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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“Thank you, Deputy Speaker. I thank Mr Martin for tabling the motion and for his work with the all-party group. I can only imagine the emotions involved in watching a loved one whose life is shaped or dominated —”
“I hope that we are not confusing each other over what we understand by the protocol. We have asked for a two-hour handover to be the target, and that is what we are aiming for, with a view to moving to an even shorter time frame. If, however, the Member is talking about some other protocol, perhaps we can discuss that offline.”
“It is a constant battle. We set a two-hour waiting time target, which we did not meet in full over the course of the extreme additional winter pressures. However, I am very proud of the Ambulance Service. It has great leadership, and it is trying very hard. I did a ride-on a few weeks ago, which was very informative, and I saw, in real time, the pressures of handover into emergency departments. I was at Craigavon Area Hospital, the Royal and the Ulster Hospital, and I felt not just for the patients but for the staff. Those guys and girls went back on the road. They wanted to deliver by getting on to the next client who needed them. As with a lot of things in Health and Social Care, the direction of travel is the right one, but the speed is not the speed that I want to see.”
“On the £80 million in the middle, we spent less than £10 million on waiting lists this year because the financial pressures were so severe on the overall Health budget that we used most of that to try to ease some of that pressure. I am determined that, next year, we will not do that and that the entire £80 million, along with the £85 million, will go towards waiting lists.”
“Lagan Valley Hospital has a critical role to play. As a rule of thumb, when you separate out emergency surgery from elective or planned surgery, you become much more efficient. Lagan Valley Hospital is doing fantastic work in a number of elective procedures. It is doing particularly well in providing cataract procedures. <BR /> <BR />On the £165 million for next year, this year, we had £165 million plus £50 million from the Executive to tackle waiting lists. We do not get the £50 million for the financial year 2026-27. The £165 million breaks down into £85 million for red-flag and critical procedures, and that will be spent again next year, as it is being spent this year.”
“I thank the Member for his question. I think that it is critical. Lagan Valley is an elective day procedure centre. The Mater and the South West Acute Hospital are overnight centres, and fantastic work is being done at Daisy Hill Hospital. When I go to some of those subregional hospitals, such as Lagan Valley, I see huge enthusiasm. I should probably declare that I have been a recent service user in the respiratory hub at Lagan Valley Hospital, and the service is absolutely first class. That is not because I arrived as a patient with the title of Health Minister; I saw a lot of very satisfied customers.”
“Once I get it, as long as it is as clear as I think that it will be, it will not take me very long at all to come to the final conclusion.”
“The second part is easier to answer than the first. I expect the report from Sir Frank, once I get it, to be pretty clear, and therefore it should not take me a particularly long time to make a decision. As I said, as part of the terms of reference, Sir Frank will advise me on whether he believes that a statutory public inquiry would be appropriate. We thought that the work would take a ballpark of two to three months, but, when the Ladies with Letters came up with the idea that more information needed to be looked at than was contained in the three reports, that, by definition, elongated the process. However, Sir Frank is now absolutely at work. I would not like to think that it will be the summer before I get the report.”
“It is my understanding that the Southern Trust has not uncovered any information that it thinks is particularly germane, but that is neither here nor there. I expect Sir Frank to make his own judgement. This has delayed the process, but it was a worthwhile delay because assurance and trust are very important, particularly for Ladies with Letters. As part of the terms of reference, Sir Frank will advise me as to whether he believes that a statutory public inquiry is appropriate.”
“I have asked Professor Sir Frank Atherton, who was a former Chief Medical Officer in Wales. I was originally going to ask him to review those reports, but I then met Ladies with Letters and a couple of others, and they made the case that, in their view, there was information that is germane to the scandal that was not included in any of those three reports. On that basis, I did two things. I instructed officials to liaise with the Southern Trust to see whether there was any information not in the reports that Sir Frank would find useful to his determination, and I also asked Sir Frank whether he would be willing to have a direct meeting with Ladies with Letters. Both those things have occurred.”
“However, there will, I guess, always be horrible examples like the one that the Member has come up with: 82 years of age and being told to wait two years for something that impacts really heavily on your quality of life. It is awful.”
“I would say that nobody wants him to die, but 104 weeks is shocking at any age, but particularly at that age. It reminds me that, if you are 80 years old and are told that you will have to wait five years, that could, as a percentage of your remaining life, be pretty close to 100%. If you are 10 years old and are told that you have to wait five years, that will hopefully be a comparatively minor percentage of your life. As a strategic decision, we have gone for the long waits, and I am pleased to report that most of the people who have been waiting four years for procedures have been seen or are being seen in the remaining weeks of the financial year. We will then turn our focus to those who are waiting three years.”
“I do not have that timeline to hand. I can certainly write to the Member about that. However, I can tell him that, when it comes to the £50 million that we are spending in this financial year — the whole £50 million will be spent by the end of this month — orthopaedics is by far the number-one area for additional work. A lot of hips and knees have been added to the schedule during this financial year because of the Programme for Government commitment and the £50 million that was ring-fenced through the Department of Finance.”
“A number of schemes come under that umbrella level of payment. If the Member is content, I will write to her with the exact detail, rather than guess. More generally, once we determine the cost of service and discuss it with the dental representatives, we will be looking at a significant redesign of NHS or HSC dental services.”
“The number of people who are unable to access dental services is rising. The Member will be aware that dental practitioners are not under any contractual obligation to do National Health Service work; they are free to charge privately. The Member is probably aware that, when the health service was instituted in 1948, it almost collapsed from the get-go because of the idea of free-to-access dental services. I accept that we are not in a good place. I am putting a lot of faith in the cost-of-service review that is under way because, until we get agreement with the dental representative body on the cost of delivering dental services, we will not be in a good place to redesign service delivery.”
“It is an apology, Mr McGrath. There are no commissioned services, as the Member knows, so any money that is spent by the trusts is discretionary spend by the trusts. The Department does not commission services. I am very pleased that we have commissioned the report, and that we have 19 clear recommendations for future commissioning, the workforce that we would need to deliver it and the development of an integrated ADHD pathway. The Member will know that I like to see consistent regional, standardised services, but the fact that we have done that, and that we cannot deliver it as appropriate because we do not have the funds to do so, leads me to apologise for the situation in which I have put those individuals, their families and their friends.”
“I do not believe that there is any specific ring-fenced money for ADHD services. The Member is aware that we have published Northern Ireland's first needs assessment, which sets out for the first time the level of demand for a commissioned service, as well as recommendations for what such a service might look like and the potential implementation and staffing costs. We specifically included consideration of the prison population, recognising its significantly higher prevalence rates of ADHD compared with the rates in the general public. I have asked for an options paper, but I have to be clear to the Member: there is no ring-fenced money for the implementation of any such option.”
“It is a serious issue. I wish that there were more money for the backlog maintenance because, if you do not address those issues, they will get worse. However, I assure the Member that the money that we have is prioritised to the most urgent safety issues.”
“The Member may know that £251 million worth of high-risk backlog maintenance works are required: £44 million in the Northern Trust; £17 million in the South Eastern Trust; £14 million in the Southern Trust; £17 million in the Belfast Trust; £1 million in the Fire and Rescue Service; and £158 million in the Western Trust.”
“Given the current financial climate, it is unlikely that the Department will be able to make substantial reductions to the overall backlog maintenance burden. However, my Department will continue to work closely with the trusts with the aim of ensuring that risks are effectively managed, that essential works are prioritised appropriately and that the limited resources available are directed and utilised as efficiently and responsibly as possible.”
“For the 2025-26 financial year, the Department of Health has allocated £30·79 million to address high-risk backlog maintenance across the HSC. I will break that down: £25 million is provided through the Department's core annual backlog maintenance capital budget, and the remaining £5·79 million is received through December monitoring. The funding is allocated to each of the trusts to support priority works that present the greatest potentials to service continuity, statutory compliance and the safety of patients and staff, ensuring that essential infrastructure remains operational and resilient. <BR /> <BR />I am keen to see standardised backlog maintenance reporting and improve the accuracy of the associated cost and risk data.”
“It is particularly useful if you have a major break in your arm as well as two minor breaks. Boneview will make sure that the clinician does not simply focus on the major break and will say, "You do realise that there are two other breaks that you will need to look at". Yes, patient delivery and outcomes are getting better.”
“Yes. We see clearer, safer and more consistent care. A single digital patient record means that clinicians have the same up-to-date information wherever a patient presents. For example, if you went to Lagan Valley Hospital and the team there decided to send you to the Royal or the Ulster Hospital, they would not give you a big manila folder with a paper-based trail of your condition to take in the ambulance; rather, the intake clinician at the Royal or the Ulster can go on their machine and look through Encompass to see what to expect when you arrive. That is fabulous. <BR /> <BR />More generally, there is an AI system called Boneview that I have seen at Antrim Area Hospital. That looks at fractures. Within two minutes, it will give a solid analysis — better than the human eye can do.”
“It is not just me who feels like that; there are some in HSC who feel that there is so much potential in Encompass that we have not yet tapped into. To a certain extent, that is frustrating, because we are missing a trick.”
“I thank the Member. Data will be and already is king. The ability of Encompass to give us that solid foundation for analysis is absolutely critical. I see the future of Encompass being not just in electronic patient records but in the ability to do population health initiatives based on the trapping and analysis of data. What is the timeline? I believe that I am right in saying that the digital people talked about it taking two years to fully embed. <BR /> <BR />I get the argument that you should not rush into something and that you need to take solid steps and show that phase 1 has been completed and works really well before moving on to phase 2, rather than trying to get to phase 10 immediately. However, I have a sense of frustration.”
“I believe that the best example is Encompass, on which we have moved from implementation to continuous optimisation. Trusts, my Department and the supplier partner, Epic, work together to manage upgrades, apply security and functionality upgrades, refine workloads and maintain a clear regional road map. Altogether, that ensures that clinicians and staff have the tools that they need and the system continues to support safe and effective care.”
“Over the past three years, the Department has spent £508 million directly on digital systems infrastructure and support across the HSC. The wider figure of £2·5 billion refers to the whole-life costs of major digital programmes identified by the Audit Office, including Encompass, new pathology systems and regional imaging. Those are large, multi-year investments that modernise essential clinical and corporate systems. Ensuring that the systems remain up to date and fully utilised is central to our digital strategy. We now have a strong regional governance model across all major programmes that provides clear oversight of performance, risk and standards and aligns with clinical and operational priorities. That, in turn, ensures that systems evolve safely and consistently.”
“This was not arranged by the farm families health check people, but, in the space of those 60 minutes, two farmers came up to say that they had randomly undertaken a check at another agricultural fair and the results had led to life-saving interventions. It is an excellent service.”
“In partnership with DAERA and the Public Health Agency, we have supported the farm families health checks programme for a number of years. The overarching aim is to improve the health and social well-being of rural farmers and farm families; increase local access to health screening services; provide health-related advice and information; and signpost to existing services for further advice and support. The Northern Trust administers the programme with the support of a full-time band 7 nurse coordinator, a part-time band 6 nurse and a band 4 programme administrator. It is also supported by a pool of band 5 nurses across all the trusts. <BR /> <BR />At last year's Balmoral show, I visited the health check truck that the programme has there.”
“The Member will be aware that I intend to bring forward a women's health action plan, hopefully sooner rather than later. We are in the last phase of the listening exercise, in which we are trying to hear the voices of harder-to-reach women, and that applies particularly to women who live in rural areas. When that comes forward, I hope that it will inform the answer to the Member's question.”
“As the Member is aware, we do rural needs impact assessments of all our policies. We liaise with the Department of Agriculture, Environment and Rural Affairs on future rural policy. A Department of Health Health and Social Care (HSC) forum was established to take forward work to address loneliness and social isolation, and it includes a specific focus on rural areas. My Department and its arm's-length bodies undertake rural needs impact assessments in line with the Rural Needs Act (Northern Ireland) 2016. We also engage regularly with many stakeholders, including the Northern Ireland Agri-Rural Health Forum.”
“Last year, as I said, I tested Live Better, and I hope that it will inform the new neighbourhood model of care that we intend to roll out from April.”
“While, in general, rural populations tend to experience better health outcomes, that can mask issues faced by rural communities such as transport connectivity, access to services and isolation. Health inequalities are a key focus for me, as I have said, and we are working across government to tackle the wider social determinants that will improve the well-being of our communities. <BR /> <BR />Beyond my Live Better initiative, the Executive have a Making Life Better strategy. It sets out our commitment to creating the conditions for individuals, families and communities to take greater control of their lives and to be enabled and supported to lead healthy lives. My Department leads on work on substance use, suicide prevention, tobacco use and obesity prevention, all of which underpin the strategy.”
“I respectfully say to the Member that she was not in the room when Alma White said that she did not understand. I am not misinterpreting her; I am quoting her. I will continue to work with other Ministers who have key roles to play in post-19 provision.”
“My point was that there is a mixed message, in that people say that there is no room for new legislation, yet the Chamber can rise at 4.00 pm on a Monday. As I said to Mr Baker, our resources for new legislation have been deployed for the rest of the mandate.”
“I understand that, if I were Alma White, I would see it as a mixed message. I can, however, commit to putting in place some building blocks to ensure that we — or you — can move forward in the next mandate.”
“You can shout at me from a sedentary position —.”
“Secondly, the Department of Health has already defined its legislative programme between now and purdah, so the question for us is not the availability of Chamber time but the availability of resources in the Department of Health and among those who would draft the legislation”
“First, I hope that the Speaker did not feel that that was a criticism directed at him.”
“We are moving in the right direction, just not as quickly as the Member, I or Alma might like.”
“<BR /> <BR />I am reassured by my Department that the learning disability service model, which we are starting to think about rolling out together with a delivery plan, matches or exceeds what is available in neighbouring jurisdictions.”
“I met Alma White and Caleb, who came into the Building the week before last. It would be fair to say that she was upset and did not understand why, although we are still just over a year away from purdah, there is no time to legislate. She wanted an amendment to the Chronically Sick and Disabled Persons (Northern Ireland) Act 1978. I had officials with me, and we tried to talk her through the process to explain why it was impossible to legislate this side of purdah. Then, on Monday of last week, the House rose at 4.00 pm. Therefore, I begin to wonder why we cannot look at the Chronically Sick and Disabled Persons (Northern Ireland) Act 1978.”
“<BR /> <BR />The draft learning disability service model outlines the goals for young people with learning disabilities, including those with SEN, to receive personalised lifelong support that allows for choice and control.”
“The children and young people's emotional health and well-being framework proposes an inclusive, needs-based approach to neurodiversity, which, importantly, does not require a formal diagnosis as a prerequisite for support. The model aims to reduce stigma, promote earlier intervention and improve outcomes across health, education and developmental domains. Work is ongoing to define the requirements that will underpin the pathway and inform future commissioning. <BR /> <BR />Building on the recommendations from the 2023 adult autism services review, work is now under way to update the adult autism care pathway. The review aims to deliver greater consistency in the diagnostic and support services across all trusts, aligned with the NICE guidance and reflective of differing levels of need.”
“I am not entirely sure what that has to do with the question that was asked by Mr Gildernew, which was about how social care needs are being addressed in Fermanagh and South Tyrone.”
“I can confirm to the Member that it is my plan to introduce the real living wage in this financial year. As the Member is aware, my budget has yet to be confirmed. Indeed, no Department or Minister has had their budget for 2026-27 confirmed yet. As soon as I have that, my two priorities are honouring the wage recommendations from the Review Body on Doctors' and Dentists' Remuneration on the one hand and fixing a date for introducing the real living wage on the other. It is my intention that, whatever date is deemed appropriate for the introduction of the real living wage, it will be back paid to 1 April 2026.”
“I thank the Member for the question. It might be better answered by the Member who asked the previous question, because that is his background. Absolutely, it is a worthwhile career. If you speak to any service user or their family and friends who observe what is happening with home care, they will tell you that social workers are fantastic people. When you talk to the people who deliver it, they will tell you that it is a worthwhile career. I have to deliver better for them not just with the real living wage but with the whole employment package and the work/life balance. That includes showing them more respect, honouring them, trying to increase the workforce and giving them more prominence.”
“The challenges of shifting left into the neighbourhood model are there, but, as I have said previously, challenges are there to be overcome, not to be used as obstacles to define why you cannot act.”
“I thank the Member for his supplementary question. The challenges in rural areas are distinct from those in urban areas, and I accept that. When I decided to tackle health inequalities with the Live Better initiative, we started with two urban district electoral areas (DEAs), because it is easier to club together services and flood an area if it is a dense urban area like The Moor DEA in Derry/Londonderry or Court in West Belfast. The challenge now in health inequalities is to deliver in more rural areas. The previous Minister in the Republic of Ireland, Stephen Donnelly, said that he had tried to tackle health inequalities, but he had started with too broad a geographic spread.”
“Work is ongoing to implement a regional home care brokerage system with independent sector providers that will deliver further efficiencies. There has been an extension to block home care contracts, particularly in rural areas with high levels of unmet need. All trusts hold regular recruitment events to build their home care workforce. I have given my commitment to introducing the real living wage for the social care workforce as soon as it is affordable.”