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 62 of 107.
“On 1 April 2024, my Department announced an uplift of the regional hourly rate for direct payments by 9·8% to £16·88 per hour from the previous £15·37. It is a set regional rate per hour, and therefore that is the rate that all trusts give to an individual in receipt of a direct payment. <BR /> <BR />I am aware that there can be a disparity in the rates paid to personal assistants. However, the rate of pay is ultimately a private arrangement between the service user and the personal assistant whom they employ, and, on that basis, the rate of payment to the personal assistant is negotiable.”
“Mr Deputy Speaker, before I answer the question, I want, with your indulgence, to acknowledge that I came across a social media post from Mr Baker last night that marked the second anniversary of the sad passing of his baby nephew Enda, who succumbed to a genetic disease called Edwards' syndrome. I believe that that was not the first time for the family. I just want to acknowledge that and reach out. As I often say, health is personal. <BR /> <BR />In answer to Mr Baker's question, my Department has always supported and continues to support the promotion of self-directed support, as it allows an individual to have as much choice and control as they wish over their personal budget, which has been identified and allocated to them by their local trust to meet their assessed needs.”
“I thank the Member. In her last few words, she mentioned something important: the word "network". I am coming towards the end of my deliberations and consultations with senior colleagues on a reconfiguration plan for our hospital network, and I hope to have something detailed to say about that in the immediate future, ahead of going into pre-consultation. That plan needs to consider where all-Ireland work is appropriate, and I will look to explore and maximise that. Once again, it is about capacity, and, if we can maximise capacity in cooperation, so much the better; I am absolutely for it.”
“Many hospitals, including Daisy Hill Hospital, the South West Acute Hospital in Enniskillen and Altnagelvin Hospital in Derry/Londonderry, are in that position.”
“I thank the Member. No, there was no substantive discussion, and the reason for that is simple: there is nothing in my budget to permit such a replacement. It was a successful scheme. Well over 4,000 people applied to it, and just over 4,000 went through it. The satisfaction level was high. As I have said before, I have no political or ideological objection to reintroducing the scheme, but it is a question of capacity in our budget to do it. At the moment, it is not on the agenda.”
“I am not, however, comfortable rehearsing my conversation with Minister Donnelly without first speaking to him again.”
“The Member raises a very important point. I confirm that we did indeed discuss that issue specifically. I hope that the Member will permit me not to go into the detail of that discussion, because, I think, Minister Donnelly wished to take some points away to consider them with his officials and bring those back in the autumn. I think that we agree that it is a big, horrible ask to require parents to travel by plane or ferry to Alder Hey Children's Hospital in Liverpool in such horrible and tragic circumstances. In my view, if it were possible to have a pathology centre, in Belfast preferably but, if not, in Dublin, that would relieve a lot of that stress and strain. It is in that area that we are moving, if I may put it like that.”
“I thank the Member for his question. I think that it already is. My assessment is that the North West Cancer Centre is at the leading edge. As for what further can be done, there are two issues. First, we have to scope it out. Officials will do that as part of the work programme that I discussed, which they are working on to present at the next meeting in the autumn. Secondly, we have to ask about the budgetary ability, particularly for our Department of Health, to invest further in the North West Cancer Centre, because, as Members are aware, the budget settlement to date has proved to be disappointing for my Department.”
“We go into schools. We give money towards resilience and mental capacity training, and there are reflective benches in all the large housing configurations in Newtownards. We sponsor safeTALK training, which is an awareness campaign that empowers people not to be counsellors but to listen to people and to signpost them to services. I want to develop such initiatives with the Government of Ireland as we go forward.”
“I thank the Member. As with a lot of issues, it is about data collection, about understanding the data and about recognising that there are common threads, but behind data is the human cost. Every data set is about the human cost of somebody who has taken their own life. Every suicide has to be regarded as preventable. <BR /> <BR />I want to build on an initiative that I started in my constituency a number of years ago. I was contacted by a mother whose 23-year-old son had taken his life. She wanted to hold a vigil in Conway Square in Newtownards to remember him. A lot of people turned up, but we realised that they had come not in solidarity but because they had also lost loved ones to suicide. Those of us who organised the vigil felt that we could not just leave it there, so we started the Ards Suicide Awareness Group.”
“<BR /> <BR />To return to the specifics of the Member's question, yes, cooperation on cancer care and research has to be done on an all-island basis. As, I think, I have said before in the House, it is not a question of whether we should cooperate but a question of what our capacity is to cooperate. That is the only inhibitor.”
“I thank the Member for his question. I can absolutely give that commitment. It was the first time that I had met Stephen Donnelly, and, for my part, I thought that we got on extremely well. I look forward to working with him. I will have no difficulty doing so and will enjoy working with him. He is obviously well across his brief and has some great ideas. I talked about my proposed initiative for the autumn to tackle health inequalities, and he told me about something that he tried in his jurisdiction that did not work as well as was intended, because its delivery was not as he had envisaged it would be. It was affirming for me to realise that what he had intended to do is pretty much exactly what I intend to do.”
“I thank the Member for her question. I wish to explore that with senior officials. I noted the discussion that we had on what the health sector can do on biodiversity and climate change. I then stayed on as Minister O'Dowd's accompanying Minister for the sectoral meeting on infrastructure. I am not criticising the officials who were there for the health meeting, but there was a detailed presentation at the infrastructure meeting about what can be done on biodiversity. I brought that back with me from Armagh, and I want to inject it into the Department of Health to ask, "How can we learn from it? How can we mirror it? How can we expand on our current plans?".”
“If I heard the Member correctly, she asked for a commitment to bring forward a cancer research strategy within this mandate. I hope to please the Member by going a little further: I would like to do that within this calendar year — that is my objective — and, certainly, within the mandate.”
“The way to start that is to collect the data, which we are not necessarily doing.”
“I thank the Member for her question. I have to be honest and say that women's health, as a specific agenda item, was not discussed in great detail. Cancer was discussed in considerable detail, in particular the need for this Administration to bring forward a cancer research strategy. I would like to think that that will, of course, include a section that is relevant to women's health. As it happens, I will have a Zoom call with my Welsh counterpart later this afternoon, and, certainly, women's health will be part of that agenda. <BR /> <BR />The Member knows that I am keen for this body and its Executive to look at the idea of gender budgeting, the impact of how we spend our money and what that means for men and women, because there are areas in which the outcomes are, frankly, grossly imbalanced, and that needs to be addressed.”
“I thank the Member for his statement and his question. I can commit to that, yes. Cross-border cooperation on alcohol and drug misuse, which does not respect a boundary or a border, is something that I discussed with Minister Donnelly last Thursday in Armagh. I would like to see that work brought forward in the work programme that is being developed for our consideration in the autumn.”
“It noted further planned sustainability work and plans for further alignment of many operational public health programmes and activities towards the achievement of the UN sustainable development goals that are relevant to Safefood’s remit. <BR /> <BR />Finally, the Council agreed that the next NSMC health and food safety meeting will be held this autumn.”
“Ministers noted that the business plans for 2019, 2020, 2022 and 2023 and the corporate plans for 2020-22 and 2023-25 will be presented for consideration at a future meeting following approval by the Department of Health in Northern Ireland and the Department of Finance in Northern Ireland. The Council noted that the Safefood annual report and accounts for 2019, 2020, 2021 and 2022 have been laid before the Northern Ireland Assembly and both Houses of the Oireachtas. <BR /> <BR />Ministers welcomed the commencement by Safefood of a process to identify suitable candidates for appointment to the Safefood advisory committee, and the NSMC will be invited to consider nominees at a future meeting. The Council welcomed Safefood's progress and leadership on climate change.”
“Further, the body has carried out research, including research relating to meat thermometers; handwashing; food hypersensitivity; the use of antimicrobials in animals; convenience foods; costs of a healthy food basket; food offered to children in social activity centres; whole-system approaches to childhood obesity; plant-based dairy alternatives; children’s diets; food supplements; portion-control tools; fiscal and pricing food policies; and building sustainability into national healthy eating guidelines. <BR /> <BR />The Council approved Safefood’s 2024 business plan and recommended budget/grant provision, and noted the position regarding Safefood’s business plans and budgets for 2017 and 2018 and the 2017-19 corporate plan.”
“They include a progress report from Safefood on the high-level achievements and updates in relation to its public health role to promote food safety and healthy eating advice to the public and those involved in providing food on the island of Ireland. The body has developed and delivered various public health campaigns across all media; developed various all-island networks and programmes to promote food safety and healthy eating; promoted new working partnerships and all-island collaboration; and developed and distributed various resources in educational settings.”
“<BR /> <BR />The Council went on to note the scale of the climate and biodiversity crisis and the opportunity for the health sector to support biodiversity throughout its estates. Ministers noted the role of the health sector in promoting the physical and mental health co-benefits of actions to support biodiversity and address climate change; the intention of both Departments of Health to engage in discussions on climate change and loss of biodiversity; work to develop shared areas of interest to protect biodiversity and address climate change on the island; and the commitment to report on that at the next NSMC sectoral meeting. <BR /> <BR />On food safety, Ministers welcomed the achievements of Safefood since the last meeting and the valuable contribution that it makes through its various activities.”
“<BR /> <BR />During the meeting, Ministers received a presentation on cancer care and cooperation delivered by officials. The Council welcomed the significant developments by both jurisdictions in improving cancer services for people on the island of Ireland, including the continued cooperation and expansion of radiotherapy services at Altnagelvin Hospital and further cooperation on services provided through the North West Cancer Centre; the ongoing work of the Ireland-Northern Ireland-National Cancer Institute (NCI) Cancer Consortium and its role in securing Health Research Board funding to support the priority thematic areas of the consortium, with the overall aim of advancing cancer research and innovation across the island in partnership with the NCI; the award, in June 2023, of Government of Ireland funding to the Cancer Fund for Children, including funding through the Shared Island Fund, to develop a second therapeutic residential centre that will be accessible to children and their families across the island of Ireland; and the ongoing and concerted effort and engagement in improving cancer research and clinical trials at an all-island scale and the fact that both Administrations are working together to develop projects to improve cancer services for patients across both jurisdictions, including efforts to identify funding streams to facilitate that work, including the exploration of further opportunities to avail themselves of Shared Island funding.”
“That cooperation includes the following: progress following the successful implementation of the Licensing and Registration of Clubs (Amendment) Act (Northern Ireland) 2021; continued progress on the development and implementation of strategies to prevent harm related to alcohol and drug misuse in both jurisdictions; continued engagement on opportunities to cooperate on common elements of substance abuse strategies across both jurisdictions; the potential for further collaboration on issues connected with alcohol and drug use, such as the sharing of learning through the North/South alcohol policy advisory group; the update on obesity prevention, including partnership through Safefood; suicide prevention initiatives in both jurisdictions, including joint working on the self-harm registry and the potential for further joint working on suicide prevention; updates on the All-Island Congenital Heart Disease Network; the update on cross-border emergency planning and emergency response and the fact that both Health Departments will work collaboratively to seek ways to cooperate further on emergency planning and emergency response; the pharmacy update, particularly the information regarding the upcoming all-island medication safety conference; and the update on joint funding applications under the PEACE PLUS programme.”
“The Council welcomed the ongoing engagement between the Departments of Health in both jurisdictions in the context of the North/South Ministerial Council health and food safety work programme, and noted that a review of that work programme is ongoing. Ministers noted that a revised work programme will be developed by sponsor Departments in the coming months and then presented at the next NSMC sectoral meeting. <BR /> <BR />The Council welcomed the continued cooperation of both Departments in the health sector since the last meeting.”
“Thank you very much, Mr Speaker. In compliance with section 52 of the Northern Ireland Act 1998, I wish to make the following statement about the twenty-fifth meeting of the North/South Ministerial Council (NSMC) in the health and food safety sectoral format, which was held in Armagh on Thursday past, 27 June 2024. I chaired the meeting, junior Minister Aisling Reilly MLA attended as the accompanying Minister and Stephen Donnelly TD, Minister for Health, represented the Government of Ireland. The statement has been agreed with junior Minister Reilly, and I make it on behalf of both of us. <BR /> <BR />I will begin with health.”
“I take Mrs Dodds's point that some cannot afford to pay up front. <BR /> <BR />I am running out of time, so I am glad I did not go for the 12-minute option before we broke. I acknowledge that Mr Donnelly said that the Bengoa report is on the shelf: it is not on the shelf. Some actions have been taken: for example, the day procedure units at Lagan Valley and Omagh Hospitals. I can inform the House that I was in discussions with Professor Bengoa as recently as yesterday, and he will have more to say about the reform of our health service in the months to come, certainly before the end of the calendar year.”
“Nuala McAllister asked about returning to the Committee with thoughts about bringing back cross-border programmes. We shall do that in due course. The Member also asked when we will have news about the structure of our hospital network and suggested that there would be a statement in June. However, it is more likely that it will come before the House in the week beginning Monday 8 July, because of the general election purdah period. <BR /> <BR />In addition, my predecessor introduced the Republic of Ireland reimbursement scheme in June 2021 as part of the elective care framework to help reduce lists. The scheme provided an option for patients to seek and pay for routinely commissioned health service treatment in the private sector in the Republic and have the cost reimbursed up to the cost of treatment to the NHS in Northern Ireland.”
“The funding has been used to secure extra capacity both in-house and in the independent sector, including providers in the Republic of Ireland, across a range of elective specialities.”
“The framework, published in June 2021, was updated on 24 May this year. It sets the strategic direction for the development and reform of effective and efficient delivery of elective care services here over the next five years, and it details measures that are needed to address the unacceptable waiting lists. For many years, we have been heavily dependent on the availability of additional, non-recurrent funding to tackle waiting lists.”
“It is easy to make demands in the House for more investment in staff pay, tackling waiting times and a long list of other areas in which improvements are badly needed. We cannot be blind, however, to the current budgetary realities. We cannot engage in denial. Our waiting lists are not good. We can all agree on that. I fully understand the distress and anxiety that long waiting times cause, particularly when patients are suffering pain and discomfort. Long waiting times also have a societal impact that goes much wider than individuals. Waiting times in Northern Ireland are wholly unacceptable, and tackling them is one of the areas on which I have committed to focusing over the next three years. <BR /> <BR />Some progress has been made under the elective care framework, but there is much more to be done.”
“<BR /> <BR />Members will be aware of a Strategic Investment Board (SIB) assessment of pay and related issues across the public sector in Northern Ireland. My Department will engage with the Strategic Investment Board to look at wages, the cost of living, tax and other relevant factors across all neighbouring jurisdictions, including the Republic of Ireland. We need to better understand the differences between jurisdictions and attempt to determine potential areas of focus for our region. We should be mindful that different taxation rates, housing costs and overall cost-of-living factors are key parts of the picture alongside pay. <BR /> <BR />Waiting lists are a big concern for all Members, and, at this point, I make a plea to them.”
“Let me say at the outset that there is no easy fix. Although I acknowledge that pay rates are an integral element of the functioning and efficiency of healthcare services, I must point out that rates of pay across Health and Social Care (HSC) are linked to Agenda for Change terms and conditions. There is an established and valued policy of pay parity with England for Agenda for Change workers. It was hard-won. There is a nationally agreed set of terms and conditions under which all healthcare staff in HSC, with the exception of doctors and dentists, are employed. Those agreements are the basis for my Department's commitment to pay parity with England. The part of the motion that refers to harmonising healthcare pay rates poses me, frankly, an enormous problem.”
“The consortium is credited with saving lives and enhancing the quality of life for many cancer survivors by supporting work on cancer clinical trials infrastructure and an all-island joint research project, providing upskilling and training opportunities for scientists, doctors and allied health professionals. Meanwhile, cancer policy units in both Health Departments have had ongoing engagement over the past couple of years on identifying potential projects to submit as Shared Island Fund applications. Such projects include the use of artificial intelligence in screening applications, development of virtual rapid diagnostic clinics, further development of services at the North West Cancer Centre and development of community-based support services. <BR /> <BR />The motion highlights healthcare pay rates.”
“The Minister of Finance successfully argued with the Treasury that our block grant should be based not on population but on need, yet it seems that, when it comes to the Health budget, need is forgotten. It is a big quantum, but it is there for a reason. <BR /> <BR />I mentioned the North West Cancer Centre. Based at Altnagelvin Hospital, it serves the whole north-west corner of the island, but it is not the only example of such cross-border cooperation on cancer care. The all-island cancer consortium — the Ireland-Northern Ireland-National Cancer Institute Cancer Consortium — was established in 1999, following the signing of the Good Friday Agreement.”
“There are currently no trainees in the pipeline, and any internationally recruited postholders are likely to go to those national centres. <BR /> <BR />I remind the Member that the service was stopped because of the pathologist's retirement. I also suggest that, perhaps, it is the sort of job that people should not do for life. For example, when I was on the Policing Board, there were police officers whose job was to look through extensive files of images of child abuse and child sexual abuse. That is not something that any individual should do for a 30- or 40-year career, and that is part of the problem with paediatric pathology services. <BR /> <BR />Mr Robinson also talked about the Health budget. I gently say to him that there was no mention of assessed need in his remarks.”
“I thank the Chair of the Health Committee for her intervention. Would I like the service to be available locally? Yes, of course. Is it currently possible to do that? No, it is not, so what are the best alternatives? The Chair makes a compelling point about not having to get on a plane and fly. The scoping exercise will be conducted. <BR /> <BR />Mr Robinson made some points about the unacceptability of the service not being available in Northern Ireland. I assure him that I have taken advice from the Belfast Health and Social Care Trust, and it appears that there is a move nationally to centralise services by having fewer centres, which is not the direction of travel that the Member wants to see, because of the international shortage of pathologists with a specialist interest in paediatrics. Alder Hey is one of those new centres.”
“I am reassured, on the basis of the feedback received, that parents have felt supported by the interim service provided at Alder Hey.”
“I think that the Member has made a very good constituency pitch ahead of the next Assembly election. I will turn to the configuration of hospitals in the weeks ahead. <BR /> <BR />Returning to the children's services that I was talking about, I assure Members that significant efforts were made to retain the service in Northern Ireland prior to 2019. However, the provision of perinatal and paediatric pathology services is under considerable pressure across the UK and, indeed, globally, due to a shortage of paediatric pathologists. Our first priority must be to ensure that Northern Ireland maintains access to high-quality, reliable and timely pathology services at Alder Hey, at least in the interim, so that bereaved parents can continue to receive pathology reports as quickly as possible.”
“Progressing the feasibility assessment will require the commitment of Governments in both jurisdictions in order to proceed.”
“Families accessing the service receive all the clinical advice, psychological support and aftercare that they require. I understand that the uptake of the service is comparable with the uptake when it was based in Belfast. <BR /> <BR />That said, I certainly do not disagree that a service based on the island of Ireland could be somewhat easier for families who find themselves in that situation. However, until a full assessment of feasibility has been carried out, it is not possible to say that an all-island paediatric pathology service would be clinically or economically viable. My Department remains committed to progressing scoping work with the Department of Health in Ireland to explore the feasibility of an all-island approach to those services.”
“<BR /> <BR />Regarding paediatric and perinatal post-mortem services, I will say, first, that I, of course, fully sympathise with the devastating loss that many people and families have experienced, and that includes at least one Member of the House. Therefore, I recognise the importance to them of having the causes of a pregnancy loss or of a child's death examined and understood in a professional and empathetic manner. Mr McGrath talked of two words: "efficiency" and "compassion"; I would add "professionalism" and "empathy". Paediatric and perinatal post-mortem services have been provided to Northern Ireland by Alder Hey Children’s NHS Foundation Trust in Liverpool since 3 January 2019. That is when the service in Belfast became unsustainable, following the resignation of the sole paediatric pathologist.”
“For example, paediatric gastroenterology has on-call support with the South and referral pathways to Great Britain centres. Where there are further viable opportunities for cross-border collaboration in vulnerable or specialist services, these could and should be fully explored within available resources. Therefore, it is not so much a question of cooperation as of capacity. The child health partnership programme board, which was established to provide strategic direction for the child health partnership may consider vulnerable and specialist paediatrics as part of the future work plan of that partnership.”
“There is, of course, a long-standing principle of cooperation and collaboration with health services in the Republic of Ireland, where it has been demonstrated that it is safe, deliverable and beneficial to patients and their families in both jurisdictions. Indeed, we have seen very good examples of that in the all-island congenital heart disease network, a single service for children and young people across the island of Ireland; and in the North West Cancer Centre, which I shall return to later. <BR /> <BR />Specialist paediatric services, which are referenced in the motion, are, by their nature, relatively low-volume, high-complexity services, and many already operate on the basis of clinical cooperation with other specialist centres in both Great Britain and Ireland.”
“Thank you, Principal Deputy Speaker. Perhaps I should begin by repeating something that I said in yesterday's debate: I have no ideological or political objection to further cooperation with health authorities in the Republic. I have no issue with exploring opportunities for reasonable cooperation on health, and, indeed, I look forward to my first engagement with my counterpart, Minister Stephen Donnelly. I understand that I am due to meet him next week. <BR /> <BR />When it comes to health and well-being, doing what is right will always be my main priority. My mantra, of course, is for better outcomes. Given that health services in countries across Europe are under pressure to varying degrees, it makes sense that we work together with our nearest neighbour in a mutually beneficial way to improve outcomes for everybody.”
“I will wait, Madam Principal Deputy Speaker.”
“I thank the Member for giving way. Do you have a JustGiving page?”
“We must base it on data while remembering that, behind every data set, there is the human cost of some disease, be it cancer or whatever. <BR /> <BR />I bring my remarks to a close by, once again, thanking the mover of the motion and those who tabled the amendment, which we support.”
“Where collaboration with other jurisdictions can achieve that, we must take those opportunities, where possible, and, on my watch, we will do that. <BR /> <BR />I will touch on a couple of Members' comments. Danny Donnelly talked about cooperation with the Minister from the Government of Ireland, Stephen Donnelly. I am scheduled to have a meeting with Minister Donnelly before the end of the month, and I very much look forward to that. I hear what Mr Dickson says in his assessment of the state of cooperation with the Republic. "Could do better" might be a summary of his remarks, and I very much will take that on board. As for sharing the registry, yes, I think that data is absolutely critical in improving how we deal with the health service and getting better outcomes.”
“It is essential that we grasp those opportunities. <BR /> <BR />Greater specialisation of cancer treatment means that it is increasingly important that we adopt a collaborative approach to delivering cancer services with our nearest neighbours. We need to enhance collaboration, North/South, east-west and globally. That is particularly important for cancers that require specialist treatment that cannot be delivered in Northern Ireland or for rare cancers where clinicians must have access to a larger population to develop and maintain the expertise to treat patients. Therefore, in answer to the motion, I am open to all discussions, ideas and proposals that enable us to deliver better cancer services for the people of Northern Ireland.”