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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“I recognise the point that the Member is making. If we had a blank map and we were starting from scratch, absolutely, but we are in a position where the pressures are, to some extent, unprecedented. If we do not spend the money on those independent services, people do not get seen in a timely manner, or they are seen in an even less timely manner than they are being seen at the moment. In an ideal world, absolutely. Is it a position that I would like to move to? Absolutely. Would I like to be spending less on the independent sector generally? Absolutely, but we do not have the capacity to do what we need to do within the HSC.”
“Hopefully, we are through the winter, but the Member will be aware that, very early on, I stopped talking about winter pressures and described them as additional winter pressures, because the pressures are on, 24/7/365. I am confident that we are moving in the right direction. I am not satisfied that we are moving as quickly as I would like, but, in the real world, everybody is focused on trying to do better. I am very grateful to the health and social care staff and workforce, not least in emergency departments, who are trying to push for better.”
“I sense a willingness on the RCN's part to try to make this work; let me put it that way.”
“As it happens, I was at Windsor Avenue this morning at a conference that was being run by the Royal College of Nursing. The relationship there is good, but I go back to the point that I understand the pressures and the moral injury better than I can provide a proper solution to it, because it requires more funding and more resources. <BR /> <BR />With regard to the specific Release to Rescue protocol, I am not aware of any significant concerns. Maybe the concerns are significant, but that may be a judgement call.”
“That is why we get to this sense of moral injury and of staff going home and waking up the next morning not looking forward, as they should, to going on shift because they cannot see any light at the end of the tunnel. <BR /> <BR />With regard to the Release to Rescue protocol, I have no indication other than that it will go live in April. It puts more pressure on the workforce in the ED because there will have to be a handover so that they can release the crew.”
“I agree with the Member. I do not think that there is anybody working in Health and Social Care who does not want to deliver the best for their patients and service users. However, the Member will know that such are the pressures, particularly in emergency departments. Nurses, doctors and ambulance crews are trained to do the best thing for patients, but, because of the pressures and the numbers, too often, they end up trying to decide what is the least worst option. That is not a single decision. Once they have made one least-worst-option decision, there is another one in their face and then another one and another one for the whole of their shift.”
“First of all, I extend my sympathies to Mr Darragh's family. That is a very regrettable loss of life. I hope to see improvements in hospital flow that are expected to help restore the capacity of the Ambulance Service. The future operational approach to responding to category 2 calls in the final hour of shift will depend on the outcome of ongoing discussions with trade union representatives, so I can make no promises there. Regardless, category 2 calls will continue to remain fully visible, clinically governed and actively managed at all times, even when immediate deployment is constrained by wider system pressures. <BR /> <BR />As for meeting Mr Darragh's family, of course I agree to that.”
“That includes the Release to Rescue protocol, which is scheduled to go live next month. It will allow ambulance crews to safely return to the community when extended hospital handover delays occur, helping to restore lost capacity at emergency departments (EDs). <BR /> <BR />NIAS continues to engage constructively with trade union representatives on the issues underpinning the action short of strike, including staffing, staff welfare and the operational impact of hospital handover delays. I am scheduled to meet trade union representatives and the Ambulance Service leadership later this week to discuss those matters further.”
“The Northern Ireland Ambulance Service (NIAS) continues to engage constructively with recognised staff-side representatives regarding the current industrial action and associated action short of strike (ASOS). Since November 2023, three of the four recognised trade unions in NIAS have been undertaking ASOS. The issues that have been raised relate primarily to safe staffing levels, staff welfare and the impact of prolonged hospital handover delays, which contribute to late finishes and reduced opportunities for rest. <BR /> <BR />NIAS has established regular partnership forums with trade union representatives to review those issues, monitor operational data and identify actions to reduce the impact on staff. Progress has been achieved across a number of areas, with further improvements expected through ongoing hospital handover reform.”
“I want everybody, when they wake up in the morning, to feel content and to look forward to delivering HSC services, but that is not where we are.”
“I assure the Member that I have sat down and listened to the community pharmacy people about their concerns. I have been told that provision has increased by almost £60 million since April 2018. We are coming towards the end of this financial year. We started with a £600 million shortfall in the Department. I said that that was unprecedented and unmanageable, and I was correct on that, because it is only through the Treasury reserve claim of up to £200 million, which we will have to pay back, that we hope to balance the books. Effectively, we are finishing £200 million light. Going into next year, our starting position is at least £800 million short. I would love to do more for community pharmacy. Community pharmacy and GPs are central to the shift-left agenda, and I want them to get more.”
“I quoted the figure of £20 million to Mr McGuigan. Removing clawback arrangements would allow in excess of £20 million to be retained by community pharmacies. The actual annual margin achieved by community pharmacies in Northern Ireland has significantly exceeded the guaranteed level, and, when that is coupled with the fact that any excess in margins is not recouped by us, we cannot consider the removal of discount clawback at this time, I am afraid.”
“Scotland's suspension of generic discount clawback has been feasible only because of legacy differences between Scotland and England's drug tariff prices, which are now beginning to align. There is a request from Community Pharmacy Northern Ireland to adjust or remove long-standing discount clawback arrangements to allow in excess of £20 million to be retained by community pharmacies but with no additional service provision or benefits for patients or the HSC. I am afraid that that is a bridge too far.”
“I can certainly make that commitment, because I have met Community Pharmacy Northern Ireland directly on a number of occasions. I believe that I have a relationship with Gerard Greene. I am interested in the clawback that the Chair of the Health Committee mentioned. My Department has worked with the Scottish Government to gain a greater understanding of their funding arrangements. That engagement has identified that recurrent core funding levels in Northern Ireland and Scotland are broadly comparable.”
“I am a daily user of medication, so I can say anecdotally, from speaking to my own community pharmacist, that I have been made aware that pharmacists are feeling particular pressures from price points at the moment. It is fair to say that we have regular negotiations and conversations with Community Pharmacy NI but have yet to find a joint landing space when it comes to what we think is the right thing to do about investing in community pharmacy and what it thinks we need to do for it. I am not happy that we are not in the same place. I therefore want those discussions to continue until we are in agreement.”
“Claims that 90% of pharmacy customers of one wholesaler did not pay their bill in January are concerning for the company involved. My officials will continue to engage with wholesalers to ensure that the continuity of supply of medicines to patients and members of the public is assured.”
“<BR /> <BR />Community pharmacies access medicines via a range of commercial arrangements, with different pharmaceutical wholesalers operating within a UK-wide supply chain for medicines. Those commercial arrangements are agreed between the wholesaler and the community pharmacy business and operate in a competitive market. Wholesalers compete on price, service levels, delivery speed and credit terms. Departmental officials engage with wholesalers to ensure that the continuity of supply of medicines to patients and members of the public is not affected. Notable examples include work that is related to EU exit, the COVID pandemic and times of medicine shortages. <BR /> <BR />Wholesalers have advised of pressures in the community pharmacy sector across the UK, including here.”
“I recognise the vital work that community pharmacy teams do each day to ensure the safe supply of medicines to patients. That is reflected in the considerable investment that my Department has made over recent years, the aim of which has been to strengthen the role of the sector in primary care, including making yearly increases to recurrent funding, annual pay uplifts and exceptional investments, such as for National Insurance increases. Government funding for community pharmacy Health and Social Care (HSC) service provision has increased by almost £60 million, or 57%, since April 2018. That is the highest level of funding to date and is commensurate with funding in the rest of the United Kingdom.”
“I repeat that it is a matter of regret for me. I join the Member in welcoming the students from St Clement's, who live in a jurisdiction on the island where there is minimum unit pricing on alcohol, and that is good for people's health.”
“The Member is aware that the worst moment of my tenure — my 21 or 22 months as Minister — came last September, when I had to say that we could not introduce the real living wage as promised. Mrs Dodds made the point, with which I very much agree, that, if we can find £5 million of savings somewhere, we could introduce 24/7 stroke thrombectomy services, which would impact on around 160 lives per annum — people who suffer permanent damage from a stroke because it happens to occur outside the opening hours of the existing thrombectomy service. Yes, whether or not £117 million is a low estimate, I could very quickly draw up for you a list of services and benefits that would spread across the Health and Social Care system.”
“The purpose is certainly to target cheap white ciders and cheap beers. I am told that our supermarkets sell small bottles of water that are more expensive than tins of beer. When it comes to impact, I know that some people felt that minimum unit pricing would affect their local pub, but that is absolutely not the case. If, for example, we were to set a minimum unit price of 65p, a pub could not sell a pint of plain for less than £1·30. If the Member can show me a pub selling Guinness for £1·30, I will look forward to recess.”
“I have tried to ascertain why some people may not be in favour of the introduction of minimum unit pricing. I have not heard an argument that I find convincing and compelling. As for the Member's other point, I have already stated my view that the best way in which to express opposition to proposed legislation or policy is allow it to come to the Floor of the House for debate. Often in the House, we debate with the objective of victory for our side, but, sometimes, the purpose of debate is to make progress. This would have been progress.”
“I assure the Member that I will ask officials that question. It is not something on which I have been particularly focused; my focus has been on trying to get agreement at the Executive table to introduce the legislation.”
“The Member referred to "Paisley versus Farage": some people have said to me, "The party of the devil's buttermilk now refuses to support minimum unit pricing. Who knew?".”
“The Chief Medical Officer was more than happy to engage, because, as I said, he is at least as passionate as I am about the issue and has been campaigning on it for much longer.”
“I believe that I have exhausted all the appropriate options. Perhaps I was naive: I felt that this was, to use the common parlance, a no-brainer, and I was very surprised to find that it did not simply pass on the nod through the Executive. I then took whatever actions I thought were appropriate. A number of papers were presented to Executive colleagues.”
“Scotland's evidence shows a reduction in wholly alcohol-attributable hospital admissions due to chronic causes. There is also strong and consistent evidence of a reduction in alcohol consumption. Total alcohol sales reduced by 3%, which was driven entirely by a reduction in sales through the off-trade; in other words, supermarkets and shops. The households that purchased the most alcohol prior to MUP also reduced their purchasing the most after implementation. <BR /> <BR />While Ireland has not yet completed a full evaluation, Alcohol Action Ireland has concluded that there are promising early results, including a 5% drop in consumption in 2022, compared with the pre-pandemic level. <BR /> <BR />All the evidence that I have seen is heavily weighted towards the positive impact of the minimum unit price of alcohol.”
“<BR /> <BR />While the Scottish evaluation also concludes that MUP may be associated with relative increases in deaths due to acute conditions, an acute alcohol-attributable condition is one that is likely to be associated with an episode of excessive alcohol consumption, such as alcohol intoxication. There was considerable uncertainty around that finding, which was not statistically significant.”
“As part of the introduction of minimum unit pricing for alcohol in Scotland, a five-year evaluation of the impact of MUP was commissioned to inform future decisions by the Scottish Government. The evaluation sets out strong evidence that MUP reduced deaths directly caused by alcohol consumption in Scotland, compared with what would have happened in the absence of MUP. The overall reduction was driven by reductions in deaths due to chronic causes. A chronic condition or cause is one that develops slowly and may worsen over time, such as alcoholic liver disease.”
“I believe very firmly that the legislation would have a significant impact on the 30% of behaviours that are part of the formula for tackling health inequalities. I am not in the business of trying to censor a Member's expressing himself or herself with their own language in their reaction to the position that we find ourselves in.”
“Just for the record, the report from the University of Sheffield that I referred to was from September 2025. It was, indeed, 2023 research, but once again, like her colleague Mrs Dodds, the Member is choosing to go for the other half of the equation, which is about what we do to support drinkers who are in need of support. This debate is about minimum unit pricing.”
“The whole concept of shifting left is to get from hospital to community, with a focus on prevention where possible and early intervention where necessary. Minimum unit pricing is entirely consistent with the shift left, taking the pressure off the hospitals — as the Member said, over 7,000 admissions — and saving lives.”
“The Chief Medical Officer, Professor Sir Michael McBride, has been at this much longer than I have and is at least as passionate as I am about the introduction of minimum unit pricing for alcohol. Yes, he was available to any MLA, and I believe that he actually had a meeting with the Democratic Unionist Party.”
“As I said, in my opinion, the best way to express disagreement with any policy or legislation is to allow it on to the Floor of the House, make your case and try to win your argument. I regret that we are unable to do that. We will be going to the polls in just over a year's time. Think of the number of people who might still be alive if we had introduced minimum unit pricing.”
“As I referenced in passing in my opening remarks, several Health Ministers have tried to introduce minimum unit pricing. That includes at least two Ministers who were members of the Democratic Unionist Party, yet it appears that that did not find favour. As a matter of principle, I can understand why any single party in this Chamber might not support any particular specific piece of legislation, but I think that the right way to do it is to allow the legislation on to the Floor of the House and have the debate. If that party wins the debate, so be it, but let us be mature enough to have the debate in the Chamber and to have scrutiny in the statutory Committee.”
“The formula that we use is that it is 20% health, 40% socio-economic, 10% environment and 30% behaviours. Within that 30%, alcohol misuse is right up at the top of harm.”
“The Member will know that the business of the Executive is confidential. However, I think that it is very much in the public domain that my party, the Ulster Unionists, supports minimum unit pricing. I think that it is in the public domain that Sinn Féin supports minimum unit pricing, that the Alliance Party supports minimum unit pricing and that the Social Democratic and Labour Party support minimum unit pricing. <BR /> <BR />The scientific and moral arguments have been made by me. I commend to Members, if they have not seen it yet, a report from the University of Sheffield that is specific to estimating the burden of alcohol on the health of Northern Ireland. I think that there is ample evidence to show that minimum unit pricing works. The Member will know that I have a passion for tackling health inequalities.”
“Finally, while there is clearly insufficient time left to legislate in this mandate, even if there were Executive agreement, it is my fervent hope that an incoming Health Minister and Executive will be able to introduce legislation early in the next mandate to address this important public health issue. I commend the statement to the House.”
“From my perspective, I feel that not introducing minimum unit pricing is a missed opportunity — an opportunity that would have allowed the Assembly to make a meaningful difference to reducing alcohol-related harms and inequalities across our region. Therefore, I reiterate my regret that I am making this statement today rather than introducing legislation.”
“The evidence shows, however, that by cutting off the supply of cheap alcohol, MUP is likely to reduce the number of people who become dependent in the future and reduce demand on our already overloaded health and social care (HSC) system. In fact, there is also evidence that increasing alcohol prices delays the initiation of alcohol use, slows younger people's progression towards consuming larger amounts and reduces heavy episodic use of alcohol among them.”
“That is consistent across alcohol types and for those in poverty and those not in poverty. Finally, there is no evidence that it causes people to shift to illicit alcohol or other drugs. <BR />It is also important to note that MUP is not focused on dependent drinkers. Dependent drinkers need timely access to high-quality treatment and support services. MUP targets the wider cohort of harmful and hazardous drinkers: those who drink above the UK Chief Medical Officer's guidelines but are not dependent. They are a significant population, and they come to harm; thus, MUP is a highly targeted measure. <BR /> <BR />Through our wider substance use strategy, I am working to deliver improvements to our alcohol treatment system to help all those who are affected by alcohol harm. That is essential with or without MUP.”
“It would reduce crime by an estimated 3,188 offences a year, reduce workforce absences by an estimated 58,910 days per annum and result in healthcare savings of £117·4 million over 20 years. <BR /> <BR />I have always been clear that MUP is not a silver bullet, but it is a proven, effective tool to reduce alcohol harm. It is also surrounded by misunderstandings, and it is important to address those. First, MUP is not a tax; it is simply a way of ensuring that the price of alcohol reflects its alcoholic strength and its potential harm. It will not affect the price of alcohol in the on-trade, which means pubs and clubs, nor will it impact on the price of products above the MUP. It does not target those on lower incomes; it is the heaviest drinkers who consume the cheapest alcohol and come to the most harm.”
“In addition, the event reinforced that the impacts of MUP are targeted, with the greatest benefits being seen among the heaviest drinkers and those living in poverty, meaning that a minimum unit price would help to reduce health inequalities. For example, while the impact depends on the level at which MUP is set, modelling estimates that a 65p MUP would reduce alcohol consumption by 8·5%, with the largest reduction coming from harmful drinkers and increasing-risk drinkers; increase spending by only 1·9% for moderate drinkers and 2·3% for increasing-risk drinkers but reduce spending for higher-risk drinkers; and lead to a reduction of 82 alcohol-related deaths a year and a reduction of 3,482 alcohol-related hospital admissions a year.”
“I was delighted to speak at the Northern Ireland Chest, Heart and Stroke MUP event at Parliament Buildings in November of last year. The event showed strong support for MUP across the public health sector, elected Members and the community and voluntary sectors. Their support has been amplified by the recent open letters from the Noncommunicable Disease Alliance and the Alcohol Health Alliance UK. <BR /> <BR />The evidence presented at the event clearly sets out that an MUP would reduce alcohol consumption and lead to fewer people being admitted to hospital and dying as a result of their drinking. For example, in Scotland, it is estimated that MUP has led to 120 fewer alcohol deaths every year.”
“Alcohol-specific causes make up the biggest group of admissions, accounting for over 50% of the total. Alcohol-attributable cancer admissions are the second-largest contributor, accounting for almost one in five admissions. <BR /> <BR />The report also records that the 25% of drinkers who exceed the UK Chief Medical Officer's guidelines account for 80% of all alcohol-related hospital admissions and 78% of all deaths caused by alcohol. Indeed, over half of all alcohol harms are concentrated among the 10% who drink at the highest levels, and the modelling and evaluations show that MUP targets those groups and highlights its benefits in addressing harm and reducing inequalities. That is why there is wide support for the measure across Northern Ireland.”
“That report estimated that 676 people die each year as a direct result of their alcohol consumption. Around half of those deaths are from alcohol-specific causes — those deaths are, by definition, caused by alcohol consumption. The remainder of the deaths are from conditions where alcohol is not the only cause but plays a contributory role. Alcohol-related liver disease is by far the single largest cause, accounting for 248 deaths a year, which is over a third of the total. The report illustrates the breadth of conditions where alcohol plays a direct role in increasing mortality rates, including injuries, seven different cancers and a range of cardiovascular conditions. <BR /> <BR />The report also shows that, each year, an estimated 7,426 hospital admissions are caused by alcohol consumption.”
“The Chief Medical Officer also gave evidence to the Health Committee as recently as January 2026, briefing members on the latest evidence and his professional public health position, supporting the introduction of minimum unit pricing. <BR /> <BR />Primary legislation had been provisionally scheduled for introduction in 2026-27. Unfortunately, however, despite my efforts to provide information and address any concerns, it has not been possible to secure Executive agreement. Sadly, we have now reached the point where legislation for MUP is no longer deliverable in this mandate. That will have an impact on many vulnerable and at-risk people in Northern Ireland. <BR /> <BR />The British Heart Foundation recently published a report estimating the burden of alcohol on Northern Ireland.”
“At the same time, updated independent modelling was commissioned to estimate the impact of MUP in Northern Ireland at a variety of price levels. Subsequently, I considered a full options paper, which set out a range of potential ways forward on using pricing mechanisms to reduce the harm that alcohol causes. The paper considered the consultation responses, the updated modelling and evidence and evaluations from around the world. From that very robust evidence base, I concluded that MUP, while not a panacea, would be an effective and targeted way to address the issue. I appeared before the Health Committee in October 2024 and again in February 2025, setting out my belief that we needed to progress legislation to introduce MUP.”
“<BR /> <BR />All of us will know that alcohol use has long been an accepted part of our social life and culture. Perhaps, to some extent, we have become desensitised to the harm that it causes. To put it in context, each year in Northern Ireland, alcohol causes twice as many deaths as illicit drugs. Much of our current activity is inevitably focused on addressing the harms of alcohol use. The prevention of those harms is more challenging, however the evidence strongly points to pricing initiatives, particularly minimum unit pricing (MUP), as providing one of the most effective ways of reducing such harms. That is why MUP has been under discussion for a number of years and has been proposed by multiple Health Ministers. <BR /> <BR />My Department consulted on MUP in February 2022, and a summary of the responses was published in 2023.”
“The Licensing and Registration of Clubs (Amendment) Act (Northern Ireland) 2021 places an onus on my Department to introduce legislation in Northern Ireland to set a minimum price for the sale or supply of intoxicating liquor and to prohibit its sale or supply below that price. If it has not been reasonably practicable for the legislation to be introduced, the 2021 Act requires me to make a statement to the Assembly on why it is not reasonably practicable so to do. The deadline for that is by the third anniversary of the Act coming into force: 6 April 2026. As the Assembly will be in recess for Easter, I make that statement today. I very much regret having to make the statement rather than introducing legislation on setting a minimum price, as envisioned in the 2021 Act and supported by the Assembly at that time.”