 with transformation funding. As a result of that funding, the regional paediatric palliative care network was established. That network is shared by a palliative clinical care lead. The health and social care trusts, under the direction of their palliative care lead, hold trust-wide multidisciplinary team meetings to consider cases within their trust.”
“It is the only children's hospice in Northern Ireland, as we know, and it provides care and support to children from across the region. The needs of life-limited children are often complex and require the collaboration of a range of professionals to be met. Children's palliative care services are largely provided by the health and social care trusts in hospitals and community settings. Alongside that, there are services that are provided by the hospice. <BR /> <BR />The 'Strategy for Children's Palliative and End-of-Life Care 2016-2026' was published in 2016. It was developed in consultation with all relevant stakeholders across the sector, in Northern Ireland and beyond, to ensure that it was a comprehensive document.”
“I know that the Member wants to hear an announcement. I also want to hear an announcement, but there is a process to go through. It is not just down to me and my Department, and I would like the Member perhaps to be a bit more realistic and accept that those quiet conversations are the only way in which to start on a path to success. <BR /> <BR />I was recently invited to visit the Children's Hospice. I have accepted the invitation as I want to see and acknowledge at first hand the exceptional work that it undertakes in supporting children who have life-limiting conditions and their families. The Children's Hospice is a local charity providing specialist respite, palliative and end-of-life care to children and young people living with life-limiting and life-threatening illnesses.”
“I assure the House that those discussions are going on quietly in the background and that, if there is something to report in due course, I will be delighted to report it if it is a positive message.”
“I said "up to approximately 50%". <BR /> <BR />The issue of access to paediatric palliative care for seriously ill children and young people in Northern Ireland is extremely important to me and to the work that is being done in my Department. <BR /> <BR />On that, I will pause to address an issue that Mr Carroll raised. It is wrong and deeply regrettable that parents have to go to Alder Hey for paediatric pathology, but the fact is that it is very difficult to attract consultants into that area of work. Globally, it is being concentrated in specific areas, and, without wishing to raise expectations too high, I believe that the most practical answer will be an all-island solution.”
“It is important that the context be understood by Members for the purposes of the debate. <BR /> <BR />I will give way to the Member.”
“<BR /> <BR />Thirdly, the palliative care services that are currently commissioned through the Northern Ireland Children's Hospice are already funded up to approximately 50% of their cost, and working in partnership with the voluntary and community sector has been very successful across many health and public services, with many successful models built on some degree of charitable fundraising. I therefore suggest that such a model is not to be disposed of, but I do recognise the extremely challenging environment in which the sector is operating.”
“<BR /> <BR />Secondly, palliative care for children and adults is a core health and social care service. All our trusts are commissioned and work with other sectors to provide palliative care in a variety of ways, including in hospitals, in the community and at home. The Northern Ireland Children's Hospice is a vital part of that landscape, and I recognise the sustainability issues that it and many other voluntary-sector organisations are facing today.”
“Thank you, Madam Principal Deputy Speaker. In recognition of the motion and the amendment, I will state something clearly and up front: if I had a magic wand, the Children's Hospice would have no financial issue today, tomorrow or in the future, no concerns about resources and no shortage of staff and volunteers. That, however, is in an ideal world, which we do not inhabit, so I will start by setting out a number of important facts about the motion. <BR /> <BR />First, statutory funding for almost every aspect of Health and Social Care and, indeed, all public services has not risen in line with demand and inflationary pressures. That is the unfortunate reality of the situation that all our services are currently in, and it is the nature of the challenge that Health and Social Care faces day and daily. There are no easy solutions.”
“It is also preventable, and I am pleased that we are taking this significant step forward in helping to reduce drug-related deaths. I often talk about my desire to deliver better outcomes: today, collectively, we are doing just that, Therefore, I commend the regulations to the Assembly.”
“I thank the Chair of the Health Committee and the other Members who spoke for their contributions. It was important that the Chair talked about the availability of the nasal spray, an application that is to be welcomed. Diane Dodds made a very important point encouraging us all to acknowledge the lives lost to the use and misuse of illicit drugs and not just the lost lives but the impact on families and communities. I thank Mr Donnelly for highlighting the online training that the Public Health Agency will undertake, which will expand the reach of those who administer naloxone. <BR /> <BR />I firmly believe that the introduction of the legislative changes will widen access to a life-saving medicine. Any death from an illicit drug is tragic.”
“It is with the Committee's support, therefore, that I bring the SI before the wider Assembly and its Members. I commend the motion to the Assembly.”