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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“In 2023-24, 76% of Dalriada's patient contacts were managed by telephone or video call with a clinician; home visits accounted for 5% of its contacts; and patients seen face to face accounted for 19% of contacts. <BR /> <BR />Owing to workforce challenges, Dalriada does not currently have the capacity to provide a service across four centres, with the service being delivered from its main hub in Ballymena and the new out-of-hours centre at Antrim Area Hospital. That, though, is constantly under review.”
“The GP out-of-hours service is a core element of health and social care provision and of primary care. The service is available from Monday to Friday from 6.00 pm to 8.00 am, as well as for 24 hours at weekends and on public holidays. The majority of patients who contact out-of-hours services across the region do not require to be seen face to face. The percentage of patients who contact the out-of-hours service and need to be seen in an out-of-hours centre — known as "base visits" — has changed dramatically over the years. In 2015-16, for example, base visits accounted for 40% of Dalriada Urgent Care's patient contacts; in 2019-2020, base visits had reduced to 30% of contacts.”
“The number of community pharmacies per head of population in Northern Ireland is 30% higher than in England, 16% higher than in Scotland and the same in Wales, so, yes, there remains good access to community pharmacies across Northern Ireland. Some 99% of the population live within 5 miles of a community pharmacy. After adjusting for the higher rate of prescribing in Northern Ireland, it still results in a higher rate of provision compared with that in the rest of the UK, with 6% more pharmacies per item dispensed than in England.”
“I thank the Member for his question. I believe — the evidence supports this — that Northern Ireland is well provided for in respect of access to community pharmacy services. As of 31 March 2024, there were 511 community pharmacies in Northern Ireland, which was a reduction of 14 — 2·7% — compared with the 12 months previously. I should, however, note that two pharmacies have closed since then, so, as of 1 September 2024, we are at 509 on the pharmaceutical list. <BR /> <BR />We do not always know the reason that pharmacies close, as contractors do not have to give the strategic planning and performance group (SPPG) a reason for closing, but we are aware that some of the branch closures of Boots UK were a result of a consolidation exercise by Boots in Northern Ireland.”
“Pharmacy First is very much on the left side of the field, which is where I want to be playing healthcare.”
“I thank the Member for his question. I am certainly open to looking at that. My entire ambition as Health Minister is to "shift left", as it is called; in other words, I want to get away from hospital care and as close as possible to community and primary care. That is not just about GP services: pharmacies have a critical role to play. I tend to go to a pharmacy first, if at all possible, and to a GP next. My last resort is to go to a hospital. I have said on many occasions when I have been out and about as Health Minister that, in an ideal world, I would want everybody to get their healthcare at home, and, if not at home, as close to home as possible. The second-worst outcome is to have to go to an acute hospital, and the worst outcome is to have to go to an acute hospital and stay overnight.”
“I thank the Member. Northern Ireland has its own drug tariff. Following the 2010 judicial review and subsequent consultation on improving arrangements, the then Health Minister decided that the English drug tariff should be used as the basis for reimbursement of medicines supplied, with modifications for Northern Ireland circumstances such as the services that we provide here. Former Minister Swann reaffirmed that policy position in May 2024, and, at this stage, I have not heard a robust argument for moving away from it.”
“My Department will continue to work with CPNI and the pharmacy profession in order to progress a phased approach to implementation of the strategic plan over the coming years, subject, of course, to appropriate funding.”
“However, whilst we have the aim of keeping that under review, containing costs as much as possible is a priority. The Member will appreciate that significant changes may give rise to further pressures having to be managed in the year. <BR /> <BR />My Department recognises the valuable role that community pharmacy has in health and social care, and I am happy to report that a strategic plan for community pharmacy 2030 was launched in May. The strategic plan for community pharmacy aims to fully realise the potential of community pharmacy services to support better health outcomes from medicines and in preventing illness. Implementation of the strategy will support not only the elderly and vulnerable but the whole population.”
“Earlier this year, my Department increased funding to community pharmacy, bringing its opening position to £147 million this year. That is an increase of £19 million from the 2023-24 financial year. It is also the highest level of funding to date in Northern Ireland and compares favourably with that in the rest of the United Kingdom, representing a 40% increase in funding over the past six years. <BR /> <BR />My Department has repeatedly acknowledged the concerns raised by Community Pharmacy NI (CPNI) and by individual contractors about drug price increases and differences due to inflationary and cost-of-living increases generally. There are significant difficulties in financial planning across HSC, and my officials continue to work closely to review the position as we move forward.”
“Right. I acknowledge that. Let me correct myself: I think that a majority of elected representatives were against the move. I apologise if I misrepresented you.”
“Sorry, I missed that. Did you say that you supported the move?”
“<BR /> <BR />Many Members are interested in cross-border work and the reimbursement scheme and have asked whether it will ever come back. The answer, currently, is no. Had we got the £135 million for waiting lists, we would have spent £31 million on the reimbursement scheme, which would have meant that 4,000 patients who have been waiting for over one year, largely for orthopaedics, would have been seen.”
“I thank the Member for his question. The disappointment and frustration felt by dermatology outpatients is the same as that felt by the many patients who are on long waiting lists. It comes from the failure to secure our bid for £135 million to be ring-fenced to tackle waiting lists. Take new assessments for dermatology outpatients: at a cost of £2·8 million, we could have seen 6,000 patients who had been waiting for over four years for an appointment. The Member may be interested to know that, in other categories, such as cataracts, we could have seen 2,800 patients for £5 million. We bid for £10 million for mega clinics, because we have the evidence not just locally but internationally that mega clinics work. Had we got it, we could have seen 20,000 patients across a range of specialities.”
“A family member of mine was admitted to the ED at the Ulster Hospital on a Monday evening, which is the worst time for pressures, and it was remarkable to watch the nursing and clinical staff delivering with unrelenting professionalism in the face of endless pressure. <BR /> <BR />The trust hopes to have a third unit — a critical care unit — alongside the minor injuries and emergency departments to relieve the pressure in the ED. The long-term plan is for GPs to refer patients directly to the critical care unit, bypassing the emergency department and thus relieving a lot of the pressure. I have seen that in hospitals elsewhere across Northern Ireland, and it seems to work well. It is part of the future of reform of health service delivery.”
“I thank the Member for his follow-up. I supported moving the minor injuries units from Newtownards to the Ulster Hospital on the basis of the clinical evidence that the trust presented at a meeting that I attended as a constituency MLA. Part of the reasoning was that it put the MIU beside the emergency department, the MRI scanners, the X-ray machines and all the facilities of an acute hospital. It seemed to me that, on clinical need, that was the right decision. Let us remember that we are talking about a move of 4·6 miles along a dual carriageway. <BR /> <BR />I am well aware of the pressures in the emergency department.”
“To address the matter, the trust has already implemented text reminders for all its consultant-led clinics.”
“As a result of the continuing Budget position, we are losing opportunities to see and treat more people each and every day. <BR /> <BR />Nevertheless, the trust continues to seek alternative ways to provide outpatient consultations to help reduce waiting times through initiatives such as virtual or telephone appointments that provide advice and guidance. The trust also seeks to implement a patient-initiated follow-up and enhanced triage clinics to further reform the outpatient service. <BR /> <BR />Last year, over 22,000 patients did not attend their allocated appointment. Without timely prior notice, those appointments cannot be offered to other patients on the waiting lists, and each missed appointment not only wastes a consultation slot but can cost between £250 and £2,500.”
“I thank Mr Dunne. As was made clear in the elective care framework published in June 2021 and again in the update of June this year, the demand for first consultant-led outpatient appointments in the South Eastern Trust continues to exceed capacity. Regrettably, patients are experiencing excessive waits for appointments and treatment, which is not the service the trust would wish to be providing. The Member will be aware that my predecessor and I submitted an ambitious ask to the Executive earlier this year to reduce our waiting lists, and there was a particular focus on outpatients who had waited the longest time. Unfortunately, the Budget that was agreed by the Executive and a majority of MLAs in the Chamber provided zero targeted funding.”
“The legislation gives us the framework, a set of principles and the matrix by which to judge how well we are doing, but, if the actual numbers do not exist, all that does is say that we have a problem. The question is this: what is the solution? It goes back to making working in our health and social care system as attractive as possible. To an extent, of course, that is about salary, but that is not the be-all and end-all in a profession that many people look on as not just a career but a vocation.”
“Creating a network of hospitals, for example, in which some are centres of excellence and specialism may help to retain staff, because it increasingly seems that doctors and nurses want to specialise in particular areas, and working in centres of excellence would give them those opportunities. <BR /> <BR />When it comes to staff shortages and the workforce, as the Member mentioned nursing and midwifery, I say this to him about vacancies in the HSC: on 30 June this year, there were 1,211 vacant registered nursing and midwifery places, which is 5·8% of that workforce, and, while there were 464 fewer nursing and midwifery support vacancies than the previous figure, that represents 8·4% of that workforce. The issues do exist.”
“I will answer two of the multiple questions that the Member put to me. In trying to retain staff who are being attracted by Sláintecare, the fact is that we simply cannot compete on salary, so we have to compete on terms and conditions. We have to try to make sure that ours is such an attractive health and social care system to work in that the money does not become the decisive factor in where staff ply their wares. Part of that is about improving outcomes. I have always said that better outcomes are not just for patients and service users: I am talking about better outcomes for the tens of thousands who deliver healthcare in Northern Ireland.”
“I thank the Member for the question. I am aware of what happened. Staff were transferred from Daisy Hill to Craigavon Area and from Craigavon Area to Daisy Hill because of workforce pressures due in large part, I understand, to absences through ill health and for other reasons. These things happen, of course, and to try to have a workforce robust enough to withstand every emergency is probably a challenge beyond the capacity of the health and social care system in Northern Ireland, given the current constraints on resources, workforce and budgets. I would struggle to give an absolute assurance that that would never happen again, but I give the assurance that it is my expectation that trusts will try to manage unforeseen issues as they arise, to the best benefit of patients and service users.”
“I thank the Member for her supplementary question. It is very important that we recognise that this is a cross-departmental issue, which is not to shirk the role that the Department of Health, the various trusts and the arm's-length bodies have to play in it. I know personally of a young man who has special educational needs. I do not think that his needs or those of his family have been particularly well met across a number of Departments. I assure the Member that I very much wish to see improvement on special educational needs for our young people, and I will play my part in that as Minister of Health.”
“<BR /> <BR />Unfortunately, my Department is not in a position to do that, and that is because current levels of funding are wholly inadequate. The one-year departmental funding cycle seriously constrains the assessment of affordability and frustrates the long-term investment in education and training, which we need in order to deliver the right number of staff with the skills that are required to meet current and future demands for our services.”
“That has involved the delivery of a comprehensive programme of strategic workforce planning; increasing the number of commissioned training places across healthcare professions; introducing more effective processes for recruitment; complementing our locally trained workforce with our highly valued international recruits; and developing initiatives to support staff retention. That strategic approach to workforce development has supported a 16% increase in the number of whole-time equivalent staff who have been employed directly by the HSC since 2018. While that increase is welcome, my Department's strategic workforce planning has identified a requirement to further expand the number of training places that we commission in order to secure the continued local supply of staff that we know is needed to meet fully our workforce needs.”
“I thank Ms Brownlee for the question. My Department's ambitions for the development of our workforce are outlined in the 'Health and Social Care Workforce Strategy 2026', which was published in May 2018 and covers 2018 to 2026. That is an ambitious programme of work. It reflects the multifaceted approach that is required to develop our workforce, with the aim of ensuring that the right numbers of staff with the right skills are in place to deliver effective treatment and care. <BR /> <BR />Since the publication of the strategy, the Department and Health and Social Care (HSC) employers have invested significant time and resource in stabilising and growing our workforce.”
“The Member's comment strikes a chord with what I am trying to achieve on delivering better outcomes. I have said previously that there was perhaps a temptation to look at the five geographic trusts and say, "Should we not have one single trust for the whole of Northern Ireland?" That would almost be like the equivalent of a cosmic black hole absorbing all the resource and focus of staff in not just the Department but the trusts. In my mind and as I have said to the trusts, "You are one trust". The outworking of and the definition of the success of that is to have regional services that mean that we can look at which trust is delivering best practice and then turn that into common practice across the other four trusts.”
“I thank the Member for the comment and the question. I have to say gently that the irony klaxon is sounding on that one, because the nature of the Department of Health's budget for this year means that we are trying to consolidate and preserve existing services. Many additional services are brought to me, pretty much on a daily basis, that I know would help deliver better outcomes and take us into areas where we are not but should be. That sounds like one of them. I am afraid that, on the current budget, I can make no promises, but I am very happy to listen to the Member offline about the advantages and benefits of that service.”
“I hope that that will be a product of the reconfiguration of hospitals. What I am talking about is a network for better outcomes. Part of that is about recognising that, while not every hospital will deliver every service, some hospitals will become centres of excellence for certain specialities. That should apply to mental health and well-being as much as it applies to physical health.”
“<BR /> <BR />In adult mental health services more generally, initiatives introduced across the region include the South Eastern Trust's recent implementation of a mental health liaison service at the Ulster Hospital, which provides rapid assessment and early intervention to people who present at the hospital with mental health problems. In the Southern Trust, referrals deemed to be of mild to moderate complexity are triaged through to the Steps to Wellness service that was established in October 2022.”
“As a result, people need longer treatments before discharge, and that is impacting on throughput and waiting times. There have been some improvements in the waiting times for child and adolescent mental health services (CAMHS). However, the overall picture is that, although activity levels are increasing, the levels of demand are increasing more quickly. In addition, I know that trusts are currently involved in a number of innovative modernisation projects that, it is hoped, will deliver greater capacity for new patient appointments and swifter responses to referrals. It is of note that those projects are being taken forward in the absence of additional funding.”
“I thank Mr Buchanan for his question. He may be aware that I have campaigned on mental health since I was first elected in 2011. I can celebrate some of the achievements — the mental health champion, the mental health strategy and enhanced awareness — but when it comes to waiting lists, it is not so good. I am keenly aware that all trusts are experiencing significant pressures as a consequence of increased demands on mental health services, including increased numbers of new referrals. It is not just about the numbers but about the increased complexity and acuity of the people who are presenting. Of course, there are also the well-publicised financial constraints and the significant workforce pressures as a result of increased vacancy levels. <BR /> <BR />The trusts report that they are dealing with more complex presentations.”
“I thank the Member for the question. I encourage him to speak to the clinicians whom I spoke to at Causeway Hospital and at Antrim Area Hospital about the future.”
“I am as guilty as anybody of thinking that, but we have to think a bit more broadly if we are going to be more productive and more efficient and deliver those better outcomes.”
“I thank the Member for his question. Causeway Hospital will remain a key element of the hospital network in Northern Ireland. Separating emergency surgery from elective or planned surgery, as I have said on a number of occasions, makes great sense for the people who access hospitals. The Member should have no fear about the future of Causeway Hospital. When I visited it a few weeks ago, I found there to be hugely positive energy amongst the staff and a great appetite for going forward together. <BR /> <BR />If we are to reform health service delivery, we will have to make changes. As I have said, I understand that, for many people, the National Health Service — Health and Social Care (HSC) here — is not just personal but deeply local. It is people's local GP surgery and their local hospital.”
“I thank the Member for his question. I can only tell him that it is under review. I encourage him to respond to the consultation by making that important and valid point.”
“I thank the Member for her question. I will acknowledge her frustration, but I gently suggest that she might be more frustrated had I not brought the statement to the House today. <BR /> <BR />As for people having to travel, particularly in an emergency situation, I am working to the concept that no type-1 emergency department is going away. Emergency departments will still be there. The principle is stabilising patients as soon as possible and then getting them to the best place for their procedure. That is the way to go, with, as I have said, aftercare being delivered as close to home as possible.”
“It is all very well saying that 80% of people have said that they are willing to travel for a procedure, but that means that 20% have not responded that positively. In the survey, 16% said that they were not particularly keen on the concept. If we are to deliver a health service for all, which is our obligation, we need to understand why that 16% are not buying into the concept. I am more than willing to engage with the Member on how we might consult in the way that she might intend.”
“If the Member is asking me whether I have plans at the moment to go out personally and consult in rural areas, that is not the case. However, I encourage Members to encourage people, particularly in rural communities, to respond to the consultation, because I want to know what people's concerns are.”
“The consultation that I have had so far has been with the Minister of Agriculture and the Minister for Infrastructure. Officials have gone away to look at community transport and at how we might provide transport for people who do not have ready access to it.”
“We discussed paediatric pathology, and we are making great advances on those terms. I know that a lot of Members have made clear in the House that it is far from ideal that we ask parents to fly or transport themselves to Alder Hey Children's Hospital in Liverpool. I hope that we will be able to offer an all-island solution on that. There is another initiative, which I will not mention at the moment but about which I am very excited. Mr Donnelly equally sees the benefit of an all-Ireland approach in this area.”
“I thank the leader of the Opposition. I think that I have said in the House — I have certainly said it at the North/South Ministerial Council and also at the North/South sectoral forum — that I have no political or ideological objection to cooperation with the Government of Ireland on healthcare delivery. In fact, it makes an awful lot of sense. Indeed, going back 15 years, the development of the breast cancer unit at Altnagelvin was based on a cross-border business model. SWAH was also built on the basis of cooperation across the border. <BR /> <BR />I have had two meetings, which, to my mind, were very useful, with my counterpart, Stephen Donnelly, the Minister for Health in the Government of Ireland. We talked about certain issues, including the need for a mother-and-baby unit.”
“I am sorry that I missed the question the first time. <BR /> <BR />It is my understanding that, in many ways, it already is a regional hub. Certainly, it is my intention that that is the case going forward. Certain services, like percutaneous endoscopic gastrostomy (PEG) treatment, are only available at the Royal.”
“Sorry, could the Member repeat the question? I did not quite catch it.”
“Are you asking whether it can be a centre of excellence? Are you talking about the Royal Belfast Hospital for Sick Children?”
“If she would rather go local, even if it means waiting a bit longer, that is her choice, and I want her to have that choice. Those things are part of a continuum. It is not that we will get to the end of January and a whole series of initiatives will come. I am doing every one of those as quickly as I can.”
“It is something that I hope to bring to the Health Committee. I apologise for missing my slot last week due to illness. I think that it is something that the Committee and the Department can work together on. That will not have to wait until January and the end of the consultation. I want to go ahead with trying to see whether we can get agreement on minimum-unit pricing for alcohol. <BR /> <BR />Officials have been told to press on urgently with work on breast cancer screening. I want to get as soon as possible to the point at which every woman can go online and have control over her own appointment. If she wants the earliest available appointment, wherever that might be in Northern Ireland, she should be able to click a button and book herself in for that.”
“I thank the Member. I understand the nature of the question. It is going to be a rolling programme. For example, as I indicated, officials in my Department have been liaising with officials in the Department of Health and Social Care in London about the Tobacco and Vapes Bill. It is our intention that whatever legislation is brought in for England will apply here in Northern Ireland. I would love to see a smoke-free generation as soon as possible. Smoking is one of the social determinants of health inequalities. I am sure that the Member will join me in hoping that we can tackle that. <BR /> <BR />I have talked about minimum unit pricing of alcohol. We, as a Department, have already consulted on that. I am at the early stages of discussing with officials how we take that forward.”
“I thank the Member. SWAH is a very good example of separating out emergency and elective care. It has become an elective-care centre of excellence in Enniskillen. That works really well. It gives an assurance to the staff and healthcare workers who are based in the SWAH that they have a really sustainable future and a worthwhile role to play in delivering as part of the network of our Northern Ireland hospitals.”