Debate contribution: Maternity and Neonatal Services

Debate contribution by Mr Mike Nesbitt on 22 October 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

22 October 2024

Type

Debate contribution (made as a minister)

Business

Ministerial Statement

Heading

Maternity and Neonatal Services

Assembly identifier

Official Report component 4608101

Read the official Assembly record

Text

I thank the Member. If she were a fly on the wall in the ministerial office in the Department, she would note that, over the past four and a half months, staff morale has been a particular interest of mine. I have very much picked up the impression that, of the various groups of professionals who deliver healthcare, morale is at its lowest among those who deliver maternity services, and midwives in particular. We need to improve that. I hope that the Member has already picked up the impression that I am not happy with the way in which the management of the Southern Trust has been dealing with that issue.

I understand that it is a genuine workforce issue, but the best way to resolve workforce issues is to bring your workforce with you.

That is something that flows into safe staffing legislation, and we are working on that. I recognise that some Members are perhaps a little frustrated about the pace of development in that area, but the document that we published today is very important in many areas. On the specific point that the Member raised, I guarantee that the report will input into our thinking on safe staffing legislation.

I thank the Member. Did she mention community-based care?

I will focus, if I may, on the community aspect, because the professor suggested that we go for community midwifery hubs. I do not think that we are ready for that. It needs more work, particularly if we are talking about births in what the professor called "community hubs" or "midwifery-led units". She mentioned eight requirements for community midwifery hubs, which were free-standing midwifery-led units. It is worth defining those eight requirements, if the Principal Deputy Speaker will allow me the time to do so. They include:

"Development and implementation of consistent, evidence-informed and context-specific standards, policies, guidelines, with commitment to evaluation and ongoing improvement"

and

"Ensuring evidence-informed decision-making, information for women, and knowledge and skills of staff".

The third requirement is:

"ensuring appropriate staffing and experience"

in those units. The fourth requirement is:

"Implementing interdisciplinary support, consultation and regional referral pathways".

The fifth is:

"Pathways and regional policies and protocols for emergency procedures".

The sixth is:

"Ensuring education and training for safe, quality care and services in out-of-hospital settings".

The seventh is:

"Appropriate funding, leadership and governance".

The final requirement is:

"Community engagement to ensure equity and inclusion, local relevance, meeting community needs".

Ticking all eight boxes will require time. At that point, I will be with the professor on the matter of the community hubs.

Funding is a continuing issue. The Member will know, because she voted for the Budget, that we are under severe pressure when it comes to funding for this year. I do not anticipate that that will get better in the next financial year. I will consult the Department about timelines, and I might be able to write to you and give you something indicative on timelines.

The Member will know that we are rolling out Encompass, and, in 2025, the Southern Trust will join the others that are currently online. Once we have Encompass in all five geographic trusts, we will certainly be in a unique position in the United Kingdom, and on these two islands, in having the ability to harvest data that will impact on population health.

To answer in reverse order, yes, I will keep a close eye on that because that is an extremely important area. Effectively, the trusts have been asked to ensure that, at all times, they are providing a safe, empathetic and professional service for people who are pregnant and those in the early weeks and months after delivery.

Any loss is a tragedy, and it is, of course, personal to that woman and that family. Unfortunately, healthcare workers have to deal with that daily. I am not aware of any particular concerns, although you raised the fact that these things happen while others are celebrating a successful and healthy birth. Given the confines of space and budget, it is very difficult to do everything that you would want to do in separating people out. I am very happy to engage with the Member if she has ideas on how we can do that better.

I thank the Member. I am afraid that I do not think that a strategy for women's health will happen in the immediate future, and the reason for that is the financial constraints and the absence of a long-term Budget in Northern Ireland. I am saying to my officials, "Let's talk about an action plan. Let's talk about what we can actually do with the resourcing and funding that we have available". The Member can shake her head, but I can tell her that I was very pleased when my predecessor brought forward a 10-year strategy on mental health. I was really, really pleased, yet I stand here knowing that we have, in the assessment of the mental health champion, one eighth of the budget that we need to deliver the action plan for this year's part of that 10-year plan. What is the point of saying to people, "Here is a lovely, shiny strategy" and raising really high expectations when you do not have the funds to deliver on it? I will focus on an action plan that is deliverable in this financial year and in this Assembly mandate, and I will not raise expectations. Of course, in an ideal world, I would ask for a strategy, but I just do not see the value of it in the real world.

I thank the Member for her question. I have outlined the eight areas of work that the professor wants to see, and which I will want to see enacted before we go to these community hubs. Communication of that, as with all policies, is a challenge, but I do not see it as a particularly difficult challenge. When somebody becomes pregnant, they engage with healthcare professionals, and we will ensure that the healthcare professionals alert them to all the options: home birth, birth at a community hub or birth in a hospital. I do not see it as being a particular issue.

Work is ongoing in the area of antenatal screening for fetal abnormalities and inherited conditions. Once the information is collated, it will be considered by the Northern Ireland screening committee before informing a future policy decision. I hope that that addresses your questions in that area, but I am happy to engage.

I acknowledge the Member's continued passion for services at Daisy Hill Hospital. I can only repeat that I do not have the power to stop the Southern Trust if it decides to make a decision on a temporary reallocation, but I do not want it to happen. I can only repeat that, if there is going to be a reconfiguration of service deliveries between hospitals, it needs to be planned and managed, and people — the staff and the community — need to be brought with us. We need to explain why we are doing it. We are only going to do it on my watch if I am convinced that the outcome is better outcomes for people. I do not see better outcomes if there is a collapse of maternity services at Daisy Hill Hospital, and we are working to understand the problem and to try to identify solutions. That is all that I can say to the Member, except to repeat that if he were to ask me whether I am happy with the way in which the management of the Southern Trust has conducted business in that area over the past number of days and weeks, no, I am not.

Yes, there is a proposal for a mother-and-baby unit, and we have looked at the potential location for it and identified Belfast City Hospital as the place where we would base it. The Belfast Trust has been asked to look at a business case. I understand that that business case is pretty well advanced. Once we get the business case, we will have to look at available funding. That, of course, will be a capital project rather than part of the resource departmental expenditure limit (DEL), and, from early discussions, I do not think that funding is going to be an insurmountable obstacle. We are making progress to deliver a mother-and-baby unit in due course.

On the second point, I think that I have already addressed workforce issues during the question-and-answer session. I stand over the decision to move maternity from the Causeway to Antrim Area Hospital. The Member will be aware that there is also a consultation live from the Northern Trust regarding general emergency surgery, again, potentially moving from Causeway to Antrim Area Hospital. Not every hospital will be able to deliver every service, and that is why we have to start looking at hospitals as a network. I accept that transportation will be an issue for some, and that is why it is a focus of mine in thinking about how we introduce a new regime where not every hospital delivers every service.

We have a workforce strategy 2026, so it would be wrong not to say that we are focused on the vacancies and on how we improve recruitment. It is not just about recruitment; you have to retain your staff, and there are a lot of competing and some new pressures. I have said before that we used to worry about nurses and doctors moving to Australia and we now worry about them moving to Athlone, such is the attractiveness of salaries in Sláintecare. Workforce planning is an issue, but we are well focused on it.

I accept the points that the Member has made, and the inconsistency is something that I would like to see rectified. Again, let us identify what is best practice and where it is being rolled out and then roll it out to make it common practice across all five geographical trust areas. I was up at Altnagelvin a couple of months ago and met some family nurses who deal with young mothers. It is a tremendous support for those young mothers during pregnancy and then in the months and indeed years after delivery to help them deliver the best outcomes for their young children.

1,725 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 11:27 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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