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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“Regional endoscopy centres in the South Eastern Health and Social Care Trust and the Western Health and Social Care Trust are treating suspected cancer patients from across Northern Ireland, while rapid diagnosis centres in the Northern Health and Social Care Trust and the Southern Health and Social Care Trust are providing regional cancer imaging services and helping to reduce variation across a number of cancer pathways.”
“Significant action is being taken to increase capacity across diagnostic imaging and endoscopy services, which are central to many cancer pathways. Recent management information shows encouraging progress. Between 31 March and 11 June this year, the number of patients waiting more than 28 days for a suspected cancer diagnostic test reduced by 41%, falling from 1,452 to 852. Variation between trusts has also been reduced. That has been supported by regional approaches to service delivery.”
“Adopt a simple policy: be human. <BR /> <BR />At requiem Mass on Saturday, some of his friends and colleagues reminisced about how he would hold you to account — no excuses — but, when it was over, he was still your friend, courteous and with a wicked sense of humour. My condolences to his wife Marie, children Rachel, Joe and Dan and the broader family. They will miss him the most. I shall miss him selfishly because I do not know where I will find another mentor to match him.”
“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 have had the privilege to meet a number of wonderful, passionate and compassionate public service leaders, such as Maurice Hayes, Sir George Quigley and Professor Sir Desmond Rea, who passed recently. Tom Frawley is a member of that elite. <BR /> <BR />I share this thought: anybody considering a leadership role in public service would do well to study not just his career but the values that Tom Frawley cherished and, more important, how he put them to work for the public good. Be curious. Ask questions not just about what is in place but about how it is working, and ask for proof. Celebrate the success of others more than basking in your own achievements.”
“Tom was ombudsman when I was Chair of what was then the Committee for the Office of the First Minister and deputy First Minister, which is now the Committee for the Executive Office. He promoted the idea of amalgamating the positions of ombudsman and commissioner, because, depending on which hat he wore, he had significantly different powers, and, unsurprisingly, that was confusing for the public. For Tom, serving the public always came first. That Committee remains the only Committee, I believe, to successfully pass legislation in the Assembly, and I am forever grateful to Tom for understanding how to advise without interfering. <BR /> <BR />His CV is impressive, but more impressive was Tom the person.”
“Members will be aware of the sad, sudden and untimely passing of Dr Tom Frawley CBE, the chair of the Western Health and Social Care Trust. Tom had a long and extremely distinguished career as a public servant that began in the health service. I am told that he became the youngest person ever to be appointed as chief executive of any public body throughout the United Kingdom when he became CEO of the Western Health and Social Services Board. After that, he was both the Assembly Ombudsman for Northern Ireland and Northern Ireland Commissioner for Complaints. Following that, he was vice chair of the Northern Ireland Policing Board, before returning to his first love: the health service.”
“I would love to do that. However, I live in a world where conditions and treatments compete for funding and resources, and nobody has given me a proposal for where I should find the money. Should I give up the plan to do 24/7 thrombectomy? Should I abandon plans to lower the age for bowel cancer screening? Should I close an intensive care unit bed to find the funds? That is the world that I live in. I regret that, because I would like to move to three cycles immediately. In the real world, however, we can do it only as quickly as we can. That, I am afraid, is my limited commitment to Members today.”
“I have to go back to the motion and the call on me:”
“While some areas may provide more cycles of IVF, the criteria in Northern Ireland are less restrictive and mean that treatment is available to a wider number of women. Nevertheless, the guiding principle, as we seek to expand provision in what is an extremely constrained climate, is to use the resources that we have to maximise access to these important services on a fair and equitable basis. <BR /> <BR />Diane Dodds pointed out that, on 31 March 2026, NICE published a revised guideline, NG257, fertility problems: assessment and treatment. In response to her question, that is being assessed by my Department. However, 31 March was effectively three months ago, so I will ask questions and look for a decisive timeline for reaching a decision on that. Kellie Armstrong asked about a time-bound commitment to investment and expansion.”
“For example, there is no barrier to women accessing fertility treatment here if they or their partner already has a living child. That is not the case in Scotland or Wales, where treatment is available only if either the woman or her partner does not have a living child. In addition, couples accessing treatment in Wales and Scotland must have been in a relationship for a minimum of two years. That is not the case here. In Scotland, those who use artificial insemination to demonstrate infertility must undergo six to eight treatment cycles, and it is six in Wales. In Northern Ireland, that has been reduced to four, thereby offering earlier access to other treatments than in Scotland and Wales. I accept that that makes it somewhat difficult to compare across regions.”
“While I am not yet in a position to confirm a further increase in provision, I am assured that all avenues are being explored to identify the additional financial and physical resources to allow that to happen. <BR /> <BR />With regard to the equity of services across the rest of the United Kingdom, I ask Members to note that, in England, provision varies across the country, depending on the location of the patient. Many authorities provide one IVF cycle, while others provide up to two or maybe even three. While I note that Scotland currently offers up to three cycles to eligible women and Wales offers up to two cycles, access criteria in both those jurisdictions are more restrictive for some of the criteria, meaning that publicly funded treatment is available to a wider cohort of women here in Northern Ireland.”
“That includes considering the additional staff required to deliver any increase and seeking to secure additional accommodation as required. <BR /> <BR />I mentioned waiting times. Part of the challenge of expanding a service within its current funding envelope is to do so sustainably and to ensure that any increase in provision is not to the detriment of the current service. In May, the waiting times were 12 weeks for a first appointment, one month for IVF after being put on the waiting list for treatment — it was 16 months during COVID — and three months for frozen embryo treatment after being put on the waiting list. Again, that was much longer — 12 months — during COVID.”
“At that time, however, it was made clear that any further expansion of the service would depend on securing additional funding and additional capacity at the regional fertility centre, both physical space and additional staff to deliver that increased capacity. <BR /> <BR />Although those are significant constraints, I remain keen to find a way to increase provision for those who are struggling with fertility. It should be noted that any increase would be on an incremental basis, and, accordingly, efforts are being made to scope requirements to offer a second cycle. While additional funding has still not been secured, I assure Members that my officials and the staff at the regional fertility centre are working to continue to explore ways to increase provision within the current funding envelope.”
“We then established a project board to work with the regional fertility service to explore ways of expanding provision. Like many, that service was severely impacted on by the COVID response but recovered quickly, and I record my thanks to those staff for clearing the resultant backlogs. Investment to increase staff numbers and physical space have also been key constraints. By February 2024, my predecessor, Robin Swann, was able to announce an increase in provision to one full cycle from within existing resources. That enabled all eligible women who were added to the waiting list for treatment from 1 October 2022 to use all their frozen embryos until a live birth was achieved.”
“The commitment was, on the one hand, a welcome recognition by the Executive that, for far too long, women and hopeful couples in Northern Ireland had to experience the imbalance of IVF provision, which is below what NICE recommends and below that which is available across some other parts of the United Kingdom. On the other hand, I ask Members to recognise that no additional funding has ever been provided by the Executive to implement that NDNA commitment. That means, of course, that the service can only grow by doing more with the same resources, as we have done — I will come to that in a moment — or by stopping something else. <BR /> <BR />In 2020, women who met the access criteria were able to access one fresh cycle of IVF and one frozen embryo transfer — that is to say, a partial first cycle.”
“Thank you very much, Deputy Speaker, and thanks to the Opposition for bringing a debate on this issue. All healthcare is personal, and I thank Órlaithí Flynn, Kellie Armstrong, Linda Dillon and Nuala McAllister for making the debate personal, because that is the only way that we will really understand. <BR /> <BR />I welcome the opportunity to update Members on the work to increase the provision of IVF. As Members have said, that is a commitment from New Decade, New Approach, and it is also recommended in guidance from the National Institute for Health and Care Excellence. There are many people who long for a child to start or extend their family and are desperate to hear when the current fertility service will be expanded. Members will be aware that it was actually my party that requested and secured that commitment in NDNA.”
“As I mentioned to the House, when it comes to resignations of consultants in HSC under the age of 60 in recent years, we are only talking about a couple of per cent. Sláintecare is perhaps not as attractive as I thought instinctively when I took up the role, and that is not just about salary. It is about not being allowed to work in the private sector if you are under Sláintecare. It is about programmed activities being protected in Northern Ireland, whereby two out of 10 four-hour shifts can be used for personal development. We work with and listen to the workforce, and I insist that we cherish the workforce, because, of the five elements that I articulated, it is the only one that I cannot do without.”
“All I can say is that there will be a cost, because, inevitably, there will be disruption. As I said to your colleague Mr Robinson, at this stage, it is not possible to accurately predict the level of disruption and, therefore, the associated costs.”
“Rather than continue to roll out statistics and disagree about where we start and how we finish, I am willing to sit down with the consultants and all the others again and continue to discuss the workforce, because, to my mind, five elements are key to delivering health and social care: buildings, beds, equipment, medicine and the workforce. If you do not have the right workforce in the right numbers in the right place with the right skills, and its members are not happy when they wake up and head off to their shift, the first four do not count for much more than a hill of beans.”
“The Member is right to point out that there is a level of disagreement between the Department and the various BMA groups on the starting point and the comparator. We in the Department are very clear. If we take consultant pay, we see that, after the uplift to incorporate the DDRB's recommendation for 2026-27, the current maximum salary for a consultant in England is £150,569. I want to implement that recommendation locally, and, if and when we do that, the maximum pay point for consultants here will be £150,610, which is £41 more than that in England.”
“That is not possible at the moment. The trusts continue to meet regularly, and they will meet at 4:00 pm tomorrow. At that point, I would like to think that there might be a little more clarity, but until we see the exact impact of the strike action, it is impossible to put figures on that, because, as I have already said, the majority of consultants, for example, did not vote for strike action. They may not be members of the British Medical Association, and they may decide to go for business as usual this Thursday and maybe even next Monday. It is not possible, at this stage, to put a figure on it, but the trusts have come together and communicated a single clear message to anybody with an appointment on either of the strike days: please assume that your appointment will go ahead unless explicitly told otherwise.”
“By comparison, for example, across the Agenda for Change, nurses and allied health professionals are at 14·8% and teachers are at 14·2%. However, consultants are saying, "No, you need to go back to 2008". If one does that, one sees that there has been a degree of pay erosion. We reckon it is around 8%. Therefore, it depends on where you pick your starting point. You really need the two sides to come together in the spirit of finding a resolution. <BR /> <BR />There is a thing to be said about a consultant saying, "I earn £145,000 because I am at the top of the tree, but 3·5% is not enough because of the cost-of-living crisis". Well, 3·5% of £145,000 will cover the cost-of-living crisis in the way that 3·5% of £25,000 or £35,000 a year will not. I am certainly still open to talks, but they seem to be dug in.”
“I met the chairs of the three BMA doctor committees on 11 June. I recognised their right to take strike action, and, indeed, they were very determined in their responses to me on that. I tried to make it clear to them that I feel that to move beyond the 3·5%, which I cannot pay at the moment, because we do not have an agreed Executive Budget, but that I will pay as soon as that Budget is agreed, was beyond my vires because, as I have said, it would be repercussive, certainly in my opinion, right across the public sector. Therefore, as it would be potentially contentious, I would have to take it and, hence, the paper, to the Executive. <BR /> <BR />One of the issues is the starting point, because we are going back three years and saying that, in that time, those three groups have had pay rises of between 24% and 30%.”
“I will. There are 2,300 consultants working in the HSC. The number of BMA members is lower. However, the total number of consultants is 2,300, of whom 542 voted for strike action. That is 23·6%. There are 2,600 resident doctors, again, not all of whom are members of the BMA, and 608 of them voted for strike action. That is 23·4%. There are 870 SAS doctors in total, of whom 282 voted for strike action. That is 32%. Across the three medical workforces, approximately a quarter, 24·8%, have voted for strike action.”
“I, of course, want to see every single penny be spent wisely and to best effect. A pound wasted in the Department of Health is a pound that could have been spent on social housing, in the Department for Infrastructure or in any other Department. On recruitment, however, I have to say to the Member that, in the three years from March 2023 to March 2026, there are 175·6 more whole-time-equivalent consultants, 174·9 more whole-time-equivalent SAS doctors and 376 more whole-time-equivalent resident doctors working in Health and Social Care (HSC). Those represent increases of 8·9%, 31% and 17·3% respectively. It is therefore not as though nothing is happening.”
“Full-time consultants who are working for us can use two of their 10 programmed activities for their personal development. Our consultants are also free to work in the private healthcare sector. Neither of those opportunities applies under Sláintecare.”
“I take the point that sectors are unhappy, but there has hardly, if ever, been a debate in the Chamber in which someone did not point out to me that I have over 50% of the Executive Budget. We will have to reform how we deliver health and social care, because the direction of travel — from 46% to over 50% of the Executive Budget — is not sustainable. <BR /> <BR />A lot has been made of Sláintecare. Indeed, I was probably more concerned about Sláintecare than the statistics reveal that I should have been, because data demonstrates that, in the years since its introduction, the number of resignations of consultants aged under 60 in our health and social care system has remained consistently at under 2% of the workforce. I hope that that surprises the Member, because it surprised me. It is not just about money but about terms and conditions.”
“Yes, I would, but my hands are tied, because, even if I were able to go beyond 3·5%, I would deem that to be repercussive not just for nurses but police officers, prison officers, teachers and, in fact, the entire public sector. I would therefore have to take it to the Executive. Today, I have submitted a paper to the Executive that I hope will be discussed at the next meeting.”
“Look, I would like everybody who is delivering health and social care to wake up feeling good about themselves every morning, looking forward to going on shift, enjoying their work, going home feeling satisfied and feeling that their terms and conditions are reasonable, appropriate and equitable. As I understand it, however, the Member's party, my party and all the other Executive parties have bought into the idea of delivering pay parity as defined by delivering the recommendations of the DDRB and the National Health Service Pay Review Body, which is offering only 3·3% to allied health professionals and nurses. In this case, doctors are therefore getting another 0·2%. Would I like it to be more?”
“First, I accept that we have around half a million people on waiting lists. I hope, however, that the Member will accept that, for the past two quarters, the overall number has begun to shrink. That is a positive and hopeful sign to send out to the population, although I accept that those who are on long waiting lists have been waiting far too long and continue so to do. <BR /> <BR />The Member asked for my opinion on the pay award. In this case, the suggested award comes from the Review Body on Doctors' and Dentists' Remuneration (DDRB), which is a national body that makes recommendations for England, Wales and Northern Ireland. It is 3·5%.”
“I have made it clear that pay parity is a matter for the Executive, and I apologise to the patients who will be impacted on. I urge the BMA to reflect on who is most greatly impacted on by its action. When the matter in dispute is not one that can be resolved by my Department alone, it is difficult to justify placing further pressure on many patients who are already waiting too long for their care.”
“For instance, while the BMA locally may be warning of only a "Christmas Day" service later this week, I expect and anticipate significant volumes of elective activity to still be delivered. My Department will receive further details on the level of disruption by close of business tomorrow. The requirement to be agile right up to and on the days of strike is a lesson from the 2024 resident doctors action. There will be close monitoring of the rescheduling of any patient intervention, although, as scheduling is normally undertaken six weeks in advance, there may be some patients who are delayed. Trusts will, however, risk-assess those who require prioritisation. <BR /> <BR />It is regrettable that the action is proceeding.”
“<BR /> <BR />Trusts have been working to quantify the level of impact and are undertaking risk assessments to ensure that emergency, cancer and time-critical interventions are protected as far as possible by involving parts of the workforce that are not participating in strike action. Trusts have agreed a regional payment rate for additional shifts, including on-call periods, and, where possible, are utilising a wider non-medical skills mix. Discussions are also ongoing regarding the potential for additional GP out-of-hours provision. Trusts will issue communications to clarify which appointments, diagnostics and treatments are affected. <BR /> <BR />Let me be clear: my firm expectation of the trusts is that disruption, cancellations and delays are kept to an absolute minimum.”
“With your indulgence, Mr Speaker, I may request an additional minute to respond. <BR /> <BR />Following last month's ballots, Northern Ireland members of the British Medical Association (BMA) have agreed to take industrial action over two 24-hour periods: consultants and SAS doctors on Thursday 25 June; and resident doctors on Monday 29 June. My Department has been working with the five health and social care trusts and with primary care to ensure that arrangements are in place to minimise and mitigate the impact on patients. However, it is deeply regrettable for the patients who will be impacted on that it is inevitable that some services will be disrupted.”
“<BR /> <BR />Once again, Mr Kark's recommendation 2 gives me up to six months to respond. My Department and I and everybody in HSC will not take until Christmas to respond to the recommendations.”
“It is not possible — I am surprised that the Member thinks that it is — to give a defined timeline for all 106 recommendations. Some are not even within my gift. Recommendation 88 is for the Police Service of Northern Ireland; recommendation 89 is for the Department of Justice; and recommendation 101 involves the Housing Executive and the Department for Communities. As I said, I have put the recommendations into three categories. I believe that the great majority are, basically, actionable immediately, and there are some whose resource implications I do not sufficiently understand. There are 27 that I want to explore with officials — I will do that at pace — and there are at least 11 that need exploration because of the funding and resource implications.”
“I would like to think that the Department will discuss with the trust and any other relevant organisation, including the Patient and Client Council, which, of course, is there for such circumstances, and we can put in place some protocol for anybody who feels that they regret that they did not take the opportunity or did not have the opportunity to engage with the inquiry. When abuse occurs, it is always important that people are acknowledged and have the opportunity not just to tell their story but to have their story listened to and acknowledged by the right people. If the Member's constituent is looking for an immediate fix as far as being heard is concerned, I suggest that she contact the Patient and Client Council today.”
“In fact, in one organisation that I was part of, I was made aware of historical abuse, and I phoned the father and introduced myself and asked how his son was. There was a long pause at the other end of the phone. I heard something that I thought was sobbing, and it was. The man, when he got himself together, said, "You are the first person in 10 years from that organisation to enquire about my son". If that is the sort of attitude that anybody in Health and Social Care is going to take, it is just not acceptable. I will not ignore it, I will not sit on it and I will be decisive.”
“I am not across the last point that the Member has made. Am I concerned about the trust taking an overly legalistic approach to it? Of course I am, because that is what Mr Kark reports in the inquiry report: that it was adversarial. Again, it is not about the volume of response, which is probably justifiable, but about the tone and the attitude. Did the trust make a decision that it had to protect the trust's reputation above safety and concern for the patients? That is unacceptable. I have seen it happen before in organisations where things go wrong and abuse takes place, and the first thing that the leadership does is say, "Let's form the wagons in a circle and let's not do anything about it".”
“It is about the systems and the culture that is embedded in people who deliver health and social care. Am I concerned that an isolated incident of abuse could be happening as we speak? Of course I am. Can you guarantee that it will never happen? No, you cannot. Can you pledge to do everything that you can to prevent it and to stop it when it happens? Yes.”
“Having thanked the leader of the Opposition for making this possible, I now wonder for how long he has sat on that information, rather than bringing it to me. However, we will have that conversation. <BR /> <BR />I will assure myself as best I can about the quality of resettlement and, more broadly, about whether abuse is happening. I have to ask, when you think about 75,000-plus people delivering health and social care daily, is it possible that physical, psychological or mental abuse, not on the scale of Muckamore Abbey, is happening? Human nature dictates that that is highly possible, so we have to keep working and working at the system and at the culture. It is not about structures. As Rafael Bengoa said, it is about systems, not structures.”
“That is the last of the current series of public inquiries, so that will be an appropriate time at which to call that health summit, where we will have the leadership across HSC in one room and I will have the opportunity to say to them, "Enough's enough. The line is drawn. Be human. Deliver care compassionately. Stop the scandals. Do your job".”
“On that last point, officials have assured me that exceptional care and a lot of time are taken to try to meet the individual needs of patients when they are being resettled, but I look forward to starting the conversations on the other side, as it were, by talking to families immediately after this session. <BR /> <BR />I referred in my statement to a health summit. I inform Members that there is one more public inquiry report to come: I believe that Christine Smith KC will publish her report on urology on Wednesday. I expect that that will also be a blow to the Health and Social Care system.”
“We are analysing the responses received during the public consultation on the learning disability service model. We need to ensure that the lessons arising from the inquiry help to shape the future direction of the learning disability service model. We need to provide a long-term framework for the transformation and improvement of adult learning disability services. The Member will not be surprised to hear that implementation will be phased and prioritised over a number of years. Once we have finalised the model, we need a detailed costing exercise to be undertaken, as well as a strategic delivery plan. I am not committing to publishing anything at this stage, but we will follow the process, and I will encourage the relevant officials to do so at pace.”
“The different ideas that they have brought in have been more than welcome.”
“I take the Member's point about a revolving door. However, we are bringing in fresh ideas and fresh faces, such as Steve Spoerry, the chief executive of the Southern Trust, and Mike Farrar, the permanent secretary in the Department of Health.”
“I am absolutely prepared to take further action to restore public confidence, if I feel that that step is necessary. The Member will know that, with regard to the Belfast Trust, I have previously taken what could be regarded as decisive steps. I am not afraid to do so again, if I deem that necessary.”
“In the report, Mr Kark and his colleagues do not make recommendations specific to the Belfast Trust, which owned and ran the Muckamore Abbey Hospital. Rather, of the 106 recommendations in the report, 63 — way over half — are for the health and social care trusts, plural. That gives some indication of where Mr Kark thinks we should go to ensure that it never happens again. On my initial reading, I am pretty much on the same page as he is.”
“As I have said, we will not only advance the Adult Protection Bill but introduce an organisational duty of candour Bill. Alongside that, we will support the UK-wide Public Office (Accountability) Bill, commonly known as the Hillsborough law, which includes individual duties on every person working in the health and social care system. That is a valid position. The Member takes a different but equally valid position. That is fine; I understand. When the Bill on the duty of candour comes to the House, the Member will try to amend it or, indeed, will bring forward his own Bill. That is perfectly within his political rights.”
“I am sad to hear about the Member's experience. In summary, those patients are vulnerable. Some have families who were more than capable of advocating on their behalf, but patients who do not should have advocates and key workers. They should have people who know them, understand them and care for them on every step of their journey.”