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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“<BR /> <BR />In conclusion, the aim of the deferral is to protect the delivery of front-line services, do our best with the budget and make sure that the Treasury does not come in with a deep dive and say, "I see that you have surrendered £7 million that you did not need to surrender". I thank the Members who contributed, and I commend the Second Stage of the Bill to the House.”
“If you look at the three-year plan that I published last year, you will see that the three pillars are stabilisation, reform and delivery, but it starts with stabilisation. We are still challenged in respect of stabilisation because of the budgetary pressures, which, I repeat, are likely to be £800 million-plus from 1 April over the next financial year. So it is not hypothecated, and it would be difficult to start hypothecating spends like this because of the competing demands and pressures. However, I take the point that 24/7 thrombectomy is something that Mrs Dodds wants to see, and I want to see, before everybody else goes off seeking a vote in May 2027.”
“I agree with Mrs Dodds: I would like to see 24/7 thrombectomy services introduced as soon as possible. She is right to say that the money would see 160 people who take a stroke outside the hours when thrombectomy services are available, and whose stroke was amenable to a thrombectomy service, being able to walk out of hospital rather than perhaps having lifetime conditions arising from the stroke. So it is really important, and it is a £5 million annual recurrent cost. <BR /> <BR />This morning, I was with three clinicians who deal with a particular type of cancer, and that £7 million would go a very long way to funding their service. They were so reasonable: all they want, as a first phase, is something that will cost £100,000 or £200,000, but even that is really difficult to get.”
“They have the discretion to apply eligibility criteria in other situations, but I have to say to Mrs Dodds that I have no intention of introducing further exemptions, and I am not aware of any of the trusts being in that space. However, I expect them to continue to keep operational arrangements under review, and, in the event of a specific vulnerability or exceptional circumstance being identified, to support and consider accordingly. <BR /> <BR />The one other issue is whether this is £7 million that would come off front-line services or go to front-line services. To be clear, it is not hypothecated, but if we were to lose the £7 million, we would have to make it up from somewhere. Money is so tight that we are increasingly edging towards taking the money off front-line services. That is why it is that serious.”
“I take no pleasure in doing what I am doing, because I understand that I am going against the will of the House as expressed in the 2022 Act. There is one specific question that I want to answer, and it is about whether there may be further exemptions during the deferral period. To be clear with regard to the division of labour, my Department sets the policy, and that includes guidance on free and concessionary parking. That is for patients, next of kin and visitors. We want to see it in particular care pathways. For example, it is currently in place for radiotherapy, chemotherapy, renal dialysis, critical care and high-dependency care paths. It is implemented by the health and social care trusts.”
“I know that Members supported that measure for the best of motives, reflecting a genuine desire to show solidarity with health service staff, patients and patients' families and friends. However, the House needs to balance that benefit against the impact on vital services if it is not possible to offset the lost income with other funding. I therefore ask you all to support the Bill.”
“That is because of the importance of securing Royal Assent in advance of 12 May, when the Act is currently due to come into operation. <BR /> <BR />Although the timescales for approving the legislation remain tight, and the risk remains that charges will be abolished for a short period, Members will see that that eventuality is accounted for in the Bill, with the deferral coming into operation when the legislation secures Royal Assent. Departmental officials will continue to liaise with those responsible in the trusts to ensure that they are prepared for that eventuality. <BR /> <BR />In concluding, I give credit to those who are responsible for the often unglamorous but vital work of managing our hospital car parks. Having put a lot of time and effort into preparing for the abolition of charging, they will have to change tack.”
“<BR /> <BR />During the deferral periods, staff parking permits will remain free of charge, and a needs-based system will apply to ensure that staff with the greatest need are provided with free, on-site parking. In October, I circulated the initial draft of an Executive paper to ministerial colleagues to seek their approval for the deferral of parking charges in order to protect front-line services. That was followed by further versions of the paper over the following months in my attempt to secure a discussion at the Executive. However, it was not until the Executive met on 26 February this year that I was finally able to secure Executive approval. The delay from the Executive meant that it was necessary to secure approval of the Bill by accelerated passage.”
“For that reason, the Bill includes provision for a deferral of up to three years, but if the financial circumstances turn out to be better than expected, and sustainability is achieved at an earlier date, the Bill includes provision for the 2022 Act to come into operation at an earlier date, with May 2029 as the backstop. The Bill includes a provision that approval of the revised operational date for the Act will be sought by way of a statutory rule, subject to the affirmative resolution procedure in the Assembly. The affirmative resolution procedure, instead of the negative resolution, will provide an opportunity for the Assembly to debate and improve any draft statutory rule.”
“I could not allow one of the first discoveries of the Treasury's open-book review to be that we had willingly surrendered £7 million. <BR /> <BR />Turning to the details of the Bill, rather than specifying a date on which the 2022 Act will come into operation, the Bill indicates that it will subsequently be specified by regulation. Although I am confident that the challenging financial position can be addressed, I also know that it will take time. I hope that the necessary steps will be taken over the next three years to return our health and social care sector to a financially sustainable position, while protecting and enhancing the priority care that is delivered.”
“To be frank, the proposed approach set out in the Bill will not be the last time that I will need to make a difficult decision, and while £7 million on its own will not solve all the financial problems, the fact is that financial sustainability will require many small steps because there is no silver bullet. <BR /> <BR />While I might take pride in some of the new initiatives and projects that I have announced during my time as Minister, being in the Government is not just about making the positive and popular decisions; it is about making the necessary ones. At a time when the Treasury is conducting an open-book review of the budgets of all Northern Ireland Departments, it is important to show that the Executive and the Assembly take their financial responsibilities seriously.”
“Looking to the years ahead, the health and social care sector faces an unprecedented challenge, with the situation even more serious than it has been recently. The overall financial deficit facing the health and social care sector in 2026-27 is estimated at around £800 million, and it will grow further in subsequent years. That means that it is simply not possible for the health service to keep operating in the same way as it has been. Difficult decisions will need to be made across every part of the HSC sector. In that context, the abolition of hospital car parking charges would simply be unaffordable. It would require me to make decisions to reduce services to patients and their families to cover the £7 million in lost revenue every year.”
“I want to be very clear that the deferral is not being sought because we are not ready to implement the Act. The trusts would have been ready to abolish the charges in May. The investment will not be wasted. Plainly, the new equipment will be needed when charges are abolished, and, in the meantime, the new systems will provide much-needed data and management reports on car park usage, and that will allow trusts to make evidence-based decisions to increase efficiencies in their car parks and better manage the available space. <BR /> <BR />Although the trusts are willing and able to implement the abolition of car parking charges, the financial circumstances have now changed materially.”
“Over the past two years, the trusts have undertaken further work to prepare for the Act coming into operation. For example, a new traffic management system is being implemented regionally to control parking, preserve blue-light routes and protect designated spaces in the absence of charging.”
“However, in early 2024, a need was identified for a two-year deferral due to contractual issues and to provide sufficient time to have the necessary infrastructure in place.”
“Its main policy objective was to abolish hospital car parking charges across Health and Social Care (HSC) hospital sites in Northern Ireland for staff, patients and visitors. The 2022 Act was agreed by the Assembly with the best of intentions to reduce the financial burden on those who need to park at a hospital. At that time, it was a worthy aim. However, as the financial environment has grown more challenging, we have to recognise the impact of that loss of revenue at a time when literally every penny counts. <BR /> <BR />Subsequent to the Act receiving Royal Assent in May 2022, the health and social care trusts made good progress in preparing for its implementation to the original timescale.”
“Deputy Speaker, thank you for the opportunity to open the debate. At the outset, I thank my Executive colleagues for their support in bringing the Bill to the Assembly. I also thank the Health Committee. <BR /> <BR />While I readily accept that many colleagues in the House will be disappointed by the Bill, the inescapable fact is that our health and social care services face an unprecedented financial challenge. The aim of the deferral is to protect the delivery of front-line services from a loss of income should parking charges be abolished. <BR /> <BR />As Members will recall, the Hospital Parking Charges Act 2022 prohibits the imposition of charges for parking vehicles in hospital car parks. The Act was originally due to come into operation on 12 May 2024.”
“I thank the Chair of the Health Committee for outlining their considerations. I also note Mr Carroll's objection not only to the Bill but to accelerated passage. I made clear in my opening remarks the actions that I took to try to avoid accelerated passage. I tried to get earlier agreement from the Executive, but we are where we are. Accelerated passage, frustratingly, is the only way forward in my mind, and I encourage the House to support it.”
“I hope that it is clear to Members that that would create an unacceptable risk of traffic chaos in and around critical hospitals, bringing with it risks to staff, patients and the public. I therefore commend the motion to the Assembly and ask that it agree that the Hospital Parking Charges Bill proceed under the accelerated passage procedure.”
“<BR /> <BR />If the normal approach were to be adopted, it would not be possible to secure Royal Assent before 12 May, with the result that charges would have to be abolished temporarily, and it would be for a considerably longer period than the four days in 2024 before the current two-year deferral period came into effect. During that time, there was an uncontrolled surge in demand for car parking spaces. That resulted in significant disruption to flow in our busiest hospital sites. That is not something that I want to see repeated. <BR /> <BR />If Members do not grant accelerated passage, the stark reality is that hospitals will have limited means to control parking, to preserve blue-light routes and to protect designated spaces.”
“I also set out some of the income-generation measures that I would need to consider, including deferral of the abolition of car parking charges in hospitals under the 2022 Act. <BR /> <BR />Formal proposals for the deferral of the ban on charging vehicles for parking in hospital car parks were first circulated to Executive colleagues on 8 October last year and recirculated on 11 November. Subsequent versions of the papers were circulated on 5 December last, on 14 January this year and on 9 February. I then made a request for a decision by the First Minister and the deputy First Minister under urgent procedure on 17 February, with my recommendations finally being approved by the Executive on 26 February. That has left a very short period in which to go through all the stages of Assembly approval and secure Royal Assent.”
“Achieving financial sustainability will take a number of years to achieve, and that is why the deferral is for up to three years, in line with the timescales for the ongoing Budget process. <BR /> <BR />I assure Members that I have made every possible attempt to avoid the need for accelerated passage. Last July, I wrote to Executive colleagues highlighting the implications for my Department of the outcome of the UK-wide 2025 spending review that took place in June.”
“<BR /> <BR />Before I do that, I will say a few words about why legislative change is required. I will, of course, cover that in more detail in the Second Stage debate that will follow the debate on this motion. Health and social care trusts have been working to implement the legislative requirements of the Hospital Parking Charges Act by 12 May 2026. However, the financial challenges facing the health and social care sector mean that difficult decisions will need to be made across all areas of spend to return the sector to financial sustainability. That includes deferring the abolition of charging for hospital car parking to avoid the loss of some £7 million in charge income recurrently.”
“Deputy Speaker, thank you. I am grateful for the opportunity. I seek agreement to progress by accelerated passage the Hospital Parking Charges Bill, which will postpone the ban on charging money for parking vehicles in hospital car parks, as contained in the Hospital Parking Charges Act (Northern Ireland) 2022. I confirm to the House that Executive approval was secured for the process of accelerated passage, but I do not make the request lightly. Whenever possible, primary legislation, of course, should be subject to full Assembly scrutiny. The Committee Stage of any Bill is, clearly, a significant element of that scrutiny process. However, for reasons that I will outline, there are, on occasion, compelling grounds for the use of accelerated passage.”
“I beg to introduce the Hospital Parking Charges Bill [NIA 29/22-27], which is a Bill to further postpone the ban under the Hospital Parking Charges Act (Northern Ireland) 2022 on charging money for parking vehicles in hospital car parks.”
“We need to be innovative and imaginative. If we focus solely on the money, we will be beaten. We cannot continue to absorb over 50% of the entire Executive Budget because the other Departments are doing very good work, not least in addressing the social determinants of ill health.”
“Mr McGrath hit on something, which is that the drivers are not just drivers. If they are regular collectors and deliverers of the same service users, then, to some extent, they become carers and deliverers of care. It is about a package. The role involves more than simply driving a vehicle for an hourly rate. That is where I see the potential. <BR /> <BR />Did I have 10 minutes, Mr Deputy Speaker?”
“Every week, I am in the Chamber to hear the will of Members that I do more for a particular service or set of services. The money does not exist. <BR /> <BR />I will give way to the Member by all means.”
“It is really good news that children are now surviving into adulthood because we are able to care for them better than we were previously. The problem is that, if I need to find millions of pounds to bring the hourly rate up to something that is competitive with the other statutory services, where will I get that money? <BR /> <BR />A couple of hours ago, I was involved in another debate in the Chamber, and the mood and will of the Assembly was that I should find about £2·5 million to fully deliver on the business case for eating disorder services. During that debate, Mr McGrath made clear that I am delivering less than 20% of the £1·2 billion that it will cost to deliver the mental health strategy in full over its 10-year lifespan.”
“I thank the Member for that question. Yes, I have done that. In fact, before I left Edgcumbe that day in late January, I spoke to officials about the quantum that would be required to bring the hourly rate for those drivers into line with the rate in other statutory services. The answer was that it would be a very significant sum of money. <BR /> <BR />That brings me on to this point. Mr Brooks said that, if it is on the risk register, it is time for action and that, if the system is broken, it needs to be addressed. My question to Mr Brooks is this: how? The learning disability service is the third-largest programme of care in Health and Social Care when measured by cost. The cost equates to around £500 million per annum, and it is expected that it will continue to grow because we have increasing rates of disability.”
“<BR /> <BR />Trust representatives advised that the trust continues to explore alternative transport provision as appropriate and in line with assessed need. Trust and departmental officials remain committed to addressing transport issues to ensure that individuals assessed as requiring support with transport consistently receive that support. Family carers and service users should direct any queries to the trust to ensure that alternative service provision to assist family carers in their role is fully explored. The Belfast Trust has provided a contact number for families in the event that they experience issues: the transport supervisor's number is 028 9504 0801. That line is live from 7.30 am until 8.30 pm. The number will be available in the Hansard report, once it is published.”
“My officials advise that, although the issues remain challenging, the trust's transport service department is working hard to bring the service to full capacity. <BR /> <BR />When it comes to considering additional buses, the Belfast Trust's transport service advises Edgcumbe Day Centre and all other centres in the trust area that it does not have a bus shortage. The Belfast Trust confirmed that five buses are currently out of operation, including those that have planned routine service requirements. The trust considers, however, that there are enough spare buses to cope with any that may be off-road due to service or maintenance requirements. The trust advises that the main issue regarding transport to Edgcumbe is driver shortages, with one vacancy and one long-term sickness. The trust plans to fill that vacancy in the coming weeks.”
“The trust continues to progress pathways to employment for bus drivers with the local council, supporting people who are currently unemployed to obtain the necessary licence. Time frames for that are yet to be finalised. The trust advises that its transport and human resources department continues to seek a resolution to the ongoing issues, as well as considering options to advance recruitment by using agencies and trust recruitment drives. The trust plans to progress more localised advertising and social media advertising. <BR /> <BR />It is acknowledged that the issue of transport staff working to rule and the pay disparity compared with other employers will take time to address because it involves human resource and staff-side representatives.”
“I am pleased to report that there has been some improvement. On recruitment, the Belfast Trust transport team has advised that two bus drivers have commenced in post since 1 January this year: one in January and one in February. Additionally, two more drivers are due to commence post: one in March and the other in April. The trust further reported ongoing engagement with the Business Services Organisation to advertise again for bus drivers. The trust anticipates those vacancies being advertised early this month. The trust further reported that there has been an improvement in agency recruitment, with two drivers commencing via an agency in the past two weeks.”
“As Minister of Health, I accept the need and consider it to be imperative not only to hear from staff but to listen to the views of families and service users about provision. From my visit, it was clear to me that day centres are an essential lifeline for many service users and carers. I took on board the issues that the families and service users raised about transport provision to and from the day centre. It was disappointing to hear from a family representative that transport issues had been ongoing without resolution, as Mr Brooks said, since 2019. <BR /> <BR />Following my visit, departmental officials met trust representatives, and key actions were agreed with the Belfast Trust to address transport issues. In advance of the debate, officials contacted the trust to obtain an update on those agreed actions.”
“On many occasions, that has resulted in associated costs, including the use of the personal independence payment (PIP) to assist with transport-related costs. That is not what PIP is for. Carers also expressed particular difficulty with organising alternative transport when taxis are unable to accommodate wheelchairs. Some wheelchairs are bulky, and some vehicles are not designed to accommodate them. <BR /> <BR />Family carers advised that difficulties with transport arrangements can result in adults with a learning disability not being able to avail themselves of a full day's attendance at the day centre, which is their life. We are reducing their opportunities to engage in meaningful activity and reducing the support that is available to the carers, not least the few hours in which they can be themselves.”
“Thank you, Mr Deputy Speaker, and thank you to all the Members for East Belfast who have contributed. I pay particular thanks to Andy and Joanne, who made me aware of the issues. Joanne invited me to visit the day centre. I am glad that I did, but I must say that my visit was informative rather than enjoyable, because there is no fun in hearing about the impacts of a lack of transport on service users, carers and parents. Towards the end of his remarks, Mr Brooks touched on some of the impacts. He talked about anxiety levels, behaviours, distress and harm among individuals who are unable to access their day-care services. <BR /> <BR />Carers referred to difficulties as a result of having to make alternative arrangements at very short notice.”
“We do not know yet what the Review Body on Doctors' and Dentists' Remuneration will offer, but I will seek to implement that in full. The real living wage also has to be implemented right across Health and Social Care. All I can say to the Member is that, after that, this issue will be very much on the agenda when considering how to spend what is left in the budget.”
“I know that, in the great scheme of things, Members may think that that is not a huge amount of money out of a budget of over £8 billion, but Members will also be aware that at least once a week — I am in here most sitting weeks, if not every sitting week — I am asked to prioritise and invest in something. The money does not exist. The shortfall that we are currently projecting for next year will be in the order of £800-plus million. It was £600-plus million this year. We failed to balance that, and we needed nearly £200 million from the reserves in the form of a Treasury loan to get us close to balancing the books. I have to be honest with Members: it will be a challenge. When we finalise the budget, the first thing that I will do is pay for the 3·3% uplift for Agenda for Change staff.”
“I say this to Members: the business case has, in fact, been partially funded already. A part-time regional clinical lead, a social care lead and a project manager for the regional eating disorder managed care network were all appointed in late 2024, and they have established that managed care network. However, completing the business case depends on funding. <BR /> <BR />The business case costings in full are £3,483,439. If I discount the recurrent moneys of just over £1 million that have already gone into the part implementation, the additional funding required for the full business case stands at £2,396,439.”
“<BR /> <BR />I acknowledge the motion's call for a:”
“I stress that eating disorders cause real distress for service users and their families and friends, and every admission is one too many. It is true that CAMHS admissions rose sharply after the COVID-19 pandemic, but they have since returned to roughly pre-pandemic levels. Nonetheless, I remain committed to strengthening early intervention and community support so that timely, effective care is available for every child, young person and adult who needs it. <BR /> <BR />The mental health strategy states clearly that additional investment is required to develop services in line with NICE guidance, including the establishment of intensive day-treatment options. Unfortunately, the deliverability review has highlighted the extent to which funding constraints have limited progress across the strategy, including in eating disorder services.”
“That will help to prevent deterioration, avoid crisis-driven referrals and reduce the pressure on acute inpatient settings, as the Member said. Early intervention is consistently shown to improve recovery rates, shorten treatment duration and reduce the likelihood of relapse.”
“Absolutely. Those are the two objectives of shifting left into a neighbourhood model of care. There will be better outcomes for patients, and it will also be much easier on the budget because, by the time that we treat people who have lingered on a waiting list for three, four, five, six or seven years, we have to treat them in an acute hospital, where all the really expensive procedures take place. Community care enables services to respond earlier and more flexibly. For many individuals, concerns emerge long before the need for hospital treatment. <BR /> <BR />By strengthening community pathways such as GP awareness, early intervention teams, mental health hubs and voluntary sector supports, we can identify difficulties at the earliest possible stage.”
“It includes a renewed focus on community-based care, which is vital in ensuring earlier intervention, reduced reliance on inpatient treatment and better long-term outcomes. Community-based care is widely recognised as one of the most effective ways to support individuals who are living with eating disorders, offering treatment that is timely, person-centred and aligned with everyday life. Eating disorders rarely occur in isolation; they take root in social contexts, family systems and community environments. For that reason, treatment approaches that extend beyond hospital settings can often lead to improved engagement, earlier intervention and better long-term recovery outcomes.”
“The first is communication and training on reducing stigma and raising awareness. The second is access to services and workforce. That seeks to align care pathways regionally, embedding evidence-based models and supporting our workforce through the development of specialist skills. The third is research, data and outcomes, building academic partnerships and using meaningful data to drive improvement and monitor treatment outcomes. Finally, co-design and co-production, ensuring that lived experience shapes every stage of service design and delivery. <BR /> <BR />A key priority for the network's access to services and workforce is the review of the You in Mind care pathway for the treatment of eating disorders from 2016.”
“A few weeks ago, its chief executive, Vanessa Longley, was upstairs at another event in room 115 and surprised me by saying that we are leading the way across the UK. We are, to an extent, trailblazers in the work that we are doing. However, having said that, I acknowledge that there is more work to be done. <BR /> <BR />On 23 February, as part of the awareness week, I launched here in Parliament Buildings the strategic framework and three-year implementation plan for the network. The plan sets out a clear collaborative approach to enhancing community eating disorder services, with strong representation from community and voluntary organisations on the implementation group and its work streams, with many actions being delivered with low or no cost. There are four strategic areas that are being addressed by the managed care network.”
“Here in Northern Ireland, data is available for only individuals who receive a diagnosis, so we can conclude from that that the true prevalence is likely to be higher. That stark reality underlines the importance of ensuring that our services are robust, accessible and evidence-based. In line with action 29(d), the regional eating disorder managed care network was established last year to drive improvement. The network brings together statutory, community and voluntary partners to deliver equitable, high-quality care right across the region. By standardising care pathways, strengthening workforce capability and improving outcome monitoring, the network supports care that is efficient, accountable and aligned with best practice. <BR /> <BR />Some Members have made reference to the GB charity Beat, which deals with eating disorders.”
“Research shows that individuals with an eating disorder have a mortality rate seven times higher than that of the general population. Worldwide, about 7·8% of people will experience an eating disorder in their lifetime.”
“— by an eating disorder. <BR /> <BR />Last week, I was pleased to take part in an event, upstairs in the Building, to mark Eating Disorders Awareness Week, not least because the theme was "Community". In the remaining year and two days between now and purdah, I want as much of my work as possible to be community-based, as we roll out the neighbourhood model of care, which, I hope, will transform the delivery of health and social care. <BR /> <BR />As the Chair of the Committee said, a specific action in the mental health strategy, 29(d), is dedicated to strengthening our response to eating disorders, which is an area that continues to require focused attention, innovation and investment. I will come to investment before I finish my remarks. <BR /> <BR />Eating disorders are among the most serious mental health conditions.”