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 give way to the Member, but I have no confidence that this will have anything to do with South Antrim.”
“Regrettably, there have been 16 contract hand-backs since financial year 2023-24. There were 11 in that year and five in financial year 2024-25. However, no contracts have been handed back since last February. Mrs Cameron said that there was not the same level of hand-back in South Antrim as there had been elsewhere, but, in fact, there have been no hand-backs in South Antrim. Despite the pressures on general practice and the number of practices that have handed back contracts, we have been able to ensure that only one of those contract hand-backs resulted in practice closure.”
“In that context, I fully recognise the dedication and tremendous efforts of all GPs and practice staff in working to meet the needs of their patients. In South Antrim, there are 11 practices and 59 GPs, both partners and salaries, and they have a combined patient list of 85,000-plus patients. It is no small commitment. I assure you that my Department is committed to addressing the issues across Northern Ireland and to ensuring that patients will be able to access high-quality, sustainable GP services now and in the future. To help achieve that, my officials continue to take forward a wide range of work in the short and longer term with stakeholders across the system.”
“I thank Mrs Cameron and welcome the opportunity to outline my thoughts on primary care. Mrs Cameron mentioned the Public Accounts Committee's 'Report on Access to General Practice in Northern Ireland', and I welcomed the report. We have considered the findings and the recommendations in full, and we will now work in partnership with general practice, the representative bodies and patients and service users to address those recommendations. That said, a number of the recommendations in the Committee's report are being addressed in work that is already in train and is set out in my reset plan, which was published in July last year. <BR /> <BR />I am aware of the enormous demands on general medical services (GMS) and the impact it has had on patients and general practitioners.”
“Engagement with stroke clinicians has highlighted the concerns of the workforce about the inability to deliver time-critical treatments for stroke patients. This morning, I had a good meeting about clinical priorities for the next financial year, and thrombectomy was on the list. If I turned it into a mental wish list of my own, a 24/7 thrombectomy service —”
“My plan is to look at hospitals as a network. The big issue will not be that people are not prepared to travel but that people who need to travel do not have easy access to transportation. It would be a significant minority of people — at least 10% and possibly higher — and it needs to be addressed. <BR /> <BR />I recognise how impactful thrombectomy can be. For our stroke patients, the impact on outcomes is profound, and that has been clearly demonstrated in all the documentary evidence. I also recognise the impact that the lack of a 24/7 service has on our dedicated and committed workforce. I get the sense of moral injury that Mr Donnelly referred to, and I see it when I am out and about every week.”
“I am intent on trying to address rurality where it becomes an issue. It becomes an issue across Health and Social Care delivery: absolutely. I go back to the point that you cannot have an acute hospital at the end of every street. There has to be a bit of common sense and pragmatism in how we deal with the matter. However, I certainly do not want any disadvantage to fall on somebody who chooses to live in a rural community. There should not be a particular advantage given to someone because they live in an urban area and are close to an acute hospital that provides stroke services.”
“I absolutely agree that, in principle, we would look at a graduated or evolving roll-out of the service. I am keen on that. It makes sense in the current financial situation, because it is not all or nothing. Let us see whether we can find something in-between that is manageable, affordable and sets the direction of travel. The Member knows that, in the months remaining to me, hopefully, as Minister through to 6 May 2027, I hope to set directions of travel that the next Minister of Health will feel they want to follow over the five years of the next mandate, and that is where we really should see significant improvements.”
“I do not think that Mr McGrath mentioned the Shared Island Fund, but, so that it is not an elephant in the room, I say that I do not believe that it would be an appropriate vehicle, because the service would require recurrent resource funding, which the Shared Island Fund does not provide. It would be more of a service-level agreement between the two Health Departments.”
“We have begun conversations with the Department of Health in Dublin about a 24/7 thrombectomy service; in fact, on 16 September 2025, officials commenced discussions on opportunities for all sorts of cross-border collaboration. The potential for a 24/7 thrombectomy service at the Royal Victoria Hospital that would serve some residents of the Republic of Ireland was on the agenda. We are waiting for the assessment of those potential opportunities. <BR /> <BR />I say to Mr McGrath that the history of cross-border cooperations suggests that, while the Government of Ireland will invest, they tend to wait until the service is up and running and proven before they will get involved, rather than investing in the establishment of the service.”
“That programme contains a series of projects that are intended to reduce costs and drive value across all aspects of our system. <BR /> <BR />A number of Members referenced cooperation with the Republic of Ireland, and I want to touch on that. I begin by repeating what I have said from the get-go: I have no ideological or political objection to cross-border cooperation on health — in fact, quite the opposite — where it makes sense.”
“People are waiting too long to access vital services, and we have been unable to take forward all of the developments that we would want to take forward, including those in relation to thrombectomy. I am clear that the way to address that is to work differently and to try to deliver services and improve health outcomes with the resources that we have available. I have taken a number of decisive steps to progress that. The reset plan focuses on a new model of care that is a neighbourhood-centred, preventative and integrated service, prioritising investment in primary and community care, where we can deliver better outcomes at lower costs. Within my Department, a system financial management programme has been established.”
“That is an NHS Elect quality-improvement initiative to improve thrombectomy and thrombolysis rates. <BR /> <BR />As regards support for stroke survivors, models have been developed for stroke services and spasticity services that are integrated in the community. Analysis is also ongoing on the sustainability of our current stroke units, which includes consideration of future demand up to 2040. That will be informed by a stroke workforce review that is under way and is currently focused on the hyper-acute and acute stroke workforce. <BR /> <BR />I return to funding constraints and the £600 million gap. The health and social care system, as it stands, is financially unsustainable.”
“<BR /> <BR />It is important to recognise that, while thrombectomy is potentially life-saving for the 10% of patients who can benefit from it, the stroke action plan sets out a range of commitments to improve services across the pathway for the benefit of all. While capacity and funding constraints have impacted on the pace of delivery, progress in key areas has been made. In terms of prevention, that includes the development of a regional model for TIA, or mini-stroke, services. There is also an ongoing focus on improving thrombolysis treatment rates, with the aim of achieving a rate of 16%. To that end, Altnagelvin Area Hospital has been selected as one of a number of sites in the UK to participate in the thrombectomy and thrombolysis in acute stroke collaborative.”
“The societal savings from people not being economically inactive are stark. It is also about the quality of people's lives, and that should be the priority over the money. <BR /> <BR />As Members should know, we started the year with a deficit in the health service budget of some £600 million. That is unprecedented, and, as I warned, it has turned out to be unmanageable. Paula Bradshaw asked what the obstacle is. Well, the obstacle is money. I am surprised that any Member does not recognise that the funds are the obstacle. Yes, I am the Minister, but I am not master of the money: the permanent secretary is the accounting officer. He has legal obligations. He has a duty, apart from anything else, not to endorse a spend that he knows the Department cannot afford. I will return to the money in a moment.”
“Consideration is also being given to phasing a 24/7 service. We are aware that it will take time to reach 10% activity once a 24/7 service commences, and a phasing of costs might be possible. I have been advised that a 24/7 service could be delivered within months of funding being made available. I am glad to say that the Belfast Trust has expressed strong interest in making that happen as soon as the funding is approved and will make every effort to support the adoption of any new service. Work is ongoing to draft a business case that reflects the costs, the phasing and the capacity in addition to thrombectomy, which will be generated by the investment. That should be completed in a number of months. <BR /> <BR />I give way to Mr Donnelly.”
“A costed model has been completed, and the estimate is that it would cost just over £5 million in recurrent funding to deliver a 24/7 service. That funding could achieve a 10% thrombectomy rate and deliver up to 160 additional procedures per year. As Members will know, it is £5 million, but it is £5 million that I do not have. That does not necessarily mean that it will not happen. The investment would also address pressures in other areas, such as diagnostic radiology and aesthetics and TIA services. As such, my officials are working to refine that estimate further and quantify what additional system capacity that investment would achieve.”
“<BR /> <BR />Priority 4 in the action plan makes a specific commitment to expand the current thrombectomy service in Northern Ireland to 24/7 availability by the end of 2024, as Members have noted. I understand the frustration at that timescale not being met. The collapse of the institutions shortly after the action plan was published, combined with the unprecedented budgetary position, has, regrettably, had an impact on that delivery. However, let me be clear: the implementation of the 24/7 service remains a key focus for me and my Department. <BR /> <BR />The case for investment in services like thrombectomy to support a 24/7 service is compelling. The cost-effectiveness and the potential savings as a result of the intervention are well recognised. The expansion of the current service will require significant additional investment.”
“<BR /> <BR />An out-of-hours thrombectomy assessment protocol has also been developed, which will ensure that patients who present out of hours have the appropriate assessments in their local stroke-receiving hospital, and that steps are taken to facilitate an early morning transfer to the Royal Victoria Hospital for treatment where appropriate. In addition, a revised repatriation protocol has been introduced to ensure repatriation from the Royal Victoria takes place as soon as possible. The time frame for repatriation has moved from 24 hours to some patients now being eligible for repatriation from six hours post-procedure. That, of course, improves patient flow and increases bed capacity at the Royal. I take this opportunity to pay tribute to the team here in Northern Ireland for their achievements in maximising access to thrombectomy.”
“<BR /> <BR />It is important to recognise that, in the absence of a 24/7 service, innovative solutions have been put in place to maximise equitable access to thrombectomy within the current hours of operation, but it does not close that gap. It includes the introduction of artificial intelligence in stroke imaging in all stroke-receiving units, which helps to identify patients who are suitable for thrombectomy and avoids futile transfer of patients from any of the other seven stroke-receiving units.”
“<BR /> <BR />While the service can be provided up to 24 hours after the presentation of stroke symptoms, it is clear that the benefit is maximised if it is provided within six hours of having a stroke. In 2020, my predecessor, Robin Swann, took the important step of extending provision to a seven-day-a-week service. As such, thrombectomy is now available at the Royal Victoria Hospital from 8.00 am to 5.00 pm, seven days a week. However, I acknowledge that there is more to be done, especially as the absence of a 24/7 service means that not everyone who could benefit from a thrombectomy in Northern Ireland can access the procedure. I agree with Mr Donnelly: that is an inequality and an inequity that needs to be addressed.”
“The evidence is clear: thrombectomy significantly reduces the impact of a large, disabling stroke. Evidence also suggests that thrombectomy is highly cost-effective. The savings as a result of thrombectomy are realised through reductions in hospital length of stay, demand for rehabilitation and longer-term care, either at home or in a residential or nursing home setting. There will also be wider savings at a societal level with, for example, improved outcomes reducing economic inactivity as a result of a stroke. As Members have noted, it is estimated that up to 10% of stroke patients could benefit from thrombectomy and our current rate is just over 5%.”
“Deputy Speaker, thank you. Thank you to the Opposition for tabling the motion, and to everybody who has contributed to the discussion. <BR /> <BR />Stroke is a major health issue. Approximately 3,000 people are admitted to hospital every year after a stroke and more than 40,000 survivors of stroke live in our community. As Members have noted, my Department's 'Reshaping Stroke Care' action plan was published in June 2022. It sets out a range of commitments to improve services across the entire pathway from prevention to rehabilitation. At the time it was published, it was clear that we can and must do better, and I provide an assurance that I and my Department remain committed to so doing. <BR /> <BR />I am aware of the benefits of thrombectomy. It is a life-saving treatment for some.”
“The Department has taken important steps to build the evidence base through the needs assessment, alongside progressing more inclusive, needs-led approaches for children and young people. However, any decision to commission ADHD services must be taken on the basis of that evidence and in the context of significant financial and workforce constraints. I hope that Members realise that what I want here is what I want for every Health and Social Care service: a consistent, standardised regional service with no postcode lotteries. I am committed to transparency, continued engagement with stakeholders and ensuring that future decisions are proportionate, realistic and focused on achieving the best possible outcomes within the available resources. I look forward to the publication of the needs assessment within the next few days.”
“That all proves to me that we need a whole-of-government approach, but it needs to be led by the Department of Health. <BR /> <BR />Mention was also made of the local growth fund. I assure Mr McGrath that the Executive are as one in requiring a rebalance of the 30:70 split between resource and capital. We are asking the UK Government to look at that again. None of us understand why they have gone for such an imbalanced split. When we were in Europe, we had the European social fund. The Shared Prosperity Fund did not replace that. As we stand, the local growth fund will not replace that either. Perhaps those who supported Brexit in 2016 might care to reflect on that. <BR /> <BR />I want to be clear that I recognise the strength of feeling and the genuine need that we have to do better.”
“The Department is considering responses to the consultation on the children and young people's emotional health and well-being framework, and work is ongoing with colleagues from the Public Health Agency and child health to develop the definitions and requirements that will underpin the pathway and support commissioning going forward. <BR /> <BR />Before concluding, I will touch on some issues that Members have raised. As I said, it is my ambition to publish the needs assessment within days, rather than weeks. I have touched on shared care, and I will continue to try to understand better the issues to do with it. Members talked about the cost-benefit analysis primarily in relation to the economy but also in keeping people out of the justice system. Mr Durkan talked about the role of the education system in trapping data.”
“That will involve not only Health but other Departments, including Education.”
“The framework proposes an inclusive and needs-based approach to neurodiversity that will not require diagnosis or diagnostic labels as a precursor to assistance and intervention. In adopting that approach, the framework seeks to reduce stigma, promote earlier intervention for children and young people and enhance outcomes for young people across the spectrum of their health, education and developmental needs. The development of the framework has been informed by a review of existing pathways across children's autism spectrum disorder (ASD) and ADHD. The framework will also seek to clarify the roles and responsibilities of everybody tasked with working to support children and young people who present with neurodevelopmental and emotional health and well-being needs.”
“I recognise that GPs may have reservations about the robustness of assessments carried out by certain private providers, but, where there is uncertainty about diagnostic standards or continuity of specialist oversight, GPs may be reluctant to assume responsibility for ongoing care, because, ultimately, they are responsible — the buck stops with them. <BR /> <BR />I turn to the wider support for children and young people. Alongside the work on service options, the Department is progressing reforms for children and young people that adopt an inclusive and needs-led approach. For example, my Department published the children and young people's emotional health and well-being framework for public consultation. That closed in September 2025.”
“Therefore, while specialists can initiate treatment and provide ongoing clinical oversight, it is ultimately for GPs to decide whether they wish to assume responsibility for their part of the shared care agreement. Shared care involves planned, joint management between a specialist and a GP of a long-term condition. It should be supported by enhanced information sharing. In that system, specialist medicines or those initiated by a hospital specialist require complex prescribing and/or monitoring, which is not routinely undertaken in general practice.”
“GPs can decline if they feel that they lack the capacity or clinical assurance to safely manage prescribing and monitoring responsibilities. An issue that I want to understand with GPs is one that Mr McHugh brought up, which is why somebody who has been on medication for a significant time suddenly finds that it is being denied to them. I have heard of that in my experience as a constituency MLA, and I do not yet understand the underlying reasons why. <BR /> <BR />Most ADHD medications, as I have said, are classified as amber list. That places specific responsibilities on the specialist prescriber and the patient's GP under the shared care arrangement.”
“I find that unacceptable, and I will try to reassure Members by saying that I have opened communications with the chair of the Royal College of General Practitioners Northern Ireland because I want to better understand the obstacles to shared care working as, I believe, it was intended. Members have given examples of where it does not work as it should do or as was intended. My Department is not responsible for any arrangements agreed between patients and private providers. However, clinics providing private assessments have been advised that they must advise service users that they will remain under private care until such times as they reach the top of the HSC waiting list. <BR /> <BR />Shared care arrangements that go beyond just ADHD provision are voluntary; they are not part of a GP's core contractual obligations.”
“I would like to see it in your hands not in months or weeks but, preferably, within days. <BR /> <BR />I turn to shared care. In the absence of a commissioned service, many individuals have opted to seek private assessments and, in some cases, private treatment at their own expense. The question is why, and the answer is one word: love. They love their children, and they want the best for them. The waiting lists for ADHD services in Health and Social Care are either non-existent or far too long, so, of course, they turn to the only available option, which is to go private and pay for it, whether they can afford it or not, because of love. <BR /> <BR />It is clear that the use of private clinics to seek diagnosis and treatment has increased significantly in recent years.”
“The report will set out 19 recommendations and provide indicative costings and workforce requirements for the first phase of service provision. Not unexpectedly, it highlights the fact that a fully commissioned service would require significant additional and recurrent funding. The report is clear that there are no cost-neutral options for implementation. Any form of service would require either new investment or a reallocation of funding from other highly pressurised areas. In a way, it is a pity that the debate has come today. It might have been better next week or perhaps in two weeks' time, because that is the timescale in which I expect the report to be made public. You have heard from my remarks that we have, as you might imagine, come close to completing our analysis of those 19 recommendations.”
“<BR /> <BR />As Members have predicted, I will highlight the fact that any future commissioning decisions have to be taken in the context of overall affordability at a time when we face critical funding constraints across Health and Social Care (HSC). It is a horrible thing for me to say — I get that — but it is an honest assessment. I say to Members that the worst aspect of my role is to sit with people, look them in the eye and say, "I understand your need, but I cannot meet it — at least, not yet". <BR /> <BR />The needs assessment recommends a phased approach to implementation. That reflects uncertainty around future demand and the need to improve data monitoring and reporting before making longer-term commitments on workforce and service configuration.”
“It also specifically included consideration of the prison population, recognising its significantly higher prevalence of ADHD compared with the general population and the associated linkages with, for example, early criminality, a greater likelihood of reoffending and aggressive behaviour. <BR /> <BR />The review was a complex piece of work, reflecting long-standing gaps in data relating to ADHD prevalence and, indeed, future demand, particularly for adult ADHD services. It required extensive engagement and analysis. It included a desk-based literature review, significant information gathering, modelling and analysis, and engagement with representative bodies, clinicians, trusts, the voluntary and community sector, departmental leads and people with lived experience, including carers.”
“<BR /> <BR />As has been said, the situation is not unique to Northern Ireland. Other UK regions are in a similar position. As Members may be aware, the UK Government recently launched an independent review of mental health, ADHD and autism. The Government want to better understand prevalence, trends and inequities to inform new models of support and pathways in England. <BR /> <BR />In recognition of gaps here, we commissioned a comprehensive needs assessment in February 2025. We wanted to establish, for the first time, a clear evidence base on demand, capacity and future service options. The assessment covers children and adults. It was designed to determine the demand for a commissioned service and to make recommendations on what such a service might look like, including indicative implementation and staffing costs.”
“Thank you very much, Madam Principal Deputy Speaker. I cannot imagine that there is a single MLA who is not acutely aware from their constituency work of the strength of feeling on the issue. I thank the movers of the motion and the amendment and everybody who has contributed in a way that demonstrates knowledge of and empathy for the condition. <BR /> <BR />I recognise fully the impact that the absence of a commissioned service is having; the resulting delays in assessment and treatment; and what that means for individuals with ADHD and their families. We are talking about their well-being, education, employment and family life. We are also talking about the judicial system at times. The uncertainty and long waits have a cumulative effect on parents and carers who are simply trying to do the right thing by their loved ones.”
“I hope that the Member realises that it is an independent inquiry, so it would be entirely inappropriate for me to try to impose some sort of timeline on the Chair. My understanding is that it is relatively imminent, as in March/April. I have to warn Members that it will be utterly shocking. It will potentially be one of the worst reports on health and social care delivery since the inception of the National Health Service. I will put that down as a warning and in preparation.”
“I thank the Member for that question. I believe that seven patients are still at Muckamore. Four of them have pathways to a new placement that should be effected by the end of this month potentially or, if not, by the end of next month. Work continues to find placements for the other three patients. Numbers have reduced to such an extent that there is real concern about being able to continue to deliver safe and appropriate care from the workforce, because it becomes, I am told, a little more challenging as the numbers shrink. We hope to do that within months, certainly.”
“At the risk of correcting the Member, I believe that I implemented the contract for this financial year. The reason that I did that was simple: we had several million pounds — £9·5 million, I think, from memory — of additional money that those GP surgeries needed, not least because of the imposition of the additional National Insurance burden. To have withheld the contract would have meant withholding the money potentially, and that would have been absolutely ruinous for GP practices. I am pleased to say that we have all moved on or are moving on from there. It would not, however, be wise for me to say that we are putting a hard stop on when negotiations on the next contract should conclude.”
“As I said to Mrs Guy, we are about to start negotiating the new contract with the BMA General Practitioners Committee. Of course, the neighbourhood model and the shift left will be absolutely central to that. My officials have, however, been talking to GP federations about the shift-left model for some time. Negotiations have been ongoing. I understand that there have also been discussions with Community Pharmacy Northern Ireland. Those two bodies — GP surgeries and community pharmacies — are already there to provide a neighbourhood model. They are the basis and foundation from which that neighbourhood model should grow.”
“First of all, I am glad that the Member had a good experience. That underlines my belief that it is wrong to say that the Health and Social Care system in Northern Ireland is broken. Many of the pathways to access healthcare are problematic. However, once you get there, by and large, you get extremely good care. <BR /> <BR />When it comes to offering the Member any guarantees or promises that there is sufficient budget in either the Department of Health or the Southern Trust, I will make it clear, as I did in my previous answer, that we are not in a position to do that, unfortunately.”
“I speak from memory, but I believe that we totted up capital investment requirements of £3 billion. What we anticipate from the Budget is enough to cover only essential maintenance and such services. I agree with him that Craigavon Area hospital is long overdue a significant capital investment. So is Altnagelvin Area Hospital. A few days ago, I was in its emergency department. It is the oldest of the type-1 EDs in Northern Ireland. Once again, I understand that the Member is talking about something that is within his own geographic concerns. That is right and proper. However, again, we will have to look at a long, expensive list of capital projects and prioritise. That will not be easy. For some, the outcome will be painful.”
“I agree with him. There is solid research that says that a lot of our students who go away to, for example, England, Scotland and Wales tend to stay there and not return. That is a terrible loss. The Member may be interested to hear that we are also looking at a return on service arrangement whereby, if we contribute to or pay fees for people who are going through university courses or third-level courses, they will be obliged to stay in the Health and Social Care system for a period, otherwise we will claw back what we have invested in them.”
“<BR /> <BR />I take the Member's point about international student numbers. Those numbers are constrained to numbers agreed with my Department, but those students pay well, and that is a factor on the minds of the administrators of the universities.”
“The Member makes a reasonable point. Some of the brightest minds on these islands and a number of high-performing individuals apply to our local medical schools, and that is a testament to the quality of our young people, who are all potentially future leaders. In total, we approve 236 places annually at Queen's and a further 70 at the Magee campus. The number of admissions to our local medical schools is a balance between anticipated future workforce requirements and capacity for the educational and clinical placement requirements of the courses. Of course, admissions are a matter for the universities in line with their selection and admission criteria. It is highly competitive. Places are available equally to all Northern Ireland, GB and ROI students under the common travel area arrangements.”
“It would not be sensible for me to stand up in public and try to negotiate the negotiations, if I may use that phrase. The first meeting is imminent, and it will take what it takes to get where we all need to be.”
“I thank the Member. I am well aware that access to primary care is an issue and is not confined to her constituency. There are many groups that will be central to delivering the neighbourhood model that we want to start rolling out on 1 April, but none will be more important than GPs and GP surgeries. I am delighted to announce that we are now starting to open negotiations with the BMA GP Committee about next year's GP contract, and, obviously, access will be a key factor during those negotiations.”
“When I visited it a while ago, I was taken aback by the joy felt by the children, the parents and the workforce. I did not expect the Children's Hospice to be a joyous place, but it is.”