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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“It is therefore important that we continue to retain the flexibility and ability to deliver the programmes that the provisions have afforded us. Over 5,400,000 COVID-19 vaccine doses have been administered in Northern Ireland since the introduction of the vaccination programme in December 2020. During the 2025-26 autumn and winter COVID-19 programme, over 100,000 COVID-19 vaccinations were administered here, and at 11 March 2026, over 560,000 flu vaccinations had been administered in Northern Ireland as part of the 2025-26 winter campaign. <BR /> <BR />Given that almost 80% of flu and COVID-19 vaccines are co-administered during the autumn and winter campaigns, it is essential that we make the best use of the available workforce to ensure that the people considered most at risk continue to receive their vaccines on time.”
“My Department has again accepted the latest advice of the JCVI to offer COVID-19 vaccination in the spring of this year to the following cohorts: all those aged 75 or over; all those living in care homes for older adults; and immunosuppressed individuals aged six months and over. Failure to meet the deadline could result in eligible individuals being delayed in taking up or unable to take up their COVID-19 vaccination, which would have major implications for the planned COVID-19 spring campaign in Northern Ireland. The campaign is scheduled to begin on 20 April and run until the end of June this year, which is a similar time frame to that of spring COVID-19 programmes in the rest of the UK. <BR /> <BR />We know that the vaccination programmes have more than proved their worth.”
“That was followed by a formal review and scrutiny of it by Parliament's Joint Committee on Statutory Instruments. The draft SI was then debated in the House of Commons and the House of Lords earlier this month, before its coming into force date of 1 April 2026. <BR /> <BR />The regulations are being progressed at pace, given that the provisions for continued support of the COVID-19 and flu vaccination programmes in Northern Ireland also need to be in place by 1 April 2026. We know that that is a challenging timescale, but we would be extremely grateful for the Assembly's support in trying to meet it.”
“Overall, most of the responses received across the UK were supportive of the proposals outlined in the consultation, stating how the existing flexibilities in the regulations had been, and continue to be, useful in supporting access to vaccines and in ensuring that there is a sufficient vaccination workforce. <BR /> <BR />An overall broad level of support was expressed in Northern Ireland from the organisations here that participated in the consultation, while the responses from individuals who shared their professional and personal views and experiences were rather mixed. The personal views and experiences shared were of a more negative nature and were unsupportive of vaccines in general. Following the consultation, the Department of Health and Social Care (DHSC) in London laid the draft SI in Parliament on 29 January 2026.”
“The occupational health vaccinator provisions in schedule 17 will also be expanded in scope, covering any vaccination that is supplied in the course of an occupational health scheme. <BR /> <BR />On 20 January 2026, following the completion of a UK-wide consultation, which my Department ensured was circulated to all relevant Northern Ireland stakeholders, the UK Government published a response to their joint consultation on the proposals to amend the HMRs to support the ongoing supply and deployment of vaccinations across the UK. There were 217 consultation responses received, six of which were from Northern Ireland.”
“That will enable a more efficient use of a capable vaccinator workforce and support flexibilities in the supply chain. <BR /> <BR />Regulation 247A will be allowed to lapse on 1 April 2026, and the aforementioned new permanent legal mechanism, regulation 235A, which is being introduced by the SI, will ensure that the UK has the necessary agile and flexible workforce to deliver a wider range of nationally commissioned vaccination programmes, including in the event of a future potential public health emergency requiring rapid vaccine deployment. <BR /> <BR />In amending the regulations, we are seeking to maintain important safety measures while also increasing the effectiveness of the system's supply chain and workforce, including health visiting teams and community pharmacists, all of which will improve vaccination uptake.”
“<BR /> <BR />Allowing regulations 3A(1) and (2) to lapse reflects the fact that we are no longer operating in a pandemic scenario and have instead moved to the more targeted approach of offering COVID-19 vaccination to those at greatest risk. Where necessary, any exceptional preparation or assembly will be satisfactorily covered by the amended regulation 3 and the existing regulation 4 of the HMRs. <BR /> <BR />Regulation 3A(3) and (4) permit holders of a wholesale dealer's licence who do not hold a manufacturer's licence to relabel COVID-19 vaccines to reflect changes in shelf life resulting from product thawing. The statutory instrument retains those provisions as permanent legislation and expands them to include any vaccine against an infectious disease.”
“Regulation 233(8) and regulation 3 of the HMRs and schedule 17 to the HMRs do not have the same time limitations attached. The legislative proposals, however, suggest ways in which to utilise the regulations further to ensure that the vaccine system is as effective as possible. It is proposed that regulations 3A, 19 and 233 of the HMRs be expanded in scope, and a new permanent legal mechanism, known as vaccine group directions, has been drafted. That will replace regulation 247A of the HMRs and include vaccinations against any infectious disease where vaccinations are currently limited to COVID-19 and flu.”
“Without the proposed amendments to the HMRs, COVID-19 and flu vaccination services will not be able to continue in their current form, while certain Health and Social Care (HSC) vaccination activities will need to cease. That will inevitably delay or even prevent those considered most at risk from those diseases from receiving their vaccinations, as is recommended by the JCVI.”
“They will increase flexibility in the vaccinative workforce and enable community pharmacies to deliver a wider range of vaccinations off-site. <BR /> <BR />The overarching policy objective is to help safeguard public health in accordance with section 2(2) of the Medicines and Medical Devices Act 2021. It is designed to protect public health and to promote the safety of patients. <BR /> <BR />The provisions in regulations 3A, 19 and 247A of the HMRs proved vital to the success of the COVID-19 and flu vaccination programmes during the pandemic and enabled the continued safe and effective deployment of vaccines across the UK, helping to safeguard public safety. <BR /> <BR />The legislative provisions are, however, time-limited and have sunset provisions that will cause them to lapse on 1 April 2026.”
“<BR /> <BR />The current proposal relates to provisions that were introduced to support COVID-19 and extend flu vaccination programmes, namely regulations 3A, 19(4A-4D), 247A and 233(8) and schedule 17(S17). <BR /> <BR />The purpose of the SI is to further amend the HMRs to continue to safeguard public health and ensure that lessons learned can be used to support the safe supply, distribution and administration of a wider group of vaccinations. That will help the ongoing development of a vaccination system that is fit for the future. <BR /> <BR />The proposed amendments will increase flexibility in the movement, preparation and labelling of vaccinations in defined circumstances, with appropriate safeguards.”
“<BR /> <BR />The HMRs are a set of UK laws that regulate the use of medicinal products for human use. They set out a comprehensive regime for the authorisation of products for the manufacture, import, distribution, sale and supply of the products, for their labelling, advertising and pharma co-vigilance. <BR /> <BR />The HMRs have a UK-wide territorial application, and they must be amended using powers set out in the Medicines and Medical Devices Act 2021. Subsequently, any statutory instruments (SIs) amending the HMRs on a UK-wide basis must also be made jointly and debated and approved via the draft affirmative procedure in both Houses of Parliament and here in the Northern Ireland Assembly.”
“The aim is to build on the benefits that the amendments have provided to date, as well as wider lessons learned during the pandemic. <BR /> <BR />The COVID-19 and flu vaccination programmes are based on recommendations from the Joint Committee on Vaccination and Immunisation (JCVI), which is an independent expert committee advising on all vaccination-related matters. <BR /> <BR />The programmes are a critical element in helping to protect the health of our population and reduce pressures on our health and care services. Vaccinations remain our best form of direct protection against flu and COVID-19. <BR /> <BR />I will now set out and explain the proposed amendments contained in the draft regulations that are before the Assembly, and explain why the provisions are still needed.”
“Principal Deputy Speaker, I seek the Assembly's approval for the making of the set of draft regulations. They contain important further provisions relating to the Human Medicines Regulations 2012 (HMRs) to support the ongoing supply and deployment of vaccinations across the United Kingdom. <BR /> <BR />In response to the COVID-19 pandemic, multiple temporary amendments were made to the HMRs in autumn 2020 to enable the roll-out of the COVID-19 and influenza vaccination programmes. The amendments were extended in 2022 and 2024 following public consultation, and they are due to lapse on 1 April 2026. <BR /> <BR />The instrument looks to retain several provisions in the regulations as permanent legislation and expand them to other vaccines.”
“I do believe that the leader of the Opposition has asked me to disclose confidential information. I suggest that he puts in an FOI request for the minutes of the meeting in question. <BR /> <BR />In conclusion, I am content to accept the amendment.”
“There will also be ongoing running costs of up to half a million pounds a year, which will be offset by income from parking notices. That investment will not be wasted, because the infrastructure that has been installed is required for the long-term operation of hospital car parks and will directly support the implementation of free parking, once financial circumstances allow. <BR /> <BR />In summary, although, given the financial pressures, the deferral remains both necessary and justified, I support Members in their desire for any associated costs to be visible.”
“<BR /> <BR />I acknowledge that Members may wish to see the costs associated with the abolition of charges and its delay clearly set out and formally reported. I also acknowledge that the additional transparency may assist the Assembly in tracking expenditure and ensuring that the Department continues to make decisions that are based on the best available evidence. For those reasons, I am content to accept the amendment, although I highlight the fact that the costs to be reported are not expected to be significant. <BR /> <BR />When it comes to setting up the system, approximately £4·9 million has been spent to date to enable preparatory work for upgrading existing car park barriers and to support the procurement of the automatic number plate recognition equipment.”
“Therefore, to be clear, the main cost components are in respect of rates, staffing, maintenance and ongoing automatic number plate recognition system costs. Those costs will continue regardless of whether parking charges remain or are abolished. For example, around £5 million is paid annually in rates to Land and Property Services, and £3 million a year is spent on staffing costs, including attendants, estates personnel and admin staff. A further £3 million is incurred in maintenance costs, such as lighting, gritting, cleaning and repairs. Finally, the ANPR contract costs approximately half a million pounds a year. Those costs will remain broadly constant whether the Act commences now or later.”
“It is fair and reasonable to expect the trusts to review their policies in the light of what we appear to be about to legislate for. Absolutely. <BR /> <BR />Mr Deputy Speaker, my officials wanted me to reflect on a number of points raised during the Second Stage debate, but that would incur your admonishment, so I will truncate my remarks pretty significantly. <BR /> <BR />The amendment proposes two things: an initial report within six months outlining the costs arising from the delayed implementation of the 2022 Act; and annual reports thereafter on the costs associated with the Act in subsequent years. While the underlying cost base associated with operating car parks does not materially change as a result of the 2022 Act or the deferral of the Act coming into operation, I recognise that transparency is important.”
“I welcome the opportunity to respond to the debate on the amendment, which I will support. I am conscious that Mrs Dodds was asking to make an intervention. If that is still the case —”
“Absolutely. Last winter, there was a series of days in January when 400-plus people were in emergency departments having had decisions to admit, but they could not be admitted because no beds were available, but over 500 of the people occupying those beds had been deemed as being fit for discharge. If we can crack the issue with discharge, we will crack the issue of emergency department queues.”
“If we are going to shift left, community capacity will be critical.”
“I do not have specific plans for rural areas of Newry and Armagh, but I have plans for the whole of Northern Ireland. I accept that some of the challenges of provision are more severe in rural areas than in urban areas. The Member will be aware that the most important thing that I wanted to do — the one that has caused me most pain not to have done yet — was the introduction of the real living wage. That will be incredibly important in bolstering the existing workforce and making it more attractive for new recruits. <BR /> <BR />I have said many times that, to deliver health and social care, you need five things. You need buildings, beds, equipment and medicines, but those four things do not count unless you have the fifth, which is the workforce. I am focusing on the workforce.”
“The Member's questions are all important. There are those in Health and Social Care who know a lot more than I do — as clinicians and operatives, they are much better qualified — who think that type 2 diabetes could be a total epidemic that could flood our ability to deliver health and social care. The Member identifies a really important area and important issues as a substructure of that.”
“I am aware that we are the only part of the United Kingdom not participating in the audit. I want us to participate in it, and officials do not disagree; they want to participate in it. There was something missing — I am having a mind blank — from our diabetes service that we have now rectified, which opens the door for us to participate in the national survey. I ask the Member to let me get back to him on a timeline, because I want to check that. We are nearly there.”
“One of the benefits of going with you on the visit to Belleek was in my being aware that there are specific challenges not simply in rural healthcare delivery but in rural border healthcare delivery. That is a particular challenge, given that we cannot compete with Sláintecare on wages and salaries. It is attractive for healthcare professionals working somewhere such as Belleek to look over the border, and that is perfectly understandable. <BR /> <BR />It is important for me to get out and about. On Mondays and Tuesdays, I am either here or at the Department doing meetings or paperwork. That is all essential work, but it is not real. It is only when I visit somewhere like that GP surgery in Belleek that it becomes real, and I get a better sense of what I need to do.”
“I cannot make that commitment as I stand here today, because I am not sure of what the implications would be. I am not aware of why those services had to be withdrawn. It would be foolish of me to commit to reinstating them when there may be good reason why it would not be easy or possible to reinstate them. However, you have put it on my radar: you want me to go and ask the question, and I will do that.”
“The Member will be aware that I commissioned academic research on the prevalence of ADHD. We have that report, and I have now asked for an options paper. I make this promise to the Member: once we have that options paper, I will bring those people and organisations together to find the best solution.”
“That is a major challenge, and I accept it. I have been contacted about that on many occasions. I have met parents of children who were on medication that was privately prescribed and, then, the prescriptions were no longer honoured. I understand that GPs have no obligation to do so. They are encouraged to look at whether it is within their competence and the rules of their governing body — the BMA. GPs can look at a whole set of criteria. However, this is happening: children are not getting the medication. Why are people going private? They are going private because the waiting list in the health service is far too long. Parents go private through love: they love their child and do not want them to have to wait, so they go private. Do I have a ready solution? I do not, I am afraid. Is that on my radar? Absolutely, it is.”
“Yes, there is a very clear need to do so. Belmont University has a desire to follow up. Meharry is also keen to follow up to talk about the social determinants of health inequalities. The National Cancer Institute continues to have a relationship with the Department of Health and, indeed, Queen's University. I was accompanied by Professor Mark Lawler from Queen's, who has many titles but is basically the lead man in cancer research. It was interesting to see the respect for him and the esteem in which he is held. He has that respect because he has spent a lot of time and effort forming a relationship with the National Cancer Institute. We, as the Department of Health, need to do that.”
“Therefore, the visit, in particular to the National Cancer Institute in Bethesda, was very timely.”
“<BR /> <BR />Perhaps the most important thing that I did was to visit the National Cancer Institute in Washington. There has been a tri-jurisdictional relationship among Belfast, Dublin and Washington on foot of the 1998 agreement, and the first formal memorandum was signed in 1999. I still find it hard to believe that I am the first Northern Ireland Health Minister in 27 years to visit the National Cancer Institute in Bethesda. It was pointed out to me that, in the current political atmosphere in the United States, all such relationships are examined carefully to make sure that they are a two-way street and that America is not simply offering help, resource and finance to foreign countries.”
“The Member knows that I have a passion for addressing health inequalities, and Nashville's health inequalities are similar to ours. I was at Meharry Medical College, which was the first in the United States exclusively for African Americans. It was affirming to discuss the social determinants that the college is trying to tackle and to discover that they are the same social determinants that we are trying to tackle. <BR /> <BR />Another major takeaway came from my visit to Belmont University. What it can do at its "sim center", as it is called there — it is a centre for training and simulation — is out of this world for training doctors and nurses. Gratifyingly, the university is keen to form a relationship with Northern Ireland, and we will be trying to connect it to the right officials and, possibly, to our two universities.”
“We will continue, because here is certainly a starting point for making financial savings in Health and Social Care, but there is no end point.”
“I am aware of the £1·8 billion that has been spent on agency and locum staff between the financial years 2020-21 and 2024-25. We incur that expenditure to ensure that safe and effective services are sustained, so it is important that we do so. It increases short-term capacity. Given the current gap between demand for care and the system's capacity to meet that demand, it is crucial. Reducing agency spend is a key priority, however. We are committed to bearing down on that cost. It will not be possible to reduce the cost completely, because we have to maintain services. <BR /> <BR />Yes, I am aware. I am aware that we have done good things elsewhere to reduce agency costs, and we now look at locum costs.”
“The Member may categorise my trip as he wishes, but I met a lot of healthcare providers in Nashville, and, as we speak, they are upstairs at a follow-up meeting, so some progress has been made on cooperation on healthcare initiatives. I was not fully across what the Member says, however. I was not fully across what was happening in real time in Health and Social Care delivery.”
“Its potential remains absolutely massive, particularly for public health initiatives.”
“By standardising data capture, improving timeliness and reducing manual returns, Encompass will enable more consistent and reliable analysis of the flow, the demand and the capacity. It already supports improved reporting in areas such as inpatient escalation beds. Further work is under way to complete ED corridor care reporting, which is important to me, and reduce reliance on manual manipulation of extracted data. That will give us consistent real-time data about the pressures across the Health and Social Care system. As I said to Ms Flynn, however, it will take a bit of time to bed in. The best description that I have had of it came from somebody working in the system, who said, "We have an engine to get us to the moon, but, at the moment, we are using it only for a short break".”
“I am afraid that I am not aware of that specific, but I can ask officials to bring me up to speed. Sometimes, with the roll-out of Encompass, we are still saying that the datasets are not validated yet. I have to accept that two years seems to be the norm for bedding in a system such as Encompass. It seems like a long time to me, but it is what it is.”
“I absolutely do. The Member is maybe suggesting that some of the reduction in waiting lists is not through activity beyond validation: maybe or maybe not. Validation is a very important and necessary process. By the end of the financial year, which is a week or more away, I want to know not that we have exceeded the Programme for Government target of 70,000 but how we have exceeded it. I want to see it broken down by appointments, diagnoses and procedures. That, by necessity, will involve knowing the numbers trust by trust. I was not aware of the experience that the Member had with that trust, but I would like to rectify that as we come to financial year end.”
“The logic of that is that the answer is yes, but there is a logic to reporting only vacant positions that are under active recruitment because we are so strapped for funding in the Department that that is almost an inevitability. Does it skew the risks and the shortfalls? Off the top of my head, I am saying that, yes, I would like to know exactly what is missing rather than what we are trying to fill.”
“That is further supported by statistical quality assurance processes, ongoing collaboration with data producers through the system and regular reviews of both data definitions and sources to ensure continued relevance and accuracy in reflecting operational realities.”
“Data definitions do not directly measure or describe pressure within Health and Social Care. Rather, they serve to enable the consistent recording and reporting of information across the sector. That consistency supports robust assessments of system pressures using statistical and operational data. The Department makes use of a combination of official statistics and management information, grounded in standardised data definitions, to evaluate pressures in health and social care environments.”
“A couple of hours later, however, he arrived back in a second ambulance. He had gone home for a drink. I repeat: he had gone home to get himself a drink. <BR /> <BR />I will also say that, yes, I support the use of body-worn cameras, and, yes, it is potentially a good thing, but it is also a sad thing that we have come to the position of needing them.”
“Yes, there is certainly anecdotal evidence. It seems that, if you visit emergency departments or their environs, you will find people who have taken substances, including illegal substances, that are the motivator for physical and verbal violence towards staff. Well before COVID, I was fascinated to be told that Monday nights were the busiest in emergency departments because some people do not want to give up their weekends, so they thole it until they get to Monday morning. I asked to spend an overnight in the Ulster Hospital, and one thing that happened was that a man came in by ambulance, full of alcohol, and a chair was found for him. At around 2.00 am, the chair was empty. I asked the nurse, "Have you managed to deal with that gentleman?", and she said, "No, he has gone".”
“We think that we have a workaround in legislation that, I hope, will be passed by the Assembly before we hit purdah, which, I believe, may kick in one year from tomorrow.”
“The pilots will run their course. I hope that we will end up with body-worn cameras being available to all HSC staff who work in areas where there is engagement with patients or service users where appropriate. Ultimately, however, it will be for the trusts, as it is an operational matter for them. I would like to see that it is consistent and regional across the five geographic trusts. We should not end up in a position where one trust does one thing and another trust does another. That does not appeal to me. <BR /> <BR />The Justice Minister and I have sat down face to face. We have discussed the issue and the fact that the employer has no legal vires to step in, protect their staff and operate a prosecution on their behalf.”
“it would be tempting to say that we can never do enough. However, once again, we are moving in the right direction. I am very much in favour of body-worn cameras, and there is evidence that they are a successful and appropriate deterrent. My focus, Mr McNulty, is on changing the law. At the moment, it prohibits the employers — the trusts — from taking action to prosecute somebody who has been physically or verbally violent towards a member of their staff. We are actively looking at what we might do by way of a legislative change to empower the trusts to do more to ensure prosecutions rather than leave staff feeling that they are on their own and have to get a solicitor to do their own prosecution.”
“<BR /> <BR />HSC trusts have a number of measures in place to protect front-line staff, including safety intervention training, which helps to equip staff with the skills to identify potential risks and effectively de-escalate situations. There is also the use of trained security staff, who respond to incidents 24/7; CCTV coverage, which is effectively used to deter and detect criminal and antisocial behaviour; and the use of body-worn cameras. A number of trusts are piloting the use of those cameras, which act as a potential deterrent and allow staff to capture video footage of instances of violence and aggression. I would welcome a change in the law that would strengthen employers' ability to support the progression of incident reports to the PSNI.”
“My Department implemented a new violence and aggression in the workplace HSC framework in December 2023. The framework outlines the HSC's commitment, developed in partnership with staff representatives, to ensure prevention, reduction and management of violence and aggression towards staff in the workplace. Since its launch, all HSC organisations and key stakeholders have been working to embed the framework's principles and support local implementation. I am clear that creating a culture of zero tolerance towards violence and aggression in the workplace is not a one-off action but a sustained commitment. Every member of staff has the right to feel safe and respected at work. We will continue to take all necessary steps to protect and support our workforce.”