Mike Nesbitt
Strangford · Ulster Unionist Party · Northern Ireland
“Think public service, wisdom, generosity and courtesy. Think integrity, insight and curiosity, the lack of which is a key criticism of the two public inquiry reports of recent days.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and D…”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery.”
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“The trusts have a very practical attitude to that, looking at how you get to and from work. If you are no longer happy or content to take public transport and feel that doing so presents a risk, the trusts work hard to find alternative transportation for you. You may find an international colleague saying, "I do not want to work a particular shift because I do not feel safe getting to and from hospital". There is a degree of flexibility being applied by the management in the hospitals and the trusts, looking at practical measures to try to support our international colleagues.”
“I was in Ballyclare, in the Member's constituency, during the week of the race riots, and I met an international colleague who runs an advice centre for ethnic health workers. I also went down the street and met a body that delivers healthcare in the community. Its workforce is pretty much 100% comprised of international workers, and it had had all its windows put in. That is just racism. I repeat: if our international colleagues decide that it is not worth the candle any more and up sticks and leave, our health service will collapse.”
“The primary support comes from the trusts because they tend to be the employer.”
“I cannot confirm that number because I am told that a bit of duplication was involved in the numbers. I am happy to write to the Member with an update on that. It was a significant number. In fact, one is one too many because Encompass is an incredibly expensive system. It just should not happen. Although the referrals were negative in that the consultant was saying, "I don't need to see your patient", there may have been occasions when the consultant was also saying, "but you may want to consider" some other course of action. Therefore, we should not be, in any way, dismissive of the breakdown in Encompass. The question that I am still asking is this: on top of a system failure with the machinery, was there also human error?”
“As I understand it, there was a technical failure in what should have been a fail-safe system and a number of referrals were not issued. That is a matter of deep regret for me. However, those referrals were telling GPs that the consultant who was issuing the referral did not need to see their patient.”
“Again, I accept that it is regrettable. However, I think that the first thing that a woman in that situation needs to be told is, "We're taking you somewhere not that far away where a safe service is waiting for you and your baby".”
“For example, emergency general surgery at the South West Acute Hospital in Enniskillen was temporarily suspended because staffing levels were not safe.”
“I am tempted to say to the Member that that is, of course, an operational matter for the Southern Trust. However, I take very seriously any unplanned interruption to service delivery. I am being told that the service was picked up in Craigavon Area Hospital. While that is an inconvenience, there were, as far as I am aware, no particular safety concerns at that time. In fact, it was due to staffing levels falling below safe levels at Daisy Hill that the service there had to be closed down for a period. That is regrettable. However, across Health and Social Care, recruitment and retention is an issue. The Member will have heard Mr Bradley suggesting that, perhaps, more services should be done regionally. That is a big challenge.”
“I hope that the Member does not expect me to make up policy on the hoof during Question Time. I will simply say to her that I will certainly take her question away with me. I have made the point many times during Question Time that I want to be much more vocal and open about saying that patient safety is the number-one priority. Safeguarding falls very much within that category.”
“I will write to the Member if I am wrong, but it is my understanding that a patient suffering a stroke can be stabilised at the Causeway Hospital and then transferred to the thrombectomy service in Belfast. I gently point out to the Member that, by his logic, he is calling for an acute hospital at the end of every street, and that is simply not affordable.”
“When I referred to the £80 million for waiting lists and building capacity, I made it clear that some of that money will be invested in turning the thrombectomy service into a 24/7 service. That should help the around 160 people every year who suffer a stroke potentially to walk out of hospital on the same day, with no side effects. I hope that that is to what the Member was referring.”
“First, I have mentioned tomorrow's health summit. That is about putting patient safety at the top of the list of priorities for the leadership of Health and Social Care. Secondly, on an individual duty of candour, I again refer the Member to the Public Office (Accountability) Bill, commonly known as the Hillsborough law, which is making its way through Westminster. It places a statutory duty of candour and assistance on public authorities and, I stress, officials, and there is a new criminal offence of misleading the public. I think that that satisfies what the Member is talking about when he mentions having an individual duty of candour, but we shall see, because the legislation has not yet completed its passage.”
“I repeat my condolences; Lynsey and Erin lost their lives, and that should not have happened. I direct the Member to the report from Professor Frank Atherton, who assimilated all the other reports, which were conflicting in some of their conclusions. His conclusion was that it would not be appropriate to pursue individuals. That is the position of the Department of Health. The families may take a different view and pursue a different path.”
“Our responsible Opposition have spoken. I am not looking for a fight with anybody. Some 75,000 or 76,000 people deliver health and social care in this country. I would like them all to wake up feeling good about life, to get out of bed looking forward to going on shift and to go home at night thinking, "That was a good day. I did some good work, and I'm well rewarded in my terms and conditions". That is my ambition. I will try to deliver it within the constraints that I have outlined to the Member.”
“<BR /> <BR />To go beyond the 3·5% that the three groups of doctors have rejected as inadequate is not in my gift. If I did so, it would be repercussive across the public sector, which the Member well knows.”
“No, I do not agree that the matter is down to me. When I came into post, the pay regime that was in place was clear: two independent bodies make recommendations on pay awards, one of which is for doctors and dentists, the other being for everybody else working in Health and Social Care (HSC). We were recommended a pay rise of 3·5% for doctors and dentists. I am happy to pay that once I have a budget. In fact, unlike previous Ministers and unlike in previous years, I made it clear that, as soon as I have a budget, the first thing that I will do, as the number-one priority, is to make the pay awards. That remains the case. That will have implications for service delivery, which the permanent secretary and I have agreed that we will simply have to deal with after we make the pay awards.”
“Across the Executive, that is the only agreed Budget line for 2026-27. It will be used wisely in order to address long waits and to build capacity to try to ensure that waiting lists that are coming down do not go back up.”
“I am grateful to Executive colleagues for accepting the argument I made to them that, having done well in the last financial year in exceeding many times over the Programme for Government target on addressing long waiting lists, we were in danger of losing momentum without a Budget. I am really grateful to them for agreeing that I can spend £80 million — £30 million more than last year — specifically on waiting lists.”
“The second stage will see expansion into 50-week working and evening sessions by March next year, with the third and final stage delivering expansion into weekend working.”
“There has been significant improvement in endoscopy waiting times. Between 30 June 2025 and the end of March this year, a 35% reduction is reported in the number of patients waiting for the procedure, alongside a 92% reduction in the number waiting in excess of 78 weeks. <BR /> <BR />My Department continues to invest in endoscopy services, with £13 million allocated to the expansion of capacity in the elective care framework implementation and funding plan. That investment is expected to deliver an additional 16,500 procedures per year when fully implemented. The elective care framework outlined a plan for expansion of endoscopy capacity over three stages. The first was to commission vacant Monday-to-Friday sessions by March this year.”
“I will continue to work with the trusts to strengthen recruitment and retention and work alongside wider reform efforts at reducing demand through earlier intervention and improved family support.”
“The children's social work workforce continues to experience significant pressures. However, there has been a modest increase in staffing over the past two years. In April 2024, there were 1,133·5 whole-time-equivalent band 5 to 7 social workers in post: as of April this year, that has increased to 1,199·8, which is an increase of 66·3 whole-time-equivalents. That is reflected across a number of health and social care trusts, although variation remains. Belfast increased from 215 to just over 263; Northern from 222 to 257; South Eastern from 226 to 229; Southern went from 210 to 192; and Western slightly decreased from 259·4 to 257·1. The figures demonstrate progress in increasing capacity in some areas, but pressures remain.”
“I assure the Member that, when I meet the leaders of the HSC tomorrow, I will make it absolutely explicit that, while there are huge pressures on balancing budgets and transforming shift left, for the remainder of my time as Minister the number-one priority will be patient safety.”
“There will be a considerable amount of work over the remainder of the mandate. We have the adult safeguarding Bill, which was paused to allow us to absorb the recommendations — as it turned out, the 106 recommendations — from the Muckamore Abbey Hospital report. I also made a commitment to a statutory duty of candour for organisations. Westminster is passing the Public Office (Accountability) Bill, commonly known as the "Hillsborough law". It places a statutory responsibility on organisations and officials, and it makes misleading the public a criminal offence. <BR /> <BR />A lot of work is going on on patient and service-user safety.”
“That impacts on the ability to deliver preventative work, which, of course, is what I want, and statutory safeguarding functions to the desired standards. Yes, we are far from where we need to be.”
“I assure the Member that I very much value the work of social care workers, social workers and everybody who is delivering health and social care. I have often said that there are five elements in its delivery — buildings, beds, equipment, medicine and the workforce — and that the first four do not add up to a hill of beans if you do not have a workforce that is properly trained, properly motivated and well rewarded. Again, that takes me to the disappointment of not being able to implement the real living wage last September, as I had wanted to do. <BR /> <BR />I acknowledge that capacity pressures remain a significant concern across the HSC. Increasing acuity, rising demand and challenges in recruiting and retaining staff continue to place strain on teams.”
“Twenty-five of the review recommendations are being progressed by the reform programme, including recommendations to improve support for families at an earlier stage as an alternative to high levels of protection activity by the trusts.”
“The role played by social workers in delivering safeguarding and family support interventions is complex and challenging. The work frequently pivots on multidisciplinary collaboration, with parents and carers positioned as partners in the formulation and delivery of safeguarding and support plans. Their work ensures that concerns are identified early; that interventions are proportionate and specifically focused on identified need; and that a correct balance is struck between respecting the role of parents and ensuring that children are protected from harm. <BR /> <BR />The independent review of children's social care services led by Professor Ray Jones reinforced our understanding of the wider systemic and structural challenges faced by social workers and other professionals working in the area.”
“I thank the Member. We provide a range of services. Long waiting times were one of the prominent themes raised during the consultation on the emotional health and well-being framework. It takes action to address that. A key change is the move away from multiple single diagnostic pathways, which often create delays, duplication and inconsistency, towards a unified, needs-led neurodevelopmental pathway. <BR /> <BR />I want to see support. While waiting is a standard expectation, I want to ensure that children receive early help and early advice and brief interventions even before they reach the specialist team. Strengthening early intervention in schools, youth services and community settings means that many needs can be met sooner.”
“The Committee in Common exists to perform the function of bringing those five geographically limited trusts together and asking, "Where is best practice, and how do we turn that into common practice?" so that we achieve what the Member refers to.”
“That is one of the intents of the Committee in Common. As the Member will know, the trusts were, in effect, set up under a sort of Thatcherite model of competition driving down price. That does not work for me. If I could start with a blank page or click my fingers, we would not have five geographically based trusts. We would have a geriatric trust, a paediatric trust and a mental health trust. That would be the best way to achieve regional consistency in service delivery and get rid of the postcode lottery. That will not happen, because such reorganisation would be so massive that it would slow down delivery at a time when we need to speed it up.”
“I absolutely share the Member's ambition to see people living in the community. The trusts provide a range of evidence-informed programmes for individuals who are awaiting assessment. For children and young people, early intervention teams deliver proactive needs-led programmes that are neurodiversity-affirming and trauma-informed. They include structured group interventions addressing common challenges such as managing anxiety or emotional regulation. Alongside that, we have targeted individual supports for families who have more complex needs. Trusts are also working in partnership with statutory, community and voluntary sector partners, adopting a "Think family" approach. Training and support is provided to local services, including Sure Start and family support hubs. That enhances community capacity to respond effectively.”
“<BR /> <BR />Yes, targets, and yes, timelines, but above all is patient safety.”
“I very much understand the Member's desire to see hard targets set, both on numbers and on timelines. I get it and am not against it, but, in the past number of days, two public inquiries have reported, and my conclusion from that is that there is something that has to go above timelines, targets, savings and transformation: patient safety. Patient safety must be number one. When we have the health summit tomorrow, where, I hope, all the leaders across all the Health and Social Care bodies will come together, I will make the point forcefully to them that patient safety is now our number-one concern, explicitly. It should always have been, but the history of public inquiries in recent years suggests that, far too often, it has not been and avoidable harm has occurred.”
“That includes the public consultation on the children and young people's emotional health and well-being framework and the development of neurodevelopmental pathways aimed at enabling earlier intervention and better aligning services with population need.”
“I fully recognise the impact of the current delays on individuals and families. The situation has arisen due to a combination of factors, including funding that falls short of objectively assessed need and previously missed opportunities to reform health and social care delivery. I am committed to addressing this, and that is, of course, subject to available funding. Through the strategic planning and performance group, my Department has identified the level of funding required to address the existing demand capacity gap and reduce the waiting list backlog across children's and adult services. It is currently being considered in the context of the current funding constraints. <BR /> <BR />Notwithstanding all of that, work is ongoing to improve assessment pathways and optimise existing delivery.”
“I am unaware of the individual case, and I am unaware that that is something that occurs in Health and Social Care (HSC) delivery, so I will take it away.”
“The hospital reconfiguration consultation produced a significant number of responses, some of which were basically from a cut-and-paste template. That led me to have a discussion with the permanent secretary about what would be a novel way forward in Northern Ireland. That plan is being progressed. Unfortunately, it is not being progressed quickly enough for me to announce it on this side of recess, but I hope to announce it in the autumn.”
“Two additional MRI sessions have also been recurrently funded in the SWAH, which will ensure that there is full evening and seven-day working for MRI on that acute site.”
“Recent investment has been made via the elective care framework, with seven additional sessions having been funded over a 42-week year as part of the first phase of endoscopy expansion. The bulk of that capacity is being delivered on the SWAH site and includes the provision of an additional consultant post based at the hospital alongside additional nurse endoscopist capacity. Further investment will be made to expand the service in the trust to deliver 50-week working across all endoscopy sessions with appropriate expansion of medical and nursing roles to support that. A funding allocation was recently released to the Western Trust to recurrently fund 10 sessions of CT in the SWAH on the previously uncommissioned backup CT scanner.”
“I am struck by the Member's remarks and give her my assurance that, when I leave the Chamber, I will instruct officials to ask the Western Health and Social Care Trust for a written report detailing — in detail — the pre-engagement, including who they have spoken to and which organisations those people represent. If what the two Members say is correct, it is shocking and I have not been given accurate information, and that would not be acceptable.”
“When I say that it was a flawed process, I refer to the fact that only one consultation event was planned for Enniskillen, which is the main town, and that that event was on 13 July, the day after a public holiday. No public engagement was planned for Omagh. I think, therefore, that I was right to intervene. I share the Member's frustration that such a process takes longer in the public sector than it would in the private sector, but, in my opinion, we are following the right path.”
“Thank you, Mr Speaker. The Western Trust has assured me that it has undertaken a comprehensive early engagement exercise with stakeholders, involving all political parties, local businesses, service users, community groups, the Patient and Client Council (PCC), local media, community planning partners and Departments, including mine and DAERA. The vision process has a clearly defined programme of work and a timetable, with formal engagement now under way. Its purpose is to inform future planning and decision-making. I expect the final report to be published by March 2027. <BR /> <BR />The Member seems to be very cynical about the entire process, but the only viable alternative would have been for me to sit back and allow a badly flawed consultation process to proceed, rather than to intervene, which is what I did.”
“It is a superb facility. <BR /> <BR />The vision is wider than a single-service issue. It is an essential step in setting out how services can be configured in a way that is future-proofed, clinically safe and responsive to local need.”
“I spoke during Members' statements earlier about the untimely passing of the Western Trust's chair, Dr Tom Frawley CBE. I repeat my condolences to his family, his friends and his many admirers. <BR /> <BR />The Western Trust's vision for Fermanagh and west Tyrone is intended to provide a long-term framework for the delivery of health and social care services right across the area, including at the South West Acute Hospital (SWAH), at the Omagh Hospital and Primary Care Complex, in community services and in primary care. Members will recall that that work is happening after an intervention that I made last summer. The vision has now moved from its early engagement phase to the important formal public engagement phase, which commenced earlier this month. As Minister, I have had the pleasure of visiting the SWAH on multiple occasions.”
“It is a little early to be definitive about the statistical analysis of the disruption from the strikes, but some elective procedures will undoubtedly be postponed, which is a matter of deep regret for me. The doctors know that all that I am empowered to do is implement the 3·5% pay rise that the independent body recommended. I cannot do that until I have an agreed budget, but I hope that that will happen sooner rather than later. Going beyond that percentage would require the Executive to fall in behind me, because it would have repercussions for public-sector pay right across the board.”
“The statistics that I have quoted suggest that we are moving in the right direction. It is cold comfort for anybody who is waiting beyond the stipulated waiting time to know that other people may have benefited from the work that has gone into that, but I do not buy into the idea that there is total despair in the system. The system is working very hard. The pathways need to be improved, but, by and large, if Members speak to anybody who has had healthcare recently, they will tell them that, once they get through the pathway, they get first-class care.”
“We are now at just over five weeks, and pressure continues to be applied to get down to the target time.”
“The current waiting time is, I believe, just over five weeks, which is down from 12. That is cold comfort, given that the target is 14 days, but I will point out two issues to the Member. The first was the unacceptable variation between trusts. The Western Trust and the Southern Trust were the best and the worst. If you were living in the Southern Trust area, you might have had a wait that was three months longer than that of your best friend who was living in the Western Trust area, despite only living half a mile from them. In getting rid of the variation and having a consistent service with a single booking system, progress has been achieved. The second objective, which is to drive down the waiting time, is being achieved but is not complete yet. As I said, we started at 12 weeks.”
“Part of the answer is funding and resource. The elective care framework implementation and funding plan includes £13 million for endoscopy services and £12 million for diagnostic imaging. When the plan is fully implemented, the investment will deliver approximately 16,500 additional endoscopy procedures and 7,800 imaging sessions each year. <BR /> <BR />It is about having a regional service that is consistent across the five geographic trusts. To encourage that, we have introduced a committee in common, bringing the five trusts together and saying to them, "In many ways, as a Department, we should look on you as one trust. Let us deal with the variation, where it is not appropriate, and make sure that we have consistent regional services".”