Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Mr Mike Nesbitt, the Minister of Health; Ms Tracey McCaig, chief operating officer of the strategic planning and performance group (SPPG); Mr Jim Wilkinson, deputy secretary of the healthcare and policy group; and Mr Chris Matthews, deputy secretary of resources and corporate management group. You are all welcome. Thanks for coming.

I will hand over to you, Minister, for some introductory remarks, and then we will take questions.

Mr Nesbitt (The Minister of Health): Thank you, Chair. I begin by making a point that, I hope, will resonate through the session. Governance and accountability are not abstracts; they are the mechanisms that ensure safe, high-quality care for every patient. Robust oversight, clear lines of accountability and timely intervention are vital, particularly given the sustained pressures on services and the constrained resources within which we are operating. As you know, trusts are independent legal entities. Accountability operates, first, with the trust itself, between the board, the chair and the chief executive. The chief executive, who is the accounting officer, is accountable for stewardship and probity through the permanent secretary and, in turn, through me to the Assembly.

My Department supports those arrangements through sponsorship roles, with Chris Matthews overseeing the five locality-based trusts and Jim Wilkinson covering the Ambulance Service. Performance management is delivered across business areas and, in particular, through the SPPG, ensuring clear oversight and timely support. Performance management is perhaps the most substantial task in sponsorship. The support and intervention performance management framework, which we introduced in 2024, provides for five levels of escalation where issues require attention and improvement. Since December 2024, 87 issues have been highlighted under the framework, and 62 of those have subsequently been improved or resolved. Currently, 51 issues remain, all with clear improvement trajectories. Bimonthly accountability meetings are held with the trusts' leadership, ensuring that concerns are addressed and progress is actively monitored. Separate formal meetings between the permanent secretary and the trusts' chairs and chief executives focus on governance and assurance at the very highest level. Those arrangements have helped to build a more responsive, transparent system in which issues are identified early and addressed effectively.

Alongside performance, quality and patient safety remain my top areas of focus. It is the responsibility of trusts to deliver safe, high-quality services and to maintain robust clinical governance systems. To enhance the arrangements, each trust is establishing a dedicated patient safety and quality committee. Those will be standing committees of corporate boards operating within a regionally standardised approach, providing enhanced oversight, governance and assurance arrangements in matters of patient safety and quality. While all trusts have established governance arrangements in place, by formalising the new committees and standardising practice, we are creating structures that support trusts to have a dedicated board committee focused specifically on preventing harm, reviewing incidents or embedding learning consistently across all trusts. The initiative also responds directly to a recommendation from the independent neurology inquiry.

Central to patient safety, learning and improvement is the serious adverse incident (SAI) process, which my Department is currently redesigning. The new patient safety incident framework aims to streamline and simplify reviews, ensuring timely conclusion, embedding learning to prevent recurrence and placing those affected by incidents at the heart of a compassionate, person-centred review. Following consultation, officials are carefully considering responses, and the final proposals are expected in April. Once finalised, a managed transition and implementation phase will ensure that trusts are fully supported in embedding those improvements. The aim is to create a system where lessons are acted on quickly to the benefit of patients and staff.

I turn to the Belfast Health and Social Care Trust. Members will recall the attention that this trust has received. Last May, the trust was placed at the highest level of the support and intervention framework (SIF) following the independent external report on cardiac surgery. Given my concern, I commissioned a further review by Peter McBride and Dr Jennifer Hill. They examined culture and governance. Their work highlighted important areas for improvement, particularly in leadership, culture and accountability. My officials continue to work with the trust through monthly executive-level meetings. They are focused on overall leadership, culture and improvement in both the cardiac surgery service and the trust more widely. That includes monitoring progress against all recommendations made by the independent external review and the McBride/Hill report. Progress has been demonstrated by the trust through the process, and it is likely to lead to a de-escalation, with clarity on the expectations for the next stage.

I hope that those examples illustrate the practical impact of governance and oversight. The frameworks that we have put in place are not just about structure; they are about ensuring that patients experience safer, more reliable care; that staff receive guidance and support; and that lessons from incidents are learned quickly. The combination of the support and intervention framework, the patient safety and quality committees and wider trust governance arrangements and the SAI redesign contributes to a system where accountability should be clear, interventions proportionate and improvements continuous. Throughout my tenure, we have delivered reform that is designed to strengthen governance and accountability, from clearer performance frameworks to the establishment of the dedicated patient safety and quality committees. We have introduced mechanisms for proportionate intervention, ensuring that trusts receive support where needed but are also held accountable. Those measures ensure that oversight is transparent, structured and centred on patient outcomes.

Governance and accountability are not just ends in themselves but tools to protect patients, support staff and deliver sustainable improvements in our system. By combining strong frameworks, clear oversight and a culture of learning and improvement, we ensure that every trust operates to the highest standards. The reforms that we have implemented and those that we have planned will provide a robust foundation to achieve those goals.

Thank you, Chair.

The Chairperson (Mr McGuigan): Thank you, Minister. I commit that I will ask questions on trusts and oversight, but, given the week that we have had, I want to mention the devastating consequences of violence against women and girls that we have seen in recent days: two devastating cases in the North in the past week on top of an already intolerable situation. The instances this week are not separate from but rather reflect the wider systemic crisis of violence against women and girls in the North. Women's Aid has long been on the front line of the response to that, providing life-saving refuge, advocacy and safeguarding support for women and children. Despite that crucial role, the Department of Health cut its funding by 50% in 2023 and withdrew its core grant funding completely in 2024. Given the seriousness of what we have seen this week and the ongoing crisis of domestic and sexual violence against women and girls and given the central role that Women's Aid plays, will you undertake to review that scenario, as your Department said it would in 2023 and 2024 when it cut and then reduced that funding, with a view to reinstating that vital funding for Women's Aid?

Mr Nesbitt: If you are talking about core funding, Chair, we did not cut Women's Aid out this time. Two years ago, we redesigned the scheme, and we redesigned it again for the coming year, because it had been around for over 20 years and new charities could not even apply for it. What happened was that Women's Aid did not meet the criteria to get anything. There is a very important distinction between us actively deciding to withdraw its funding and it being unsuccessful in the application. I would much rather that it was receiving core grant funding from the Department of Health. That is why we provide feedback to unsuccessful applicants every year. I was in Fermanagh with Women's Aid after the dreadful murder there a few months ago. I want to support the charity. I have come to you from an Executive meeting that started at 10.00 am and is still ongoing. I hope that I will be forgiven if I am breaking confidence by saying that the substantive discussion this morning was on violence against women and girls and the two deeply regrettable, tragic murders.

The Chairperson (Mr McGuigan): It is an Executive focus; we are all aware of that. I am glad to hear that it was the focus of your meeting today, because we need to get it right across the Executive. I hear what you say about the criteria and some groups missing out. However, given the Executive's focus, I ask you, when you leave the meeting, to see whether anything additional can be done to help and support Women's Aid and the work that it does.

Mr Nesbitt: I will certainly do that, but we are talking about governance. We have to have governance structures for how we distribute the money.

The Chairperson (Mr McGuigan): Earlier in the week, I had a meeting with representatives of the independent care sector. You will not be surprised because, the last time that you were here, I laboured heavily on the impact that that sector can have on relieving pressure on our secondary care system. I am not getting a sector that seems to be getting better, unfortunately. It seems that, every time I meet the representatives, the problems are increasing, whether they relate to the workforce, the living wage, which we will come to, core funding from the Department and trusts or the engagement and coordination from the trusts.

I was told by those I met that the Department gave funding to cover unforeseen costs in 2025 — the National Insurance hike etc — but a number of those providers have told me that that money is insufficient to meet their needs in that and that there are ongoing conversations between the trust and them. They have told me that, in some cases, the deficit is anything from 3·5% up to almost 5%. They have said that the Department has inspected the Department's figures, but they ask that the Department inspect their figures independently. They will open their books to allow that, so that there can be some kind of resolution. I welcome the fact that the Department has given them money to do a certain thing, but I am confused as to why people who are at the front end of that are saying to me that the money is not sufficient to do the thing that it was meant to do. I appeal to the Department to look at that again and engage with the independent care sector to resolve that issue. That was last year's position, but, if I may quickly pivot to this year's position, I am told that, given the current context, the 78p uplift is not going to do what it needs to do.

Mr Nesbitt: I will pass to Tracey in a second, Chair, but, on a broad point, what I want to acknowledge is that, if we are going to shift left towards prevention and early intervention — by the way, my considered view is that, if we do not do that this calendar year, it may be too late, because there are forces at work that could take us in directions and, if it develops a certain momentum, it will not be reversible. I am determined that we make a significant step towards shifting left before the end of the mandate. To do that, we have to have a good relationship with GPs, community pharmacists, the dental service and the independent care providers.

We all know that, when it comes to the issue of flow through our secondary care hospitals, the problem is community capacity. We need to grow the community capacity. It is not about bigger emergency departments (EDs); it is about the back door. I do not feel comfortable that we have got the relationship right, so I am determined to work on that.

The real living wage, as I have told you before, was the most difficult decision that I have made in my 22 months or whatever of being in post.

On the finances, I will defer to the expert.

Ms Tracey McCaig (Department of Health): You set me up well for that. I declare a conflict of interest, as I have a very close family member who works in the sector.

On the conversations with independent providers, the financials are challenging for each of them. The uplift was provided, which did increase. When the national minimum wage and National Insurance contributions increased, those percentages were applied to the previous existing values. That does not mean that independent providers feel that the rate per hour, in the totality of their business, is enough. We are certainly being reached out to by lots of independent providers from lots of sectors who say that the uplifts are not enough. What we have done is to apply it to last year's value. I remind members that, at one point, we pegged that to a value that we very much had negotiated with the independent sector, and we have been working from that point for all of those essential statutory increases, such as the national minimum wage and National Insurance contributions. However, providers may feel that, in totality, when they run that through their business model of how they run their business, it is not enough. I understand that. It is certainly a sector that we need and with which we want to have good relations. It is a regret that we are in that position at this point.

The Chairperson (Mr McGuigan): I thought that the Department was saying that what it gave was adequate for what it was supposed to be. You seem to be saying that you recognise that it is not enough.

Ms McCaig: It is, at rate per hour for the pay part of our model; it absolutely is. To make sure that it was sufficient in that regard, we modelled it at 16 hours and 24 hours, because that is the model that the independent sector would say between 24 and 48 hours. We modelled it at that, and we modelled it at 40 hours. For the pay rate, there is certainly enough. I cannot speak for every independent business and how they run their business or whether it is sufficient for them when they take all of the hours and add them together and the total amount of activity that they do. We have on-cost additionality on that. I am sure that they might say that there are a range of pressures, as do other providers.

On the pay rate, we have increased it on the basis of the percentage uplifts for national living wage and for National Insurance. Look, I understand that it is a challenge. It is not a sector that has a significant rate of pay, hence the Minister's stated commitment around the real living wage and other things, but we have increased it by those percentages and modelled it at different levels of part-time and full-time hours to make sure that it was sufficient.

The Chairperson (Mr McGuigan): I agree with the Minister. The last time you responded to me, you said that some of your decisions were counter-strategic. Everything that, you say, you want to deliver, I certainly want to help and support you to deliver, but it is confusing. First of all, there are 30,000 workers in the sector, so it has a substantial impact on the health and care that we can provide. It is the lowest-paid workforce that we have. The people who are trying to run those care providers tell us that the system is ready to collapse. They are literally losing people to other employment, and they cannot retain staff.

There are other issues that we just do not have the time to go into, such as the relationships with the trusts around getting people out of hospital. They tell me that they have capacity and that the trusts are not using that capacity. What I am appealing to you today for, Minister, is that we up our engagement with that sector. At present, there are probably 500 people in hospitals across the North who should be out of those hospitals. If we do not get to grips with the pay and funding issue — I have not even had time to raise the increase in fuel costs — it will have a huge impact on the statutory trust staff who carry out this service, as well as the independent sector. We are in real danger of adding to the problems that we have if we do not get to grips with this.

Mr Nesbitt: It was only this week that I was made aware that the Integrated Care Partnership (ICP) is contesting the agreed narrative about capacity in the community. I am interested in that because, if that turns out to be the case, there is a problem somewhere else that needs to be resolved urgently.

The Chairperson (Mr McGuigan): Can I get a commitment from you today, now that you have said —

Mr Nesbitt: Yes. Absolutely.

The Chairperson (Mr McGuigan): — that you will go away and look at this from start to finish?

Mr Nesbitt: I have already started.

The Chairperson (Mr McGuigan): OK. Thank you.

I have 100 other questions, but I have to be fair to everybody, so I may get the chance to let myself in later to ask some of them.

Miss McAllister: Thank you for coming today. I have a few questions, and I will try to keep them as quick as possible. They are mostly around governance and assurance.

My first question is on waiting list validation. Three out of the five trusts have provided figures on waiting list validation. Have you or anyone in your Department had time to examine them?

Mr Nesbitt: No. I am focused on the year end, which is coming up so rapidly.

Miss McAllister: So, for example, you will not be aware that, in the Belfast Trust, roughly 6% of people — 2,116 — died before they were treated. They are counted in the waiting list validation. I assume that you are not aware of that figure.

You are aware. Are those people included? Some 7,600 people were removed because they did not write back, and that was without any clinical interference, clinical oversight or clinical approval. Are those people — the 7,000 and the 2,000, which adds up to 9,000 — included in the success story of driving down waiting lists in the overall figures and percentages?

Ms McCaig: Perhaps I can give you some of the answers. On the 7,600 figure you provided, I have 7,700 for no response to validation by the trust. It should be noted that that is no different from the process we would have used before: removal to no response due to partial booking. It is a process that has been there for some time, and we are constantly wanting to cleanse our list to make sure that we understand that people still wish to avail themselves of the services, have not moved to another jurisdiction etc. That is part of that process.

We count our waiting lists in two ways. One is saying, "Here is the end. This is the level of the waiting list", but you are also being provided with information on how many active treatments we have delivered during the year at the same time. We are trying balance both of those things so that we do not give misleading pictures on either of those factors.

Miss McAllister: The picture that we get, as a Committee, is that there were x number waiting in this year, and now there are x number waiting this year. It adds to the narrative that it is overall just positive. We have had clinical professionals come to us with concerns that people are being removed from waiting lists without any clinical input. Where is the oversight?

Ms McCaig: That process is constant. In any good system across the whole of the UK and, I am sure, in other jurisdictions, there is a process of validation that is both administrative and clinical.

Miss McAllister: Those are separate. There is administrative validation, and there is clinical validation. They are separate, and those two figures are kept separate.

Ms McCaig: They are, because we want to keep oversight on both those elements of that. However, when we provide information on waiting lists, we are providing the numbers of patients whom we have treated. When we talk about how many additional diagnostics there have been, we are talking about people who have gone through a process, but we are also saying what the waiting list number is now. If we did not validate, we would be putting out an incorrect position on the number of treatments for which we are likely to have to plan and have capacity. It is important that we do both those things.

Miss McAllister: I do not disagree: validation is important. However, clinicians come to us confidentially and say that they are concerned that that validation is happening not because of productivity but outside of clinical reasons. That can skew figures as to, "This is what we have done", as opposed to, "This is what we have treated".

Mr Nesbitt: I get the purpose of the question, but — keep me right, Tracey — administrative validation is about, basically, whether you are still around, and clinical validation is about having a discussion, effectively, on the risk or reward of going through a procedure. Some people will say, "I am OK now".

Miss McAllister: Those are non-responses. A total of 7,640 people did not write back. Another 2,000 people died. That is over 9,000 people. There is concern that, one, people are dying before they get treated — perhaps a lot of them are elderly or frail — and, two, if someone has moved or is busy, as people are, they do not see correspondence from them; they do not reply. There is concern that those are not clinical decisions. Where is the oversight of that outside the trusts? I respect that it is the same in the UK: that does not mean that it is OK, though. Where are the governance and oversight arrangements for that?

Mr Nesbitt: If you were in real need of a procedure and you had missed a letter, you would not just leave it at that. You would go back to your GP.

Miss McAllister: Then you would be put back on the waiting list from which you were removed, and you would be waiting again.

Mr Nesbitt: Not necessarily.

Miss McAllister: That is what we are being told. I want to know where the oversight is by the Department.

Mr Nesbitt: You have been told that, if you miss a letter and you go back to your GP, you have to start from scratch?

Miss McAllister: You are put back on the waiting list, because you are not a priority. You are just put back on the waiting list and you are back to waiting one year, if not four years or three years. That is happening to people. My question is —.

Mr Nesbitt: If there are examples of that, we can certainly look at it.

Miss McAllister: Absolutely, but where is the oversight, though? I want to know where there is oversight from the Department, because we are talking about oversight and governance with regard to those statistics.

Ms McCaig: I suppose that the oversight is in the fact that we have a full set of figures that we look at. We look at them across specialty and across each of our trusts. At the same time, we have to say that this is a process that is set up in our arm's-length bodies that manage those processes. They have that direct process. However, we have oversight of it at our level to ensure that we can see the numbers. If we saw something that looked askew or did not sit within a trend that we would expect, we would certainly —.

Miss McAllister: So you get those figures.

Ms McCaig: Well, I am sitting with them in front of me now. We see those figures routinely.

Miss McAllister: That brings me nicely on to my next question, which is about the Northern Ireland Audit Office report 'Partnership Working: Departments and Arm's Length Bodies', which came out yesterday. It found that the Northern Ireland Fire and Rescue Service (NIFRS) had more staff to oversee it than the health trusts, despite the health trusts — this is coming from the Audit Office report — having a spend that is 5,000 times greater than that of the Fire Service. Can you comment on that with regard to oversight? Why does the Fire Service, with a spend of £130 million, have more staff providing its oversight and governance than the trusts, which have a spend of £7 billion?

Mr Jim Wilkinson (Department of Health): I do not know. I am trying to think of our departmental structure. I do not recognise that.

Mr Chris Matthews (Department of Health): We would need tolook at how the Audit Office classified what counted as oversight. Instinctively, that does not seem right to me.

I am corporate sponsor for the Fire Service as well, so that is not a picture that I necessarily recognise. I am not saying that it is not a fair representation; I just do not understand how that is being presented.

Miss McAllister: I am happy for us to come back to that.

Mr Wilkinson: I have sponsorship of the Northern Ireland Ambulance Service (NIAS), the Northern Ireland Blood Transfusion Service (NIBTS), the Regulation and Quality Improvement Authority (RQIA), and the Northern Ireland Medical and Dental Training Agency (NIMDTA). Each of those has a team overseeing it, so, cumulatively, it just does not feel right.

Miss McAllister: Hopefully, it is incorrect. I am happy to go back to it.

My other question is about oversight of commitments that you gave, Minister. You committed to provide £13 million to help parents with respite. The trusts told us that they were in good communication with families. We received feedback since that they are not, in fact, in good communication with families and that last-minute respite was cancelled. Just last week and the week before, families that were approved for respite and were not getting it were sent £500 or £250 in the post because the trusts simply could not meet their needs. I just want your comments on that. One woman said that she might as well throw the money out the window because it did not get her what she needed. How is that helping families? How do you oversee that and hold trusts to account when it was a commitment that came from the Department?

Mr Nesbitt: First, I am unaware of such cash offerings.

Miss McAllister: I could check. It was not necessarily [Inaudible.]

Mr Nesbitt: I find that puzzling. I am disappointed to hear you say that the lines of communication are not good. I have met the 'Spotlight' mums on a number of occasions. I was with a relative of one of the 'Spotlight' mums as recently as last night, and she would always report if there were issues. Although there was nothing to report last night, on previous occasions she was pleased to report progress, so I am disappointed to hear that.

Ms McCaig: If would be helpful, obviously with the person's permission, if you could share that information, as I would certainly want to pick that up.

You asked how we govern and oversee what we have done. In my team — at present it is called "Community Care", but it will change its name next week — you would have met Dr Ciara McKillop. She has a team that would absolutely be over that. It has been working closely and liaising with every trust as the new schemes were implemented and worked through. We have had significant developments with substantial additionality.

From time to time, something might happen at the last minute, and that is entirely regrettable and disappointing for the families looking forward to respite. We have a detailed programme that monitors the additionality to see where there are problems and how they might be resolved across the system, not just at single trust level — how they might share and work through those problems for the benefit of all families.

Miss McAllister: Coming from a finance role and background, do you think that throwing money at the problem is a priority? Does that solve issues? Should that be happening?

Mr Nesbitt: It is one of those matters in which, unusually, money is not the big issue. The big issue is buildings and workforce, and it is incredibly fragile because, if one service user or patient comes out of the blue, it can disrupt the entire apple cart, because it is so tight.

Ms McCaig: What I would also say on the funding, in the way that you described it, is, "Probably not". However, we have direct payments that we use in other schemes, so I do not know whether it is a version of that.

Miss McAllister: Those who got direct payments got less; those who did not get direct payments got more.

Ms McCaig: I do not recognise that specific, but I will go back and ask.

Miss McAllister: That happened in the past two weeks. I do not feel as if I need to give names, because that happened to families.

Ms McCaig: That is OK. We will make enquiries, because it is not something that I am aware of. We will make enquiries to understand it more.

Mrs Dodds: Thank you for the presentation. I have a number of questions, so I will get straight to it.

I was contacted two weeks ago by families involved with Muckamore. They have care packages for their loved ones, who have been greatly harmed, and great distress has been caused. You said, Minister, that, when the report comes, it will be one of the biggest scandals in the history of the health service.

Those families have now been subjected to further review of their care packages by the Liaison Care group. That has caused significant distress. You can imagine the upset that it has caused. Just yesterday, I was contacted by a lady whose daughter is in a specialised facility and is non-verbal with complex needs. The lady thought that she was going to her yearly care review meeting, but, when she logged on, there was a representative in attendance from the South Eastern Trust and three people from the Liaison Care group in England. The meeting lasted three hours, during which that mum was subjected to enormous distress. She contacted me because her greatest fear is that her daughter's care package will be cut. How do you feel about that, Minister? Will you apologise to the Muckamore families in particular and to all families who are being subjected to that process?

The company openly advertises on its website that it is there to cut NHS costs. People are completely distressed by what they have been put through. I have heard of three or four trusts in Northern Ireland that are using that company. Can you confirm how many trusts are using it? Surely, we need to apologise to those families for what they have been put through.

Mr Nesbitt: First, I acknowledge that what went wrong at Muckamore was dreadful. I will reserve judgement until the final report is published. For accuracy's sake, I said that I believed that the BBC 'Panorama' programme was looking at it as the biggest scandal in the history of the National Health Service.

With regard to the company, the principle of reviewing packages is fine. It happens all the time to make sure that service users and patients get the right package and to ensure efficiency. If efficiency relates to money saving, I do not have a difficulty with that principle. However, I have a lot of questions about what is specifically happening with that company. I have asked a lot of questions, and I have asked officials to get the correct answers to them. Who commissioned the company? Why did they commission it? Why are we using a company that is not based in Northern Ireland? What are its credentials? What are its competencies? There may be a question for the Northern Ireland Social Care Council (NISCC). Are all those operatives acceptable to NISCC? There may be a role for the Regulation and Quality Improvement Authority. A number of issues need to be addressed.

I very much regret the distress of families such as the parents of a non-verbal patient being asked questions or a carer being asked to demonstrate how —.

Mrs Dodds: Yes, it is shocking.

Mr Nesbitt: — the biting —.

Mrs Dodds: I am glad that you have clarified that. All trusts seem to be involved. You are nodding, Tracey, so I presume that that means that all trusts are involved. There seems to be some joint commissioning or individual commissioning — I have no idea — but it is a serious issue.

If we are to judge our society and our health service by the compassion and care that we give, we have failed on that one. Minister, I have written to you with questions from the RQIA, which monitors all the issues, and it says that it was not involved or instructed about any of it.

Mr Nesbitt: There are serious questions to be asked.

Mrs Dodds: I look forward to that. It would be great if you could come back to the Committee with answers to those questions. It is a serious issue.

The Chairperson (Mr McGuigan): Sorry to interrupt, but I am not clear. You are asking questions, Minister, about that. Does that mean that the work that this company is doing will be halted until you have the answers, or will the work continue?

Mr Nesbitt: There will be contractual arrangements between the trusts and the company, so I am not sure that I can order it to cease. However, all the trusts using that company now know that I am asking extremely serious and pertinent questions about that decision.

I have to go back to the fact that I have, since I took up post, consistently said to the chairs and chief executives that we have to make sure that every penny that we spend is spent wisely. This financial year, we started with a £600 million shortfall, and we are going into a financial year with an £800 million shortfall. I cannot criticise them if they say, "Let us bring in experts to review something on our behalf." However, there is a question about that company and how it goes about its business.

Mrs Dodds: I am glad that you have talked about spending money wisely. I asked a question about the cost of the extensions to the contract that were given in relation to the maternity hospital. In your answer, you said — it is part of the overall cost; it is not additional to what we already know — that £17·4 million — I am reading your answer — was charged to the contract because of extensions that were requested for — I am looking at it here — fire safety matters,; the gas arrangements, which, we know, at the end were probably not fixed and, I think, are one of those things still being addressed; internal ducting and cabling; emergency call lighting systems; and so on. Therefore, £17·4 million of that contract was on the extensions.

I then asked about the extensions to the contract for the children's hospital. The answer came back that £1·4 million has already been spent over and above for extensions to the contract in relation to changes that you or the contractor have requested. Have lessons been learnt from the maternity hospital, or are we just going to have a repeat of the same?

Mr Nesbitt: I would like to think that lessons have been learnt. I know that this is capital funding, but it is still public money.

Mrs Dodds: It is, absolutely.

Mr Nesbitt: You and I both have a passion for finding £5 million to turn our thrombectomy/stroke service into a 24/7 service, so that the 160 people a year who do not get that advantage because their stroke comes at the wrong time of day get that service. Every penny should be a hostage in the current financial situation. We are talking big figures here. I pass to Chris.

Mr Matthews: Absolutely. On your point about lessons being learned, it is standard practice on every major project that we have an after-action report to look at what we could have done better and what should be rolled forward into the next project. Indeed, some of the additional costs for the children's hospital are through the redesign of the water system, which is based on learning from the experiences with the maternity hospital.

As a Committee, you will often have heard evidence about estates issues. In Belfast, you have heard the explanations about how complicated and difficult many of those projects are. We have given evidence on the enhanced governance arrangements that we have brought into place to support Belfast in taking through those major projects because they are complicated and difficult.

On the main point, absolutely, there are always lessons to be learnt and ways in which we can do better. In approaching the children's hospital —

Mrs Dodds: The Chair will shout at me at any time now, because he always does [Laughter.]

I would like you to write to us and tell us what lessons have been learnt and how those points will be improved. That is really important.

I will ask about another question that I tabled, Minister. I asked you whether the water in the maternity hospital was drinkable, because I have been told by people who are regularly in the new building that new signs have gone up to say, "Do not drink the water." The answer that came back to me is:

I can think of no new building where the water would not be drinkable. That sounds ludicrous to someone who is looking in from outside. I would like you to explain this: are there any other new hospital buildings or any other new buildings where the water is not drinkable from the get-go? Is the issue with the water in the maternity hospital a result of the chemicals being poured down the pipes, meaning that there are now some heavy metals and microplastics in the water? Is that why the water is unsafe to drink? What was found by the Scottish engineering consultants who reported in November that was so concerning that it led to those signs going up?

Mr Matthews: I completely understand the confusion on that point.

Mrs Dodds: I am not really confused. I just think that, if we have spent £100 million on a new building —

Mr Matthews: OK, so I think that this —

Mrs Dodds: — we should be able to drink the water.

Mr Matthews: As I understand it, that is a follow-up to the appearance of the trust before the Committee, at which time the chief executive said, I think, that the testing of the water had suggested that it was safe to drink. We have since clarified through our arrangements with the trust the apparent dichotomy between that statement and the signs that have gone up.

I am unfamiliar with the results of the Scottish engineering report, as it has not been shared with me, but the explanation from the trust is that, although the most recent testing of the water shows that it is safe, general practice, when it is a building site, is to say that it is probably not a good idea to drink the water because other things might have happened since the last tests, considering that construction work and so on is going on. The signs are a general precaution, but, when the chief executive was before the Committee and talking about the safety of the water, the most recent testing had shown the water to be safe. It is, however, a building site, and that position could change as work goes on.

Mrs Dodds: Chris, I have walked through the new hospital, as has everybody here, and I can say that it is not a building site. It may not be safe for patients to use, but it certainly is not a building site. Can you come back to me on this? It is important that we know. We know that there has been a flushing programme in the pipes for a considerable time, and I have been reliably informed that chemicals have been used as part of that flushing programme. Are those chemicals now impacting on the pipes throughout the building?

Mr Matthews: To my knowledge, no, but we can come back to you to confirm that.

Mrs Dodds: That would be really valuable.

Mr Nesbitt: It might be appropriate to say at this point, Chair, that I put the trust into level 5 of the SIF, which is the highest level. I am now bringing it down to level 4. That is largely because I wish to express my confidence in the new leadership team: Stuart Elborn as the new chair and Jennifer Welsh as the new chief executive. I think that we have the right people in charge. The cardiac surgery department is coming down to level 3, but that is about its clinical performance rather than its culture. The Belfast Trust's estates services is separate, because we put it into special measures before the support and intervention framework was introduced. At the same time, we are thinking about where to place it in the SIF, but Belfast Trust is down to level 4, and its cardiac department is down to level 3 for clinical.

The Chairperson (Mr McGuigan): That is good news.

Diane, you have one more quick question.

Mrs Dodds: On the subject of trust in trusts, will you tell us when we will see a public inquiry into the cervical screening scandal in the Southern Trust? On Saturday, I attended a coffee morning in memory of Lynsey Courtney. The families affected are completely devastated. They have no assurances that the trust is acting appropriately or that it acted appropriately: in fact, it did not act appropriately. They believe that an inquiry is the way forward, and the Committee has committed to supporting a public inquiry as the only way forward. Professor Atherton's report should be with you soon, if it is not already; I do not know whether it is. We would like to hear more about that issue soon.

Mr Nesbitt: I have not received the report from Professor Atherton yet. This is not a criticism, but one of the reasons for that is that the Ladies with Letters said to me that, if he simply reviews the extant reports, he will not have all the information that he needs, because there is information that has not been included in the reports. That caused a delay, because we asked the Southern Trust to go through all the paperwork again. That is why I have not had the report yet.

You should be aware that, in the terms of reference, I have asked him to advise me at the conclusion of his work on whether I should call a public inquiry. On that basis, I am not in a position to call a public inquiry at today's Committee meeting.

The Chairperson (Mr McGuigan): Thank you.

Mr McGrath: Minister, how did you get on with finding out about the Downe Hospital?

Mr Nesbitt: I have nothing to report to you just yet.

Mr McGrath: This session is about governance and accountability, and, as the health spokesperson for the Opposition, 48 hours ago, I tabled a question for written answer to you.

Mr Nesbitt: I will pass to Tracey.

Ms McCaig: Just for clarity, are you referring to St Patrick's Day?

Mr McGrath: Yes.

Ms McCaig: I was advised by the trust that it was due to an individual's unexpected absence. At that point, normal contingency arrangements were put in place, including Phone First and all the other parts of the urgent care provision. I was advised that it was down to unavailability of staff due to an absence.

Mr McGrath: How many other times have urgent care centres across the North had to be downgraded as a result of staff shortages?

Ms McCaig: I do not have that information for you. However, there are contingency plans not just for urgent care but for all our services in instances where there is an unexpected absence. Whether we are talking about cardiac care or otherwise, contingencies will move in behind, and processes are in place. We cannot always expect that staff who are on the rota will be available or that we can get a replacement in due course. It is not what we plan for, but we also have to have contingencies should something happen.

Mr McGrath: Have you ever heard of an urgent care centre having to be closed because of staff shortages?

Ms McCaig: I do not have information on that.

Mr McGrath: Is it that you have not heard of that or that you do not have information on it?

Ms McCaig: It is not information that I routinely collect, but I followed it up because of your question. I do not routinely get that information. We are monitoring it. Our trusts' processes kick in at that point. If a trust felt that the contingency would not work, the situation would be escalated to us, but it would be in multiple layers. The trust would issue an early alert, and we would pick it up from that point.

Mr McGrath: Minister, when it comes to accountability, I want you to track that issue. I would bet my bottom dollar that there has never been an instance of an urgent care centre being shut because of a lack of staff, but it happened in the Downe. That continues to feed the narrative that people in that area feel that their healthcare is secondary to that of everybody else.

If I was the manager of a trust with an urgent care centre in the Ulster Hospital, one in Lagan Valley Hospital and one in the Downe and the Downe was short of staff, I would have shuffled staff around. I would reflect on the fact that the Ulster has an emergency department, a minor injuries unit and an urgent care centre, all of which were functioning on that day, yet the Downe had to be downgraded. That is felt by local people, and they are unhappy about it.

Mr Nesbitt: I will certainly feed that back to the South Eastern Health and Social Care Trust.

Mr McGrath: On another issue, what message do you have for parents across the North whose children are at special schools, all of which have had their summer schemes cancelled? They have been cancelled because they cannot guarantee the children's safety during those schemes because of multiple cutbacks by the Department of Health. I think of the little bit of comfort that is given to parents and families and the opportunity for those children to enjoy a social experience outside school. That has been wrested from them and thrown away, leaving them for two months without access to structured activities because of further cutbacks. What message do we have for those families?

Mr Nesbitt: While I do not want to dodge the issue, I note that you said "two months": the summer schools were to last for two weeks. Do you accept that?

Mr McGrath: The children are away from school for two months: July and August. The summer schemes were to be for two to three weeks during that period, so they now have to go two months without any structured activities.

Mr Nesbitt: We are looking at contingency plans to cover that period. The suspension of the summer schools is very disappointing, as they are important to all the children who attend and their parents and carers. I am trying to understand why they were able to go ahead last year but not this year and what has changed in the intervening 12 months. I have sat in a meeting room — it might have been this room — with some of the principals, officials from the Department of Education and the Minister of Education. The Chief Nursing Officer has been looking at the issue for some time.

I was surprised to hear that announcement today, because one of the issues was that the Department of Education is not aware of all its classroom assistants' qualifications. Some classroom assistants do not have contracts that last 52 weeks; others do. My proposal was that the classroom assistants who are on 52-week contracts could be switched to look after the summer schools for two or three weeks. I am not sure why we have given up so early when the summer is still some months away.

Mr McGrath: I hope that that can be pursued. It sounds very much as if you and Minister Givan want to have a row about the official title of somebody's job during a certain time.

Mr Nesbitt: Not at all.

Mr McGrath: There is a clear message that the summer schemes must happen. They have happened for a generation. Hearing that they are being cut and about the impact that that will have on families is terrible. I implore you to work with Minister Givan to deliver the summer schemes, which give the families two weeks' respite over the summer period.

Mr Nesbitt: To characterise my work with Mr Givan as looking for a fight is deeply unfair, because it is just wrong.

Mr McGrath: You said that it is the terminology of the classroom assistant's title or where they work. That is passing —

Mr Nesbitt: No. I said "qualifications".

Mr McGrath: — the buck to Minister Givan.

Mr Nesbitt: I am saying that an official from the Department of Education said that they did not have full knowledge of the qualifications of classroom assistants: that is just a fact. That is not poking at anybody.

Mr McGrath: You said that Minister Givan's staff do not know the qualifications of the people who work for him. It is farcical that one end of our Executive does not know what the other is doing. You are saying that one part of the Executive does not even know the qualifications of the staff who work for it. I know one thing —

Mr Nesbitt: Whose qualifications?

Mr McGrath: — it is the families who will be impacted. I have had multiple emails today from families who are spitting fire over it. We will have to see how it goes.

Chair, I have a final question. Have any additional measures been put in place should we have an outbreak of meningitis, given that many of those in England will now travel back to Northern Ireland for the holidays? Has anything extra been done in the past two weeks above and beyond what would normally be in place?

Mr Nesbitt: There was a four-nations call last week when I was on what you would, no doubt, describe as my junket to the United States. The UK Health Security Agency (UKHSA) gave some reassurances about the outbreak’s containment in the south of England. The outbreak came specifically from the Club Chemistry nightclub. There is a reasonable degree of assurance that it will be contained there. We are trying to ascertain the small number of students from here who will come back for the Easter holiday.

We have been assured that a pupil at an east Belfast school who had meningitis did not have meningococcal meningitis, and that is part of the normal run of meningitis. There is, I think, an average of one case a day across the United Kingdom. We have a sufficient supply of vaccinations that work with that strain of meningitis. We are reasonably assured that we are not on the brink of something disastrous.

Mr McGrath: It is good to hear that. To correct you, the only person to use the word "junket" is you. I suggested that you were "enjoying the festivities". If you are suggesting that you did not, perhaps you should not go back next year. I made that remark, but I did not use the word "junket".

Will you do anything to increase the number of people who take the vaccination? The year-12 programme was for those who are now in university and could be travelling back. Do we know the drop in the vaccination rate?

Ms McCaig: We would have to ask the Public Health Agency (PHA) for a fuller briefing.

Mr McGrath: The figure was in the mid-80s and dropped to the mid-60s: just short of 20% fewer people are vaccinated. That is why there may now be a need to look at vaccination. The Minister has assured us that there are extra precautions and checks in place. We hope that nothing will happen here with the return of those students because people are concerned. Hopefully, that issue can be addressed.

Mrs Dillon: Following on from the previous comments, my thoughts are with families who have had anybody suffer with meningitis or who have lost anybody to it. As somebody who knows very well two families who lost children to meningitis, I know that, when it visits a family, it is, unfortunately, really devastating.

I have a couple of questions on the back of those that have already been asked. Minister, you said that your Department is asking the Belfast Trust pertinent questions about Liaison: can you give me an understanding — if you are not able to give the detail today, I would appreciate getting it in writing — of what those pertinent questions are? If the cost of engaging Liaison to do the reviews is not one of the questions, I would be grateful if it could be included. We are early in the process, but, when the answer will be meaningful, we should ask what cost savings there are. If the reviews are a cost-saving measure, we need to understand whether there is a cost-saving impact.

I am concerned about the people who, we have learned, are part of the reviews. They have severe learning difficulties, and some of them are finally in settings in which their families can have some confidence that they are getting the support that they need after having left Muckamore, where they were traumatised and abused. That is why it is important that we look at the reviews. It is not just about value for money: families and individuals must not be retraumatised. We need answers to those questions, if not in detail today then in writing.

I have two other questions. Do you want me to ask all my questions together?

Mr Nesbitt: No. My memory is not great, so I will jump in now. One of the answers that I want is about whether, when the company said to the trust, as, I believe, it did, "We can save you money", that was the end in itself, which I would find difficult to accept, or whether it was saying, "If we do our reviews, we can make you more efficient, and, as a consequence, you will save money", which, to my mind, is reasonable. Those are two different things, and I cannot tell you which of them was the company's pitch to the trust. That is part of the bunch of pertinent questions.

Mrs Dillon: OK. The detail is obviously the cost of engaging the company, how much will be saved and whether that will be done through efficiencies rather than withdrawing services from people.

Mr Nesbitt: Yes, absolutely.

Mrs Dillon: If the Committee could get that detail when you have it, I would be grateful.

The letter about the withdrawal of summer schemes for children with special educational needs came from the Education Authority, so the withdrawal of the programme is the responsibility of the Education Authority and, therefore, the Department of Education. Given that we are told by the Education Department that the issue was the provision of — in this case, the inability to provide — the health services that are needed to allow it to run its summer schemes, what conversations did the Minister of Education have with you prior to sending out the letter and making that decision? Did he make you aware of the situation or have a conversation with you about how it could be resolved before the letter was sent to families, causing immense distress across the special educational needs community?

Mr Nesbitt: A few weeks ago, I met the Minister. Officials and the principals of some of the special schools were in the room. They said that the issue was making it challenging this year and that, if something did not happen, they would be concerned about the safety of running the schemes this summer. Officials were tasked with coming up with a short-term solution ahead of finding a longer-term solution for 2027. That longer-term solution means more community children's nurses (CCNs). We think that we have a scheme and that we have located the funding that could bring it forward. We are not, however, in a position to train more CCNs between now and the summer. I thought that we were looking at solutions such as the 25-week-per-year contracted classroom assistants possibly being deployed to those summer schools. Given today's announcement, however, that clearly will not happen.

Mrs Dillon: As MLAs, we will probably not accept that. That is a conversation to be had with the Education Minister, and it is important that we have it.

In that same vein, how much further down the road are we on looking at what post-19 provision can be commissioned? I know that you have had the conversation with Alma White about the legislative programme not allowing for legislation to happen in this mandate, but where are we with putting in place things that will lead to real delivery for those families?

Mr Nesbitt: I wrote to the First Minister and deputy First Minister about that, asking whether they could task the delivery unit in the Executive Office with taking a look at what is needed — specifically what might be done in the remainder of the mandate. There are 364 days between now and the end of the mandate, if purdah is to be a six-week spell, as it usually is, so the time for getting legislation through is getting tight. The Department is looking at practical non-legislative improvements, and I hope to have news on those sooner rather than later.

Mrs Dillon: We would want to get detail of that as soon as you are able to give it to us. If we are looking at the potential of not having legislation, it is important that we have that detail as soon as is humanly possible. That is really important for the families.

My final question relates to the South West Acute Hospital (SWAH). We still do not know what is happening there, and I just want to get an understanding of that. There was the temporary suspension. We are talking about having accountability for the people of that area and the surrounding area. Where is the accountability for the people of Fermanagh while they wait in limbo for a final decision to be made? Will they see the evidence being based on patient safety? I am well aware that it is about getting an understanding of the best outcomes for patients — that is important to me — but we need to see the final outcomes of that. Will a vision paper be produced, or will we get something that details the final decision and what it is based on? Is there a timeline for that?

Mr Nesbitt: We will certainly get a vision. I have asked the Western Trust to work at pace to produce its vision for the future of the SWAH. As far as I am concerned, the SWAH will be around for longer than I will: it has a healthy future ahead of it. I love visiting it, because it is the most modern hospital that we have in the region. Some fantastic work is done there. Without wishing to deflect from the public debate about emergency general surgery, it would be good if we celebrated the great stuff that happens at the SWAH as well as talking about the one procedure that is not currently happening there. First, it is up to the Western Trust to come up with a vision, which, I hope, it will do sooner rather than later. We can then move on to discussing exactly what happens and what does not in the SWAH.

Mrs Dillon: That vision paper is important for the point that you just made, Minister: it is so that we and the people of the area understand what the future of the SWAH will be. We also need to understand what the patient outcomes are in the absence of emergency general surgery. As I outlined, patient outcomes and patient safety are the priorities above and beyond anything else. It is about understanding that. If the public have an understanding of the issues and can clearly see accountability, that will make for a much more positive situation.

Mr Nesbitt: I also expect the Western Trust to tell us about the outcomes that have been arising since the temporary suspension of emergency general surgery. It is such an emotive issue, so I would not expect everybody to simply accept those statistics at face value, whatever they may be. As you know, it is a very emotional and emotive subject.

Mrs Dillon: Thank you, Minister.

Mr Robinson: Thanks, Minister, and my apologies for not being there today.

There has been a focus on many issues today. One is the independent care sector. I am sure that you, like me, as an MLA, see a trickle of community care workers who frequent your office and highlight the pressures that they now face. I do not know about fuel costs in your area, but, in mine, unleaded costs £1·50 per litre and diesel costs £1·80 per litre, which is causing a bigger crisis in the care sector. When you factor it in that, as those in the independent care sector have told us recently, 73% of leavers are leaving the sector altogether, you can understand that the crisis that the Chair referred to at the beginning of the session will get bigger and bigger. I am sure that you also field those queries and concerns from carers who find that the pressure is such that they are at the point of giving up.

Another issue is summer schemes. I know from the communications that I see already on the system that there will be outrage about that, Minister. Some in the sector think that it has received a bit of a kicking over the past while, and they could see that as another one. I am not apportioning blame, because I am not across the detail. It is early doors. We have received only breaking news in that regard, but we are fielding queries already. I had hoped that there would be some kind of temporary solution, but your angle suggests that it has gone for this year. If that is the case, it is incredibly disappointing. I think that all of us on the Committee hope that we can find some mitigation for that two- or three-week period this summer.

I read the briefing that we received from you. A comment in the paragraph about the efficiency programme stood out for me. It refers to the "suite of actions" that the trusts and Department are focusing on. It states that the efficiencies:

I think that you said that, for the incoming year, you are looking at £600 million to stand still. How realistic is that comment about potentially eradicating trust deficits by 2027-28?

Mr Nesbitt: You can correct me if I have misinterpreted what you said, but I think that we are talking about the fact that, this year, we started £600 million light. By the end of next week — the end of the financial year — we will, basically, have balanced the books, but only because we received the thick end of £200 million of the Treasury reserve. However, that is a loan. The Finance Minister and the Executive negotiated with Treasury and agreed that the £400 million, which is the entirety of that reserve loan, will be repayable not over the next financial year but over three years. Is that what we mean?

Chris, do you know?

Mr Matthews: The Executive have not agreed a Budget, so, at this point, this is all just our planning. We hope that, between a mixture of savings and additional support, we will get to the end of a three-year Budget period having reached financial sustainability. The coming year will be the first year of that, and then there are the subsequent years.

Again, the trusts are building plans, but things are extremely difficult.

As the Minister said, the deficit is at an unprecedented scale, so, in a lot of ways, the system is in uncharted financial territory. We aspire to not be in the position each year where we spend every waking moment in the system fighting a deficit. At the end of three years of some difficulty and challenge, we want to be back to something that is more like what members of the Committee and the general public would expect, where we are thinking about innovation and growth in certain services and so on. At the minute, however, because of the scale of the deficit, a huge amount of activity and effort, as well as a huge amount of our time, the Minister's time and the Committee's time, is spent on talking about the deficit and its impact on services.

The aspiration that we are talking about is our three-year plan. A lot of it is still in the ether — there are Executive discussions to be made and so on — but our aspiration is to reach a point of sustainability. It will be challenging, and you are right to call out the fact that, from where we sit currently, it looks difficult to achieve.

Mr Nesbitt: Thanks, Chris.

Alan, we are trying to get balance across the whole of Health and Social Care (HSC), rather than just the trusts. The most important thing — Chris mentioned this — is that we still have not agreed next year's Budget. I have said that I want to prioritise pay and to introduce the real living wage across HSC as soon as possible, but I cannot do that until I have a budget.

You will be aware that, this week, the Review Body on Doctors' and Dentists' Remuneration made its recommendation for dentists and doctors, which, basically, was an increase of 3·5%, and 3·75% for some dentists. It is deeply regrettable that it is recommending a percentage increase that is different from that of the NHS Pay Review Body, which covers nurses and Agenda for Change staff, who are getting 3·3%, not 3·5%. That may not sound like a big difference, but it sends out entirely the wrong message to nurses and Agenda for Change staff, which is that they seem to be valued less than doctors and dentists. I have spoken to the chairs of both those bodies and asked them to talk to each other — to tic-tac — because it would be much better if they came out with the same figure. I get the same response from both of them, which is, "Oh, no, we're independent, so we'll do our own thing". If you are independent, you have the independence to talk to somebody else and tic-tac with them. I apologise for being on my high horse in that regard, but that perception, whereby nurses are undervalued compared with doctors, is so unhelpful.

Mr Robinson: We agree. Thanks, Minister.

Mr Chambers: Minister, what are the biggest opportunities that you see for arm's-length bodies, particularly the trusts, to play a leading role in the neighbourhood model, particularly in prevention and early intervention?

Mr Nesbitt: The main thing is to say to yourself, "If I had a blank map with no health service on it, what sort of health service would I build?". Would it be one to keep healthy people healthy or one to cure the sick? Of course, it should be both, because, no matter how hard you try to keep healthy people healthy, people get sick. However, it seems that we have gone off-kilter and are all about curing people who have become sick. They may have become sick three, four or five years ago, and, by the time we intervene, it has to be in an acute hospital, which means that it is expensive, and so it is bad not only for the patient who has had three, four or five years of ill health but for the budget. Let us shift instead to prevention and early intervention. For example, I can see there being opportunities for consultants to get out of the hospitals and into community settings for that early intervention.

Mr Chambers: As somebody who has been to the United States of America to do business on more than one occasion, I know that such trips are certainly not junkets. You get straight off the plane following an eight-hour journey — as I understand it, you were not sitting in one of the more palatial parts of the aircraft when you were on your trip to the United States — and into a schedule of 7.00 am breakfast meetings, which seems to be part of the American business culture, and late evening briefings, with a lot of travel in between. What important messages have you brought back from your trip to America?

Mr Nesbitt: I think that I attended 18 events and meetings. If I had to pick one as the most important, it would be my visit to the National Cancer Institute (NCI) in Bethesda in Washington DC. On foot of the 1998 agreement, there was a tri-jurisdictional cancer arrangement between Belfast, Dublin and Washington DC. I am amazed, although it appears to be true, that I am the first Northern Ireland Health Minister to have visited the NCI. The message that I received was, "It's really important that you're out here because, under the current political Administration, who are 'America First', we're being asked questions about the benefits of international treaties". One of the lessons from COVID was that, if you want to react quickly to a pandemic, for example, international cooperation is key. The Americans whom I talked to, who are the head clinicians and administrators in the NCI, are very familiar with this island, North and South, and they are familiar with and complimentary about Professor Mark Lawler from Queen's. I was a stranger to them but a welcome one.

I do want to go on for too long, so I will refer to just one other. Belmont University in Nashville has what it calls its "sim center" — a simulation centre. It is a training centre where the trainees are in a control room with a one-way mirror and mannequins that cost about $50,000. The trainees work on the mannequins, and the guy in the control room can press a button so that his voice comes out of a mannequin, saying, "You're hurting me", or whatever it might be. When I was there, the trainees were doing the pulmonary stuff, and there was a screen with two horizontal green lines, one above the other, with a yellow arrow in between them. Every time the trainees push, that push is measured. If the yellow does not hit the bottom green line, the push was not good enough. That training is all recorded and played back to the trainees.

I have brought back a lot of stuff that I find quite energising and which is relevant to how we develop Health and Social Care delivery.

Mr Chambers: My last point is on violence against women and girls, which is currently at the front and centre of things because of recent events. It has, I think, been there for a long time but has been under the radar and is now coming more into the public view. How can we address it? Does it need to be addressed through Health, Education or Justice? What can we, as Back-Bench MLAs, do to help to do something about the issue?

Mr Nesbitt: It is a whole-of-government responsibility. As I said, we had that discussion at the Executive table earlier. I think that I will write to FM and DFM with a proposal, because we have to engage better with the community. It is probably one of those issues on which transformation will be generational.

I am thinking not just about Women's Aid but about all the community and voluntary sector groups that are funded by the Department of Health. I am sure that every other Department funds similar community and voluntary sector organisations. Could we pull together all the groups that deal with women's issues, particularly those that deal with youth? Could a summit be held through a group such as the Northern Ireland Council for Voluntary Action at which we could say, "We have to get out and start messaging and really engaging the community about what's going on"? The issue will not go away quickly.

Mr Chambers: Thanks, Minister.

The Chairperson (Mr McGuigan): I have a final question, Minister, before we let you go. The session is about governance and accountability. Until recently, you were the leader of the Ulster Unionist Party and the Health Minister, so, essentially, you had carte blanche when it came to the decisions that you made in both those roles. There has been a notable change in the Ulster Unionist Party's policy and tone since Jon Burrows took over. We met Save Our Acute Services (SOAS) at the front of the Building a number of weeks ago. Some of the representatives with whom I engaged were concerned that decisions about the South West Acute Hospital may be made or not made, depending on which way you look at it, for party political or electoral purposes.

I am aware that you were forced, as it seemed to the outside world, to change a decision over the weekend, regardless of where the influence for that came from, so —

Mr Nesbitt: What decision?

The Chairperson (Mr McGuigan): — for the purposes of governance and accountability, can you assure Health Committee members that the decisions that you will take between now and the end of the mandate will be based purely on your role as Health Minister and on patient outcomes rather than on party political influence?

Mr Nesbitt: I give you that assurance. I am personally unencumbered by the search for votes, because I will not be standing on 6 May 2027, and I give you the assurance that, if I feel that the party is trying to influence how I carry out my role, I would rather walk — resign; step away — than become some sort of lapdog or functionary for a political party.

The Chairperson (Mr McGuigan): Thank you. I appreciate that. We all try our best to take the politics out of Health, because it is so vital for the people whom we represent and because of the jobs that we are trying to do, so I appreciate that honest answer.

I thank you all for coming before us today.