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 particularly pleased that, as is envisaged under the mental health strategy, a mental health outcomes framework not only has been developed but is being embedded in Encompass. The framework focuses on three linked questions, which concern quantity, quality and effect: how much did we do, how well did we do it, and is anybody better off? Those measures bring together activity, experience and clinical impact in a way in which clinicians recognise and service users value. Implementing outcomes measurement is a long-term commitment that requires engagement, training and practice development but that also enables teams to see improvement, reduce variation and address long waits in a disciplined way. <BR /> <BR />A key objective has also been to understand our waiting times.”
“Task and finish groups are fixing the hard problems, such as waiting-time definitions, post-discharge follow-up, referral routing, activity reporting and bed occupancy. That is the patient, detailed work that translates an IT platform into a repository for reliable and comparable statistics.”
“<BR /> <BR />To turn a single record into meaningful data, we need a single set of rules. The regional reporting group, which was established in 2024, brings together all five geographic trusts, the strategic planning and performance group (SPPG), Digital Health and Care NI and Encompass reporting specialists to standardise definitions, align workflows and test report logic.”
“Encompass replaces dozens of legacy systems with consistent, coded workflows across mental health, CAMHS, addictions, crisis and dementia services. As it matures, Encompass will provide real-time, comparable regional data for planning, public reporting and accountability. It is the biggest digital modernisation that our Health and Social Care system has undertaken ever, because it covers both health and social care, and it has been incredibly ambitious. <BR /> <BR />Kate Nicholl mentioned the fact that no system can operate effectively if we do not have the proper use of secondary data. Yes, we need to correct an error from previous legislation. It remains my intention to introduce legislation on secondary data and have it passed into law in this mandate.”
“The PAC's specific expectations also align with our priorities, which are to use outcomes in order to improve services; benchmark consistently across the trusts; and publish mental health data regularly, once validated. It is not about creating league tables; it is about creating a shared language that reflects quality, safety and effectiveness, which, in turn, helps teams to learn from one other and helps us to see where to invest for the greatest impact. <BR /> <BR />The cornerstone of improvement is, as I said, Encompass: our unified, electronic health and care record. Its region-wide roll-out concluded on 8 May 2025. We are now in a structured two-year stabilisation and optimisation phase. Again, I recognise that Members may think that two years is a long time. I am not a techie: I think that it is a long time.”
“Some trusts have, understandably, reported lower confidence in certain waiting-time and activity metrics during the early phase. That is why governance has been strengthened and validation has been intensified while we stabilise the new reporting logic. <BR /> <BR />As Members noted, the Public Accounts Committee has been forthright about the historical quality of mental health data and the need for urgent improvement. I welcome that scrutiny. It helps to focus attention on what matters: consistent activity measures; clinically meaningful outcomes; and transparency so that the public can see what is improving and where there is still work to do. Public confidence is key here. The Department's responses make it clear that a single, standardised dataset and regular public reporting are the direction of travel.”
“Of course, as it moves to Right Care, Right Person, it will not deal as often with patients with mental health issues, and the reporting of data may, correspondingly, decline. There is also the self-harm registry, covering ED attendances for self-harm and suicidal ideation, and the substance misuse database and impact measurement tool for addiction-related monitoring. Each adds value. None on its own provides the complete, integrated picture that clinicians, planners and the public deserve and that Members have, rightly, called for. <BR /> <BR />During the roll-out of Encompass, temporary discrepancies have arisen, as historical data is cleansed, workflows are aligned and staff are retrained. That is normal in a transformation of that scale.”
“In parallel with that, the Public Health Agency receives quarterly aggregated returns from the community and voluntary sector on mental health, addictions and suicide prevention services. Those are really useful for understanding demand, waiting times and indicative outcomes, but they are not patient-level datasets, so it cannot yet unlock fully standardised pathway-level analysis right across the region. Alongside those resources, we use some specialist datasets, including annual suicide stats from the Northern Ireland Statistics and Research Agency (NISRA) and PSNI stats on sudden death notifications to support real-time surveillance. Mr McGrath mentioned the PSNI.”
“Deputy Speaker, thank you. <BR /> <BR />I thank the sponsors of the motion. Data has to be the fundamental foundation if we are going to deliver consistent, standardised, regional services. It is the key to planning best services, targeting resources, monitoring safety, measuring outcomes and learning what truly helps. Without it, there is a real risk that people will design services for the benefit of the system rather than for the benefit of the individuals. That simply cannot stand. <BR /> <BR />Let me be candid about where we are today. Trust-level information is drawn, as Members noted, from the new Encompass workflows. I think that Members were expressing frustration that Encompass is taking a long time to bed in and move to truly validated statistical reporting.”
“That is because it was a response to a direct query from a journalist at the 'News Letter'.”
“I understand, and it is no surprise to me, that that is the Member's ideological position. What is also normal and natural, and something that he did not mention, is that young people can sometimes feel very confused about who they are, about their body, and about who they are supposed to be, and I am empathetic to that position.”
“Those were not specific criteria for any young person to engage with King's College in London. I simply suggest to the Member that he reads Cass and what Cass had to say when she came here to review our gender identity service. The whole focus is moving away from medication or, indeed, body-altering surgery towards psychological interventions. Those interventions are exactly appropriate for people who have gone through the experiences that the Member has just listed.”
“I do not claim to be wiser. I claim to think that it is prudent to pause and wait on the result of the judicial review.”
“The decision followed pretty shortly on the publication of Dr Cass's review of the gender identity service in Northern Ireland.”
“In December 2024, the Executive unanimously backed my request that we join the UK-wide indefinite ban on puberty blockers for new patients under 18 being prescribed by private prescribers. There was no voice raised against the idea that we would then invest heavily — £806,000 — in the gender identity service. Likewise, there was no dissenting voice to the idea of joining the clinical trials. If I have made a mistake, it is in the fact that the minutes of that meeting record agreement around only the indefinite ban. It is fair to say, therefore, that the Executive had not formally endorsed the other two ideas, and yes, that is on me.”
“Those reasons will be outlined by the people who are bringing the judicial review against the clinical trial. The Member can certainly criticise me. I am not standing here feeling that I have done particularly well by the trans community. I imagine that that is their perception of me, but I repeat that my objective is to be not just sensitive to them but to protect them. When a person such as Dr Cass and a body such as the Commission on Human Medicines make clear that this is a very dangerous area to be engaging in, I have a duty and a responsibility that the Member does not.”
“I apologise to the Member because I cannot remember the exact names of the two people whose names are attached to the formula, but there is certainly an accepted formula in clinical trials for determining whether a young person is fit to give their consent.”
“First, to qualify, you would have to have been known to the relevant authorities, as it were, for two years; you would have to have given deemed consent; you would have had to have given your consent and been seen to have the capacity to do so; and you would have needed the consent of at least one parent.”
“That is part of the rationale and the objective of the clinical trial by King's College London.”
“I do not accept that it necessarily inevitably leads to a second judicial review, but we need to try to get to a reasonable consensus on what is best for those young people.”
“At all times since taking up position, I have tried to rely on medical and clinical advice. I am sure that the Member has heard me say before that the best advice that Professor Rafa Bengoa gave me was, "Remember that you want to be really tight in your outcomes but loose in how you get there, because you're not a nurse, a GP, a clinician, a surgeon or a hospital administrator. So, listen to the people who know best". This is an incredibly sensitive, emotive and controversial area where there are different views. I am not using people; I am trying to protect people. The judicial review has become very important in my mind, so I think that it is worth taking that pause to see where that leads us.”
“I cannot predetermine or guess the outcome of the judicial review. I have made clear, however, that should the judicial review give a green light to the King's College London clinical trial, I will take that matter back to Executive colleagues to take their views before coming to a view as to whether the Northern Ireland Assembly should continue to support participation in that trial.”
“<BR /> <BR />One of the briefings that I received told me that one private provider is Spanish but lives in Romania and prescribes out of Singapore. There is no way that you can consider that to be a safe way of prescribing something like a puberty blocker, which Dr Cass says is not safe except in a clinical setting. She was talking about the principle of a clinical trial. It appears, however, that the detail of the clinical trial, which has emerged since there was agreement in the Executive in December 2024, is open to question. One way or another, that question will be resolved by the judicial review.”
“I have not done as the Member suggests. Dr Cass came for, from memory, three days and assessed our gender identity service and our plans for it. The Member will be aware that, as part of all this, I made a promise to make a pretty significant investment — some £806,000, initially — in the gender identity service. That was because, when I sat with those parents and some of the children, they made the point that the only reason that they were going to private providers was because the gender identity service existed in name only. There was not even a waiting list for new patients. New patients could not get into the service. It was because of that that they felt that they had no alternative, and, because they loved their sons and their daughters, they were finding the money to go to private providers.”
“I understand the Member's strong feelings. She is echoing the First Minister by calling it a disgraceful decision. All that I can say to the Member is that it was a decision that came to me. Ultimately, it was not about discriminating against people, nor was it about health inequalities. Rather, it was about protecting young people. It seems to me that there is evidence, which we will have aired in the judicial review, on whether or not it is safe to conduct the clinical trial.”
“I do not believe that any person who is involved with King's College London, which has been commissioned by the Department of Health and Social Care in London, or anyone in the Department, the UK Government or this House is out to treat children as guinea pigs or to bring them to any harm. The Member and I disagree on many things, and that is fair enough, but being sensitive to the young people, their families and their communities is more important to me than what the Member thinks.”
“The Member's language is most unwelcome. "Guinea pigs" is very emotive. As I said in answer to Mrs Dodds, clinical trials are well established.”
“Those families love their children and want to do the best thing by them. However, Dr Cass and then the Commission on Human Medicines made it clear that it is dangerous, outside a research or clinical setting, to allow children access to puberty blockers. <BR /> <BR />The Member points out that I have come on a journey, and the position that the journey has taken me to has led me to pause our participation in the clinical trial, pending the outcome of the judicial review.”
“No Northern Ireland child is involved in the trial yet. When the issue came up, the idea of a trial was a concept — there was no detail to it — and the Ulster Unionist Party supported the principle of a clinical trial. Clinical trials have been around for a very long time and they have been, by and large, extremely effective in advancing medical and social care into the 21st century. However, it became clear to me that the judicial review has a chance of success. As I said in my statement, I do not want to drag children and their families unnecessarily into the courts and into a squabble that might descend into party political interests. <BR /> <BR />I found it a difficult decision, because I have sat with families who want puberty blockers for their young ones, because they believe that that is in their best interests.”
“<BR /> <BR />Our participation is now paused and will remain paused. Should the trial ultimately be given the green light to proceed, I shall take the views of Executive colleagues before any potential lifting of the pause. The welfare of all our young people must come first.”
“To be clear, her report was an assessment of Northern Ireland's gender identity service's compliance with her 2024 review; it was not about whether Northern Ireland should participate in the trial. <BR /> <BR />Members will be aware that, in recent days, I confirmed my decision to suspend Northern Ireland's agreement to participate in the UK-wide trial. That is primarily for two reasons. First, and most importantly, the trial is being challenged through a judicial review. Secondly, it was my political sense that we were on the cusp of an issue developing into another Executive row. Gender identity is too sensitive and too important an issue for that, and I did not wish to see those young people and their parents and the many others on both sides of the debate being dragged through the courts or subjected to the lowest form of debate.”
“Her report was published last week, and I am glad that she has endorsed the position of Northern Ireland moving to a lifespan model.”
“I am glad that the request was agreed to: by bringing us into line with the other regions across the UK, it prevented Northern Ireland from potentially becoming a back door for prescriptions. <BR /> <BR />It was widely discussed and accepted, with no opposition from any other Minister or Executive party, that Northern Ireland would also participate in the clinical trial. That is simply a matter of fact, yet at least one party now seeks to distance itself from the decisions that it fully supported in establishing the service over a decade ago and, more latterly, in Northern Ireland participating in the trial. <BR /> <BR />In the period since that decision was taken in late 2024, Members will be aware that I appointed Baroness Cass to review Northern Ireland's gender services.”
“Members will be aware that, in April 2024, the landmark independent review of gender identity services for children and young people was published. Dr Cass found that there was not good evidence that puberty blockers were safe or effective. <BR /> <BR />Subsequently, in December 2024, and further informed by recommendations of the expert Commission on Human Medicines (CHM), I asked Ministers to support the legislative proposals for Northern Ireland on the making of an indefinite order. That was a legal ban preventing new patients aged under 18 from beginning to take puberty blockers for the purposes of gender incongruence and/or gender dysphoria under the care of private prescribers.”
“I ask for your indulgence, Mr Speaker. I would be most grateful for a short extension to the time permitted, given that it is such an important and sensitive issue. <BR /> <BR />Let me start by saying that I fully appreciate that the debate around gender is incredibly complex and emotive. Regardless of how strongly individual views may be held on the issue or the toxicity that sometimes surrounds it, when discussing it in the Chamber or anywhere else, it is, however, imperative that we approach the matter with the utmost care and consideration and do so in a person- and family-centred manner. <BR /> <BR />I do not intend to rehearse the full history of the development of Northern Ireland's gender policy.”
“I hope that Members will note the actions and initiatives that my Department is taking forward and will be reassured that I am committed to ensuring safe and equitable access to general medical services for all the people of South Antrim and Northern Ireland. As Mrs Cameron said, GPs are the lifeblood of our health and social care system. When it works well for them, it works well for everybody. That is my ultimate determination.”
“Those integrated teams will know the populations that they serve and will work together as a team of teams. In doing so, they will lead and drive delivery on improving access and priorities for moving more care closer to home. They will work with smaller neighbourhoods within the footprint — the natural communities to which people feel that they belong. <BR /> <BR />There are new ways of working, new ways of thinking, new partnerships and new approaches to service design. The potential is enormous. By building care around communities, we can improve outcomes, reduce pressure on hospitals and create a more sustainable system.”
“It is because GPs know their patients and their communities that they are so well placed to play that central role in the establishment of a model that will improve access to care and shift the focus from reactive treatment to proactive engagement. <BR /> <BR />Over the past number of months, my officials and I have been engaging with GP colleagues as part of the design phase of that new neighbourhood model. I assure you that that will continue. What is clear is that building a neighbourhood model will require providers to work in new ways to deliver their services. The proposed model will be built around 17 integrated neighbourhood teams that act as provider alliances. They will operate with the trust and area integrated partnership boards at GP federation level, serving an average population of 115,000.”
“That model will see GPs and their federations, along with Community Pharmacy, voluntary and community organisations, trusts and independent providers working closely together to provide coordinated care to patients in their localities. It is an important enabler of my commitment to shift left. I hope that GP practices will play a decisive role in the ongoing development of the model and in its implementation. <BR /> <BR />We are now working at pace to take that work forward in line with that commitment. To inform the early developmental work, I visited examples of how neighbourhoods can work within that model in England. We saw that GPs were at the heart of those models. There is very good reason for that.”
“However, it is important to bear in mind that any increase in the level of spend on primary care must be investment with a purpose, that purpose being to improve the sustainability of and access to services and to ensure that patients can expect the same high standards from their GP, no matter where they live. The focus of investment in general practice in the future should be on meeting the evidenced demand for services and transforming the way GP services are delivered. In my reset plan, I made a commitment to developing a neighbourhood model to deliver greater levels of care to our citizens in their local communities and as close to their front doors as possible.”
“<BR /> <BR />In the interim, a number of practices in the south Antrim area recently received significant investment in their premises in advance of the MDT roll-out across the south-east Antrim locality. That will enable them to accommodate the additional staff associated with the roll-out. However, all practices in the South Antrim constituency already have access to a practice-based pharmacist. <BR /> <BR />Looking to the future, we remain committed to working with GPs and their representative bodies to support primary care services with the aim of securing the long-term future of general practice over the coming years.”
“Detailed local plans that determine the sequencing and timescale of investment in practices during phase 1 have been agreed, and funding for 2025-26 has been allocated accordingly. The south Antrim area, which is part of the Antrim and Ballymena GP Federation, will commence roll-out during phase 2, along with the east Belfast, south Belfast, Lisburn and Mid Ulster GP federations. Phase 2 will run for four years, from financial year 2029-2030, and that will see the MDT model completed in the remaining five GP federation areas. Lessons are being learned as further roll-out progresses, and, while phase 2 may seem some way off, I can assure you that, if it becomes possible to do more faster when it comes to that roll-out, that is exactly what will happen.”
“<BR /> <BR />As we are mindful of the serious staffing and funding pressures facing Health, full roll-out of the programme will be taken forward in a two-phase approach over the next seven to eight years. The first phase is supported by £61 million from transformation funding. That will enable completion of the model in the seven existing MDT areas and expansion into five new GP federation areas, with a population of around 670,000, over the next four years up to the end of financial year 2028-29. The new areas to benefit from transformation funding during phase 1 will be north Belfast, the south-west — Fermanagh and west Tyrone — east Antrim, Craigavon, Dungannon and Armagh.”
“The multidisciplinary team model remains the key to stabilising and strengthening vital primary care services and ensuring that they can continue to provide high-quality care to our people, now and into the future. The MDT programme has significantly expanded the capacity of primary care since its introduction, with an additional 335,000 consultations provided in financial year 2024-25 alone. It is estimated that a full roll-out of the programme could provide around one million additional appointments in general practice settings. On 24 July last year, I published a plan for the completion of the primary care multidisciplinary team model across all areas of Northern Ireland.”
“We have introduced other schemes to support the GP workforce, including the Attract, Recruit, Retain scheme, which is designed to support the recruitment of GPs in hard-to-recruit areas. Since that scheme was established, in January 2023, 110 GP practices have applied for and received approval in principle for funding under the scheme, and 70 practices have applied for and received final approval for payment in respect of a recruited GP. <BR /> <BR />Members will be aware that, last year, my Department announced investment of £61 million over the next four years to support the wider roll-out of the primary care MDT model, which will provide access to a wider range of services for primary care and help to stabilise GP services.”
“To help primary care to deliver and grow, it is critical that we train, develop, support and retain the GP workforce. My Department has funded initiatives to recruit and retain GPs. Training places are at an all-time high of 121, which is an increase of no less than 86% since 2015-16, and my officials are progressing work to project the number of GP training places required over the next five years. I hope that that answers, in some part at least, Members' questions about how we will supply our workforce, going forward. We are working with key stakeholders to increase the exposure of undergraduates to general practice. We are encouraging more GP trainees and ensuring that there are sufficient GP training practices to meet demand and support GPs in training.”
“I am pleased to say that we have made good progress on that recently, and I am optimistic that we will be able to re-engage in substantive contractual discussions in the coming weeks. <BR /> <BR />The 2025-26 GMS contract included an additional investment of £9·5 million in general practice. I also made a ministerial direction in line with the recommendations of the pay review bodies, which the Executive have agreed. That has enabled my Department to implement the pay award for independent general medical practitioners in full in 2025-26. That was at a value of £11·7 million of additional investment. That payment is due to be made to GPs and their teams in the February pay run.”
“A best practice guide, 'Making all Contacts Count', has also been developed and shared with all practices, supporting the management of patient demand and optimising workflow, with the aim of improving experience for patients and practices. <BR /> <BR />My priority is always to ensure that patients, including those in South Antrim, can continue to access safe, high-quality, sustainable GP services when they need to. My desire has always been to work constructively with GPs to help achieve that outcome. I have stated many times that I regret that it was not possible to reach agreement on the GMS contract for the financial year 2025-26. My Department has remained engaged with GP representatives over the past year with a view to finding a way forward to re-establish normal relations and re-enter negotiations for 2026-27.”
“<BR /> <BR />On short-term measures, the general practice improvement and crisis response team supports practices at risk. That has been important in providing stability, but more sustainable options are required in the longer term. I note that none of the 11 practices is receiving support from the crisis response team, never mind handing back contracts. We are also working with the GP federations to explore how they can play a role in the longer-term sustainability of general medical services. Over the past number of years, my Department has made available significant funding to help GPs meet the growing demand for primary care services and enable practices to improve their telephony systems and accessibility and increase staffing levels to ensure that telephony demand is managed effectively.”
“I am not aware of GP practices denying people access until March. I will make this more general point to the Member: we are now at a position at which, after a hiatus, negotiations on the 2026-27 contract can begin between the Department and the BMA General Practitioners Committee. That is absolutely critical. Every year's contract is important, but this year has to be a consequential year for health and social care delivery, because we have to shift left into the neighbourhood model. While that will include community pharmacies, as Mrs Cameron mentioned, ophthalmologists and dentists, GPs are its heart. We need them all, but, above all, we need GPs. I will not say anything that will be critical of something that you have stated and which is news to me, but I will take it away and ask officials to examine it.”