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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“which was the recommendation for a region-wide children and families arm's-length body. I think that Members will accept that those are significant steps to take, and we need to be assured that they have real potential to deliver the change that is being sought and that they will not destabilise services. <BR /> <BR />Professor Jones concluded that there is a "systemic and endemic" children's social care crisis in Northern Ireland, caused not by individual failings but by the current children's social care structures, systems and processes. In August, I met Professor Jones, and it was clear that he had not changed his mind since the publication of his review report.”
“I would like to make some progress. <BR /> <BR />Ten of the 53 recommendations are subject to ongoing consideration, because they either are the responsibility of other Departments or require cross-departmental support in order to progress. Those include the recommendations that relate to having a Minister for children and families, the expansion of the Sure Start programme and the implementation of the Gillen review of civil and family justice and seven recommendations that relate to what Professor Jones termed:”
“<BR /> <BR />Of the 53 recommendations, I have accepted 34. Three are now considered closed, four have not been accepted, and two are beyond the scope of the review.”
“<BR /> <BR />The review found that we have a higher rate of children being referred to children's social care services compared with the rest of the United Kingdom. We have a higher proportion of children in need of help, a higher proportion with child protection plans, and record numbers of children in care. The review, as Members will know, was commissioned in 2022, and reported in June 2023. The report made 53 recommendations along a continuum, ranging from the establishment of new ways of delivering and overseeing services through to hosting an annual conference. My Department consulted on 51 of the recommendations. We received 134 responses. Some recommendations were accepted in advance of that consultation, either on the basis that they were necessary things to do or on the basis that they reflected work that was already in train.”
“<BR /> <BR />Children's social care services have experienced significant pressures over the past number of years, made worse by COVID-19, workforce issues such as high vacancy and turnover rates, and increasing family complexities. We know that there is a strong correlation between deprivation and the need for intervention in family life. Around 43% of children in care come from the 20% most-deprived areas in Northern Ireland compared with 5% from the least-deprived areas. Previous research identified that children in the 10% most-deprived small neighbourhoods here were nearly six times more likely to be on the child protection register. We also know that child poverty rates have been rising.”
“Mr Deputy Speaker, thank you very much. I welcome the opportunity to speak in this debate. I begin by recognising the need for immediate and sustained action — action — to protect and support vulnerable children and young people. I also acknowledge, as many Members have done, the excellent work of Professor Ray Jones in reviewing children's social care in Northern Ireland — not just the work of the report but his work since then, and his continued focus on ensuring meaningful change for children and families. I assure you that I share his determination to deliver that change. It is a fact, though — it will not be welcomed, I am sure, by Members — that the pace of change in some areas will be determined by factors beyond my control.”
“I thank the Member for his question and his comment. Yes. As a generalisation, we have overcomplicated the delivery of healthcare, and, in this case, we certainly have not made available a smooth and easy process. The work streams, the associated reviews and the investigations have been long and very difficult processes, especially for the former patients of Dr Watt and their families. I can say that I am committed — I will repeat that: I am committed — to restoring public confidence, but making it as quick and easy and also as fair and accurate as possible is always the challenge. <BR /> <BR />Again, if, as I believe, there are frustrations amongst families, I can only apologise for that and commit to trying to continuously improve the service that we offer.”
“I thank the Member for his question. I am not quite sure what he has in mind. I have confidence in the individuals who are conducting this particular bit of business, but if the Member would like to speak to me offline about how he thinks it could be done better in a way that does not disrupt the workings of what is going on but adds to public confidence, I am willing to meet him.”
“It is very difficult for a politician to stand in a Chamber like this and restore public confidence if people are not willing to give it a try and accept that others are working genuinely and professionally to improve services.”
“I regret that the Member feels that way. As she obviously puts so little faith in the answer, I will not rehearse it. I simply ask her to reflect on the fact that health professionals are vocational people. They do not just do it for the money or because it is a job; they do it because they really want to. Yes, we get examples like Dr Watt that disrupt public confidence in the way that health and social care is delivered, but, ultimately, it is down to people to decide whether what I have said gives them any confidence. You may have had a bad experience of a Dr Watt, or perhaps you simply read about an incident and it has impacted on you or even traumatised you.”
“I assure the Member that I am genuine when I say that I am here to deliver better outcomes. That is not just a catchy phrase that I hope people will remember me by; it actually sets me up to be judged. Hopefully, I will be in post until May 2027, and, at the end of that time, I expect that people will reflect and make a decision on whether I, in any way, delivered better outcomes. Is it possible in the time remaining, with the budgets, resources and staffing levels, to fix everything and deliver better outcomes? That is a valid question. It is something that I will try to do. You have, in a way, defined the nature and the scale of the problem and the challenge, but I will try to rise to it. That is all that I can say to the Member. I cannot give a guarantee.”
“That is based, primarily, on the family reviews that took place during phases one and two. I want to be person-orientated and family-orientated in this process. I am very open to hearing any valid criticism or recommendations on how we might do this better.”
“I thank the Member. I absolutely apologise, through him, to anybody who feels that they have not been well served by what has happened since the revelations about Dr Watt. At the moment, my mind is with phase 3 of the dead patients review, and the Member will, I am sure, be aware that a third phase is beginning. That will see a number of families, 18 in total, having expressed an interest in having a review of what happened to their loved one. There will be a period between now and the end of the year when other families can come forward and ask for the same thing from the Regulation and Quality Improvement Authority (RQIA). The reason it is not being opened to everybody is that I do not think that it is right to force a family that does not want to be involved in a review process to do so.”
“I thank the Member. He has definitive and well-expressed views on the issue. However, one of the questions that I have to ask myself is this: would it be right to bring in the sort of legislation that the Member obviously prefers and favours simply for people working in Health and Social Care? Should it not be brought in for the entire public sector? I accept that some people may be frustrated that I am taking too long, in their opinion, to come to a conclusion. However, the Member need only look at the number of debates on health in the Chamber to be aware that there are a huge number of issues that people want prioritised. They cannot all be done at one time, not with the staffing, resource and budget that is available to the Department of Health.”
“Therefore, I have to continue to ponder that and reflect on it, and, finally, I will come to the Committee and maybe come to the House with my recommendation.”
“Again, I say to the Member that you can take actions in introducing some sort of duty of candour, and I know that some people would like a duty of candour that reflects not just a corporate responsibility but an individual responsibility and maybe an individual responsibility that has the facility to lead to legal action against somebody who is not being open, honest, transparent and candid. The question is this: does that help, or does that hinder the process? I still have an open mind on that. I hear evidence from some who think that it is a good thing, and I hear evidence from some who think that it would be a retrograde step and would not work in the interests of patients and of openness, transparency and candour.”
“We will not deliver everything for all the families involved, because many of the families simply want their loved ones back, and we cannot, of course, do that.”
“I thank the leader of the Opposition for his question. On the last point, yes, I am always willing to meet people who feel that they have been badly treated by the health service. In this case, that is beyond any doubt: they have been extremely badly treated. I can only assure the Member that it is a matter that I take extremely seriously. When the Department started to offer briefings to MLAs, although it was not my particular area, I got engaged and attended the meetings with the then permanent secretary and the Chief Medical Officer. <BR /> <BR />It just should not happen that something such as this is allowed to occur. We put so much emphasis on safe practices that it should not happen, so, when it does happen, it is not only shocking but a scandal. I am determined that we will follow this through.”
“I thank the Member for his question and will simply say to him that, if he reflects on the answer that I just gave Mrs Dodds, he will see that a lot of work is going on to ensure that the recommendations are implemented. I give him a personal assurance that that will happen at pace.”
“<BR /> <BR />The work has been supported by two key independent groups: an assurance subgroup, the purpose of which is to provide the structure and process for an independent assessment and recommendations to the programme board in respect of actions required for each recommendation and to determine whether each recommendation has been fully implemented, and an independent neurology liaison group, the purpose of which is to align with the work of the assurance subgroup to further enhance feedback and recommendations from service users, carers and families on the assurance process and implementation programme. <BR /> <BR />I hope that that gives the Member some assurance that a lot of work has been going on to make sure that this never happens again.”
“I thank the Member for her question. I can tell her that the independent neurology inquiry report was published in 2022 and included 76 recommendations for the Department, healthcare organisations, the independent healthcare sector and the General Medical Council to improve and ensure patient safety and to reduce the risk of similar events occurring. Ensuring that those recommendations are taken forward, implemented and critically delivered is a priority for the Department. A programme board chaired by the permanent secretary was established to oversee the implementation of the report's recommendations. The Department published an overarching implementation plan on 27 July 2023. The plan outlines the specific actions required against each recommendation and was published on 7 March this year.”
“I am still looking at that, still consulting and still open as to a final decision.”
“The inquiry was a substantive piece of work: I commend it to you. I think that there were 214 oral evidence sessions. It received in excess of 147,000 pages of documentary evidence. That should be the evidence base for reflecting on any individuals. Out of that detailed inquiry, which found opportunities wasted or missed as far back as 2006 and 2007, there are certainly lessons to be learned. <BR /> <BR />I have been examining introducing a duty of candour, and, as I have said to the House before, a balance has to be struck between creating such a chill factor by placing an individual duty on an individual so that people are not willing to come forward and creating circumstances that maximise their willingness to step forward, particularly where an error has been made or something has gone wrong.”
“The Chief Medical Officer, Professor Sir Michael McBride, does indeed retain my confidence. In all my dealings with him, not just as the Minister of Health but previously as an MLA and even before that as a contributor to a medical charity, I have found him to be nothing but professional, engaged, knowledgeable and dedicated. I would never answer in the negative a question about whether an individual retained my confidence unless I had an evidence base that guided me towards saying, "No, I do not have confidence in that individual". If the Member has an evidence base in respect of that individual that she wants to produce, I am more than willing to listen to it, but the question as posed has a definitive and definite answer.”
“I beg your pardon. <BR /> <BR />That joint expert is available at no expense to eligible patients or families. It is a streamlining approach that is supported by a set of guiding principles to ensure that eligible cases are progressed as quickly as possible. <BR /> <BR />Claims in respect of private patients are not within the remit of the Department or the Belfast Trust. Claims against independent providers will be managed by the providers' legal advisers. I and my Department wish to ensure a just outcome for all those affected and to ensure that claimants receive the compensation that they deserve.”
“I so beg your pardon, Principal Deputy Speaker.”
“Each neurology recall case will be considered on its own merit to ensure a just outcome for those affected and to ensure that claimants receive the compensation that they deserve. All claimants against the Belfast Trust are managed by the Business Services Organisation's directorate of legal services on behalf of the trust. Recognising the scale of the issue at hand, however, Members may also be aware that there is already a dedicated neurology recall legal team in place in the legal services directorate. It acts on behalf of the Belfast Trust, with the aim of progressing claims at pace. In addition, there is potential to instruct a joint expert to provide a joint medical report —”
“Whilst the independent neurology inquiry revealed some deeply unpleasant truths, following the neurology recall, it also played an incredibly important role in identifying and spearheading changes that have since been made to improve patient safety. I am aware that the High Court in Belfast recently awarded damages to a former patient who pursued a medical negligence claim against Dr Michael Watt and the Belfast Health and Social Care Trust. I hope that Members will appreciate that it is not appropriate for any Minister to comment on individual cases, but I assure the House that I am aware of the ruling and its conclusions. The ruling in this case will, of course, be carefully considered. <BR /> <BR />On 9 June, 2022, the then Minister of Health confirmed the arrangements for neurology compensation by way of a written statement.”
“With your indulgence, Madam Principal Deputy Speaker, before I move to address the substantive issue, I wish to take this opportunity to reiterate, on behalf of the entire health service, the previous apology to all those who have been so badly let down.”
“On a point of order, Mr Deputy Speaker. Will you clarify whether I overstepped my time limits at any point in those 45 minutes?”
“The objective of the Bill is to offer the opportunity to bring in legislation that would give us protection on an all-hazard basis. It seems to me that, if you are doing that, it is logical to put all options on the table. It is not for me as Health Minister to take certain options off the table before we even allow the public to have their say. That is the basis on which some of the proposals are in the consultation. It is quite right that the public be encouraged to respond and make their views known. <BR /> <BR />After that, a Bill will be drafted and brought to the House. It will go through the full and proper consultation, discussion, debate, amendment and approval process.”
“Beyond that, we do not have any protections, so, whether the disease is biological, chemical or radiological, if we are in that unfortunate position, much as we did during COVID-19, we will have to make it up as we go along.”
“I thank the Member. No: I did not consider withdrawing the consultation. Let me be clear: at the moment, we have the protections of the Public Health Act (Northern Ireland) 1967, which is all well and good if we are dealing with a named infectious disease.”
“The Member will be aware that waiting lists are just terrible. It is easy to say that they are the worst in the UK, but we have to remember that the statistics reflect people who are in pain, who are suffering and who need help. The fact is that, given the budgetary constraints, what we are doing is trying to consolidate services. When it comes to cancer, we are trying to prioritise red-flag and life-threatening conditions. Really, given the current budget and the limited ability to reform health service delivery at pace, I am afraid that I cannot promise the House that we can do a lot better over the rest of the financial year, except to assure the Member that, when I meet officials and talk to clinicians, we all recognise that we have to try harder and do better. I cannot promise the Member any sort of promised land in the near future.”
“I have made it clear that, in my time as Minister, one of the most difficult areas that I want to tackle is cancer, along with waiting lists and mental health, and I would certainly welcome, in his supplementary question, any observations that he has about improving the service.”
“I thank the Member for his question and acknowledge his interest in that broad area. <BR /> <BR />I think that I said before that it is my intention to introduce a regional service for breast cancer. The objective is to allow each and every individual to go online and book a screening: they can book the first available one, wherever that is across Northern Ireland, or, if they prefer to go local, they can book themselves in and wait, perhaps, a little longer. Waiting times are just not acceptable. The Member has experience of cancer. I bow to his knowledge and interest in that area.”
“The GP Federations have recently launched a fellowship scheme in the Southern Trust that is designed to attract salaried GPs to work in practices that they have taken over due to contract hand-backs. The first round of recruitment is complete, with three offers being made to candidates. The GP Federation Contracts Management CIC has now launched a second round of recruitment, which is ongoing. I suggest that that is a good news story.”
“During that time, fellows have access to a broad range of experience in primary care, covering three main areas: clinical work in a supported environment; experience in a specialist field of their choice; and taught and practical learning in areas such as leadership, confident communication and quality improvement. My Department very much values the fellowship scheme and the chance that it provides for recently qualified GPs to have access to an attractive portfolio of opportunities. <BR /> <BR />Looking to the future, my Department is considering the potential for how the scheme might be further developed, subject, of course, to available funding, to extend the range and scope of fellowship placement opportunities and provide for educational bursaries to be available for all fellows.”
“Yes, the fellowship scheme is an important scheme that is designed to support recently qualified GPs in the crucial early stages of their careers. Fellowships offer young GPs an opportunity to transition from a training environment to an independent practice by providing them with a supportive workplace and opportunities for personal and professional development. I commend that to my good friend Mr McNulty because he asked how we will retain staff in the face of pressure from Sláintecare, and I said that it was not about just salaries but about working environments. The fellowship scheme is very much a part of that initiative. <BR /> <BR />The scheme runs for 12 months.”
“I thank Mr Crawford for his question. I very much welcome the appointments, which, in the case of Ballymoney Health Centre, take effect this very day. <BR /> <BR />The positive outcome for both practices followed extensive work to identify new GP contractors to take them over. That followed the handing back of contracts by the previous contractors. I wish the new contract holders the very best with their new responsibilities. I look forward to working with them. In fact, I would also very much welcome the opportunity to visit. On my mother's side, I have family from Ballymoney and Portstewart, so it would not be a chore. It would be a pleasure.”
“I thank the Member for his question. I very much commit to such a meeting. As with many of the issues that we face as a devolved Executive and Assembly, the answers do not lie with a single Department. In this case, cooperation between Health and Education is critical. I have enjoyed working with officials from the Department of Education as I have enjoyed working with Justice officials and the Minister of Justice. A lot of these things are cross-departmental. If we are going to be a mature, devolved set of institutions that really deliver for people, that is the sort of road that we have to go down. <BR /> <BR />I apologise that I have no detail on the issue but I look forward to learning.”
“I am not aware of the detail on that. I am more than happy to write to the Member. Maybe in his supplementary, the Member will define the areas that he would like me to address.”
“Sorry, did the Member say "nurses" or "nurseries"?”
“I am not sure whether the Safeguarding Board, which kind of comes under the remit of my Department, has a critical role to play in this because it is more about giving a voice to children than ensuring that adults are reporting on people they know who, perhaps, should not be going into roles and certainly should not be if the employer does not understand the full nature of their background. <BR /> <BR />We are calling for a duty of candour in Health and Social Care. As I have said before, you have to strike a balance between avoiding the chill factor, which puts people off coming forward to say that certain things have happened, and ensuring that you have an atmosphere where people feel that they can come forward, and say, "You need to know about this". I am very disturbed by this news.”
“I am aware of those reports and I am concerned by them. It takes me back over 20 years to my time at Ulster Television when we produced a documentary for the 'Counterpoint' series about a man who had spent time in prison for child sex abuse offences. We discovered that he had got a job with a charity that owned a residential activity centre in the Mournes. Children were staying there at weekends under his supervision. The point was that the charity did not know about the man's record, and it became very messy. Here we are over 20 years later, and I do think that common sense needs to prevail. People need to recognise that there are occasions when these things need to be reported and put up front.”
“The draft Bill will place a statutory duty on the health and social care trusts, the PSNI, the Public Health Agency, the Regulation and Quality Improvement Authority and independent providers of health and social care services to report to the relevant trusts any cases where they believe that there is a reasonable cause to suspect that a person is an adult at risk and in need of protection.”
“Although there is currently no mandatory duty to ensure that employees in the public, private or voluntary sectors report safeguarding concerns, I think that all employees should comply with their employer's safeguarding policies — they should have policies, of course — including reporting processes in relation to safeguarding and protection concerns. There is a legal duty, but there is also a moral duty on everybody to ensure that children and vulnerable adults are safeguarded and to report any concerns to the relevant authorities. <BR /> <BR />My Department intends to introduce an adult protection Bill during the current mandate. Drafting is largely complete, and the business case is being considered in the Department.”
“I thank the Member for his question, which, I take it, he intended to be rather topical indeed. <BR /> <BR />To a certain extent, part of this is about legislation — I am trying to get myself to the correct part of the law — but it is also about common sense and what is the right thing to do. Section 5 of the Criminal Law Act (Northern Ireland) 1967 outlines penalties for concealing offences. These provisions can be applied in the case of an individual who has knowledge of an offence and fails to report it. <BR /> <BR />Of course, health and social care trusts have a duty to safeguard and promote the welfare of children.”
“I draw a distinction between access to services and face-to-face access.”
“Those workforce challenges are common to all GP out-of-hours services across the region. The consolidation of services to a smaller number of larger centres has improved the recruitment and retention of staff due to the benefits associated with collaboration, peer support and equitable workload distribution. All GP out-of-hours providers are expected to review activity levels and capacity challenges in order to ensure the efficient use of resources and the provision of an effective service within the allocated budget.”