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 am aware that pockets of unmet need exist in respect of home care provision in parts of Fermanagh and South Tyrone, due to a combination of factors: increasing levels of demand; difficulties with recruitment; and difficulties with retention within the home care workforce. The Department has introduced a range of initiatives to deliver further efficiencies, including early review teams. Initial indications suggest that 47% of individuals who receive an early review of their home care package either no longer require home care or require a lower level of home care, and that releases hours back into the system. <BR /> <BR />CareLineLive, a real-time digital system, is being implemented across all the trusts. It is capable of delivering 10% efficiencies in home care hours.”
“It was not on my agenda, but, obviously, it is now. If the Member would like to discuss it further, I would be happy to do that, even later this afternoon.”
“I remain committed to ongoing collaboration with the trusts to ensure that all efforts are maximised to support timely patient access to assessment, treatment and care.”
“My Department is working closely with the trusts, progressing the development of a modernised, Northern Ireland-specific breast service model, and we are doing that at speed. However, it is important that we are clear that meaningful, sustainable improvement is not quick or easy to achieve. It cannot happen overnight. Transforming a service of this scale and complexity requires a phased approach over a significant period of time. I am committed to achieving that, and I hope that that is consistent with what the Member is seeking. The vision includes expanding multidisciplinary teams and strengthening the skill mix across the workforce. It will require a substantial lead-in time to support education, training, recruitment and workforce development.”
“The idea of the money's following the patient is being rolled out with payment by results so that there is now an incentive for those teams to deliver more.”
“As of 8 May last year, Encompass has been rolled out across the five geographic trusts. The trusts are looking for a considerable period of time in which to embed Encompass. I find that a little bit frustrating, because I am not a technician or an IT expert. However, it is certainly moving in the right direction. <BR /> <BR />I suggest gently to the Member that the most important thing that I said in my original answer to her was about the introduction of a bespoke payment-by-results pilot scheme. Normally, we engage a trust and commission it to do a list. In other words, a team will go into a theatre and work for, say, four hours. It may deliver four, six or more than six procedures, depending on the variance in the trust.”
“Given the sustained capacity pressures in breast services, funding has been directed towards additional evening and weekend assessment clinics for red-flag and urgent referrals, ensuring faster access for patients presenting with time-critical symptoms. <BR /> <BR />Between April 2025 and December 2025, approximately £540,000 enabled the delivery of around 1,230 additional appointments. A bespoke payment-by-results pilot, which was introduced in October last year, has further incentivised the delivery of extra out-of-hours clinics at evenings and weekends, helping to address the breast assessment waiting list backlog.”
“Work is under way with the trusts to define the requirements for what will be a modernised, consultant-led model for breast services. That includes expanding the multidisciplinary team and strengthening the skill mix across nursing and allied health professional staff. The objective is to increase capacity, resilience and long-term sustainability. The resource, workforce and training needs emerging from that planning will shape a recurrent investment plan, aligned with the £5 million that was identified under the elective care framework implementation and funding plan. <BR /> <BR />Recognising that service reform and workforce development take time to establish, a proportion of the funding has been used non-recurrently to deliver immediate improvements that support better outcomes for patients.”
“It is now up to the Western Trust to bring forward a plan — if that is its desire — to reinstate EGS, but, before that, the trust must give us its vision for the future of the SWAH, which is a wonderful hospital with a great future.”
“<BR /> <BR />The reason for the temporary suspension must be read into the record again: the SWAH did not meet the standards identified through the review of general surgery, and it would require "fundamental change" in a number of areas to do so. The temporary suspension came into place because of safety issues. The trust experienced issues in securing sufficient substantive consultant general surgeons to reliably sustain an out-of-hours rota for emergency general surgery in the SWAH. There was no interventional radiology, and other issues were at play. Bringing in the temporary suspension was the right thing to do for patient safety.”
“<BR /> <BR />Áine asked whether I had requested that the Western Health and Social Care Trust develop a fully costed business case for the establishment of a new EGS service at the South West Acute Hospital. That is wrong way round: it is up to the trust to decide what services it is going to provide. If the trust comes to me with a fully costed plan to reintroduce emergency general surgery, I will look at it within the time frames and procedures that we have. You have reversed the process. I will be honest with you: it is not possible to reinstate EGS in the SWAH in the interim. We do not have the additional funding to do that at the moment.”
“However, I give you a commitment that, after the debate, I will expect a further assurance from officials that the Department and the Western Trust are fully maximising the cross-border potential of the SWAH for the communities that it serves. <BR /> <BR />I also give you a commitment on a frustration that I share. In July, I asked the trust to pause the public consultation because I did not think that it was good. There was no consultation event in Omagh, and that was a mistake. The consultation event in Enniskillen was not on a good date; from memory, it was on 13 July. I am glad that the trust paused and then cancelled that consultation. I want the trust to produce the vision document, and it has had a significant number of months to do so. We cannot wait forever, because it should be the foundational document going forward.”
“They show that cross-border solutions can and do work, where there is a clear service need and clinical support and where appropriate governance arrangements are in place. <BR /> <BR />Of course, as we have seen on various occasions before, whilst cross-border working may appear to be straightforward in principle, the reality is often much more difficult. We have a range of practical considerations to work through, and I have mentioned the ones that Jennifer and I have agreed on. None of it is insurmountable, but it requires detailed engagement with clinicians, regulators, commissioners, system partners and stakeholders on both sides of the border.”
“<BR /> <BR />On the Western Trust and cross-border cooperation, there is participation in services delivered through the Cooperation and Working Together (CAWT) partnership, and I was delighted to go down to the Mellon Country Inn not that long ago to celebrate some of the EU PEACE PLUS money coming in. There is also access to all-island clinical networks in specialised areas of care such as congenital heart disease services and the cancer services in the North West Cancer Centre at Altnagelvin Area Hospital. <BR /> <BR />In my time, I have had the honour of seeing first-hand examples of collaboration and how those benefit people here and across the border in the most profound way.”
“Ambulance crews regularly cross the border while undertaking routine transfer journeys and when responding to respective emergency calls. At the most-recent North/South Ministerial Council sectoral meeting on health, Jennifer Carroll MacNeill and I tasked officials to go away and look at areas where qualifications are asymmetrical — in other words, where somebody delivering health and social care here cannot work on the other side of the border, and vice versa. For the next sectoral meeting, we want a list of all the qualifications that are not in tune, and we will then figure out a work programme to try to address that.”
“We should look for opportunities to work together, but it is not just border areas, and Danny Donnelly referenced the fact that, when you get to things such as rare diseases and some clinical trials, the population of Northern Ireland is not big enough. In fact, for some clinical trials, the population of the Republic of Ireland is not big enough, so an all-island approach, to bring in seven million people, is the only way to do it. That is another example of where cross-border cooperation makes absolute sense. <BR /> <BR />There are a number of positive examples of cross-border cooperation in the Western Trust. For example, it has established mutual aid arrangements between the Northern Ireland Ambulance Service and the National Ambulance Service in Ireland. That allows for cross-border support in emergency situations.”
“You know that I stand here as a unionist MLA with no political or ideological objection to cross-border cooperation in healthcare. In fact, quite the opposite, because, when you look at the border through the lens of health and social care, the last thing that it defines is "difference". People have the same needs and the same challenges in the border counties, whether they are northern or southern counties. I heard Jemma Dolan discuss North/South progress in healthcare, contextualised within her desire for a new Ireland, which means constitutional change. That is her right, but, as the Minister of Health, I will not bring party politics into my role. <BR /> <BR />In border regions, perhaps in particular, North/South collaboration makes absolute sense.”
“<BR /> <BR />The SWAH is a wonderful, wonderful hospital doing wonderful things, so I do not really get why there is a narrative that, slowly but surely, services are being stripped away and the hospital is being downgraded. That is simply not the case. Yes, the temporary suspension of EGS has caused huge concern, but let us focus on what it does do. It is 14 years old and it has never been busier. It has never been busier or more active than it is today delivering surgical procedures. Record numbers from across Fermanagh and Tyrone, and sometimes further afield, are treated in the SWAH. <BR /> <BR />On the issue of cross-border working more generally, the idea of North/South collaboration in health and social care is not new: we are already doing it.”
“The SWAH supports a wide range of planned care activity, diagnostics, outpatient services and day-case procedures. It operates a busy emergency department, ensuring that patients can access care closer to home, where it is safe and appropriate to do so. You also have those two theatres that were not commissioned. Well, one has been commissioned. The independent sector is now delivering hips and knees, and over 70% of the patients who go in for a hip or knee replacement leave the same day. When Diana and I were down, we saw a man on crutches being taken along the corridors by the physio. He was just out of surgery. In fact, the reason that a lot of the 30% of patients who stay overnight do so is that they do not go through that procedure until mid- or late afternoon, so it is not safe to send them home.”
“The workforce at the SWAH is magnificent. I was down there recently, as Diana Armstrong said, and got the same message that I got from Daisy Hill Hospital when I was last there: "Never mind praising us for what we are doing, give us the ability to do more". There is a great appetite amongst the workforce in the SWAH to do more, and I want to facilitate that if I can. <BR /> <BR />Let me be clear on this point: as far as I am concerned, the SWAH has a long and secure future ahead of it. I understand why much of the discussion has been about the temporary suspension of emergency general surgery, which has been in place, as we have remarked, since November 2022. I would prefer it if we had a little bit of balance there and perhaps talked up a lot of the stuff that the SWAH does, rather than the one service that it does not do at present.”
“Thank you, Mr Deputy Speaker. I thank Jemma Dolan for securing the Adjournment debate. <BR /> <BR />I will always embrace an opportunity to talk about the SWAH. It is a gem. It is a wonderful facility: a great building and very modern. However, I go back to my normal formula: in order to deliver health and social care, you need the buildings, the beds, the equipment and the medicines. However, those four things are nothing if you do not have a fifth thing — the workforce — right.”
“<BR /> <BR />I thank Members for their contributions and their support. I notice that that support is limited, or conditioned by the lack of scrutiny of the Bill, but I commend the legislative consent motion to the House.”
“<BR /> <BR />On the mix of applicants and the regard in which I hold our international colleagues, I say that international medical graduates will continue to play a crucial role in health and social care delivery. Prioritisation does not mean that they will lose all their opportunities. In fact, in specialties such as core psychiatry, internal medicine and general practice, where there are often multiple vacancies, we are still likely to see strong opportunities for international graduates, as competition is not as intense in those specialties as it in others. <BR /> <BR />I return for one moment to monitoring. In common with the introduction of significant changes in policy, the UK Government and officials here will make monitoring a priority for the demographic uptakes and fill rates under the new regime.”
“Again on impact, NIMDTA has expanded its foundation programme to ensure that every graduate from Queen's University Belfast and Ulster University will be admitted to the course. <BR /> <BR />Mr Donnelly wondered about monitoring and evaluation. That will be done in the normal way. A statistical analysis will be done of who is coming from UK schools and who is coming from ROI schools and of where there may be gaps. Will the Bill have an impact on hard-to-fill posts? We do not expect it to have a major negative impact on posts that are harder to fill. In fact, there is potential that the Bill may have a positive impact, should the prioritised applicants realise that, by applying to a post in a hard-to-fill speciality or location, they are increasing the prospects of their application being successful.”
“On sex, the Bill is likely to have a neutral impact on the proportion of females and males. Overall, the Bill is likely to have a neutral impact on representation of doctors by sexual orientation. On age, the Bill might slightly increase the representation of younger doctors. On religion, there are minor differences in the religious proportions of the priority group compared with the all-applicant group: differences typically within 1% of the all-applicant group. The Bill may also cause a very slight decrease in the proportional representation of foundation trainees in a marriage or in a civil partnership. On the impact on the headcount of people with primary medical qualifications, I can say that, in 2024, UK numbers were 1,671, Republic of Ireland numbers were 62 and international numbers were 405.”
“It was cleared by the Executive on 12 February: the LCM was tabled on 12 February, and the letter to the Health Committee was issued on 12 February. Again, it is regrettable, but I make the point that it had to be green-lighted by people who were not within the Department at the time. <BR /> <BR />The Chair asked for some reassurance with regard to section 75 and the Bill's impact, and I can tell him about that in the following terms. On disability, data shows that the Bill is unlikely to change the proportional representation of doctors with disabilities entering a foundation training programme. On race and differences in the ethnic profile of prioritised and non-prioritised applicants: overall, the impact will be that there is a greater proportion of white doctors in the foundation programme and fewer doctors from other ethnic groups.”
“As somebody who served on statutory Committees from 2011 until taking up this post in March 2024, I absolutely get the fact that Committees need the appropriate amount of time to scrutinise legislation, including LCMs. However, in defence of my departmental officials, I say that Mrs Dodds talked about the Bill going through the Commons on 27 January this year, and it was on 27 January this year that we sought clearance from the Executive Office through urgent procedure. Therefore, we moved as soon as we could. The delay was that a number of further information requests came out of the Executive Office, which had to be answered before we were able to get the LCM tabled for the Executive decision.”
“In the interests of good government across the United Kingdom, insofar as the provisions of the Bill deal with a devolution matter, they should be considered by the UK Parliament, particularly considering the policy basis for the proposals in relation to the introduction of a UK-wide duty on all providers of medical training to prioritise applications from United Kingdom or Republic of Ireland medical schools. There is reassurance in the Bill in that the consent of the Department of Health in Northern Ireland is required before the making of regulations on matters within the Assembly's competence. The Bill will ensure the prioritisation of UK and ROI medical graduates for foundation training places, and UK medical graduates and other doctors with significant NHS or HSC experience for speciality training places.”
“The analysis by DHSC demonstrates that, while this approach supports the aims of sustaining a domestic pipeline of doctors and ensures that all UK medical graduates can complete their basic medical education, it will likely alter the demographic composition of the foundation programme workforce over the longer term. Recognising those risks, DHSC and the devolved Administrations will ensure that they continue to monitor and evaluate the impacts of that policy. <BR /> <BR />I can advise Members that there are no known financial implications for Northern Ireland as a result of the Bill. DHSC published a regulatory impact assessment of the provisions, and I can confirm to Members that no Northern Ireland-specific impacts are anticipated beyond the general impacts that have been identified. <BR /> <BR />I am supportive of the provisions.”
“The content of the Bill has been widely consulted on with constitutional, equality and Windsor framework senior counsel, who have indicated that they are content with the stated policy aim, which is to ensure that there is an employment pathway for UK and ROI graduates. Due to the expedited time frame for the introduction of the Bill, public consultation has not been undertaken. On human rights and equality, as recruitment to the medical foundation and speciality training programmes is carried out on a national, UK-wide level, all data pertaining to applications is held by the Department of Health and Social Care (DHSC) in England, which has, therefore, undertaken the relevant screening.”
“If the legislation is not passed, the number of applicants to these training programmes will continue to grow and the bottlenecks into speciality training posts will worsen. To prevent that escalation and ensure that changes take effect for the current application round for posts starting in August of this year, the UK Government have asked Parliament to expedite the progress of the Bill, with the aim of achieving Royal Assent by 5 March 2026.”
“The Bill will reduce competition for places and give homegrown talent a path to become the next generation of HSC doctors.”
“While international staff will always play an important role in our health service, we are recruiting doctors from abroad when there is already a substantial pool of eligible applicants who have trained in the UK or are already employed in HSC. Those doctors are more likely to work in the health service for longer and to be better equipped to deliver healthcare that is tailored to our population, because they better understand our epidemiology. <BR /> <BR />The Bill will ensure that we have a more sustainable medical workforce that can meet the health needs of the population, meaning that we will be less reliant on an unpredictable labour market and can make best use of the substantial taxpayer investment in medical training.”
“Without that provision, Northern Ireland might face increased competition for training places from international applicants and might have to withdraw from national recruitment processes, placing a significant administrative burden, with associated increased costs, on our local provider, which is the Northern Ireland Medical and Dental Training Agency (NIMDTA). <BR /> <BR />I have repeatedly acknowledged the huge contribution that internationally trained doctors make to the health service, and I will continue to do so. Through the Bill, we aim to prioritise for future training posts internationally trained doctors who have significant NHS experience. That will not exclude anybody from applying for training places.”
“It will be possible to add to the list of countries to take account of future arrangements. <BR /> <BR />I can confirm that each of the UK nations is committed to supporting and developing a sustainable domestic supply of doctors, recognising that medicine is a global profession and that the movement of doctors from the UK to other nations and vice versa is desirable and, sometimes, necessary. <BR /> <BR />The proposed LCM asks the Assembly to endorse the Bill's extension to Northern Ireland for provisions within its legislative competence. Approving the LCM will ensure UK-wide consistency and will enhance career pathways for UK and ROI medical graduates. It will also protect UK-wide recruitment practices and ensure that there are sufficient medical foundation places for the output of all local higher education institutions.”
“Its application to devolved health and social care matters necessitates an LCM to extend the provisions here. The Bill's policy aim is to ensure that there is an employment pathway for United Kingdom and Republic of Ireland graduates of UK medical training programmes. It aims to implement the UK Government's commitment, as set out in the 10-year health plan for England, to prioritise UK medical graduates for foundation training places and UK medical graduates and other doctors with significant NHS experience for speciality training places. <BR /> <BR />The Bill also includes provisions to prioritise others in a priority group that includes graduates of Irish medical schools and those of countries with which the UK has agreements on the recognition of professional qualifications and the provision of "no less favourable" access to practice.”
“Unfortunately, the emergency nature of the legislation, coupled with the need to secure Executive approval for the tabling of the LCM, hindered my Department's ability to comply with the usual protocols. Having secured Executive approval on 12 February 2026, I wrote to the Health Committee that very day to advise it of my intention to table a legislative consent motion. I am grateful to the Committee for its consideration of the motion on 19 February 2026 and to the Speaker for facilitating today's debate at short notice. I fully appreciate the Committee's decision not to adopt a position on the LCM. <BR /> <BR />I will briefly explain the policy background. The Bill introduces a UK-wide duty on all providers of medical training to prioritise applications from UK or ROI medical schools.”
“The need for a legislative consent motion (LCM) has arisen as a result of the need to extend the provisions of the Medical Training (Prioritisation) Bill to Northern Ireland. The Bill was tabled in the House of Commons on 13 January 2026. It introduces a UK-wide duty on all providers of medical training to prioritise applications from United Kingdom or Republic of Ireland (ROI) medical schools. Given that the Bill applies to devolved health and social care (HSC) matters, an LCM is required to extend its provisions to Northern Ireland. <BR /> <BR />I have apologised to the Speaker and the Health Committee for the short window that was afforded for scrutiny of the provisions of the Bill, and I extend that apology to Members.”
“That is how we will turn data into decisions, decisions into better outcomes and better outcomes into lives changed for the better.”
“As I said, regular and reliable publication of mental health data supports the strategy's promise of transparency and is not to point fingers but to build trust; you do that through an evidence base. <BR /> <BR />I will close, as I began, with thanks and a commitment to partnership. To our staff, our community partners, our analysts and our statisticians, I say thank you for your patience and your persistence. To Members across the House, I say thank you for the scrutiny that keeps the Department focused. We are not where we want to be yet, but the path is clear: a unified record, standard definitions, validated reporting and outcomes that mean something to the people whom we serve, alongside publications that build public trust.”
“<BR /> <BR />The mental health strategy promised transformation, but transformation without measurement is just an aspiration, is it not? It is not an accountable way to go forward. We want better targeting, on the basis of knowing where waits are longest and outcomes are weakest, so that we can direct our therapies, our crisis response and our specialist capacity to where they will have the most impact. We want earlier intervention. Consistent referral and triage data allows us to see where early intervention helps services reduce pressures and to scale those models. We need workforce planning. Standardised activity and outcome data inform skills mix and training needs across the trusts and, indeed, our community partners. Finally, we need public accountability.”
“Yes, I believe that the work is forward-looking. If you were to visit the digital care unit in Linenhall Street, you would see big screens full of data. I do not understand it — it is just numbers and letters — but the unit is able to identify, for example, a pattern in the greater Ballymena area with regard to a certain condition. Over time, the real value of Encompass, Epic and all the digital stuff will be in public health initiatives: understanding where patterns are emerging and making early interventions. When will that happen? For my money, I say that it will happen as soon as possible, but it is starting to happen. I have seen the unit at work, and it is impressive. I do not know whether the Health Committee has considered paying it a visit, but it might want to do so.”
“It is not always visible, but it is essential, and I acknowledge it publicly.”
“Having said all that, I pay tribute to the people who are making this happen: the front-line clinicians and the teams who are adapting to new workflows and coding standards while continuing, under real pressure, to deliver care to people. Trust informatics staff, SPPG analysts and Encompass specialists who are working together to reconcile definitions, to fix report logic and to test outputs trust by trust have my thanks. I also thank community and voluntary partners, who provide essential therapies and supports and submit returns that inform the regional picture, and public health and statistics colleagues, especially in NISRA, whose careful stewardship of suicide statistics ensures the highest standards for a uniquely sensitive dataset. Their work is meticulous.”
“As I said earlier, Epic Systems wants a two-year timeline from final implementation. The final two trusts came on board on 8 May 2025. Again, I have asked colleagues who work in digital why it will take so long to get to that point. I was at an internal conference not that long ago at which somebody made the point that Encompass is like something that we have designed to take us to the moon but that, at the moment, we are using only for a short break in Spain. That is probably unfair, but it is a pretty solid and memorable point to make. There is a lot more that Encompass can do. Like you, I am eager to see us get there sooner with it than we plan to.”
“Once validated milestones are met, routine publication will follow, and the system will be better for it. I will give way to the Member.”
“The answer is straightforward, and it is that publication confers public authority, and with that must come public trust. Publication must be based on validated data that is consistent across the trusts and correctly interpreted. During stabilisation, we are deliberately treating Encompass outputs as management information while we complete validation and align workflows. It is not about hiding. Rather, it is about ensuring that what we publish is reliable and does not mislead service users or policymakers.”
“Report logic is being developed in Encompass with the SPPG and the trusts to address historical gaps in demand and capacity indicators: for example, for referrals and activity in non-inpatient services. Once that report logic has been developed, the indicators will go through extensive validation before being used in decisions and in public reports. Furthermore, pathway-level outcomes will be addressed. With the mental health outcomes framework embedded, teams will have a clearer view of activity, of experience and of clinical change for service users. That will support better triage, more timely psychological therapies and better insight into what works for whom. <BR /> <BR />Members rightly ask why we do not publish everything now.”
“The audit is now being used to standardise pathways, improve coding and target training for referrers so that referrals are timely, complete and clinically appropriate right from the outset. Those are practical, front-line improvements that will make a difference to access and to patient experience. <BR /> <BR />A range of improvements will be made in the near future, including, for example, validated waiting-time reporting. Each trust is validating mental health waiting-time data, which is extracted from Encompass and aligned with SOM definitions and timelines. As confidence rises, we will transition from internal management information to regular public reporting that is comparable across the region. Another example is the filling of legacy gaps.”
“Epic Systems/Encompass reports are now being used to extract monthly mental health waiting-time data in line with system oversight measures (SOMs), with each trust validating its figures against regionally agreed definitions and deadlines. It is, by design, management information during that validation period, but the direction of travel is the right one. <BR /> <BR />One of the clearest lessons learned in the past two years is that referral quality matters. The CAMHS referral audit identified duplication, incomplete clinical information and inconsistent thresholds right across the trusts. Those are not just abstract issues. Rather, they affect children and families who are waiting for help.”