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 thank the Member for his question. As I said in my statement, the all-island paediatric cardiology training programme qualification has been added to the General Medical Council's list of recognised specialist qualifications. That will enhance workforce mobility and cross-border collaboration. That is something that Jennifer Carroll MacNeill and I went on to discuss. The barrier of asymmetrical qualifications — qualifications that do not migrate or are not recognised in both jurisdictions — is an impediment. As the two Ministers, we tasked officials with scoping out the qualifications that do not apply equally in the two jurisdictions and bringing us the list at the next sectoral meeting, where we will take action.”
“It is maxed out in capacity, and increasing the capacity there to service us would take longer than it will take us to open our new haematology ward and deliver CAR-T in Belfast, according to our current schedule.”
“I am sorry for the loss that the Member refers to. As I have said previously, you need a specific, clinically secure environment for CAR-T. Ward 10 north at Belfast City Hospital does not cut it. I have visited 10 north. Let me put it this way: if a visitor asked to see how well we look after patients and how good our facilities are in secondary care, you would not take them to 10 north in Belfast City Hospital. <BR /> <BR />There will be a new haematology ward in Belfast City Hospital. Speaking off the top of my head, I think that the current delivery date is 2031, so it is a number of years away. Once we have it, we will be able to do CAR-T. I have told the Member before that we have spoken to the Department of Health in Dublin.”
“There was not a specific discussion about the issue, which, I know, is important to the Member. The two services continue to make steady progress in strengthening joint arrangements for cross-border emergency responses under the North/South specialist ambulance response programme. Work is progressing on harmonising clinical and operational procedures, updating the memorandum of understanding on mutual aid and improving control room interoperability.”
“The Member makes a good point about population size, because, as I said, rare diseases may be individually rare, but, collectively, they are common, with about 410,000 people on the island suffering from some sort of rare disease. To be able to do proper research and design proper and effective pathways, you always need a minimum population size. In neither Northern Ireland nor the Republic is the population big enough to crack that for some rare diseases, but, on an all-island basis, we cross the line into what is possible. In order to achieve what we want to achieve, we try to adhere to four principles: improving diagnosis; increasing awareness among healthcare professionals; enhancing the coordination of care; and boosting access to specialist services and treatments.”
“Again, there were no specifics mentioned at the sectoral meeting, but I will certainly take that question away, because, in fairness, it is important, and come back to the Member with something a bit more substantive.”
“We are in the foothills of those discussions. There will be another sectoral meeting — that is the plan — in either the autumn or, at the very latest, early January. The Government of Ireland take on the presidency of the European Union on 1 June, which may shift their focus to some extent. Either way, before the end of our mandate, there will be another sectoral meeting. At that meeting, I expect officials to detail where those additional areas for potential cooperation are. However, I am not in a position to say to the Member, "This is where I want us to go".”
“We are exploring possibilities for collaboration. Most recently, we looked at a Shared Island proposal to establish an all-island metabolic network that would bring equitable care from robust services as close to home as clinically possible. Those conversations continue between officials. It is not as though the issue only comes up on the rare occasion when there is a sectoral meeting.”
“Yes, there was a discussion about paediatric pathology. The issue has not budged: there is a global shortage of paediatric pathologists. The two authorities are scoping out what they need for the two jurisdictions. Once we have done that, we will come together to see whether it is possible to have an all-island solution. Given the global shortage in that workforce, it seems ambitious to try to get an all-island solution and overambitious to try to get two solutions. We are in that process, and it is taking time, but that is the way it is. <BR /> <BR />One of the themes was rare diseases. Individually, they are rare, but, collectively, they are common and affect over 400,000 people on this island. We have made good progress on implementing the Northern Ireland rare disease action plan, but more can and will be done.”
“On that visit, as the Member will be aware, not only did we see magnificent things being done but we got a real sense from the workforce that they want to do more. They said, "Please, let us do more", and I am keen to try to facilitate that. We need to stop putting an exclusive emphasis on the one thing that is not happening in the SWAH and start celebrating all the wonderful things that are happening there.”
“In my first address to the House as Minister of Health, one of the points that I made was that I had no political or ideological objection to sensible cross-border cooperation on health and social care — in fact, quite the opposite — so, as a matter of principle, I will always look at ways in which to expand cooperation. <BR /> <BR />The Member will be aware that, at the South West Acute Hospital, there were, for a long time, two uncommissioned theatres and wards, although one has now been commissioned and is being used extremely successfully for orthopaedics: hips and joint replacements. Over 75% of people are going in, getting their new knee or hip and getting home on the same day. There is more potential, however.”
“Even if their capacity were to expand, we would get there with our new ward before they would be able to service us.”
“I did indeed bring up CAR T-cell therapy, because I wanted to confirm with the Minister for Health in the Irish Government and her officials that what I have been telling the House is accurate, which it is, but I say once again that a very specific clinical environment is needed to carry out CAR-T. That certainly does not exist in ward 10 north at Belfast City Hospital, which is the current haematology ward. The new ward will not come on stream until perhaps 2031, but the plan is to have a new ward that will be compatible with the exercise of CAR-T. In the meantime, we have asked officials from the Department of Health in Dublin whether they could increase their capacity to include patients from Northern Ireland. Their current capacity is maxed out from dealing with their own patients in the jurisdiction.”
“I agree with the Member: the North West Cancer Centre is an exemplar of good practice and of cross-border cooperation. As I have said many times, the border does not demark health and social care needs; it highlights the fact that we have common goals and common purposes to treat common problems. <BR /> <BR />The Member will be aware that there is a huge deficit in the Department of Health's budget for this year. In order to avoid a strike and make sure that the workforce got their pay entitlements this year — I will not say "pay rises", because staff would dispute that it is a pay rise, given the rate of inflation — we will have a big problem next year. The idea of expanding services is therefore not on my agenda, I am afraid. I would love it to be, but it is not. My agenda is to shift left into the neighbourhood programme.”
“I do not have that number, but I will certainly write to the Member when I have ascertained the figure. As a matter of principle, I am keen to look at all-island training cooperation.”
“I can confirm that there is ongoing cooperation between the Northern Ireland Ambulance Service and the National Ambulance Service. I direct the Member to look at ambulance handover times over the additional winter pressure periods, particularly in the Belfast Health and Social Care Trust area, where the target time of two hours was met more often than it was failed.”
“<BR /> <BR />Finally, the Council agreed that the next NSMC health and food safety sectoral meeting will be held in the autumn of 2026.”
“The Council also approved Safefood's corporate plan for 2026-28 and a post regrading in the body. <BR /> <BR />The Council acknowledged the retirement of Dr Gary Kearney as chief executive officer of the Food Safety Promotion Board/Safefood and the valuable contribution that he had made to the work of the body in various roles since 2002. The Council also noted that the outgoing CEO, Dr Kearney, had designated Ms Patricia Fitzgerald, Safefood director of corporate operations, to carry out the functions of the CEO from 1 January 2026 until the new CEO is in place. Ministers approved the appointment of Dr Joanne Uí Chrualaoich as the new chief executive officer of the Food Safety Promotion Board/Safefood with effect from 19 January 2026.”
“<BR /> <BR />Penultimately, the Council noted the ongoing roll-out of the 2025-28 community food initiatives programme, which aims to positively influence healthy eating habits, especially those of low-income families, through promoting greater access to and availability of healthy and safe food using a community development approach. Finally, we noted the research carried out by Safefood on a range of topics, including obesity, food poverty and health inequalities. <BR /> <BR />The Council considered various governance matters relating to Safefood, noting its revised business plan for 2025 and that the 2024 annual report and accounts were being audited. The NSMC approved Safefood's business plan for 2026 and recommended the associated budget grant provision.”
“<BR /> <BR />Next, the Council noted the collaborative approach undertaken by Safefood to deliver its remit, including working with partners such as the Irish Football Association, the Gaelic Athletic Association, Northern Ireland local authorities and public-sector organisations; the launch of Safefood's new, free healthy eating resource, 'Fuel Your Game', in Croke Park; Safefood's support of the launch of newly revised nutritional standards applying to all facilities that serve food and beverages in Health and Social Care settings in Northern Ireland; and Safefood's continued work with the district and borough councils in Northern Ireland to provide free food safety training for small businesses in their respective areas.”
“Those included Safefood's roll-out of a further iteration of its food environment multimedia campaign, with the broader goal of encouraging societal change for a healthier food environment for children's future health and ultimately driving potential policy change; and Safefood's Clean As You Go campaign to remind people about the need to wash hands, work surfaces and utensils, especially when preparing raw meat, with the aim of reducing the risk of food poisoning from cross-contamination in people's homes.”
“<BR /> <BR />The Council noted a presentation on obesity, which provided an overview of diet and nutrition, physical activity and health weight-related outcomes in Ireland and Northern Ireland, and the existing cooperation on initiatives to address obesity, including the all-island obesity action forum and the all-island healthier food environment forum. <BR /> <BR />I turn to food safety. The Council considered a progress report outlining Safefood's high-level achievements since the previous health and food safety sectoral meeting.”
“Ministers welcomed the development of a project shortlist of areas of cooperation to be considered further, with the aim being to improve cancer services for patients across both jurisdictions. <BR /> <BR />The Council noted the prevalence of rare diseases on the island of Ireland, the benefits of cooperation on rare diseases and the commitment to promoting and strengthening that cooperation. The NSMC noted that the ongoing consideration of opportunities to collaborate on efforts to support those from across the island who live with rare diseases will continue, and Ministers welcomed the ongoing work in both jurisdictions to improve the lives of those who live with rare diseases, including the work of the all-Ireland rare diseases interdisciplinary research network.”
“<BR /> <BR />Cooperation on cancer care is a long-standing element of the health work programme. The Council received updates on recent developments in that area. The Council noted the ongoing work by the North/South cancer policy and strategy group, which most recently met in October 2025, on progressing the delivery of cross-border cancer services. Ministers noted the benefits, for patients, of the ongoing cooperation on and expansion of radiotherapy services at Altnagelvin Area Hospital and welcomed further cooperation on services provided through the North West Cancer Centre. The Council noted that the inaugural all-island paediatric oncology conference was held on 16 and 17 October 2025.”
“The NSMC noted that the potential for future cooperation on perinatal and paediatric services continues to be explored. <BR /> <BR />The Council was advised of ongoing work between the Northern Ireland Ambulance Service and the National Ambulance Service and of the fact that work is progressing on harmonising clinical and operational procedures, updating the memorandum of understanding on mutual aid and improving control room interoperability. <BR /> <BR />The Council noted that 10 cross-border healthcare PEACE PLUS-funded projects have launched and are in their start-up phase. The consideration of an eleventh health project is under way. <BR /> <BR />The NSMC noted the ongoing work on Exercise Pegasus, which concerns UK pandemic preparedness and in which representatives from Ireland have participated as observers.”
“<BR /> <BR />The Council welcomed the progress made to date on implementing its work programme in the health sector and noted that both Departments of Health have identified additional areas where there is potential for further development and collaboration between the health authorities in both jurisdictions. The Council agreed the proposed revisions to the work programme and noted that work to ensure that the work programme reflects the priorities of each Administration will continue. In receiving an update on ongoing cooperation between the two Health Departments, the Council noted that the all-island paediatric cardiology training scheme qualification has been added to the General Medical Council's list of recognised specialist qualifications, which will enhance workforce mobility and cross-border collaboration.”
“The Council welcomed the cooperation of officials from the Northern Ireland Department of Health, the Department of Children, Disability and Equality in Ireland and the other relevant Departments in the area of disability. Ministers noted the commitment of the Northern Ireland Department of Health and the Department of Children, Disability and Equality in Ireland to upholding the rights of people with disabilities in line with the principles set out by the UN Convention on the Rights of Persons with Disabilities. Ministers agreed that officials should explore potential options for collaboration and knowledge exchange and provide an update at a future meeting.”
“In compliance with section 52 of the Northern Ireland Act 1998, I wish to make the following statement on the twenty-seventh North/South Ministerial Council (NSMC) health and food safety sectoral meeting, which was held in Armagh on Wednesday 14 January 2026. I chaired the meeting, and was joined by junior Minister Aisling Reilly MLA, who attended as the accompanying Minister. Jennifer Carroll MacNeill TD, Minister for Health, represented the Government of Ireland. The statement has been agreed with junior Minister Reilly, and I make it on behalf of both of us. <BR /> <BR />I will begin by addressing the issue of health.”
“If we are going to let those young people have the opportunity to live their best lives, we need a coordinated and multidisciplinary approach. I finish where I began: we need the passion of MLAs such as Emma Sheerin to keep the issue at the top of the agenda for health and social care delivery.”
“That service offers monthly drop-in advisory sessions across the trust area, along with virtual educational awareness sessions. <BR /> <BR />I may be straying a little, but, on children's short-term breaks, Health Committee member Nuala McAllister was well aware that we were able to find some money to provide additional support. However, that is one of the rare areas in health and social care delivery where the primary obstacle to delivering better outcomes for the service users and their parents is not money; it is the workforce. You need a highly specialised and motivated workforce and the physical infrastructure such as buildings. That is where, frankly, we have faced massive challenges since we announced that we had found additional money to help in that area. <BR /> <BR />The whole area is incredibly important.”
“<BR /> <BR />The analysis of the service model public consultation responses will be used to inform consideration of how individuals with severe autism who present with complex needs in adaptive and social functioning should access suitable social care services in a regionally consistent manner. <BR /> <BR />I will not get through the rest of my notes, Mr Deputy Speaker, but I will say that, for Mid-Ulster, the Northern Trust's adult autism service offers short-term therapeutic interventions aimed at helping autistic adults to identify and understand their differences and find helpful ways of coping. All individuals aged 16 and over in Mid-Ulster who are waiting for an assessment and post-diagnosis support can also access the Northern Trust's adult autism advisory service.”
“While trusts will often consider which programme of care or service area will best meet an individual's needs under their "best fit" principles, it is acknowledged that it can be challenging to meet the ongoing social care needs of individuals who do not meet the access thresholds for existing statutory support services, such as learning disability, mental health or physical and sensory disability services. Most individuals with autism will be higher-functioning — that is having an IQ of over 70 — and will not, therefore, meet the criteria for accessing adult learning disability services.”
“I want to be clear: trusts are commissioned to deliver health and social care services to adults who have a confirmed diagnosis of a learning disability. That is identified by trust psychology services and is done through the standardised testing of a significant impairment of both intellectual and social functioning during the developmental period, typically before the individual reaches the age of 18. For individuals who are deemed to have a learning difficulty, there is no dedicated commissioned service. <BR /> <BR />An individual presenting with complex health and social care needs can avail themselves of a multidisciplinary assessment with specific and specified support and intervention, regardless of their learning disability or difficulty.”
“<BR /> <BR />We have several key ambitions for people with complex needs so that they can receive lifelong, coordinated support that is tailored to their specific needs and enables them to make the right choices and have the appropriate level of control. As part of that model, we have consulted and have hosted regional, in-person roadshows that were largely attended by families and carers, as they should be. The topic of services for people with severe autism was raised during the events, as well as lengthy waiting lists for diagnosis, access to services and the lack of support and self-training. <BR /> <BR />At the roadshows, concerns were raised about IQ testing as it relates to access to services for people with severe autism who present with a level of vulnerability that requires specific care and support.”
“It was put to me that the regime in the Republic of Ireland is a lot more user-friendly, and I have asked my officials to look at it. <BR /> <BR />I think that it will all come under what I am coming on to now, which is our desire to introduce a learning disability service model. The Member asked what the model is: we are talking about a new model that takes a new approach to supporting adults with a learning disability through Health and Social Care services across the jurisdiction. I will set out the key outcomes that we want to achieve, the principles that will guide delivery and the actions that we need to take to improve services for people such as Callan and his mum.”
“Those might include, for example, the provision of specialist equipment, social care or signposting to other sources of support. If an individual has mental health issues, it is the local community mental health team that should provide that support. If it relates to employment or education, however, the trusts have no statutory remit to provide services. <BR /> <BR />I will touch on direct payments, because it is something that came to me early in my tenure. I have taken a specific interest in it, and I came to the conclusion quite early on that we have overcomplicated it. We put too much responsibility on parents. We are asking them to be employers, and a lot of them say, "We don't want to be employers. We just want the right help for the child whom we love".”
“As Robbie said, the Department of Health may lead on the issue, but there are other Departments that have to look at Callan's long-term needs, not least in education and housing, which are beyond my remit, in order to help him. <BR /> <BR />Unfortunately, it is the case that, across the five geographic trusts, there is no specific programme of support for people with learning difficulties as distinct from people with a diagnosed learning disability. The appropriate support for people with learning disabilities will be determined by their specific needs. For example, if a person has complex needs that relate to healthcare, physical disability or sensory issues, it is a trust physical disability services team that assesses the individual and provides them with the relevant supports.”
“She's been here for 18 hours, and nobody's looking after her" or, "We need a life-saving operation for my husband". I do not need to go into it. You get the picture. Again, I have not added them up, but, over that time, that is probably between 6,000 and 7,000 requests. If I start responding to all of them, we would have a two-tier system. We would have the Health and Social Care system for most and a Minister of Health national health system for 6,000 or 7,000 people. It feels brutal, but, if I did it, it would create an imbalance and a huge bias, and there would be no time left to do the strategic vision stuff as Minister of Health. I am sorry if that sounds brutal, but that is the reality of the position that I am in.”
“I just hope that the Member understands that there is a kind of line that differentiates what I do from what I do not do. I will go out and meet patients, service users, their families and Health and Social Care (HSC) providers who work with children and adults with learning difficulties to inform myself about what is and is not working as a system. What I do not do, however, is meet individuals who are advocating for themselves or their loved ones. I have not added up the number, but the reason for that is that I have a strong sense that, since coming into post in late May 2024, I receive, I reckon, on average six requests a day via email and social media saying, "Please intervene. Please help". Some of them would break your heart, such as, "I'm sitting with my 91-year-old mother in an ED.”
“I also get that Cherisse, the mum, was not happy when I said that I would not meet her and instead referred her to officials.”
“Thank you, Deputy Speaker. Before I turn to the prepared remarks that you would expect me to have, I want to acknowledge — not just acknowledge but admire — Emma Sheerin's passion in trying to help her constituents and in ensuring that Callan gets to live his best life. His particular set of circumstances mean that he needs help to do that, and I get it that that help is not there.”
“I was not saying that there is no crisis; I was trying to illustrate the fact that we need to look at demand and its causes.”
“So far this month, the Executive Office and the Department of Justice have responded to 49 AQWs: the lowest of any Department. In the same period, the Department of Health has responded to 251 AQWs. In fact, as we approach the second anniversary of the restoration of the Assembly, the Department of Health has answered over 8,000 AQWs. We have no additional staff or resource, compared with the Executive Office or the Department of Justice, to respond to five times the number of queries.”
“Mr Gaston was critical of a reply from the Department to an Assembly question for written answer (AQW). It is a two-page reply. I reviewed it over the break and can say that it does not lack detail. Regarding what he said about category 2 responses, the Ambulance Service — he knows this, because he has had the response — has agreed with staff-side representatives a formal escalation process for defined, time-sensitive category 2 incidents and specific time-critical inter-hospital transfers. Such incidents may be responded to during periods of lawful action short of strike and in the final hour of shift, where direct conveyance to a point of care is appropriate. <BR /> <BR />Mr Gaston also complained about the Department's lack of speed in responding to questions for written answer.”
“The dictionary definition and common understanding of the word "gridlock" are that nothing is moving. That is not the case in our emergency departments, although things move far too slowly. That is an incredibly important distinction for somebody who may, as we speak, be thinking of attending an ED. If there were gridlock, there would certainly be no point in doing that, but that is not the case.”
“We also learned that real-time data on attendances, admissions, discharges and handovers enables action when coupled with clear escalation protocols and empowered local leadership. <BR /> <BR />I will also briefly address the role of the public. We have asked people, and will continue to ask them, to get vaccinated when eligible; use urgent care alternatives where appropriate; attend scheduled appointments or provide timely notice if they cannot do so; and cooperate with discharge processes. I know that those are not small requests, but they are asks that recognise a shared responsibility to keep services available for those who need them most. <BR /> <BR />I ask Members to be careful and thoughtful with their language. Mr Robinson said that EDs were "totally gridlocked".”
“That is the target to improve next year. It will also be important to reach parts of the workforce that, historically, have had a lower uptake, so we will listen to staff, address their questions and try to remove logistical barriers. We will continue to work with the Public Health Agency to implement improvements for 2026-27. <BR /> <BR />To address increased admissions and longer stays, we will centre efforts on managing flow and discharge into the community and on helping people to stay at home, where possible, while receiving the treatment that they need. It is crucial that people are treated in the right place at the right time. We have learned from previous years that targeted discharge campaigns can create capacity, but they have to be sustained and connected to downstream community and care home services.”
“Therefore, in 2026, the Department of Health will try to put a focus on managing demand, because it seems that that can be done. It certainly needs to be tried. There will be a focus on helping people to stay well and preventing the need for hospital admission. <BR /> <BR />Our ongoing vaccination programmes remain the best possible protection from infectious diseases, despite what some Members believe. Workforce vaccination recognises that protecting staff means that you protect patients and sustain services, so I welcome the commitment to the vaccination programme, which was evidenced in the higher uptake in 2025-26. The total number of HSC-employed staff who received the flu vaccine in the current programme is 21,698 from a total eligible cohort of 75,028 people, representing an uptake of 28·92%, which is lower than I would wish.”
“<BR /> <BR />I acknowledge the fact that the Committee Chair and Deputy Chair attended an ED on a Sunday evening. It is the same ED that I have attended in the past number of weeks — Antrim Area Hospital's emergency department — but I attended it in the morning. There were two patients in the reception area, and, on the far side, most of the cubicles were empty. There was no pressure whatsoever that morning. That morning was 25 December. We all know that we cannot replicate that on 25 January, but it says something to me about the demand side of the equation. We have not mentioned the demand side once in the debate. It has all been about the capacity. If we focus only on capacity, we will always have to come to the conclusion that capacity will never meet demand, even with a budget of £8·4 billion.”
“If I have time, I will, but I have a lot to get through. Members raised a lot of issues, and I want to return to them, not least those raised by Mr Gaston. <BR /> <BR />Winter weather can bring about an increase in falls, and that is why we are looking at frailty. No single lever will remove a winter peak or erase a queue at an ED, but what we can do, and are doing, is shape demand intelligently by directing patients to the right care at the right time; strengthening community and primary care in line with the shift-left agenda; reducing avoidable attendances and admissions; improving internal hospital flow; and accelerating safe, timely discharges. That is the work of stabilising the system while we pursue longer-term reforms.”