Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“I acknowledge the Member's long-standing interest in those issues. I have no difficulty in saying that I will meet members of that group. It is very important for me to understand their viewpoint, but it is also important for the Member to understand that that was, effectively, an unprecedented time for the devolved Administration and that decisions were made at pace. I regret utterly and absolutely any damage that a vaccination programme caused to any citizen in this country. That is the last thing that any Member would want. However, I encourage the Member to understand that a balance had to be struck. He asked about the cost of the certification scheme. You have to balance the cost of that against the almost certain chaos that not introducing such a scheme would have caused.”
“Northern Ireland's citizens were able to use the COVID certification app to meet the criteria for access. The creation and maintenance of the service helped to allow continued access to a range of businesses during the pandemic.”
“Between July 2021 and December 2023, the COVID certification scheme in Northern Ireland cost a total of £21·5 million. The funding covered the creation and use of a Civil Service identity authentication service; the creation and maintenance of an internationally trusted mobile app and paper certificates; and the provision of a helpline to assist those experiencing difficulties with the automated process and to assist in obtaining secure paper certificates, as well as further guidance. <BR /> <BR />Had the service not been available, patients would have inundated GPs and vaccination centres with requests for documentation to allow them to undertake international travel. In November 2021, the Executive also agreed restrictions on access to a range of venues.”
“I thank the Member for his question. The Health and Social Care COVID certification scheme was introduced at the start of July 2021. It was to enable Northern Ireland's citizens who wished to undertake international travel to satisfy the requirements of the destination countries. Without the service, citizens would have been unable to avoid restrictions such as a 10-day quarantine on arrival that other countries imposed. The service closed to new applications on 19 December 2023, when the last remaining countries withdrew their requirements for vaccination certification. Between —.”
“The Member will be aware that I am fewer than two weeks in post. There is yet to be an Executive meeting during my time as the Health Minister, although I hope that that will cease to be the case on Thursday. <BR /> <BR />I have identified some of the areas that I consider to be the most difficult or challenging in Health and Social Care (HSC). I want to concentrate on those areas over the next three years, and they include waiting lists, cancer, mental health and health inequalities. We need to see the Executive take cross-cutting actions on health inequalities, and that will address where the Member is directing me.”
“I am not saying that that is a bad thing; I am just saying that we need to be aware of what those repercussions may be, and that will mean having a discussion with Executive colleagues.”
“I thank the Committee Chair for her comments and her question. I was aware that Professor Jones was at the Committee last Thursday. He was good enough, on his way back to the airport, to drive by Castle Buildings, and I was able to have a brief introductory conversation with him. I woke up this morning to find a very encouraging email from the professor. I very much look forward to engaging with him in the immediate future. <BR /> <BR />The issues are really important, and some of the recommendations are cross-cutting and, to my mind, potentially repercussive. I want to give due consideration not just to what is proposed and the impact on children's services but to how it might impact on other areas. For example, his recommendation for an arm's-length body (ALB) is potentially repercussive.”
“They include fast-tracking the employment of newly qualified social workers and the cessation of recruitment of social workers through recruitment agencies. Work on the development of a 10-year plan for pathways into social work is well advanced. That plan aims to maximise attraction into the social work profession, outline the most efficient recruitment processes and describe effective retention strategies to maintain social workers in essential health and social care services. Funding has been secured to commission an additional 40 social work training places, which are expected to commence in September of this year.”
“I thank the Member for her follow-up question. I accept that working in children's social care services requires fully staffed, well-motivated and well-managed teams of social workers and, indeed, other staff. Work to identify measures to address the issues in the social care workforce is ongoing under the workforce review implementation board and the children's social care services strategic reform programme. Under the reform programme, a social care workforce work stream has been established. An exercise to scope the existing social care workforce and work on a social care workforce strategy have also commenced. <BR /> <BR />A number of actions aimed at stabilising the social work workforce have already been taken.”
“I thank the Member for her question. The report of the independent review of children's social care services was published in June of last year. It was followed by a public consultation on the review recommendations. That ran for 12 weeks from September to December 2023. My officials are developing advice based on analysis of the responses to the public consultation. Subject to the final outcome of the consultation and other factors, including the availability of budget, of course, and the views of other Ministers, where relevant because of cross-cutting issues, the intention is to implement as many recommendations as possible as quickly as possible. A number of the recommendations will be taken forward, as appropriate, through the children's social care services reform programme.”
“Thank you, Mr Speaker. I hope to rise to the challenge.”
“I declare that I have known Dr Morrow for a very long time, since school days. Dr Morrow founded the UK epilepsy and pregnancy register. His work has been absolutely key — instrumental — in highlighting the safety issues of valproate in pregnancy and in learning more about the safer alternatives for treating epilepsy in pregnancy. We all owe Dr Morrow a huge debt of gratitude. With that, I conclude.”
“Thank you very much, Mr Deputy Speaker. Thanks also to the Chair. On the broad point of working with the Committee, I repeat that, although I have only been in this role for six days, I have worked here for more than 13 years, in the Chamber and in Committees, so I feel a great sense of loyalty to that. If we get the relationships right, a lot of things are possible. I really look forward to working with the Chair and her colleagues on the Health Committee. I thank the Committee members for supporting the legislation. <BR /> <BR />I will close by taking the opportunity to acknowledge the work of Dr Jim Morrow, a now retired consultant neurologist from the Belfast Health and Social Care Trust. His work in the field of epilepsy medicines in pregnancy has had a global impact.”
“If these regulations are approved by the Assembly today, the respective legislative provisions will then extend to and apply in Northern Ireland in the same way that they currently apply in the rest of the United Kingdom. <BR /> <BR />My officials attended the Health Committee at its meeting on 2 May to outline the policy intent of this draft statutory rule. I am pleased to confirm that the Committee raised no issues on the content of the draft regulations. It is with the Committee's support that I now bring this statutory rule before the wider Assembly and its Members. I therefore commend the motion to the Assembly.”
“<BR /> <BR />In the absence of a Minister to bring forward those legislative amendments to the Assembly for application in Northern Ireland at that time, my Department issued a chief professional letter in relation to full-packaging dispensing of valproate-containing medicines to highlight that the Medicines and Healthcare products Regulatory Agency (MHRA) guidance relating to valproate-containing medicines should be considered as good practice in Northern Ireland until such times as similar legislative amendments to that which had taken place in Great Britain could be taken forward in Northern Ireland. <BR /> <BR />The draft regulations that I bring before the Assembly therefore replicate the provisions already made for Great Britain.”
“As Northern Ireland had no sitting Assembly until recently, the UK Government made the decision to proceed with the laying of a draft amendment statutory instrument that applies only in Great Britain. That statutory instrument was debated in the UK Parliament on 20 September 2023 and came into operation in Great Britain on 11 October 2023.”
“Ensuring that patients receive the necessary information included in and on the manufacturer's original packaging will support them taking their medicine safely and effectively. <BR /> <BR />The HMRs have a UK-wide territorial application and must be amended using powers set out in the Medicines and Medical Devices Act 2021. Subsequently, any amendments would normally be made jointly by my Department and the Secretary of State for Health and Social Care using the draft affirmative procedure, meaning that they would be debated and approved via the draft affirmative procedure in both the Houses of Parliament and here in the Northern Ireland Assembly.”
“For instance, there are some prescriptions, such as a course of steroids or antibiotics, where a decision may need to be made to supply the exact quantity prescribed. <BR /> <BR />It is important to note that original pack dispensing will not apply to controlled drugs, which are medicines that have further legal controls on top of those that apply to all prescription-only medicines. That is because they may cause serious problems, such as dependency and harm, if they are not taken as intended by the prescriber, or if they are diverted for other uses. <BR /> <BR />As a whole, the amendments will directly contribute to the overarching objective of safeguarding public health by improving patient safety in Northern Ireland.”
“Further to the consultation responses, an exception is now included in these amending regulations whereby pharmacists will be able to make an exception to the whole pack dispensing of medicines containing valproate on an individual patient basis, where a risk assessment is in place that refers to the need for different packaging, such as a monitored dosage system, and where processes are in place to ensure the supply of patient information leaflets. <BR /> <BR />Amendments to the HMRs for original pack dispensing will enable pharmacists, or pharmacy staff under their supervision, to dispense 10% more or less of the medicine compared to the quantity prescribed if it means that they can dispense the medicine in the manufacturer's original packaging. However, judgement by the responsible pharmacist will remain a critical part of the process.”
“<BR /> <BR />The amendments are being made following the completion of a UK-wide consultation that took place in 2021. There were 84 responses to that consultation across the UK, five of which were from Northern Ireland. Although the majority of respondents were extremely supportive of the proposals generally, some respondents suggested that exceptions needed to be built in to support patients who have specific individually identified dispensing needs, such as patients who receive their medication in daily dosage packaging, such as a monitored dosage system to aid compliance.”
“<BR /> <BR />The statutory rule will also introduce original pack dispensing (OPD) to allow pharmacists in Northern Ireland the flexibility to dispense up to 10% more or 10% less of a medicine compared to the quantity prescribed. That happens if it means that pharmacists can dispense the medicine in its original manufacturer's packaging. That will, again, support increased patient safety by improving patient access to safety information that is included in a medicine's original packaging. These provisions will also help community pharmacies to streamline how they manage workload by enabling greater use of automation in the dispensing process and releasing capacity in pharmacy teams to undertake patient-centred services that meet population health needs and support HSC transformation.”
“Exposure of an unborn baby to valproate during pregnancy is associated with a high risk of congenital malformations and neurodevelopmental disorders, which may lead to permanent disability. The aim of the amendment is to require manufacturers' original full packaging dispensing of those medicines and to further decrease the number of babies who are exposed to valproate in pregnancy. That having been said, pharmacists will be able to make an exception to whole pack dispensing on an individual patient basis, where a risk assessment is in place that refers to the need for different packaging, and where processes are in place to ensure the supply of patient information leaflets.”
“The statutory rule creates a specific requirement for medicines containing all forms of valproate to always be dispensed in their original manufacturer's packaging. That is to ensure that girls and women receive warnings regarding the risks of taking these medicines when pregnant. The manufacturer's original packs include specific warnings and unique pictograms on the label. They include a patient card, along with a statutory patient information leaflet, and an additional patient booklet highlighting the risks of taking the medicine while pregnant. <BR /> <BR />Medicines containing valproate are used in the treatment of epilepsy and bipolar disorder. There are known risks that are associated with medicines containing valproate, including significant risks to children of mothers who took medicine containing valproate during pregnancy.”
“I seek the Assembly's approval for the making of this set of draft regulations, which will amend the Human Medicines Regulations 2012 or, as they are commonly known, the "HMRs". The regulations will enable original pack dispensing of medicines and will require whole-pack dispensing of medicines containing valproate in Northern Ireland. <BR /> <BR />The HMRs are a set of UK laws that regulate the use of medicinal products for human use. They set out a comprehensive regime for the authorisation of products; for their manufacture, import and distribution; for sale and supply of the products; for their labelling and advertising; and for pharmacovigilance.”
“<BR /> <BR />If you had limitless money and were going to invest a huge amount of it in, for example, Daisy Hill Hospital in Newry, you would not do so if the Health Service Executive (HSE) in the Republic was about to do the same thing for the same services in Dundalk, nor would it be done vice versa. I have already signalled my intent, over the remainder of the mandate, to attend North/South Ministerial Council meetings in the health sectoral format. I look forward to meeting my counterpart. In short, I assure the Member that, yes, there will be times when we will look at this on an all-island basis and, at times, on an all-islands basis to ensure that we do everything that we can to achieve better outcomes.”
“I thank the Member for his question. I suggest to him gently — collegially— that just because it is not mentioned explicitly in the text does not mean that it is not implied. If you take that imaginary map that I have of Northern Ireland, it will be informed by whether there are accessible services on the other side of the border. Think about 2010 or 2011 and the breast cancer services provided at Altnagelvin Hospital in Derry/Londonderry. As I understand it, the business model included serving Donegal in the north-west of the island. For the South West Acute Hospital in Enniskillen, again, the business model stated that there would be cooperation across the border into Sligo and the west of Ireland.”
“<BR /> <BR />All I can say is that the bids or bid, depending on whether we put in one bid or submit bids individually, will be significant and will pose another great problem for the Minister of Finance in particular. I met her earlier today. I have no doubt that, if she could, she would give everybody what they want. I am in no doubt she is doing her best to unlock the Treasury's purse strings. I assure Members that I look forward to working with her and other Executive colleagues to get the best outcomes that we can. They will not be the ideal outcomes, because we are not in that place, but my objective is to minimise harm and to do as much good as we can.”
“That includes being aware that there is not a single Minister of the Northern Ireland Executive who is getting all the finance and resources that they need. There has to be a priority. <BR /> <BR />I am conscious that my predecessor made the point that, although we might say that we allocate budgets to Departments on the basis of an analysis of risk and of which cuts might pose the greatest risk to keeping people safe — clearly, that is not just in the Health Department — he did not believe that an equal measure was being applied. He believed that Departments were using different measures. There is still a conversation to be had in that area.”
“I thank the Member for his question, which speaks to the last conversation that I had before I came into the Chamber. I have seen options for bids, but I have not signed off on them. However, I imagine that that will happen before 6.00 pm today. The difficulty is that, if we bid for everything that we want, there is the danger that people will say, "Oh, there they go again. They're after the entire cake rather than a slice of it". The danger in not bidding for everything is that it will seem that we are not sending out the right signal, which is, "This is everything we need to keep people safe, to keep the healthy healthy and to heal the sick". There has to be a bit of a judgement call.”
“As I said, that is all within a big jigsaw with all of the moving parts. I promise the Member that it is certainly on my radar — it will not be ignored — but the actual resolution, within the big picture, is still to be worked out.”
“I thank Mr McGlone for his opening remarks. I repeat what I said at the beginning of my statement earlier: I extend my sympathies and condolences to our colleague Colm Gildernew and the wider family on their tragic loss. <BR /> <BR />I am aware of the issues with community pharmacies. I visited one in my constituency recently and got a briefing on such issues as clawback on the cost of some medicines versus the reimbursement, so I get that. I get some of the other issues too. I do not want to do what we have always done; I want things to be done better. I am looking at social care, primary care and GP surgeries. I think that everybody acknowledges that multidisciplinary teams work and deliver outcomes. Not only can community pharmacies do more; they stand ready to do more and want to do more. It is a question of how we facilitate that.”
“<BR /> <BR />I accept and welcome the Member as a critical friend. I see three of them over my right shoulder as I speak”
“The Member for Fermanagh and South Tyrone has asked a good question. I, too, represent a rural constituency: Strangford. I take the point that it is all very well saying that we can have centres of excellence that have better services, but that is no good if you cannot get there. I have already had discussions with senior colleagues in the Department of Health on the question of transportation. I have not spoken to the Minister for Infrastructure yet. I have yet to attend an Executive meeting, so that is all ahead of me. <BR /> <BR />I assure the Member that I recognise that we need to think imaginatively and sympathetically about people who, for whatever reason, cannot easily access the transport that they need to get from A to B in order to get better outcomes. If they cannot do that, by definition, the outcomes will not be better.”
“I thank the Member for her question. I see no particular need to undertake a new review. I would like, though, simply to quality assure the recommendations in the current publication. I am in communication with the Children's Commissioner, Chris Quinn, and I want to have an early meeting with stakeholders, not least the commissioner, to talk about how I can quality assure that the recommendations are good. I very much take the Member's point that a significant and tangible difference can sometimes be made without huge amounts of funding, resources or personnel. Let us lift our spirits. Let us say that, despite the challenges — they are severe — we can do things that make it better. Let us not have a council of despair. I am optimistic that we can do this a bit better.”
“Despite the apprenticeship, I am not there yet in assessing what the high-impact and catastrophic cuts are, and I do not believe that the trusts are either, although they are talking about a significant reduction in hospital beds, in care home beds, in domiciliary care and even a reduction in intensive care unit beds. If we are talking about harm in an ICU, we could be talking about the ultimate harm.”
“Again, the health trusts have already come up with solid plans to save a very significant amount of money with cuts that are assessed as low- and medium-impact — that means that there will be an impact on service users and patients — but we will now have to move into higher-impact and catastrophic cuts.”
“<BR /> <BR />As for the 52%, as I said earlier, given that, over the past number of months, we consistently argued with the Northern Ireland Office, His Majesty's Treasury and the UK Government that the block grant was not fit for purpose because it was based on population rather than need, that we succeeded in that argument and that the figure is now not 100% but 124% of spending in England, based on assessed or objective need, I do not understand how, when it comes to the Health budget, the Member says not, "What is your need?", but, "You have 52%: suck it up". It may be that 52% is what we need, or it may be that we need more than that to heal the sick and keep the healthy healthy.”
“I thank the Member. I am afraid that I do not particularly agree with her analysis — in my statement, I talked about areas where I will be doing work — but, for the avoidance of doubt, I am talking about reform. While that will be constrained by a lack of funding, as everything else and every other Minister will be, that does not mean that I am saying, "This is what I cannot do". I am saying that I will start the process of reform. At times, that may be controversial and very difficult. It may be particularly difficult, at times, for Members representing specific constituency areas. On top of reform, I am talking about mental health; I am talking about cancer care; I am talking about waiting lists; and I am talking about tackling health inequalities. Those are concentric circles, all overlapping and playing into one another.”
“I do not want to challenge the Deputy Speaker, and let us not quibble, but I thought that there were three.”
“That is just one example. I hope that the leader of the Opposition will accept that I am in the foothills, on day 6 as the Minister, but that is indicative of my thinking. It is not about the Department of Health working in a silo; it is about trying to work collaboratively with everybody else. It is not about just saying to another Minister, "Come and help me deliver". I am very conscious that we talk about educational underachievement, for example. Healthier children tend to do better in school, so there is a role for my Department in helping the Minister of Education. That is my modus operandi.”
“What I found back then on the Economy Committee was that, if you looked at the areas of deprivation that were in the top 10 in the league table, you saw that they were still in the top 10 after 10 years. They might have gone from fifth to sixth, but that was not enough. <BR /> <BR />When it comes to a Programme for Government, therefore, I will be about trying to achieve outcomes. Following on from my statement, one outcome that will be a good test of the Executive and of collegiate, collaborative working is tackling health inequalities, because that is not just a matter for Health. Those issues tend to arise in areas of deprivation. I believe that the Minister for the Economy and I can work well together to try to get our Departments to come up with inputs and outputs that secure actual better outcomes for people.”
“I thank the leader of the Opposition. I have not had sight of a draft Programme for Government, so I think that the best way to answer him is to say that I am rereading Mark Friedman's book 'Trying Hard Is Not Good Enough', which was the basis of an OBA, or outcomes-based accountability, Programme for Government, although some people might prefer the term "results-based". <BR /> <BR />It seemed to me, when I arrived in the House in 2011, that, as a government, we seemed to put a lot of emphasis on inputs and on outputs. For example, in considering an area of deprivation, you might say, "We have put £x million into it, and the outputs are that we've set up training facilities here and awareness facilities there". However, we did not go to the end of the equation. What were the outcomes?”
“I thank the Member for his comments and request. I am most certainly happy to do that. I am aware of the issues and of the fact that there are also issues with access to medicines. To some extent, those are global issues that we have relatively little control over, but that does not mean that we do not need to work hard to try to resolve them. I am aware, from family members who have learning difficulties and issues, of the service that they receive not just from the Department of Health but more generally. I am absolutely sympathetic to what the Member said. I will go away and speak to my private office to see whether we can make that happen.”
“I am putting a degree of store by the expectation that the budget will see some green shoots, if I may use that expression, as a result of the June monitoring rounds in a few weeks' time.”
“I am now keen to have a formal meeting with the chairs of all the committees of the BMA in Northern Ireland, because agreeing to something for one of them clearly has the potential to be repercussive on another, and I do not want to solve an issue in one place only to find that I have created an equal issue in another place. <BR /> <BR />In response to the Member's opening remarks, yes, I think that I have inherited my predecessor's problems. I will try to deal with those problems as positively as possible, because I think that everybody can agree that we want to inject a bit of hope into the future of the National Health Service while being realistic about the challenges, not least the budgetary challenges.”
“I thank the Member for his question. I am aware, as, I am sure, he and the House are, that the health service is an incredibly complex organisation with so many moving parts. To do something in one area inevitably is repercussive and will have implications for another area. As I am sure the Member is aware, I spent a few weeks as my predecessor's Assembly Private Secretary. I tried to use as much of that time as I could to do some reading and thinking, as well as conducting some meetings, including with the five chief executives of the geographic hospital trusts and a number of the royal colleges.”
“Personally, if I needed a fairly significant procedure, would I want to go to a hospital where the team performed that procedure once a week or somewhere where they performed it five or six times a day, five or six days a week? I know which one I would choose. Getting that configuration right is part of what I am looking at for reform. When I say "reform", that is just my preferred term for transformation. I hope that that answers the Member's question to some extent, if I understood it.”
“I thank the Member for the question and the point. If I understand the question correctly, it is about a different way of looking at our hospital configuration. Traditionally, we have looked at hospitals as stand-alone entities. Of course, there are people who, in an ideal world, would want an acute hospital at the end of every street. We know that we cannot get anywhere near that, nor should we try. In my view — I think that I am in sync with my predecessor, Robin Swann — it is about saying, "Let us view our hospitals as a network". It then becomes a question of who does what where, because not every hospital will do everything. That is right, because if a hospital has a specialism in a certain service, that allows the clinical staff, the consultants, to develop their expertise.”
“I repeat: I do not accept the narrative that we are in some sort of fatalistic spiral downwards. My confidence in that is based primarily on the people who run it.”
“There is a head of workforce planning in my Department. I was with him between being here and coming back, and we will have a meeting on Wednesday. I assure you what I assured him, which is that getting the workforce planning right and respecting the staff is absolutely up there in what I want to achieve. <BR /> <BR />I was going to say, "in the initial weeks", but over the next three years, I want to spend as much time as possible not in the Department but out and about, meeting and greeting. In the Long Gallery, about 100 of the 360 volunteers from the South Eastern Health and Social Care Trust were having afternoon tea, just as a thank you for their efforts. It is about not just staff but volunteers; it is about everybody who helps to make the National Health Service what it is.”