Debate contribution: Paediatric Pathology Services

Debate contribution by Mr Mike Nesbitt on 13 January 2026.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

13 January 2026

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Paediatric Pathology Services

Assembly identifier

Official Report component 5316354

Read the official Assembly record

Text

Thank you, Deputy Speaker, and I thank the signatories to the motion. I particularly acknowledge Philip McGuigan for setting the tone in his opening remarks by reminding us that it is not about systems or structures but about people and families. Mr Donnelly gave a figure of just over 1,000. The statistics that I was given for Alder Hey over the past five years are remarkably consistent: it is in and around 200 babies per year so, over five years, we are up at 1,000. Can you imagine if we took one year's cohort and 200 families were beyond those doors in the Great Hall or upstairs in the Long Gallery? It is a pretty stark visual illustration of how deeply the problem runs. It is 200 babies a year, and there is no sign of that changing any time soon. I acknowledge that, while Alder Hey is obviously not the optimum solution, it is the only one that we have at the moment. It is vital. It is a high-quality service, and it is one that I value because it ensures that families continue to have access to the full range of perinatal and paediatric pathology services. Since we started the service level agreement with Alder Hey, we have worked closely with local charities to try to ensure that every baby and every child who requires a post-mortem is treated with the utmost respect at all stages of the process and that the families receive the care, support and information — it is really important to communicate — that they need during those very traumatic circumstances. That having been said, I accept that there have been occasions when those standards have not been met. It is important to thank those families who have spoken about their experiences — not just positively but negatively — because we have to understand them if we are to maintain those high standards. I will come on to the evaluation and action plan in a moment. In the meantime, it is clear to me that we would all like the situation to be different and to be able to remove the sea journey by restoring the service locally. I remain committed to exploring all possibilities, including an all-island service. It is important, however, that we ground this important discussion in what is feasible and realistic. Members are aware — it is well documented — that there is a global — not a local or national, but global — shortage of paediatric pathologists. A sustainable local service would require a team of at least three specialists alongside long-term training and retention strategies. I am interested in what Mr Gildernew said about needing a minimum of four for a population of seven million. Whatever the numbers are, it remains a challenge; one that is not unique to Northern Ireland but is felt across the UK and internationally. The need to train and retain more paediatric and perinatal pathologists over the next decade has been widely recognised as essential for successional planning and sustainability. That makes the restoration of the former service here in Belfast, as the motion calls for, very challenging. That being the case, although it is far from straightforward, I am seeking to develop the service on an all-island basis. It is one of those rare occasions when money is not the issue: the issue is the workforce. One of my earliest actions as Minister was to raise that question with the former Minister for Health in the Government of Ireland, Minister Stephen Donnelly. In fact, the first time that I met him, the two things that were at the top of my agenda were paediatric pathology and a mother-and-baby unit. We had detailed discussions on both issues. On this issue particularly, Minister Donnelly was supportive. Likewise, his successor, Minister Jennifer Carroll MacNeill, has continued in that vein. However, as we have talked about capacity, let me make it clear: at no point in my discussions, particularly at the beginning with Minister Donnelly, was it the case that either he or I believed that the Republic had adequate capacity to provide paediatric pathology in that jurisdiction. Therefore, it was not a simple case of additionality to cater for Northern Ireland, but it was a case of, "He needs more, and I need more". To be clear: the current situation is that officials in the Health Departments in both jurisdictions are scoping out what they think that we need in Northern Ireland and what we think that the Republic needs down south. Once we have done that, we will come together, contrast and compare and then, hopefully, decide on the best way forward, whether that is to have separate paediatric pathology services in Belfast and Dublin or to go for an all-island solution. I have no political or ideological skin in that game. The skin that I have in that game is what will deliver the best outcomes for the families who are suffering that unimaginable loss. As I said, it is clear from our conversations that Ireland does not currently have the capacity for themselves or to take on additional post-mortems from Northern Ireland. As those services move to more centralised models nationally, my priority is to ensure that bereaved parents continue to have access to reliable, timely and compassionate care through our current arrangements with Alder Hey and that those arrangements meet the highest standards of compassion and care that we would all wish. To that end, the Department has commissioned an independent evaluation, as many Members have mentioned, which was carried out by Queen's but supported by the Public Health Agency and guided by a stakeholder steering group that included two voluntary and community organisations, Sands and Cruse Bereavement Support. The evaluation has provided a largely reassuring assessment of the service at Alder Hey, with the majority of parents and staff generally positive about their experiences. However, that has not consistently been the case, and it is clear that further work is required to improve the timeliness of post-mortem reports and the communication between trusts and families at every stage of the process. We need to enhance the clinical education of those involved and ensure that there is robust follow-up care for the parents. As Members have noted, the report contains 21 recommendations, including enhancements to reporting, communication, clinical education and follow-up for parents. I have accepted all 21, and they have been shared with trust chief executives and the Northern Ireland Medical and Dental Training Agency. The report also concludes that, subject to those improvements, the current service remains the most appropriate and viable option for parents and families. I have also approved a draft action plan to support delivery against the recommendations, and work has commenced with local trusts, Alder Hey and other stakeholders to take forward the action plan. However, to be clear, that is an implementation plan for the recommendations; there is no separate implementation plan for the restoration of those services locally or on an all-island basis at this stage. We are still scoping our respective jurisdictions. We have made strong progress in delivering key actions that truly matter to families and staff. The minimum dataset with Alder Hey is now agreed, key performance indicator measures are in place, and the service level agreement has been updated to include children up to 16 years of age. We have also put clear processes in place for parents who wish to accompany their baby for a post-mortem. That is a rare occurrence. Trusts have assured us that staff now have protected time to report and discuss results with those parents. Those are important steps forward. There has, however, been a slight delay in achieving a number of recommendations, which has been caused by challenges that are often outside our control. That includes a short delay in rolling out the regional consent process and bereavement care guidance, where timescales have been impacted on by changes to national consent forms and the need to realign them with the agreed Northern Ireland consent form. I am pleased to say that that will be completed by the end of this month. The standardisation of the bereavement midwife role has been extended to the spring of this year. Training and education initiatives, including e-learning and video resources, along with bereavement support pathways, mandatory training and research projects, remain firmly on track for completion by March 2026. Other work includes, as I said, the initial scoping of options for cross-border cooperation and for a less invasive post-mortem approach, which many Members mentioned. We are talking about the use of scans: taking them locally, where possible, and having them reviewed remotely. I think that we all agree that non-invasive techniques, which are in the foothills of development, are to be supported. We are moving forward with determination. Although there are challenges, the commitment across all partners remains strong. As I come to my conclusion, I cannot be anything other than straightforward: there is no quick fix to this issue. Any future model, whether local or all-island, will require significant investment in training and service development to build the necessary expertise and capacity. Although the challenges are considerable, I thank Members for their contributions and reaffirm to them that I continue to have a commitment to do everything possible to explore viable options for improving those services for families at the most difficult time that they will ever face. In my determination, I will bear in mind not an empty Great Hall or Long Gallery but a Long Gallery filled with 200 families, representing just one year of babies whom we are sending across the water.

1,609 words. Text as published by the Northern Ireland Assembly.

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