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 can give that confirmation to the Member. I am aware that some have said, "Take the £61 million for MDTs and use it for another purpose", but that is not possible for this reason: that £61 million is not Department of Health budget; indeed, it is not even Northern Ireland Executive budget. It is Northern Ireland Office budget, allocated after a competitive process in its transformation schedule. We won that competitive process, and we have £61 million. I stress that it is not £61 million in one financial year; it is over four years. Either it gets spent on the roll-out of MDTs, or it does not get spent.”
“We are continuously talking about the challenge of vacancies not just in social work but across the full Health and Social Care (HSC) workforce. It is always a priority. I constantly meet those in the Department who are engaged in workforce planning. We are very aware of the vacancies and of the impact that they have on health and social care delivery, but there is no magic bullet or magic wand to fix the problem.”
“The question is whether we should have two mental health practitioners in an MDT, but, if you have that, is that an additional whole-time-equivalent staffer, or do you do without some other specialism? That debate will come, but, at the moment, my focus remains on the roll-out over the next number of years.”
“That is a very interesting question. The focus at the moment is on making sure that there are MDTs across Northern Ireland. We have not got across all the federations — as I said, it will take seven or eight years to complete that journey — but I am already thinking about whether we are right to have MDTs that are basically a one-size-fits-all where you get a first contact physio, a social worker, maybe a social work assistant and a mental health practitioner. The Member is well aware that north Belfast was at the heart of what we so euphemistically call "our Troubles" for 30 years, so legacy mental health issues are particularly severe in his constituency.”
“I can certainly talk about prioritising the roll-out to where they are needed most. As the Member knows, recruitment and retention is a difficulty across the piece, particularly in rural areas. We have to be imaginative in how we make the packages attractive to people to come and work in rural areas. It is not just about the salary. Like all of us, people coming into a profession want to see the prospect of progression, so we need to be imaginative about how we can package and, effectively, sell the idea of working in a rural area as being not just good for patients and that rural community but good for the workforce. We need to listen to the workforce and the rural community. I need to listen to the experts who know best how to do it. The problem is not particular to Northern Ireland: any country has rural areas with similar challenges.”
“Over four years, 12·9 whole-time equivalents of each professional role will be recruited. A hub-based delivery model is also under consideration, with services being delivered from the Omagh Hospital and Primary Care Complex, Erne Health Centre and Maple GP surgery. That approach aims to ensure equity of access —”
“<BR /> <BR />The federation in north Belfast comprises 21 GP practices, serving 114,353 patients. Plans are well advanced to introduce MDTs in 18 practices this financial year, with the remainder next year, subject to premises readiness. Selection was informed by premises suitability, clinical need, ICT preparedness and risk of contract hand-back. Over four years, 11·4 whole-time equivalents of each role — first-contact physios, social workers, social work assistants and mental health practitioners — will be employed to reduce health inequalities and improve well-being through accessible, high-quality services. <BR /> <BR />In the south-west, the federation covers 20 practices serving 129,044 patients. Thirteen practices are scheduled to adopt MDTs this financial year, with the rest next year, subject to infrastructure readiness.”
“With your permission, Mr Speaker, I will answer questions 3 and 14 together. <BR /> <BR />The multidisciplinary team model remains central to stabilising primary care services to ensure that they can continue to deliver high-quality care to our communities now and in the future. In line with the Department's commitment to the wider transformation agenda, £61 million is being secured for the MDT programme over the next four years. Recognising the significant staffing and funding pressures across Health, roll-out will follow a two-phase approach over the next seven to eight years. Phase 1, which has started and runs to 2028-29, will complete MDT implementation in the seven existing GP Federation areas and expand it to five additional areas this year, including north Belfast and the south-west.”
“Yes. I have asked Professor Sir Frank Atherton to look at all the work that has been done to date and beyond the actual reports. I give the Member this assurance: he will report his findings directly to me. There will be no influence from officials in the Southern Trust, the Public Health Agency or the Department of Health. I will liaise directly with the professor.”
“We have had many reports, and I have now asked Professor Sir Frank Atherton, previously the Chief Medical Officer (CMO) in Wales, who is completely independent of the Southern Trust, the Public Health Agency and my Department, to look at all the work that has been done to date and to be my eyes and ears, because I am not on expert in the field. Having spoken with Ladies with Letters and others, rather than ask him to confine himself to the reports published to date, which Ladies with Letters fear do not cover every aspect, I have asked Professor Atherton to have a meeting exclusively with Ladies with Letters and that they discuss between themselves what else the professor may need to look at, beyond what is written in those reports, so that he takes a comprehensive view when he reports back to me.”
“I have not committed to a public inquiry, but I have not ruled one out. I have consistently said that I want to establish what happened, why it happened, including who was responsible for its happening, and what we do either to prevent it from happening again or to make sure that we have done everything in our power to minimise the chances of its happening again. <BR /> <BR />I am therefore determined to get a full understanding of what happened. As I say, I have not ruled out holding a statutory public inquiry. It is, however, a complex issue. As the Member knows, it stretches back to 2008.”
“On the first question, I understand that there was a migration from one IT system to a second. That should have gone smoothly. There should not have been any issues, but it appears to me that issues arose. I want to understand fully what those issues were and why they were not spotted when the changeover from an old IT system to a new one was done. I will certainly engage with the Committee once I have surety about what happened and why it happened. <BR /> <BR />I do not have an update on the women's health action plan to give the Member at the moment, but she may be aware that I have a weekly meeting with the permanent secretary, and it is certainly on my agenda for this week's meeting.”
“I thank the Member for his question. I am not sure that I quite understood the question, but equality of access and service is 100% what I want. I have said many times that I want standardised, regionalised services. On patients who have missed out, I am aware of an issue with patient samples from a number of GP practices in the Southern Trust that were not processed. I understand that some women have unfortunately been asked to give a further sample. I stress that, as Minister, I expect the processes to be managed carefully from end to end. An investigation is being completed, but, until we know more about what happened and why, I do not want to speculate or comment further.”
“Monthly monitoring returns of those audit activities are provided by the trusts and collated by the Public Health Agency, and assurances are provided to the Department's cervical screening oversight and assurance group. <BR /> <BR />The Northern Trust's monitoring return on the audit of invasive cervical cancer includes data for women who have had a diagnosis of cervical cancer made by services in the Northern Trust between January 2022 and December 2024. Data for those diagnosed in 2025 is not yet complete. I advise the Member that 43 women who were diagnosed with cervical cancer by the Northern Trust during the three-year period from January 2022 to December 2024 had a review of previous cytology slides undertaken. There has been no wider re-examination of cervical smear tests in the Northern Trust in the past three years.”
“Where a woman is diagnosed with cervical cancer, the diagnosing trust leads a review of all elements of the woman's screening history for the 10 years prior to diagnosis. That is done if such a history exists; not all women will have one. The audit will involve a review of every element of the screening pathway, including the invitation process, laboratory services and colposcopy service, and it includes a review of their cervical smear tests, where those are held. The regional 'Framework for the Audit of Invasive Cervical Cancers and Disclosure of Findings' was issued to health and social care trusts by the Public Health Agency (PHA) in March 2019. It included advice to trusts that all audits of cervical cancer diagnosed from 1 January 2019 should be managed in line with that framework.”
“I am certainly not aware of any partnership or organisation that is not up for looking at it. Since I took up post, right from the get-go, everybody whom I have spoken to who is involved in delivering health and social care in any way, including those in the voluntary and community sector, has been up for a reset, for reform and for a shift left, because I think that everybody realises that the current model is not sustainable. The question of finance remains the critical one. Can we release enough money to make a significant impact in the next financial year and set a direction of travel by the end of the mandate that the next Minister of Health feels compelled to follow? To be honest, that has to be an open question, but it is one that I am determined to try to close.”
“I am unaware of those details, but, obviously, I will check that as soon as I am able to leave the Chamber.”
“That will be incredibly challenging in the next year, but the idea is to try to get everybody, or, at least, as many people as possible, to the starting line for 1 April. Rolling out a neighbourhood model will not be done in a month or a year or even in this mandate. It could be a five- to-10-year project, but the idea is to start it on 1 April in certain areas at least and prove evidentially that it works, so that we create the desire around the rest of the country to be next in line to join the model.”
“The core funding budget is not satisfactory for anybody, including me and the Department. When you break it down into GPs, community pharmacies or the hospital trusts, which are having to save hundreds of millions of pounds in this financial year, as they did last year, that is at the core of the problem. <BR /> <BR />I have a number of concerns, but at the top of my list is the shortfall in next year's budget to do everything that I want to do. When you look at what we must do, which is to keep the current health service functioning, the question is this: how much money can we release for this "save to shift" rather than "spend to save"? Can we spend to move to the shift left model?”
“Those two different populations — one urban population in Derry/Londonderry and one urban population in Belfast — came up with different desires. It is my desire that rolling out the neighbourhood model will not be a one-size-fits-all but will, indeed, reflect the desires of local populations.”
“I thank the Member for her observation. Of course, I want patients and communities to be involved in the model. Without their buy-in, it will be very difficult to achieve. For me, the starting point has to be talking to the experts who know how to deliver a neighbourhood scheme. I will take you back to what Professor Bengoa said to me when he was last here: "Be very tight on your outcomes but very loose on how you achieve them, because you are not a nurse, a doctor, a GP, a clinician, a surgeon or, indeed, a health service administrator. <BR /> <BR />I mentioned my Live Better initiative to look at health inequalities, which began in two demonstration areas. Those models were based on liaison with populations that we were there to serve.”
“We are about to move into phase 2, which is the build phase, identifying neighbourhood sites and activities and establishing systems for delivery, as well as the funding arrangements. Implementation will commence from April 2026, when we will have worked through the operational details and will move into the delivery phase.”
“Integrated neighbourhood teams will know the populations that they serve and will work together as a team of teams, leading and driving the delivery of the neighbourhood's core functions and priorities for care closer to home. They will work with smaller neighbourhoods within the footprint, which are the communities to which people feel they naturally belong. <BR /> <BR />We will take a phased approach to developing and implementing the model. The design phase has involved significant research, stakeholder engagement and launching a call for evidence to identify existing good practice. In addition, learning from my Live Better initiative will be taken into account.”
“I made a commitment in the reset plan to developing a neighbourhood model to deliver greater levels of care to our citizens in their local communities. The model will see community pharmacies, GPs and their federations, voluntary and community organisations, trusts and independent providers working closely together in formal partnerships to provide integrated care. It is an important enabler for my commitment to shift left. <BR /> <BR />Building a neighbourhood model will require providers to work in new ways. It will be built around 17 integrated neighbourhood teams, which will act as provider alliances. They will operate within trusts or within an area-integrated partnership board footprint at GP federation level. They will serve an average population of 115,000 people.”
“Mary, of course, was a great advocate for the people of Derry, and particularly for those who were suffering disadvantage. She was also a great advocate for women in politics and, indeed, for women serving more generally in public life. It is fitting, Mr Speaker, that you make space for all of us to pay tribute to two people who walked the hard yards in the difficult years and devoted themselves to public service. May they rest in peace.”
“Some will say that Joe's passion was for agriculture, but he did not have passion just for that: he had a passion for educating our children and for all matters rural. He also served on the Policing Board, and he did so at a time when the whole concept of a Policing Board was relatively novel and all the more challenging because of that. I remember Joe as a gentleman but also as a quiet but effective politician in the Chamber and in Committees. <BR /> <BR />Like Mr Dickson, I came here in 2011, so I did not serve with Mary Bradley, who was stepping down at that time, having come here first in 2003. She served during some of the really tough years for the Assembly as it was trying to bed itself down. If there is something that connects Joe and Mary, it is that they were two great advocates of the mantra that all politics is local.”
“On behalf of the Ulster Unionist Party, I offer condolences to the friends and families of Joe Byrne and Mary Bradley and to the Members and supporters of the SDLP — but also, actually, to anybody who supports democracy, because here were two great democrats who gave their lifetimes to public service, as we all aspire to do. <BR /> <BR />I had the pleasure of serving with Joe Byrne during my early years in the House. That was his second spell as a Member of the Legislative Assembly. Of course, he came with life skills, because he was a graduate in economics from Queen's University, from where he went on to become a lecturer in business studies at the then Omagh College of Further Education. It is so important that Members come into the Chamber with life skills.”
“Principal Deputy Speaker, this is the last sitting day of the year, so I wish you and fellow Members a very merry Christmas. I believe that 2026 will be a highly consequential year for the delivery of health and social care in Northern Ireland, and it is my commitment to come back in January and begin with some good news.”
“I assure you all of my commitment to deliver better neurology services and outcomes for the people of Northern Ireland. The challenges are significant in some cases, and there are no quick fixes. However, I am confident that the report's recommendations provide an opportunity to build neurology services that are equitable, timely, suitably resourced and centred on the needs of people with neurological conditions.”
“That is an unsustainable direction of travel, which is why we have to reset and to go for the neighbourhood model. Mrs Dodds also had a specific question about waiting times in the South Eastern Trust. The waiting time for a neuromuscular first appointment is 19·1 weeks; for other conditions, it is a little longer. <BR /> <BR />I am clear that the challenges faced by people with a neurological condition and those who care for them are unacceptable and are the product of a system under extreme pressure. I must also take the opportunity, however, to commend the committed and dedicated Health and Social Care workforce, who, in challenging circumstances, do their best for patients.”
“That will inform the development of an implementation plan. It is intended that a neurology delivery team will be established to oversee the delivery of the review recommendations. The development of an implementation plan will be an initial priority action for the delivery team. <BR /> <BR />In conclusion, I will touch on something that Mrs Dodds said when she opened the debate. She listed the specialists who are required to make the neurology service fit for purpose, and, indeed, I listed a number of them. She explicitly said that the service needs investment. The question is this: where do we get that investment from? I am often told in the Chamber that Health has over 50% of the Executive's Budget, and I recognise that that has gone up from 46% in recent years.”
“<BR /> <BR />The neurology review recommendations are aligned to the neighbourhood focus and the commitment to reform that were set out in the reset plan, so the funding required is included in those bids. Depending on the outcome, the scale and pace of implementation may be adjusted in line with available future funding. That is a more positive and encouraging statement for the Member. <BR /> <BR />My Department recently concluded a public consultation on the review report. An initial assessment of the responses indicates that the report adequately reflects the experience of people with a neurological condition. The impact on people who struggled to access the care and support that they need came out loud and clear. I look forward to receiving the final consultation analysis report in the coming weeks.”
“The current position is that it is all under review. Until I know what my three-year budget will be or what next year's budget is, I will not be in a position to make definitive, concrete commitments. We now know what the pressures are, and we have a pretty good idea of how we will end this financial year. We will be in deficit, and it will be a significant deficit. That money will have to come out of next year's budget, but, until I know what next year's budget is, I will not know how big the pressure of this year's deficit will be. It is just too early to make definitive commitments. I made a definitive commitment on the real living wage for social care workers, and I do not want to make that mistake again, having had to withdraw that promise.”
“A multi-year budget will allow my Department to better plan for the next three years, and that will enable us to prioritise spending and investment. As part of the Budget process, my Department has submitted nine high-priority bids that are aligned to the health and social care reset plan that I published in July 2025. <BR /> <BR />I will give way to the Member.”
“<BR /> <BR />In that context, while I would like to be in a position to commit the funding required to implement the neurology review recommendations, the current financial position means that, unfortunately, I am unable to do so at this stage. With regard to future years, the Finance Minister has indicated that he will bring forward recommendations for a multi-year Budget.”
“That is critical to ensure that we are in a position to sustainably address the issue of unacceptable waiting lists for a first appointment and review appointments that Members have raised. <BR /> <BR />The report estimates that an additional £65 million will be needed over the first five years of implementation, primarily to support growth in the workforce. While that amount will be refined as part of the development of the implementation plan, it is clear that the funding needed for reform is significant. Many of you — most of you — should be aware of the financial challenges that my Department faces, starting with a funding gap this year of £600 million. Today, we had December monitoring and another pressure in terms of pay that will materialise in the next financial year.”
“Those are already present in the South Eastern Trust and the Southern Trust and have been shown to be a very effective way of working. In addition, there is a focus on trialling new ways of working, including the use of patient-initiated reviews and providing protected slots in neurology clinics for people experiencing a change in their condition. The drive for efficiency is further supported by recommendations to improve the use of data in neurology and for closer partnership working with our colleagues in the voluntary and community sector. <BR /> <BR />It is clear that the implementation of the report's recommendations would drive improvements across the service. Workforce development, supplemented by working more effectively, would provide the basis for a more responsive, sustainable service that better aligns capacity with demand.”
“In that context, the report recommends the establishment of local neurology teams in each trust area to support that approach and ensure robust service delivery. The completion of condition-specific pathways within the first two years of implementation is noted as a priority recommendation. Pathways will set out the services and care that people should expect and ensure equity of access for all. Progress against that priority will be a key metric during implementation. <BR /> <BR />The fourth priority focuses on opportunities to work more effectively with the resources that we already have. Recommendations include the roll-out to all trusts of innovative practices, such as referral management for outpatient appointments.”
“<BR /> <BR />The report is also clear that, where patients are admitted as a neurological emergency, access to specialist neurological opinion must be available in line with recognised standards of care. It is not acceptable that almost a quarter of neurology patients are admitted to a hospital with no neurologists available on-site. To address that issue, the report recommends that trusts must ensure access to specialist neurology opinion at all acute hospitals that receive unscheduled admissions. Where workforce constraints pose a challenge, trusts must consider alternative methods, such as tele-neurology, as an interim measure. <BR /> <BR />Regarding access to ongoing care and support, the report notes the benefits of a multidisciplinary approach and care closer to home where that approach is sustainable.”
“The assessment, much of which is reflected in the motion, identified significant variation in access to inpatient neurological care. In addition, a large proportion of patients are admitted to a hospital without a consultant neurologist on-site. More widely, access to some supporting services that sit outside neurology, such as mental health services, was also identified as a major gap. The report makes specific recommendations to address those gaps and promote equity. They include a recommendation to double the number of inpatient beds at the neurosciences centre at Royal Victoria Hospital. That will ensure that all patients have access to inpatient neurological care when they need it, regardless of where they live.”
“That will be achieved through extended roles, such as advanced nurse practitioners, advanced practice allied health professions and GPs with enhanced roles. All that will ensure that people are seen by the right person in line with their needs. Growth in the workforce will not only better align demand and capacity but, crucially, support new ways of working, which will make the system more responsive. <BR /> <BR />It is clear from the personal accounts that I have listened to and those shared in the course of the review that, for many people, timely access to services is key. That is the focus of the third priority in the report: "Addressing gaps in current services". In order to better understand the extent of the challenges, a gaps and constraints assessment of current services was undertaken as part of the review.”
“The report identifies that we are operating with only 60% of the recommended consultant and nursing capacity; 50% of the recommended allied health professions capacity; and only 20% of the recommended psychology capacity. Those shortages have a direct impact on the delivery of timely diagnosis, treatment, care and support. <BR /> <BR />In that context, the report recommends substantial growth and development across the spectrum of the neurology workforce. That includes an additional 20 neurology consultants; 41 neurology nurses, including 12 advanced nurse practitioners; 38 allied health professionals and 22 psychologists. In addition to an increase in numbers, the report recommends the development of a broader skill mix.”
“<BR /> <BR />The "House of Care" model set out in the report crucially recognises that people with neurological conditions are experts in their own health. By also ensuring that people have access to the right information and have a designated point of contact, we can ensure that the voices of patients are at the centre of neurology. <BR /> <BR />The neurology workforce is the focus of the report's second priority, and there is no doubt that our workforce is made up of passionate and dedicated individuals who do their very best every day to deliver care and support to everybody with a neurological condition. However, it is clear from the report's comprehensive analysis that there are significant shortfalls in the current workforce.”
“<BR /> <BR />The first priority identified in the report is the need to ensure that neurology services are person-centred. The voices of people with neurological conditions and their carers have been central to the review, and that has been achieved by working closely with the Northern Ireland Neurological Charities Alliance and through direct engagement with people with neurological conditions. <BR /> <BR />As Members have noted, I recently attended and spoke at an event organised by the Neurological Charities Alliance, which focused on the experience of people with neurological conditions. I had the opportunity to hear first-hand the devastating impact on the physical and psychological well-being of people while they wait for a diagnosis, treatment and support. That has to change. We can and must do better.”
“Principal Deputy Speaker, thank you very much for your indulgence: I begin by adding to the good wishes to Mr William Irwin as he steps away from the Chamber. <BR /> <BR />From listening to the contributions, there can be no doubt how serious neurology and the issues surrounding it are. As Members are aware, my Department published a final report of the regional review on 7 May this year, and, in the context of ongoing challenges in the service, the review team was tasked with identifying the optimum configuration for neurology for the next 10 to 15 years. The review report sets out an ambitious vision for future services and is underpinned by priorities for improvement and associated recommendations. The focus of my comments this afternoon will be on how those priorities and recommendations address the issues that have been raised today.”
“I thank the Committee for its comprehensive inquiry report. I thank Members for the dignity and empathy with which the debate has been conducted. I will have to take time to carefully consider the Committee's findings and recommendations, and I will respond when I have done so. I guarantee that I will not leave the report on a shelf. <BR /> <BR />Finally, I mentioned visiting the Children's Hospice. My first visit was a real surprise to me, because I discovered something that I did not expect to discover, and I saw it in the children, the parents and the staff. It was joy, and, to me, that is a motivation to do better in this area. Once again, I thank the Committee for putting it on my radar and giving me a focus.”
“I want to create, in the next three to five years, what I believe can be a world-leading health and social care system. To do so, I need the support of my Executive colleagues, I need the support of the Chamber and I need a multi-year budget that prioritises the health of the people of Northern Ireland. You have got to give me the capability to deliver.”
“<BR /> <BR />I am determined to drive forward the reform that we need for the medium-to-long term.”
“<BR /> <BR />In looking to the future, the Finance Minister has indicated his intention to bring forward recommendations to the Executive for a multi-year Budget, as Members will be aware. I very much support and welcome that drive. A multi-year settlement would allow my Department to plan for the next three years, enabling us to prioritise spending, investment and workforce planning much more effectively. However, we will still be constrained by the funding allocation that we receive. While it will not be possible to provide a definitive assessment of our future funding position until that final budget settlement for future years has been reached, it is likely that we will not have all of the resources to do everything that we want to do or, indeed, everything that needs to be done.”
“That is a basic tenet of how, as a society, we value and care for people when they are often at their most vulnerable. <BR /> <BR />I am aware of calls for new palliative and end-of-life care strategies. In a recent meeting with hospice representatives, my Department indicated that it would support a new palliative care strategy to replace Living Matters, Dying Matters. However, it is important to recognise, as reflected in the report, the wide-ranging aspects of palliative care that are not restricted to Health. In the context of increasing demand for palliative and end-of-life care, the Committee's report can provide a road map that will inform a strategic direction now and into the future.”