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.”
The complete record
Every one of 5,312 lines we hold for Mike Nesbitt, in date order, each linked to its source. Free to read, in full, without an account. Page 6 of 107.
“As previously stated, Sir Frank Atherton has said that it would not be appropriate to hold individuals responsible. We hold the Southern Trust responsible. We hold the PHA responsible. We will, going forward, bring controls and quality assurance to the HPV service being offered by the Belfast Trust.”
“As the Member will know, because he will have studied the report, Sir Frank has deemed it inappropriate to hold individuals accountable, but the Southern Trust and the Public Health Agency (PHA) have been held accountable. We have now moved to a new regime that is being run by the Belfast Trust, and it will be held accountable both for its quality control, which is an internal matter, and quality assurance, which is an external matter. The PHA is in negotiations and talks with colleagues in Scotland to provide that external quality assurance.”
“A lot has happened in the past three years. For example, all eight recommendations from the Royal College of Pathologists report have been implemented. As I said, we have made HPV screening the primary test. We now have a single regional laboratory, provided by the Belfast Trust. All recommendations from NHS England's peer review visit, and those arising from the Southern Trust's serious adverse incident review, either have been fully implemented or are in the process of being implemented. Therefore, we have done a lot. Once again, I encourage women to have confidence in the new regime.”
“The Member used the present tense. As I have said in previous answers, we have now moved away from cytology, as the front line of testing, to HPV screening. I simply encourage women to go and get that screening when appropriate.”
“The Ladies with Letters primarily led the charge to have a public inquiry into the results and operation of that screening in the Southern Trust. If there are issues in the Western Trust, I am more than happy to engage on them with the Member or the people with whom the Member wants me to engage.”
“I certainly encourage every woman to go and have their screening when appropriate. However, let us remember that it was screening and not diagnosis. We have now switched cervical cancer screening to human papillomavirus (HPV) screening. That has a success rate of around 90%, as opposed to around 70% to 80% for cytology. Cytology is now the second line for women who test positive in HPV screening.”
“The Southern Trust deviated from the norm, which is that there is a full review by one screener and then a rapid review by a second. The Southern Trust believed, in good faith, that it would be better to have two full screenings, which is what it did. However, that meant that sensitivity tests were not possible because you could not compare like with like; you were comparing apples with pears. The question of whether those two women would still be alive is, I think, an open one, actually.”
“The legal representative made clear that some of the individuals or families are already seeking redress, and, when I asked whether redress meant legal redress, he confirmed that that was the case. In some public commentary since then, it has been very clear that some of those involved are exercising their absolute right to consider legal redress down the line. I accept that. <BR /> <BR />I return to the fact that Sir Frank has looked at all the evidence, and, because of inconsistencies in data management, not least with the very first report from the Royal College of Pathologists, he sees very little chance of unravelling the issue any further. That is a tragedy in its own right, added to the tragedy of the loss of a daughter.”
“First of all, I am extremely sorry for the loss of Lynsey Courtney. Secondly, I had no oversight of who came to the meeting. That was largely, I believe, driven by the Ladies with Letters. It was brought to my attention before the meeting that the group was bringing a legal representative, and I was asked by officials whether I was content for that to go ahead or whether I objected to it. I said, "I am happy for that to go ahead". For anybody who thinks that I am trying to be involved in a cover-up, why would I allow the Ladies with Letters and the families involved in the serious adverse incidents who attended the meeting to bring a legal representative with them?”
“Mrs Courtney raised a question about not meeting her. I understand that, after the Ladies with Letters had met Sir Frank, information relating to Sandra Courtney and her daughter Lynsey was then submitted by the Ladies with Letters group. While that information was passed to Sir Frank, unfortunately — this is very, very unfortunate — it appears that the request for a meeting was missed.”
“The Ladies with Letters then, in a meeting with me, suggested that there was information that was pertinent to this cause that was not included in any of the six reports. Therefore, I then asked Sir Frank whether he was willing to meet the Ladies with Letters, which he did. He met other people involved with the screening programme as well because it —”
“Sir Frank was very balanced in his assessment on holding a public inquiry. He gave the positive assessment to which the Member refers, but, on balance, he also said that it was highly unlikely that an inquiry would unravel any further information that would add to the body of knowledge. As the Member said, 17,425 women were involved in the recall. Sir Frank came to the conclusion that there was no absolute evidence that harm was caused. He also said that, equally, there was no evidence that harm was not caused. However, he did conclude — there were 17,425 involved — that there was evidence that there was no widespread harm involved. <BR /> <BR />The Member seemed to imply that Sir Frank did not engage with anybody. For the record, he did. To begin with, I asked him to do a desktop review of the six reports that had gone before him.”
“We must ensure that all the necessary improvements to the current cervical screening programme are fully implemented and robustly and transparently assured.”
“I have considered fully the calls made for a statutory inquiry, particularly from the women affected and their families, whom I have met on a number of occasions. On balance, the findings and the advice from Sir Frank are convincing. I therefore decided not to commission a statutory inquiry, but it has been the hardest of all the decisions that I have taken in my two years in this role. I recognise that the decision is disappointing for the women and families who have campaigned for a statutory public inquiry. I pay tribute to their determination and acknowledge the profound effect that the events have had on their lives. <BR /> <BR />Moving forward, it is essential that we take the learning from what happened in the organisations that were charged with delivery and oversight of that important screening programme.”
“His report explains that the inconsistencies in programme delivery and data management act against:”
“I am sure that everybody in the House will agree that our thoughts should be with the women and families involved. All had a reasonable expectation of better. To me, a public inquiry is a means to an end to discover what happened, why it happened, who was engaged in what happened and what can be done to prevent it from happening again. I thank Professor Sir Frank Atherton for his summary and analysis of the six reports that went before him. As part of his terms of reference, I asked Sir Frank to consider whether a statutory public inquiry might provide additional significant information. Sir Frank stated that it is:”
“I absolutely do. That is the analysis that I brought to the House when I first became Minister of Health. In the first winter in which we talked about such pressures, the discussion was all about what was happening and not happening in EDs. The House now realises that it is about flow and that the problem is a lack of community capacity, so I agree with the Member. <BR /> <BR />Finally, I remain mindful of the concerns that some independent-sector providers have raised about the balance to be struck between in-house and independent provision and about whether the true cost to care is fully recognised. I am out of time, Mr Deputy Speaker. I welcome the fact that we have debated the issue today.”
“As a result of the self-directed support round-table meetings, work is already progressing to streamline processes, reduce democracy and develop managed budget pilots. I will give way to the Member.”
“We have also seen evidence from elsewhere in the United Kingdom that such approaches can improve outcomes while reducing pressures elsewhere in the system. In other words, it is not simply the right thing to do but the smart thing to do. We must also make greater use of existing community assets and, where possible, scale them. That approach aligns directly with the wider ambitions of the neighbourhood model. <BR /> <BR />We must also fully explore the role that technology can play. Assistive technology and digital supports are already demonstrating significant benefits elsewhere in the United Kingdom through improving independence and delivering greater efficiency. Another important priority is to increase the uptake of self-directed support in all its forms.”
“Where we know that approaches are working, we should not wait years to replicate them elsewhere. <BR /> <BR />Another key part of reform is prevention and early intervention. Part of addressing demand for home care must involve finding ways in which to reduce delay or to remove the need for statutory intervention altogether. Work is already under way on a preventative framework that is focused on strengthening local community supports to help people remain safe, well, connected and independent. Many of those supports already exist, and they are delivering excellent outcomes. I have visited organisations and community groups that deliver precisely that kind of preventative support, which is helping older people remain active, resilient and connected in their communities.”
“The group is also considering whether existing legislative, policy and procedural frameworks remain fit for purpose. That work builds directly on the home care round-table discussions that were conducted between August and December last year. Those discussions reached broad agreement that the future of home care must involve moving away from rigid time-and-task models towards taking a more flexible, person-centred approach that is focused on outcomes. They also highlighted the importance of re-enablement, ensuring that short-term support helps people recover independence wherever possible, while also ensuring sustainable, long-term provision for those who have ongoing needs. The round-table meetings also identified examples of best practice already operating across the statutory and independent sectors.”
“That is precisely why we developed and published a 10-year adult social care reform strategic plan and an initial three-year delivery plan earlier this year. The strategic plan identifies six core priorities and 33 delivery actions. Those plans strike what, I believe, is a careful balance between ambition and realism in an exceptionally difficult financial climate. We have prioritised actions that are either immediately necessary or capable of delivering the greatest impact. <BR /> <BR />A new approach to home care is identified as one of the central commitments in that reform agenda. Work has already commenced through a sustainable systems implementation group, which is examining how home care is commissioned, funded and delivered.”
“We know that current approaches will not be capable of meeting future demand. That means that we must explore new solutions, embrace innovation and empower people to live well and live independently for longer. Importantly, any future reform must be shaped by those who provide care and by those who receive it. We are working with the Patient and Client Council (PCC) and the Northern Ireland Social Care Council (NISCC) to ensure that engagement is meaningful, practical and capable of delivering real improvement. <BR /> <BR />Home care cannot be viewed in isolation. It exists within a wider adult social care ecosystem, and many of the pressures that affect home care are symptoms of wider systemic pressures across social care itself.”
“<BR /> <BR />As I have said previously, pay alone will not resolve all the challenges facing the home care sector. What is required and what the motion rightly calls for is a comprehensive, sustainable and future-focused approach to strengthening home care. That will require further investment in staff. The social care workforce strategy sets out our ambition to attract, retain, grow and develop the workforce. The social care fair work forum, which is made up of trade unions, employers and statutory partners, also continues to work to improve terms and conditions and to embed fair work principles across the sector. <BR /> <BR />Strengthening home care will also require changes in how we deliver that care. We cannot simply continue doing more of the same and expect different outcomes.”
“Participation in a debate about the longer-term sustainability of the sector is equally important, and it is regrettable that some key representatives have withdrawn from those wider reform discussions and fora. I genuinely hope that that can be rectified, because sustainable reform requires partnership working. <BR /> <BR />I assure the sector and Members that my commitment to introducing the real living wage in line with the fair work forum criteria remains absolute. However, I need the funding and the financial flexibility to make that happen. The financial pressures that face Health and Social Care are becoming even more constrained with each passing year. Today, we believe that our shortfall is £760 million. That is unprecedented and potentially unmanageable.”
“Once again, I emphasise that my accounting officer told me that it was unaffordable and that I could not do it. I note that the Member, who is Chair of the Committee, is reneging on his duty to assist and advise me by telling me that it is my problem. <BR /> <BR />I will move on, because I am mindful of the ongoing concerns raised by independent sector representatives. I acknowledge their dissatisfaction. As part of the fair work forum, they worked with us in good faith to establish a case for paying the real living wage in the independent social care sector. On that basis, their expectation that it would be paid was reasonable. However, critical as pay is, it is only one part of the answer to the wider pressures that are facing social care, a point that has been made already in these discussions.”
“Well, I made the promise in good faith. Between making the promise and its implementation, it was put to me by the accounting officer that it was not affordable without cuts. <BR /> <BR />Once again, I will give way if the Member wants to identify a cut that I was unable to identify.”
“That is what I said to him and his Committee. However, I listened to him carefully and noted his language: the verb that he used was "demand". He demanded that, as Minister, I introduce the real living wage. I could not identify where to make the cut that would release the money to introduce the real living wage, so I will not demand anything; rather, I invite the Member, not least because he is Chair of the Statutory Committee that scrutinises my work and has a statutory obligation to assist and advise, to tell me where the cuts should be made.”
“It is simply not credible to speak about transformation, workforce reform or long-term sustainability while Departments remain trapped in cycles of financial instability and constrained annual budgeting. I want to be equally clear that the delay in implementing the real living wage is not due to a lack of political will from me as Minister. It is now a direct consequence of the wider financial constraints and is worsened by the absence of long-term budget certainty. That is a matter of great professional frustration to me, because I completely accept the need to level the playing field for those working in the independent sector and to ensure fair wages for the challenging and important work that they carry out. <BR /> <BR />I listened carefully to Mr McGuigan when he opened the debate, and I agree with him that it is counter-strategic.”
“<BR /> <BR />That brings me to the issue of the real living wage, which is, rightly, highlighted in the motion. The failure to secure agreement on a multi-year Executive Budget has materially constrained my ability to implement the real living wage within the timescales that I want. I have been clear about my commitment to the issue right from the outset, but meaningful reform in health and social care cannot be delivered on short-term financial settlements or year-to-year uncertainty alone. The independent social care sector deserves better than that, workers delivering essential care in people's homes deserve better than that, and Ministers trying to plan sustainability for the future of our public services require better than that.”
“I understand that those pressures have real and visible consequences, such as unmet need in the community, increased pressure on families and growing strain on our hospitals because of delayed discharges, which, again, Members analysed during the debate. We also know that extended and non-essential stays in hospital are rarely conducive to good health outcomes, particularly for older and frail people. I want to be definitive and say that those challenges are not the result of a lack of commitment or professionalism in the sector. Home care workers and providers continue to go above and beyond, often under the most difficult circumstances. Those pressures reflect long-standing structural issues, demographic change, rising demand and years of financial instability and uncertainty.”
“<BR /> <BR />However, I also fully realise, as the motion highlights, that, like many other parts of the health and social care system, the home care sector is under significant and sustained pressure. Workforce shortages persist, and recruitment and retention remain challenging, particularly when other sectors may offer comparable or higher pay, as many Members have pointed out. As well as offering better pay, those sectors may offer more predictable hours and lower travel demands. I accept that rising fuel and travel costs have also had a disproportionate impact on home care, especially in rural and hard-to-cover areas, where staff often travel significant distances between visits.”
“I hope that Members understand that I am very much wedded to improving the lot of social care delivery for patients, service users and the people who deliver social care in our community. <BR /> <BR />As we know, demand is increasing. Not only are the numbers going up but so are complexity and acuity. Many of us are living longer — I am a living example of that — and more of us are living with multiple long-term conditions and with frailty and cognitive impairment. Therefore, I will push strongly, in policy terms, to help people to live well and live independently for as long as possible, and home care is and will continue to be an essential service at the centre of that ambition.”
“Mr Deputy Speaker, thank you, and thank you to all who contributed to this important debate. When I took up post nearly two years ago, it was put to me that Ministers tend to go out and about at some point on day one. It was suggested that I visit the Ulster Hospital, just around the corner from Parliament Buildings. I said that I did not want to visit a hospital. I was interested in visiting social care settings, because I was conscious that the "H" in "HSC" is very much dominant. I wanted to start an immediate focus on shifting left, because in an ideal world, in my mind, if you need health and social care, you get it at home, and if not at home, as close to your front door as possible. A hospital should be the last resort.”
“Several Members referred to the 'Spotlight' programme, 'I Am Not Okay' and to some of the mums. A few days ago, I had the pleasure of visiting the Redwood home, just down the hill on the Belmont Road, which has finally reopened, with its famous — or infamous — staircase having been reinstalled. Two of the children who featured in Tara Mills's excellent 'Spotlight' programme are now in place in Redwood, and it is anticipated that a third will have a space in Redwood before our summer recess. I am glad to note that at least some progress is being made in providing the right services and accommodation for those children. <BR /> <BR />I finish by encouraging all Members to support the efforts to achieve the outcome that, we all agree, we seek.”
“Moving forward, that will also support stronger alignment between monitoring and delivery planning, thus improving the visibility of outcomes. It will also lay the foundation for the next autism strategy in 2028. If we genuinely want to realise vital improvements in our autism services in order to meet the needs of those with an autism diagnosis and, indeed, for the whole population, autism services need real and sustained funding additionality to ensure the full delivery of the strategy.”
“Each of those actions has a range of measurable quality assurance and impact indicators and timelines for completion, which will enable scrutiny against delivery.”
“<BR /> <BR />It is important to highlight that many of the actions in the delivery plan are outwith my responsibility, and, therefore, focus may be better directed elsewhere. However, in relation to Health responsibilities, I will highlight some actions that are included in the plan, such as the implementation of the children and young people's emotional health and well-being framework and the publication of a learning disability strategic plan. It also includes support for:”
“To address that, and in keeping with legislative requirements, departmental officials have developed the next delivery plan using specific, measurable, achievable, relevant and time-bound (SMART) targets and measures of success. <BR /> <BR />Officials have also been working closely with Ema Cubitt on agreeing and finalising the delivery plan. Ema has provided some very helpful and constructive feedback on the plan, particularly in relation to SMART targets and measures of success. It was my honour to appoint Ema as our first Independent Autism Reviewer, just as it was my honour to be the first MLA to push for a mental health champion. Although I was unsuccessful at the time, I am delighted that Professor Siobhán O’Neill is now in place.”
“The second progress report for 2024-25 is available on the Department's website. <BR /> <BR />Work is also complete on the development of the delivery plan, which covers the remaining years of the strategy up to 2028. That is despite the challenge of long waiting lists, gaps in services and the constrained financial environment. The plan will remain a live document to enable the system to respond to emerging priorities. <BR /> <BR />One of the key issues is the inclusion of measurable targets to assess effectiveness, which Pam Cameron highlighted in her remarks. I acknowledge that she has been at this a lot longer than I have. In the first two years of the implementation of the strategy, feedback from key stakeholders, including the Autism Reviewer, indicated that more focus is needed in that area.”
“The funding plan, which was published alongside the mental health strategy in June 2021, identified a requirement of an additional £1·2 billion over the lifetime of the strategy to fully deliver all 35 actions. <BR /> <BR />As many of you are aware, the autism strategy was developed and is being taken forward in a period of exceptionally constrained financial circumstances for all Departments. While there is a continued commitment to the implementation of the actions, that has necessitated a creative and innovative approach. The autism strategy sets out to deliver actions across health, education, housing and public services generally, including the Civil Service. Work is ongoing across Departments and public bodies, and progress is assessed through annual monitoring reports.”
“I am aware that specialist learning disability mental health inpatient services are significantly stretched, and there is an urgent need to develop a more robust community mental health system to prevent hospital admissions. <BR /> <BR />The strategy aims to meet the requirements of our unique autism legislation, setting Northern Ireland apart from and, in some ways, ahead of many countries to ensure that public services understand the needs of autistic people and provide the right level and type of services. <BR /> <BR />While considerable progress has already been made on the key actions in the mental health strategy, alongside the delivery of a range of other actions, they are being progressed with minimal budget, which I have repeatedly highlighted to Executive colleagues since taking up post.”
“The new modules cover autistic differences, providing supportive environments and promoting a neuro-affirming culture. The training has been co-produced with service users, and over 40% of the training includes neurodivergent people describing their lived experience. The training provides high-quality foundational knowledge to help staff to understand and implement reasonable adjustments. Additional specialist training for staff working in the area of mental health is being developed in partnership with Middletown. <BR /> <BR />For autistic people with co-occurring learning disability, specialist services are provided and continue to reflect a strong evidential and professional basis. That is not to say that it is a perfect system.”
“It is important that mental health services are fully equipped to identify the specific needs of individuals and address them appropriately, whether through engagement with support services such as social work teams, speech and language therapy or interpreting services; onward referral to specialist services or interventions, if required; or the employment of innovative solutions, such as digital mental health interventions. <BR /> <BR />Training is key to ensuring that appropriate adjustments are made for each autistic person. Health and Social Care staff have access to a range of training modules, and work is being developed by my Department, in partnership with the Middletown Centre for Autism, which is an internationally recognised autism centre of excellence.”
“It is acknowledged that, often, interactions with general mental health services are more difficult than they should be for autistic people. The mental health strategy recognises that there are barriers currently preventing that client group and other marginalised groups from accessing mental health services and support. It is therefore actively seeking to reduce barriers and to implement a no-wrong-door approach, ensuring that staff are appropriately trained to identify and address the specific needs of marginalised or at-risk groups and that services can be flexible and meet individual needs at the point of contact.”
“Since taking up post, they have worked with trusts to map current diagnostic and support pathways, and they have convened a series of workshops to explore ways to optimise existing delivery and improve consistency within existing resources. Building on recommendations from the 2023 review of adult autism services, work is now ongoing to update the adult autism care pathway that was originally developed by the HSC regional autism spectrum disorder network. The review aims to deliver greater consistency in diagnostic and support services across trusts, aligned with NICE guidelines and reflective of differing levels of need. <BR /> <BR />With regard to mental health, I make it clear that an autism assessment should not be required to access services to receive treatment.”
“In support of that, my Department consulted on the children and young people's emotional health and well-being framework. The framework proposes an inclusive, needs-based approach to neurodiversity that does not require a formal diagnosis as a prerequisite for support. The model aims to reduce stigma, promote earlier intervention and improve outcomes across health, education and developmental domains. My Department continues to consider consultation responses and is working with colleagues in the Public Health Agency and child health to define the requirements that will underpin the pathway and inform future commissioning. <BR /> <BR />To strengthen the focus on adult autism pathways, a dedicated project lead for adult autism was appointed in February 2025.”
“Trusts are working to manage demand and to use their existing resources as effectively and efficiently as possible. However, all Members will be aware of the significant funding challenges that I face, which mean making some very difficult decisions in respect of managing the resources that we have. <BR /> <BR />The autism strategy acknowledges that the challenges faced by autistic people are cross-cutting and require coordinated action across services and Departments to address those needs. My Department will continue to work with HSC organisations and Executive colleagues to strengthen pathways and improve coordination of support for young people with complex needs for the remainder of the mandate and, hopefully, beyond. <BR /> <BR />A key priority in the autism strategy is improving regional pathways of care.”
“The exact timeline for reviewing the legislation should be determined when both the learning disability service model and the service delivery programme are finalised. The review will require cross-departmental work involving not only Health but Education, Economy and Communities. A working group will be established to determine the terms of reference, scope and time frame for that review. <BR /> <BR />I am aware of significant delays in accessing autism assessments. That is driving some to seek a private diagnosis. There remains a demand/capacity gap, and, consequently, we have long waiting lists. Work is under way to standardise the diagnostic pathway across all trusts while better meeting needs at an early pre-diagnosis stage.”
“The workshop aimed to develop a shared understanding of the current arrangements, including transitions from neurodevelopmental pathways, such as ASD and ADHD, and to lay the groundwork for co-developing a regional CAMHS to adult mental health services transitions pathway. I am on record as being committed to reviewing the Chronically Sick and Disabled Persons (Northern Ireland) Act 1978 and all appropriate legislation during the first year of implementation of the three-year service delivery plan for the learning disability service model. I want to determine whether there is a need for legislative change — I believe that there is — that better reflects today's needs and modern models of support for people with lifelong complex needs.”