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 61 of 107.
“Thank you very much, Mr Deputy Speaker. I thank Áine Murphy for securing the Adjournment debate, and I thank the Members who have contributed. This is an opportunity to recognise and pay tribute to the fantastic work that is carried out by our primary care services. <BR /> <BR />It is obvious that I am on my own in the Chamber, in a party political sense. Baron Elliott of Ballinamallard would have loved to have taken part in the debate, as he represents the area, but he was called away, and our health spokesperson, Alan Chambers, has been inconvenienced this afternoon. So, it should not be taken as a lack of interest from my party on the issue. <BR /> <BR />I will come to Members comments presently.”
“I have been listening with great interest to the praise — the deserved praise — that is being heaped on our Olympic and Paralympic athletes and their great successes in Paris over the summer, particularly those who have joined our gold medal winners. I note that we are crediting only three previous gold medallists — Lady Mary Peters, and Jimmy Kirkwood and Stephen Martin for hockey — but we have four. We have a fourth. The first was Robin Dixon, who won a gold medal in the two-man bobsleigh event at the Winter Olympics. It is likened to someone winning a gold medal for swimming with no access to a swimming pool. Let us put him on record: Robin Dixon, our first Olympic gold medallist.”
“I thank Mr Carroll for his supplementary question. He is taking me to an area that may be just slightly above my pay grade, but I will say this to Mr Carroll: it seems to me that people of reasonably high wealth who have decent incomes and disposable cash tend to take out private health insurance, so I am not quite sure where he is going with that, unless he is suggesting that we impose additional taxation on them to help fund the health service. If that is the case, that is way beyond my pay grade.”
“I thank the Member for his question. To be clear, when I have talked about implementing cuts, it is in the context that, according to the five health trusts, there appear to be four categories of cuts: those that have low impact, medium impact, high impact and catastrophic impact. I have said that I am not willing to implement cuts that have a catastrophic impact, because that will do real damage to our patients. That represents real, serious, significant and, to my mind, unavoidable harm, and that is not for me.”
“I am more than happy to accept an invitation to revisit the South West Acute Hospital and perhaps build a day's worth of programmes, events and meetings around it. Last Thursday, I had the great pleasure of going to Crossmaglen to visit a family-run GP practice, and that was really inspiring and energising. I will expect no less when Mr Elliott takes me back to the South West Acute Hospital.”
“I thank the Member for his question. He may recall that, in another role, as the leader of the Ulster Unionist Party, I had the pleasure of visiting the South West Acute Hospital not long after it opened. It is a very impressive, very modern and very efficient-looking facility. When it comes to efficiency, I am very much focused on increasing the uptake and capacity of theatres to do more, not just in the South West Acute Hospital but in all theatres across our acute hospitals. That has to be a matter for debate, because I cannot just wave a magic wand and increase the capacity and usage of the theatres. If I could, I would, and failing me having that ability, it is a question of negotiation and strategy, as I see it.”
“I thank the Member for his supplementary question and very much acknowledge the principle of what he said. The impact of the COVID pandemic and of lockdowns are matters for the long, ongoing and necessary UK-wide inquiry. I do not want to say anything that could be considered prejudicial to the work of that inquiry. I acknowledge what the Member is saying and understand the logic of what he has concluded, but I will stop short of making definitive comment for fear of prejudicing the inquiry.”
“It could also be down to lifestyle changes in a population, access to services or the longer-term impacts of the COVID-19 pandemic. <BR /> <BR />I have discussed the issue with the Chief Scientific Adviser, Professor Ian Young. My Department has also commissioned the Public Health Agency to carry out work to investigate the potential causes. That work is ongoing.”
“I thank the Member for his question and acknowledge his long-standing interest in the area. The expression "excess deaths" is horribly clinical, but I suggest that it is a necessary definition. First, I assure Mr Frew that I do not want any partner, relative or friend of somebody who has passed away to wonder whether the implication of that person being an "excess death" is that the death should perhaps never have happened. <BR /> <BR />I am very much focused on the issue of excess deaths. Of course, the issue is not unique to Northern Ireland and has been observed internationally. The underlying explanation is likely to be multifactorial and may include an increasing number of people with long-term conditions such as cardiovascular disease and diabetes.”
“The Department recognises that the training provided needs to be readily accessible, practical in its approach and influenced by autistic people in order to ensure that the challenges that they experience are accurately represented. <BR /> <BR />With the funding that is allocated through the autism strategy 2023-28, all trusts are taking forward a regional project to develop GP training videos, and all trusts offer training and support to all their staff in the effective support of those patients with communications challenges and barriers, including autism, in accessing services, while also supporting staff to be more aware.”
“That includes providing training for all staff, run by individual trusts or commissioned from external organisations, and self-directed learning for those with a particular identified training need. The Autism (Amendment) Act (Northern Ireland) 2022 inserts subsection 4A, which states:”
“Again, I thank the Member. I acknowledge that the need for improved understanding of autism for all people has been raised consistently throughout stakeholder engagement and public consultations down the years. My Department intends to provide autism training across all the health and social care sector, rather than just empowering specialist groups of individuals. All trusts offer training and support to all staff in the effective support of those patients with communication challenges and barriers, including those with autism. When they are accessing services, support staff need to be more aware. <BR /> <BR />Trusts take a service-wide approach to addressing the needs of those with autism.”
“I can assure all Members that my Department will continue to work in partnership across Departments, the health and social care sector, public bodies and the community and voluntary sector to make that happen. <BR /> <BR />Whilst the monitoring and reporting role will be fulfilled by the independent autism reviewer, in adherence to legislative requirements, the Department of Health will commit to that role until that appointment is made. The autism strategy 2023-28 was published, along with an initial two-year delivery plan for 2023-25, on 13 December 2023, and work is under way across Departments and public bodies. Progress will be assessed through the annual monitoring report, which will be completed shortly. Once I have agreed and approved that report, a copy will be published on the Department of Health's website.”
“I thank the Member for his question. I am fully aware of the responsibility to appoint an independent autism reviewer, and I acknowledge the significant role that the post will bring for autistic people and their families. I have deferred a decision on the reviewer until I can consider health funding pressures in the round, which I have to do, particularly taking account of the outcome of June monitoring, which has now been announced. Nevertheless, I will take the decision on the reviewer in the coming weeks. I recognise the importance of ensuring that all people with autism, or those who are waiting for an assessment for autism, their families and their carers, can all receive the right access to services.”
“I hear what the Member is saying. I can only say that I have never been tempted to go anywhere near such a machine. I will take the matter back to the Department and I will reply in proper and appropriate detail to Mr Dickson.”
“Work is under way to review breast cancer services and to implement an optimal care pathway for pancreatic cancer patients. The focus of that work is on reducing the length of time that those patients are waiting for diagnosis and treatment, thereby improving patient outcomes. <BR /> <BR />I will leave it there, Mr Deputy Speaker, in order to afford Mr Dickson the opportunity to come back.”
“As the Member will know, the cancer strategy is a 10-year plan to reform cancer services here. Since it was published in 2022, we have already seen significant progress against a number of actions. Key examples of that include the development of rapid diagnostic centres and services to provide genomic testing for cancer patients. Both of those services will help to improve pathways and patient outcomes. <BR /> <BR />We have completed reviews of haematological cancer pathways and adolescent and young adult cancer services, and we are progressing work to implement their recommendations. We have invested in oncology and haematology stabilisation plans and clinical nurse specialists in order to ensure that those services are better staffed.”
“The dial is not moving. We therefore have to change the dial. To do that, there has to be a cross-departmental, all-Government initiative.”
“As a member of the Economy Committee before taking on this role, I was very focused on the fact that our rate of economic inactivity — people who are not in work or not seeking work — is 26%. That is one in four people. If Members look at the reasons that people are economically inactive, they will see that physical and mental health is probably the single biggest reason. Accessible, affordable childcare is also a major issue. <BR /> <BR />An all-Executive initiative is therefore needed to tackle the issue, but it cannot be done in a top-down way. Rather, we need to get into communities and say, "Do you agree that these are your issues?" and, "How do we co-design and co-produce the answers so that they make a positive impact?". The figures on how long people live for and on how long they live a healthy life are stubbornly not moving.”
“I very much agree with the Member's sentiment. That funding needs to continue. Although we can talk broadly about commonalities in health inequalities, each area of deprivation has its specific issues and needs. People in communities are better placed than anybody else to say what the solutions are that they believe will work for them in their community. <BR /> <BR />I have had very initial discussions with Executive colleagues about the issue. Solid research indicates that clinical and health interventions are probably only 20% of the solution and that perhaps 40% of it is down to socio-economic factors. I was very pleased with the reaction of my colleague Conor Murphy, the Economy Minister, who seems to be up for tackling the issue.”
“If we do that, I believe that other areas that suffer from severe health inequalities will see what is being done elsewhere and say, "I would like a slice of that cake". We will certainly ensure that we deliver a proportionate degree of regional balance in the roll-out of that initiative.”
“I thank the Member for her question. There are two elements to consider, the first of which is the question of tackling areas of deprivation, while the second is the issue that the Member raised about regional inequalities. I am certainly up for tackling both. As I said, I hope to work with departmental officials in the coming weeks to advance the initiative that I want to introduce to tackle health inequalities. Indeed, I have a meeting with senior officials scheduled for later this afternoon about taking the next step in developing the proposals. We will take one or two areas of deprivation, no matter where they are. We will take services that already exist and put them into a programme. We will then flood the areas with information and services, in the hope that our doing so will have an impact.”
“It needs continued, sustained collaboration across Departments and agencies, including local government and the community and voluntary sector, and with communities to address the factors that impact on health and well-being locally and regionally. The Member will be aware from my recent statement in the Chamber that health inequalities will be one of my main areas as Health Minister, and I hope to update the Chamber soon on an initiative.”
“<BR /> <BR />Making Life Better is the overarching strategic framework for public health through which the Executive committed to creating the conditions for individuals, families and communities to take greater control over their lives and be enabled and supported to lead healthier lives. The framework is underpinned by a range of public health strategies that focus on specific issues such as substance use, suicide prevention, tobacco use and obesity prevention. It is further complemented by the integrated care system for Northern Ireland, which is underpinned by a population health and outcomes-based approach. <BR /> <BR />Reducing inequalities in health is a huge challenge.”
“The health inequalities annual report that was published by my Department on 27 March 2024 highlighted the scale of inequalities that continue to exist. For example, the report showed that, in 2020-22, males in the most deprived areas lived on average 7·2 fewer years than males in the least deprived areas. The gap for females was 4·8 years. That is happening a quarter of the way into the 21st century. <BR /> <BR />Inequalities in health outcomes arise primarily because of inequalities in the conditions in which people are born, grow, live, work and age. For example, research has shown that only 20% of health outcomes are driven by the clinical care that we receive, with the rest being related to the socio-economic and physical environment in which people live and a range of health and lifestyle behaviours or choices.”
“I thank the Member for her question. Yes, I will commit to taking that away and discussing it with colleagues in the Department. I agree with the Member that it is a gap that not only exists but needs to be closed for the sake of our people.”
“I thank the Member for his question. The Department is working closely with health and social care trusts to address the long waits that we see in many of our cancer pathways. That includes short-term measures such as buddying arrangements, whereby patients are transferred to other trusts for a diagnosis. Medium- and longer-term measures are also required to ensure that we have sufficient capacity to meet the growing demand that a growing and ageing population will generate. That will require investment in workforce and capital equipment. It will also require us to transform how we deliver key services to ensure that they have the capacity and expertise to deliver.”
“My Department's health and social care workforce strategy 2026, 'Delivering for Our People', and its current, second action plan contain a comprehensive and ambitious work programme that includes the development of initiatives to enhance our attraction, recruitment and retention across all staff groups and specialities. I look forward to engaging with college representatives on that at our forthcoming meeting, which will inform our work in the area.”
“I thank the Member for his supplementary question. We do indeed have significant gaps across key professions in health and social care. Recruitment, training and retention of staff are critical. We also need to ensure that we recruit staff with the correct skills to deliver a modern cancer service. <BR /> <BR />My Department is committed to creating safe, adequately staffed work environments, which will help to ensure that we attract and retain staff across the health and social care system. Through effective workforce planning, we will ensure that sufficient resources are allocated to the education and employment of health and social care staff. The Royal College of Radiologists' three-point plan to support oncology and clinical radiology focuses on recruitment, training and retention.”
“It will provide a continuous supply of locally trained consultant radiologists and advanced radiographer practitioners, which will address the increasing demand for imaging investigations and reduce our reliance on costly outsourcing. <BR /> <BR />I remain profoundly dissatisfied with the level of funding being made available to my Department, which has hampered and limited the Department's ability to make further progress that can transform the delivery of health and social care in Northern Ireland.”
“Specific cancer pathways are being developed that will inform future strategic workforce planning to address workforce requirements for clinical oncologists and other professions. <BR /> <BR />The active expansion of multidisciplinary teams is a key part of our overarching programme to reform health and social care. With regard to imaging services, my Department and the HSC are taking forward a proposal for a multi-professional imaging academy for Northern Ireland. That will significantly increase capacity in the health and social care system for training greater numbers of radiologists and radiographers, including interventional radiologist consultants, each year.”
“I thank Mr Harvey for his question. I am aware of the workforce challenges across health and social care. I welcome the Royal College of Radiologists' report. I have agreed to meet college representatives to discuss the findings in detail. <BR /> <BR />The college is an important stakeholder in delivering effective cancer and imaging services for our population. My Department is committed to developing cancer and imaging services for all the people of Northern Ireland. Following the cancer strategy, by this year we will have invested £10·88 million to stabilise HSC trusts' oncology and haematology services. That will increase the number of funded oncology and haematology posts, including clinical oncologist posts.”
“I thank the Member for her question. There are the terms and conditions of employment, the rotas and all the wraparound that is involved in being a junior doctor. I do not for one moment think that junior doctors want to be junior doctors just because of the salary band that that offers; it is a vocation. They probably have good ideas about how to improve the National Health Service, how to improve productivity and how to achieve better outcomes. There is an awful lot to discuss, and it is perfectly reasonable to say that the Department is willing to discuss pay within the envelope of terms and conditions and that we will do so in independent arbitration.”
“The other point to make is this: how repercussive would it be to reach a pay agreement with the junior doctors, given the sort of quantum that they wish to achieve in those negotiations? I can say only that I am not looking at a plan B. What I am doing is encouraging them to sit down with the Department and engage in meaningful, constructive and equitable arbitration.”
“I thank the Chair of the Committee for her comments. The next steps are difficult, because, as I said to Ms Bradshaw, we are in a classic situation where arbitration is the only way to go forward. Were I, as Minister, to go forward with the BMA junior doctors committee on its terms, purely discussing pay, there is no guarantee that we would reach a mutually agreeable resolution, particularly given the budgetary constraints that I am operating under.”
“The junior doctors committee has stated that its current mandate is for pay and that it would consider contract negotiations once a reasonable pay offer and a commitment to full pay restoration has been made. <BR /> <BR />One of the non-pay issues on which we can make good progress is meeting the good practice requirements for delivering those rotas within the six-week time frame. There are other non-pay issues that I am keen to discuss as a way of improving the working lives of junior doctors. In brief, we seem to find ourselves in a situation that, for me, is a model illustration of why we need arbitration processes. Again, I encourage the BMA junior doctors committee to engage in those terms.”
“I thank the Member. Indeed, I engaged with them before coming into post, when I was the Assembly Private Secretary to Minister Swann. More recently, I have written to all three branches of the BMA and invited them to meet me to discuss the issues that the health service faces and how we can move forward together. I have also advised the branches that I wish to meet all three branches together. <BR /> <BR />The junior doctors committee has written to me separately, and I hope to meet its representatives shortly. I have reiterated my offer of arbitration and confirmed my desire to see a revised contract and terms and conditions for junior doctors as a way of securing any additionality to the pay bill.”
“<BR /> <BR />I have been advised by the host organisations — the trusts — that they are making every effort to provide their junior doctors with rotas six weeks prior to the trainees taking up their posts. They have, however, advised that that is not always possible due to vacancies appearing in the postings at late notice. In cases where the host organisation is unable to provide a rota within the recommended time frame, they state that they will advise the trainees and, where possible, provide an indicative rota.”
“I thank Paula Bradshaw for her question. As you will be aware, junior doctors in Northern Ireland are employed under the single lead employer. They work in a number of host HSC organisations that are responsible for developing, issuing and monitoring the working patterns and rotas of junior doctors. Under the current guidance, it is recommended that trainees receive their rotas a minimum of six weeks prior to taking up post. The Northern Ireland Medical and Dental Training Agency (NIMDTA) is responsible for providing the postings to host organisations, following the completion of their recruitment campaigns. NIMDTA has confirmed that all allocations for August of this year have been released to employing organisations, giving adequate notice to enable the health and social care trusts to prepare and issue their rotas.”
“As part of that process, employees are also offered the opportunity to attend counselling with Inspire. <BR /> <BR />The Ambulance Service community resuscitation education officers have received training in critical incident stress management, and they will engage with community first-responder volunteers, if they require support following a challenging call. If further support is required, a community resuscitation education officer can refer a community first-responder volunteer to the Northern Ireland Ambulance Service peer support team. That team can also refer community first-responder members for free and confidential support through Inspire Workplaces.”
“I thank the Member, and I look forward to visiting Desertcreat to see what the Northern Ireland Fire and Rescue Service (NIFRS) does there. Its employees regularly encounter incidents that may be defined as "critical", and such incidents can cause psychological distress to those involved. The Fire and Rescue Service is committed to ensuring that employees receive the support required through critical incident stress management. The Northern Ireland Fire and Rescue Service takes a comprehensive and integrated multicomponent approach, through that critical incident stress management process, to crisis and disaster intervention. The aims are stabilisation, symptom reduction, return to adaptive functioning and facilitating access to continued care.”
“Reducing handover delays at emergency departments has been a key priority, and a regional process has been issued to all trusts for the release of ambulances for outside emergency departments when the Northern Ireland Ambulance Service (NIAS) has an outstanding category 1 or category 2 call. That will very much improve response times. That is certainly the ambition.”
“I will make the commitment to work with my Executive partners. I will also say to the Member that I am more than happy to work on a cross-border basis, because, on Thursday, not only was I at the health sectoral meeting but I attended the infrastructure sectoral meeting with Minister John O'Dowd and his counterpart from the Government of Ireland, Eamon Ryan. The statistics south of the border for fatal road traffic collisions and serious injuries from collisions are also going very much the wrong way, so cooperation is part of the mix too. <BR /> <BR />My Department has taken steps to improve waiting times at emergency departments.”
“The strategy identifies several key factors required for success in delivering the outlined 2030 targets and strategic outcomes. I am pleased that it has secured Executive commitment. However, that needs to be followed up with appropriate funding, appropriate resources and collaborative partnership working, in which, I can tell the Member, I will certainly play my part.”
“I thank Mr Dunne for the question. In October 2022, a draft Northern Ireland road safety strategy reaching up to 2030 was published. While Departments supported it at the time, unfortunately, it could not be finalised due to the absence of a Northern Ireland Executive. Following the return of Ministers, the strategy has been updated, and it was brought to the Executive on 23 May. I support the strategy. I welcome the ambition to deliver an interim target of 50% fewer deaths and serious injuries in the decade between 2020 and 2030. <BR /> <BR />The post-crash response pillar aims to establish an effective and appropriate response to collisions to ensure that road victims receive appropriate medical care and rehabilitation to minimise the severity of the long-term impact of their injuries.”
“Yes. Minister Swann announced £70 million in March. I can tell Mr Elliott that £7·3 million was invested in self-directed support. The estimate for that was based on current expenditure levels for self-directed support in Health and Social Care (HSC). I hope that he will agree that that was a significant contribution to improving the service.”
“Yes, I am more than happy to meet anybody who has ideas about how we can best deliver those services. Absolutely.”
“The memorial fund used to offer back-to-school or short break programmes, so, if you wanted money for school uniforms for your children or grandchildren, that was all well and good and, if you wanted a short break, all the better. However, if you did not want something that came under a scheme, the memorial fund simply could not help you. The move to the Victims and Survivors Service was designed to treat every client individually: "What is it that will improve your life? What are the barriers to your being content and prosperous? How can we come in and try to remove those barriers?". It is the same with these payments. Who delivers the service should be those who, the recipient who is commissioning the service feels, are best placed to help them in their life.”
“I thank the Member for his supplementary. One of the points is that a direct payment is not intended to replace existing support offered by family members; rather, it is to supplement care. There is a range of people who provide that care, and it is important that all of them get a fair crack, as it were, at providing support. I will work with officials and ask them to look closely at ensuring that there is a fair and equitable spread of those who provide that care. <BR /> <BR />When I think about this, I always remember my time as a victims' commissioner and the move that was made from the Northern Ireland Memorial Fund to the Victims and Survivors Service (VSS). The point about that is that the move was to truly personalise the service.”
“The service user, as the employer, is responsible for meeting all the administrative costs associated with being a recipient of a direct payment, such as National Insurance contributions, pension contributions, sick pay, annual leave, redundancy and so on, all from within the direct payment amount that has been allocated to them. Over and above that, my Department endorses the need for personal assistants to receive a rate of pay that is, as a minimum, reflective of the national living wage, which is £11·44 per hour.”