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 have to review that recommendation against all of the other recommendations in that report and those in every other report. I understand that Members will pick out a specific condition, a specific service or even a specific hospice and advocate for it. It is right and proper that they do that, and it is something that I have done as a Member of the Legislative Assembly. However, I hope that the Member recognises that I have to see it in a broader context and take what is often called the "helicopter view", because there are competing priorities and demands. At times, it becomes difficult and challenging, because we are talking about a health and social care system, and it can mean life or death in some instances. <BR /> <BR />Instinctively, I am keen to do more for the Children's Hospice specifically.”
“Savings of £400 million is fantastic, but that shortfall absolutely restricts our ability to give more, do more or introduce new services.”
“I have met the hospice movement on a number of occasions; in fact, just last week, I was with the Foyle Hospice in Derry/Londonderry. I am keen to do more for all of the hospices. I am also keen that they become part of the neighbourhood network, because palliative and end-of-life care does not happen solely within the confines of the physical buildings that are our hospices across Northern Ireland. I continue to engage with the Children's Hospice. The Member must be aware, however, that we started the year with a shortfall in our budget of £600 million. That is unprecedented, and, in fact, it turned out to be unmanageable. I pay huge tribute to all those, particularly those in the trusts, who have worked so hard to reduce that figure, which sits currently at around £200 million.”
“I am not sure that "asleep at the wheel" is an appropriate analogy, given that we are talking about ambulance response times. However, I am certainly up for looking at the issue in more detail. You have put it on my radar. So far, I have been focused on looking at response times against the targets, but you have given me a significant urban/rural split. I will go away from the Chamber in a matter of minutes and begin an enquiry.”
“I thank the Member for his good wishes. I emphasise to him that I was fully focused on the health brief when I was the leader of the Ulster Unionist Party, because all decisions, bar a very few, were delegated. It will make no particular change to my focus between now and 6 May 2027. <BR /> <BR />On his specific question, no, I do not, but I think that I am about to learn.”
“It is complex, and I understand that it is frustrating, but we remain fully focused on the matter.”
“I have often compared it to a game of Jenga where the fear is that, if you pull out the wrong stick, the whole edifice will collapse.”
“I have met the mothers from the 'Spotlight' programme on a number of occasions, and I can assure the Member that they are absolutely aware that the £13·1 million was not exclusively for short breaks. Indeed, I very recently spoke to a relative of one of those mums who was very complimentary about the progress that we have made. For example, in the Belfast Health and Social Care Trust area, Willow Lodge opened as a residential children's home in July last year and now provides long-term placements for two children with learning disabilities. I believe that the Member understands that it is a complex game of chess, as it were, in that achieving success on this is not about one move; it is about moving boy A to residence B until girl C is moved to residence D.”
“The range of services that the trusts have invested in are intended, in part, to redress the balance, developing services that support families and prevent further reliance on medium- and long-term residential placements. Short-break services for children with disabilities remain fragile. I will leave it there so that the Member can ask a supplementary question.”
“The funding is being spent on initiatives to improve family and community support services for children with disabilities, to increase short break provision and to expand the specialist care programme. It was never exclusively about short breaks. The trusts have increased contracts with voluntary and community providers, securing additional support for families through a broad range of service initiatives. I am conscious of the urgent focus on overnight short-break provision for children with disabilities. Over time, a pattern has emerged of children with disabilities being placed, long-term, in beds that were previously ring-fenced for short breaks. That trend is emblematic, I am afraid, of a failure to intervene in a way that supports children and their families closer to home.”
“I do not speak for any previous Health Minister. I have been in my post for about 20 months. It is such a broad portfolio that it took me a number of months to get my head around where we were. One of the conclusions was that we have to be a lot clearer, not just internally but externally, about saying, "Here is what we are going to do. Here is what we cannot afford to do within the budget. Here is what it is not reasonable to expect us to continue to do, because it neither represents value for money nor delivers the better outcomes that we want to see for patients, service users and the health and social care workforce".”
“The appraisals consider cost, benefits, risks and potential system impacts, and help us prioritise options that maximise value for money. In a highly challenging financial context, that disciplined approach is essential to avoid simply deferring costs to future years; to maintain our commitment to improving outcomes; and to ensuring that we have a sustainable health and social care system.”
“I, too, welcome our visitors. <BR /> <BR />My Department employs a broad range of recognised health economic modelling tools to inform and support financial decision-making across the system. The tools enable us to assess different scenarios in a structured and evidence-based way that ensures that decisions are grounded in an understanding of both immediate pressures and longer-term implications. That said, in the financial year 2025-26, the Department has faced a particularly significant funding gap, which has necessitated a concerted drive to identify and deliver substantial cash-releasing savings. To support responsible choices, all major proposals are developed through business cases that are underpinned by robust economic appraisal.”
“I thank the Member, and I am more than happy to request such a meeting with the Minister.”
“That is a requirement in the Licensing and Registration of Clubs (Amendment) Act (Northern Ireland) 2021. I fear that I will be doing the latter, and I very much regret that.”
“I thank the Member. As I said, the policy requires the support of the Executive. I await formal confirmation of the position of Executive colleagues. Time is running out. I add that, prior to 6 April 2026, I am required to either introduce legislation to set that minimum unit price or:”
“I applaud the Chief Medical Officer, because Professor Sir Michael McBride is passionate about introducing minimum unit pricing of alcohol. I am passionate about MUP on alcohol. There is really solid evidence: most recently, the Chief Medical Officer and I attended a presentation by Sheffield University, which has looked in detail at the impact of alcohol misuse on the population in Northern Ireland. <BR /> <BR />There is a blockage. I need the Executive to support me. As yet, I have not had full Executive support.”
“I would encourage the next Executive in the next mandate to think about health inequalities, educational underachievement and economic inactivity, because the social determinants of all three are basically the same, and they affect the areas of deprivation — those families; those people — the most. It is generation to generation to generation, and it is time that we took a chunk out of that.”
“I thank the Member for the question. I am aware of the PEACE PLUS money for that project, and it is very welcome, but I do not have specific details on it. <BR /> <BR />I will welcome the latest stats; I was not aware that they were coming so soon. However, think about stats for avoidable deaths. There are hundreds of deaths due to alcohol-related issues; thousands of deaths — something like 2,100 a year — due to smoking-related issues; and then there are deaths due to the misuse of other substances. All those things play out most deeply in and have the biggest impact on the areas of the deepest deprivation. Those health inequalities that I talked about have been around, certainly, for as long as devolution and for longer than that.”
“I very much welcome that statement from the Member, and I encourage him to have a word with his Executive ministerial colleagues and encourage them to support the introduction of minimum unit pricing (MUP) of alcohol.”
“I encourage all Members to help secure the necessary Executive approval to allow this policy to proceed.”
“It is also estimated that one in six attending our accident and emergency departments for treatment have alcohol-related injuries or problems, rising to eight out of 10 at peak times. During the financial year 2024-25, 2,590 clients presented to services for alcohol misuse. Over half — 56·4% — were aged 40 years or over, with a small proportion — 2·4% — aged under 18. <BR /> <BR />Alcohol is also a driver of inequalities. Between 2019 and 2023, the percentage of alcohol-specific deaths in Northern Ireland's most deprived areas was almost four times higher than that in the least deprived areas. That is why I believe that minimum unit pricing of alcohol could be a key mechanism for reducing alcohol-related harm and addressing inequalities.”
“While the use of alcohol is normalised here in Northern Ireland, it causes significant harm. Notwithstanding the pressure that excessive alcohol consumption puts on the health service, research has shown that the full societal cost to the Northern Ireland economy could be as high as £900 million a year, with up to £250 million of that borne by Health. Alcohol harm touches every part of society, from rising hospital admissions and deaths to pressures on families, communities and the health service. More important than the money, since 2013 Northern Ireland has seen deaths due to alcohol-specific causes rise by 65·5%, from 206 to the latest reported figure of 341. Almost 12,000 people are admitted to acute hospitals each year with an alcohol-related diagnosis.”
“It is against that background that I want to see what is coming out of Scotland and, following the exhortation from Mr McGuigan, how they are getting on in the Republic of Ireland.”
“I certainly agree with the Member that £5 sounds like very good value for money, but I return to the fact that we follow, without exception as far as I know, the UK National Screening Committee recommendations on these things. It looked at this in 2018 and reviewed its recommendations in 2025. It found that there was no evidence to show how effective a screening programme would be; the best way to support people who receive positive results was not known; there was no evidence of effective treatments for people who did not show symptoms of SMA; the evidence for how well the test for SMA performs was limited; and there was not enough information about the total number of people who are affected by SMA.”
“I give that commitment to the Member to examine evidence from the Republic of Ireland and elsewhere.”
“Additionally, my Department has informed the NIHR that Northern Ireland wishes to be a participant in any ongoing research, if there is an opportunity so to do.”
“That evidence concluded that an in-service evaluation was required to answer remaining questions about whether screening would work well, how much it would cost and whether it would be effective in everyday practice. An evaluation is being carried out by NHS England, and there is a research study funded by the National Institute for Health and Care Research (NIHR). A separate evaluation is being carried out in Scotland. Planning for one is currently under way, and a representative from Northern Ireland sits on the implementation group.”
“Spinal muscular atrophy (SMA) is a rare inherited condition that can cause muscle weakness. It affects movement, speech, swallowing and breathing. There are different types of SMA, and the severity varies from person to person, but, by and large, it gets worse over time. However, there are medicines and other treatments to help to manage symptoms. Across the UK, screening policy is informed by the recommendations of the UK National Screening Committee, which is an independent committee that advises the four UK Health Departments on all matters screening. <BR /> <BR />The National Screening Committee does not currently recommend screening for SMA in newborns. However, in the summer of last year, the committee published four documents reviewing the evidence on newborn screening for SMA.”
“It will also bring investment that will strengthen the support that the community, voluntary and social enterprise sector can provide to people living in our communities, including people with disabilities.”
“We will implement the learning disability service model. That has been greeted positively, by and large, across the interested parties. The Member will also be aware that we are moving at pace to try to introduce the neighbourhood model of care. The fabled shift left will happen in the coming financial year: 2026-27. I envisage that that model will directly benefit people with disabilities in the community, providing a more joined-up, accessible, proactive and personalised source of support that will lead to the better coordination of Health and Social Care services. It will reduce duplication and give faster access to the right support.”
“<BR /> <BR />My focus in recent times has been more on working with the Department of Education for children's services, particularly in terms of special schools and the provision of community children's nurses, but I am aware that the transition from children's services to adult services is one of many that represent a cliff edge and that more work needs to be done to make that transition more person- and family-centred.”
“The Department's children's learning disability services have implemented the learning disability service model and the children's disability framework, putting in place a regional transitions protocol, including an easy-read version, that has been informed and influenced through engagement with young people, families and stakeholders. The template aims to improve transition planning and secure greater regional consistency. An addendum will be agreed for education and health needs, and consideration will be given to developing a protocol for young people with physical disabilities and complex needs.”
“I will answer the Member's direct question directly: I am not considering introducing legislation in this mandate, because we have run out of time. There are several pieces of legislation that I would love to see going through the Assembly between now and purdah, in March 2027, of which that is one. We are certainly not ignoring the issues or trying to scope out what legislation might look like in the next mandate, but I cannot be untruthful with the Member: there is no plan, because we are being told that there is no legislative space between now and purdah.”
“Individuals' plans are reassessed following a significant change of circumstances such as transitioning from children's service to adult services. The introduction of the neighbourhood model will enhance integrated models of care at community level, focusing on preventative approaches and forms of support that are tailored to individual need from the point of earliest contact with our services.”
“Lifelong care and support planning for people with disabilities requires all professionals involved in the process to adopt a proactive, person-centred and adaptable approach as required. That constitutes a shift from reactive, service-led interventions. Our integrated Health and Social Care (HSC) system places the formal assessment of an individual's specific needs at the centre of the care planning process. The plans are co-produced with people who use our services to ensure that they are person-centred. Each care plan becomes the foundation for future reviews, potentially across the full lifespan. They consider changes to an individual's circumstances, the impact of lifelong conditions or disabilities and future planning.”
“I have committed an additional £13 million; that is the answer that the Member seeks. That £13 million for endoscopy will see investment and yield 21 and a quarter sessions per week to resource all uncommissioned sessions. That will happen by the end of next month and will be followed by subsequent expansion into evening and weekend working.”
“For example, when we visited Daisy Hill and Causeway Hospital recently, clinical teams said, "Never mind praising us for what we do; let us do more. We want to do more". That attitude is spreading throughout the system, including Belfast City Hospital.”
“I agree with the Member about the impact of waiting times on patients and their families and friends. I do not have an answer to the Member's specific question about Belfast City Hospital. Generally speaking, however, we are trying to deal with regional variation, particularly where it is not reasonable variation. I gave an example to Mr Kingston of what I consider not to be reasonable variation or a reasonable reason for delay. <BR /> <BR />As well as making savings in this tight budgetary environment, we have to increase productivity. The regional director of elective care, Professor Mark Taylor, is pushing everybody, believe me. I have visited hospitals with Mark Taylor. We are pushing hard and, to be fair, getting a positive response in respect of what we can do not just with the long waiters on the lists but with the clinical teams.”
“<BR /> <BR />I have spoken at the highest level to trust chairs and made the point that it is sometimes inevitable that an operation or a procedure may be cancelled; for example, if something happens to a surgeon or an anaesthetist en route to the hospital, that is unavoidable. If, however, a key member of an elective surgery team gives two weeks' notice that they will not be available on a certain day and the trust does nothing to make good the shortfall of that key member of personnel, that is not acceptable. To put it crudely, as I have with the trust chairs, if they order 10 items from Amazon and only seven arrive, how many will they pay for? On some occasions, I feel that we pay for 10 but get seven and the shortfall cannot be reasonably explained.”
“First, I am extremely sorry to hear that your constituent's procedure was cancelled not once but twice. It is certainly a sharp focus of the Department and of Professor Mark Taylor, who looks after elective care regionally for me, that we understand and deal with why there are so many cancellations. I can tell the Member that, in the past three months, 97 elective operations, including but not exclusively cancer procedures, were cancelled due to bed shortages across the trusts. I do not understand the exact reasons for the two cancellations in the case that the Member has brought up.”
“Trusts therefore use a system of clinical prioritisation to ensure that time-critical cancer cases are admitted as soon as capacity allows. <BR /> <BR />I fully recognise the distress that cancellation causes for patients and families. To reduce the risk, my Department is working with trusts to expand the number of procedures that are undertaken as day surgery and the use of regional day procedure centres and elective overnight stay centres. Those measures help to protect cancer care from bed pressures and staffing shortages.”
“Inpatient treatment for cancer patients, including chemotherapy, radiotherapy and treatment for haematological malignancy is delivered through two cancer centres. The first is the Northern Ireland Cancer Centre at Belfast City Hospital, which provides 49 oncology inpatient beds and a further 50 inpatient beds for haematology. The second is the North West Cancer Centre, where ward 50 provides 24 designated beds for oncology and haematology patients. However, no beds are formally ring-fenced specifically for elective cancer surgery. Significant unscheduled care pressures continue to impact on overall bed availability, which affects trusts' ability to consistently protect elective care for cancer and non-cancer patients.”
“However, rather than being reactive, we really need a proactive five-year-plus plan to address the needs of the A20 and the people, like Kellie, who rely on the Portaferry Road day and daily.”
“I think about the recent storm Bram, when the coastguard, as well as the Fire and Rescue Service, were called out to rescue the men, women and children who were forced to abandon approximately 30 vehicles as the storm pushed an already high tide on to the road. I am incredibly grateful to our emergency services for their efforts at that time and on the many other occasions on which they have put themselves at risk for the safety of our community. <BR /> <BR />I note that the Department is planning to spend £16,000 through Translink. I note that DFI Roads has no five-year plan, and I would be very happy to see the Minister address that. I also welcome the Department acknowledging the damage at Mount Stewart and Greyabbey after storm Bram, with a promise of repair following necessary consents.”
“We now have it down to two Departments: Infrastructure and Agriculture, Environment and Rural Affairs. However, I still think that we need to have a Department that leads on it. We also need to replace the coastal erosion policy, which dates back to 1967 and the secretary to the Ministry of Finance of the day, Sir Cecil Bateman. Some of us have seen that. It was typed on to an A4 page on an old Adler typewriter and had a scrawl from Sir Cecil saying, "Nothing to see here". The evidence in 2026 is that there is a lot to see here. <BR /> <BR />I am pleased that the group has made all that progress, but there is much more to be done to ensure sufficient investment in the road infrastructure and a limitation of the dangers during adverse weather events.”
“<BR /> <BR />Not long after I was elected, I began engaging with others on coastal erosion, along with my late friend the great Angus Carson and, latterly, peninsula councillor Pete Wray. I pay particular tribute to Sandra Henderson of the County Down Rural Community Network. She manages the Ards peninsula coastal erosion group, of which, I know, some in the Chamber are members, as I am. It is a great group and very representative: elected representatives, community representatives, local business people, government officials, Ards and North Down Borough Council and the National Trust all come together in common purpose. That group has achieved a lot. When we started, responsibility for coastal erosion was shared by no fewer than five Departments and arm's-length bodies (ALBs).”
“At times, it offers wonderful glimpses of the Mournes and, of course, the iconic Scrabo Tower in the background. Sadly, it is also a road that has more than its fair share of road traffic collisions and fatalities. It starts at Teal Rocks: you are just out of the conurbation that is Newtownards on the A20, and you are into a bad bend where there have been repeated accidents. Nothing seems to be put in place to deal with that. It needs attention. Among those of us who have the honour of serving Strangford — I have that honour — and those within our local council chamber, the safety and accessibility of the road is well recognised as one of the most often highlighted local transport issues. In many respects, that is understandable, given that it is the most vital piece of infrastructure on the peninsula.”
“I was very interested in what Michelle had to say about a bridge. If you spoke to road engineers today, they would probably tell you that they would build the A20 down the centre of the peninsula as a spine, with the side roads coming off it like ribs. However, we are where we are. <BR /> <BR />I have a great fondness for the A20. My fondness dates back to my membership of the Tufty Club. Here I look to see whether younger Members look puzzled — the Minister looks puzzled. The Tufty Club on road safety included a cycling proficiency initiative for schoolchildren, going back to the '60s — for Hansard, that is the 1960s. My reward for joining the Tufty Club was being allowed to cycle, under supervision, from Greyabbey down to Kircubbin on a wonderful, sunny, summer's day. It is a beautiful road on the shores of Strangford lough.”
“When I talk about action, I mean that we are both prepared to write jointly to the appropriate professional bodies, if that is necessary, to try to ensure symmetrical qualifications that are recognised in both jurisdictions.”