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 understand that you have been hearing about it and hearing about it. A few days ago, I was in Coleraine to officially open an MRI scanner in the Causeway Hospital, so sometimes things that have been talked about and talked about actually happen. That is great and people will not now have to travel from Coleraine to Antrim to get their MRI scans. <BR /> <BR />Capital projects of that scale and complexity require extensive planning, detailed design work and multiple layers of approval before implementation can begin. All I can say to you is that I will try to deliver it for you as soon as I can.”
“In December 2024, I published a three-year plan that recognised that diagnostic capacity was a fundamental enabler of the three pillars of HSC, namely stabilisation, transformation and delivery.”
“Mr Nesbitt: The South Eastern Trust remains fully committed to the installation of a new MRI scanner at Downe Hospital. That continues to be regarded as a capital priority for the organisation. A scanner would significantly improve diagnostic capacity and ensure timely access to high-quality imaging services for patients in that area. In preparation, the trust has commenced work on a detailed business case that includes initial design work to enable rapid progress once funding is confirmed. <BR /> <BR />I am committed to progressing work across imaging services as soon as is possible in the current financial climate. I would like an imaging academy.”
“I thank the Member for her question. The majority of the recommendations in the Ray Jones report have been or are being implemented. Some are cross-cutting, not least his proposal for an arm's-length body. I think that the report's preference was to include the Department of Education. That is not going to happen, certainly not in the foreseeable future, so the Minister of Justice and I are pressing ahead. I cannot make specific promises or commitments to increase capacity at this stage because I do not yet know what my budget for next year is going to be. I have outlined the top two priorities. Once we know what the budget will be and what we need to commit to those top two priorities, we will look at everything else. I hope that the Member recognises that it is the only sensible way to proceed.”
“That was the first time that the issue was put firmly on my radar, so step 1 was to have the meeting and listen to the lived experiences. I just outlined that step 2 is to ask officials to take a look and come to me with options. Once I have those, that would be the appropriate time to reach out to the Minister of Justice, because this is very much in that Minister's bailiwick. Ministers and Departments work collaboratively all the time, which is the right thing to do. As I often say, there is very little that one Minister can achieve that the Assembly and Executive want to achieve, so I will be reaching out the Justice Minister once I have the options paper from my officials.”
“Once I get that advice, I will think about how best to improve the reports to family courts — I believe now that they do need to be improved — and how the experiences of the sorts of people whom I met along with the Member and the involvement of court guardians in such court proceedings can also be improved. I will stop short of saying that it will happen by such-and-such a month, but it is on the radar, and I will not let it drop off.”
“I hope that the Member is aware from recent comments that I have made in the Chamber that I am reluctant to start providing timelines, because it seems to me that we are not world leaders in this Department in matching up to the timelines that we set. It was very useful to me to meet those individuals with the lived experiences of private law proceedings and to hear about their engagements with social workers and court guardians. Some of it was not easy to listen to, but it is a lot easier to listen to it than to experience and go through it. Therefore, I have asked officials to provide me with advice, and I have asked for some options on how we can deal with those concerns.”
“However, I have recently received correspondence from and met individuals who have drawn to my attention issues and concerns that are related to their reported experience of engagements with social workers and court guardians who provide reports to the family court system to assist the judiciary with their deliberations. The Member is aware of that, because she was in the room, and we have action points arising.”
“Thank you, Mr Speaker. An independent review of children's social care services was completed by Professor Ray Jones in June 2023, and it included commentary on family courts and social workers' engagements with those courts. Work is being undertaken to address the issues that were identified in the independent review and to respond to the recommendations that Ray Jones made. The management and determination of individual cases that are brought before the family court system is primarily a matter for the judiciary, because, of course, it is completely independent of government.”
“After the pay, comes the transformation, because you can spend money on waiting lists — it is right that we are, and we are bringing them down — but, if that is all that you do, once the money is spent, the lists go back up again. So, we have to do the transformation in tandem with tackling the lists.”
“I believe that, if I do that this year and, if God spares me, I do it this time next year, I will have set a precedent that no future Health Minister will feel other than compelled to follow into future years.”
“First, I did not see or hear the Finance Minister on the BBC at the weekend, but I am very grateful for his comments on the savings that my Department has managed to achieve. As I have said before, they are unprecedented. I very much look forward to having a multi-year Budget not just because it would provide a degree of certainty, as the Member will be aware, but because that certainty could be used to be transformative in its own right. That is where my focus is at the moment. For clarity, once we know what our budget is for next year, the first action will be to ring-fence for pay, because I do not want what happened this year, last year and in previous years to ever, ever happen again.”
“We have elective overnight-stay centres, and the stats are there for them, and we have day procedure centres in places such as Lagan Valley Hospital, for which , once again, the stats are there. I do not want to be judged on my saying, "We have introduced rapid diagnostic centres, so that is a tick in a box". Rather, it is a question of my saying, "We have introduced rapid diagnostic centres, and the outcomes have been x, y and z". Those outcomes are there to be assessed.”
“I presume that the Member is talking about tangible measures that show how transformation works. We already do that. We have done quite a bit of transformation in primary care. Multidisciplinary teams (MDTs) are being rolled out, and I am very grateful to the Executive and the public-sector transformation board for the £61 million received, which will enable phase 2 to happen over the next four years. There are measures in there, based on the number of people who have accessed MDTs. <BR /> <BR />We have introduced rapid diagnostic centres for vague symptoms of cancer at Whiteabbey Hospital and at the South Tyrone Hospital in Dungannon. Again, the statistics come through for the number of patients who go through those processes.”
“<BR /> <BR />I know that the process has been slow, and I could, I guess, share the Member's frustration, but it is really important that we bring people with us. I suggest to the Member that she will see real movement in the calendar year 2026.”
“We have been taking a degree of time to think about that concept, and we have been right to do so, because it is, as I have said often in the House, a very radical proposal in its own right. I am as guilty as anybody of wishing that my local health and social care facility could provide every service and procedure that I might wish to avail myself of as a patient or service user. That is simply not going to be possible, however. We cannot have an acute hospital at the end of every street. I say once again that it is about convincing the public of the concept that, if they need a procedure, even if their local facility can do it, there may be somewhere else some distance away that has become a specialist facility for that procedure, meaning that it is absolutely in their best interests to travel for it.”
“That is a two-part question. The second part is certainly the part that I would have asked about if I were her but not the part that I would answer if I were me, and I am me.”
“<BR /> <BR />The plans will prioritise a preventative approach to care and support, and the aim will be to improve individual well-being, thus reducing the need for formal care, but also to utilise community assets in order to achieve a more person-centred, sustainable social care system. The hope is that that will be a much more satisfying way of doing business for the workforce.”
“To make the profession more attractive, we need to pay people the right salary. Again, I regret that I am not in a position to move as quickly to paying the real living wage as I wanted to. It is, however, also about the conditions in which people are working and the respect that we show them, as well as about the idea that there is career progression for those who want it. My Department is in the process of finalising a 10-year strategic plan and an associated three-year delivery plan, drawing heavily on the recommendations in the 'Power to People' report, which was published back in 2017, and the subsequent consultation on the reform of adult social care, which took place in January 2022.”
“<BR /> <BR />The reset plan commits to improving information sharing, aligning care pathways and strengthening local partnerships so that people experience a seamless service.”
“I thank the Member for his question. I want to put an emphasis on community-based social care, which has to be a core pillar of the neighbourhood model. That will ensure that people can live independently in their own homes for as long as possible. To do that, we have to tailor support to their needs. Social care teams will work with GPs, mental health services and the voluntary and community sector to enable care partnerships to be built and reduce avoidable admissions to hospitals and the need for longer-term care. <BR /> <BR />My Department is taking a range of steps to ensure that social care has the capacity that it needs. The neighbourhood model will directly support social care by embedding it within local multidisciplinary teams and through shared planning and better coordination between the health and social care professions.”
“<BR /> <BR />Prevention strategies, such as Live Better, will enable people to take charge of their own well-being, and we are exploring a new initiative, which we are calling "This is our health". In that, we want to create a public dialogue to encourage and empower the public to work with us as partners in managing their own health. <BR /> <BR />By March of next year, we will have developed a neighbourhood model for primary, community and social care. We hope to start that on 1 April, but I emphasise that it will be a five- to 10-year plan.”
“The reset plan that was published on 9 July is very clear. Transformation cannot simply be expanding hospital capacity; it has to mean changing how we deliver care, keeping people well for longer and supporting them in their own communities. In other words, getting health and social care services as close to people's front doors as possible. <BR /> <BR />Prevention and community care are at the heart of the reset plan. Two of the seven strategic priorities are prevention and seeing the citizen as an asset; and investing in primary, community and social care. We are taking a whole-system approach, by which I mean that we are working with the housing, education and voluntary sectors to tackle wider health determinants, not just the symptoms that appear in hospitals.”
“The key objective is to focus on how to standardise and streamline data reporting across the region because that is the way to shape service improvements and assist with future commissioning. Within that context, a priority will be assigned to reporting on the waiting times that people are having to endure before they are seen.”
“The current national target rate for the diagnosis of dementia is 66·7%. Northern Ireland currently has a rate of 62%, so we reckon that there are about 25,000 people living with dementia in Northern Ireland. In 2024, it was reported by the Northern Ireland Statistics and Research Agency (NISRA) that 13,900 people had a diagnosis. <BR /> <BR />The regional ministerial target for memory services is that individuals should have access to the service within nine weeks of their referral. That does not include the waiting time for diagnosis. The regional dementia Encompass group is validating the data for that ministerial target under the systems management oversight group.”
“I thank the Member for her question. There is huge concern, not least in the House, about winter preparedness and the additional winter demands on Health and Social Care. My primary concern, and where I have asked for focus, is on when people with dementia present at emergency departments. As the Member will be aware, emergency departments are very bright and they can be very noisy, so they can be very disconcerting for somebody who is suffering that sort of mental, rapid condition. As I said, it comes on very rapidly, and that is not an ideal environment for them. I assure the Member that the workforce is very aware of those issues and will find whatever workaround it possibly can to deal with them.”
“I thank the Member. The regional dementia care pathway sets out a vision for high-quality dementia services in a standardised, regionalised manner, emphasising early diagnosis. Through the development and introduction of resources, including easy-read guides and the Apps4Dementia library for self-care and daily living support, we have also sought to augment and support the guidance on offer to people with dementia and their families. <BR /> <BR />The introduction of Encompass, which, as the Member knows, is live in all five geographic trusts as of 8 May 2025, means that our ability to trap data that will allow for population-level health interventions is unprecedented. I very much look forward to tapping into that resource for the benefit of that cohort.”
“<BR /> <BR />Furthermore, my officials advise that active recruitment is being undertaken by the trusts that face particular challenges, especially vacant posts in old age psychiatry, that contribute to a capacity gap between the number of people on the waiting lists and the number who can be seen at clinics.”
“I agree that there is great benefit to early diagnosis of dementia. My Department has been leading on work that aims to reduce the waiting lists. We have identified a number of system-wide measures that could help to reduce delays. Each trust has sought to improve the position through initiatives such as extra memory clinics and by completing clinical validation exercises to ensure that the current waiting lists are as accurate as possible. <BR /> <BR />In addition, there has been a sharpened focus on the education of advanced practitioners and on their recruitment into memory services in order to develop a multidisciplinary team approach, which, it has been evidenced, aids diagnosis. The Western Trust and the Northern Trust have employed an advanced nurse practitioner in their memory services.”
“The short answer is no: the number of beds is not sufficient to meet demand. I respectfully say to the Member that that is likely to be the case for acute beds across our health and social care trusts. The pressure has been on for a considerable length of time, and it remains on 24/7/365. It gets worse — it gets steeper and deeper — and the demands on the workforce continue to rise. I am concerned about all those things, but there is only so much that we can do because there is a finite budget. It is a very large budget. As Executive members tell me all the time, I have just over 50% of the entire Executive Budget. However, I would prefer to look at those things in terms of objective, assessed need. If we did so, we would say that we need more delirium beds and more members of the workforce who can specialise in that area.”
“I thank the Member for his question. I was aware that age is a factor in the prevalence of delirium: his exact request is one that I am more than happy to take away.”
“I thank the Member for her question. Obviously, that is an area of concern, particularly for the loved ones of people who are suffering from delirium. They might well have a preference for their loved one to be treated in HSC rather than the independent sector. However, I reassure the Member that the Department requires very strict adherence to contractual standards. That includes compliance with the Regulation and Quality Improvement Authority (RQIA). It sets guidelines and has regular audits and monitoring. Patient safety and continuity of care remain absolutely paramount.”
“I thank the Member for the question. Work is always ongoing in trying not only to assess current demand but to predict how that demand is going to go. The answer tends to be that it is going to go up. Delirium is in with a broader area of mental health challenges. As, I am sure that the Member is aware, delirium is a specific disturbance of brain function. It is a state of sudden confusion and change in a person's behaviour and alertness that poses particular risks not only for the patient but, perhaps, for those around them. I assure the Member that it is very much on our list of areas to be mindful of, and that, as we plan for capacity in the future, it is in the mix.”
“I apologise to Mr Frew for the fact that the question was not answered in a timely manner. It is a fact that my Department conducts something like 30% of all communications for all the Departments, so there is a lot of pressure on it, and mistakes may be made. That might explain, but it certainly does not excuse. <BR /> <BR />I have every confidence in the clinicians, specialists and workforce who are conducting the diagnoses of these patients. The shortage of beds is, of course, a concern to me, but that plays into the wider concern about the capacity gap compared with the demand for health and social care (HSC) services.”
“The Northern Trust has six beds at residential level. They are located in the Roddens residential unit, which is a statutory facility. That ensures continuity of care for patients closer to home. The Southern Trust and Western Trust have advised that they have no specific designated ring-fenced delirium beds. However, they manage delirium patients within their bed cohort.”
“Each trust will have its own operating model for how it manages patients with delirium, be that in the hospital, independent sector or intermediate care. That means that trusts may not have specific designated delirium beds, but all will manage delirium patients or other patients with challenging behaviours. The Belfast, South Eastern and Northern trusts have confirmed that they have specific delirium beds. The Belfast Trust has a contract for 12, all of which are allocated within an independent sector care home. They provide essential support for patients who require specialist care in a non-acute setting. The South Eastern Trust has 10 block-booked delirium beds, which are also situated in an independent sector care home within its area. Those beds are currently fully occupied, which reflects the high demand.”
“I started by agreeing with the Member, but now I fundamentally disagree with him. I need the money. I do not have the money.”
“Again, I will ask the question and revert to him on that. I would just caution one thing, because he mentioned the sale of Holywell. The Member may remember that, some years ago, the Ministry of Defence "gifted" the Executive some former military bases on the basis that we were getting the land for free. Well, we did not get it for free. There was a lot of work, not least decontamination, that needed to be done, so I question whether it is as straightforward as decanting to Birch Hill, selling Holywell and recouping its full value. I do not know. <BR /> <BR />Mr Kearney opened by throwing it to me, so I will finish by throwing it back to him. If he can have influence with the Finance Minister and the Finance Minister can ring-fence the money required for Birch Hill, we will proceed, because I want it built.”
“I thank the Member for the intervention. The short answer is yes. We are looking at repurposing or divesting ourselves of property, as appropriate. That process is under way. <BR /> <BR />Mr Clarke said that he had submitted a question for written answer in September. I have already emailed my private office to say that I would like that expedited. Sometimes, it takes longer than anticipated to get the answers to certain questions, but, when we have reached the point at which we should have responded, we should at least say, "We are sorry that we have not responded, and here is why". That is something that we, as a Department, need to take on board. <BR /> <BR />As to the value of the sale of Holywell, I do not know the answer. Mr Clarke may be more familiar with the price of property in South Antrim.”
“I assure Members that I have looked at the list of 14, and Birch Hill, the mother-and-baby unit and the imaging academy are all at the top of it.”
“It is not possible for me to commit, as Members have asked me to do, to funding for any new capital projects today, because that is dependent on my capital allocation from the Budget process and the identification of sufficient additional recurrent funding to meet any additional resource costs associated with those projects. <BR /> <BR />The trusts and other Department of Health arm's-length bodies (ALBs) have identified capital funding requirements of around £3 billion over the next four years. That is more than £1 billion higher than what I should expect the level of capital funding to become. On that basis, inescapable pressures tend to take priority. As I said, Birch Hill is one of the partially committed projects, but there are 14 such projects.”
“Adopting that proactive model of care will help to reduce the length of stays through maximising clinical efficiency, optimising health outcomes and effective utilisation of resources. In short, it will ensure that a patient's stay on any ward is meaningful and adds value to them and their future. <BR /> <BR />Mr Kearney seeks clarity from me. This is the one area where I diverge a little. You are asking the wrong Minister. If you want clarity, you should ask the Minister of Finance. Following the announcement of the outcome of the UK-wide 2025 spending review, which happened in June, the Department of Finance commissioned a Budget exercise to determine the capital budget for Northern Ireland's Departments for the years 2026-27 to 2029-2030.”
“<BR /> <BR />What I like about it is not just the modern design; it is the fact that the ethos is about a model that allows teams to focus on engaging the patient meaningfully and engaging the family, the key stakeholders, the GP and community mental health teams, which are so important, and communicating expected dates of discharge and ongoing treatment. <BR /> <BR />As part of the service model review and development, the trust has started to engage in accreditation to the Royal College of Psychiatrists quality network standards for each service type to ensure that Birch Hill will have its care and service provision benchmarked against the best in the UK. That will enable the medical staff to deliver care that is high-quality and time-bound.”
“<BR /> <BR />My point is that Holywell is not just falling apart physically — we never really see the benefit of expenditure on repairs because, once we have done one repair, we go on to the next one, as though we are painting the Forth Bridge — but it is out of date. As Mr Clarke said, it used to be called something else; a term for the inpatients that I would not dare to use in 2025. It was built at a time when the societal and governmental attitude to people with mental health or neurodevelopmental issues was, "Get them out of sight, lock them away and forget about them". We would not even dream of doing that today.”
“<BR /> <BR />More important than the physical is the ethos. It has changed so much. It will focus on the ethos of a recovery-orientated approach in keeping with the mental health strategy. The model adopts a more holistic approach, with principles centred on empowering the individual to take as much responsibility as possible for their own well-being. It will be trauma-informed, recognising the individual's life experiences and the consequent impact on them. There is a purposeful inpatient approach. It is a model that will continue to be developed and embedded throughout the existing wards, ensuring that a patient's admission is appropriate, purposeful, therapeutic and safe.”
“I visited Holywell with the fabulous Petra Corr, the Northern Trust's mental health director, who showed me round. As well as visiting the current facility, I saw in Holywell — I am sure that Members are aware of this — two-dimensional designs for Birch Hill, as well as a mock-up of a bedroom. They are absolutely gold-plated. The design, which will put Birch Hill within the confines of Antrim Area Hospital, is magnificent and is so in keeping with the modern way that we are talking about. The proposals for Birch Hill include 134 inpatient beds, 72 acute beds across four wards and a 20-bed inpatient frail or mentally infirm ward. The proposals are even future-proofed: if there is an excess of demand for beds on an ad hoc basis, the second lounge is designed in such a way that it can be turned into a short-term bedroom space.”
“Thank you, Mr Deputy Speaker. Thank you to everybody who contributed, particularly Mr Kearney. The debate reminded me of one that we had in early October when Sinn Féin tabled a motion on the mother-and-baby unit. Believe me: my approach to Birch Hill and the mother-and-baby unit is the same. I want them — I want them tomorrow — but I also want the imaging academy that Mr Dickson referred to in the previous debate, plus a host of other capital projects. We have 14 so-called partially committed capital projects on the books. I cannot commit to any of them at the moment. I will come back to that. <BR /> <BR />Mr Kearney knows that I had no prior sight of his speech. I listened to it intently. I could have delivered just about every word of it myself.”
“We have asked, and we were told that they have no capacity for us. By developing the new haematology ward at the City Hospital, we will have that capacity before the Republic can build it, so let us not keep talking about —”
“I accept that it is a day late, but it is not a dollar shy. It was delayed because, when I was presented with the draft for publication, which would then have been in a timely manner, I was made aware that key stakeholders were not happy. I did not see the point of publishing a strategy that the key stakeholders could not properly buy into, so we have done a lot of work on it. Officials have done a lot of work with the key stakeholders — you will know people such as Mark Lawlor and Cancer Research UK — and I am told that they are now broadly happy and are willing to endorse it. We will publish the cancer research strategic framework on Thursday. <BR /> <BR />I will finish on one other thing. Mr McNulty mentioned CAR T-cell treatment in the Republic of Ireland. That treatment is available in the Republic of Ireland but not to us.”
“That is especially true of rare cancers, such as pancreatic and ovarian cancer, because the symptoms are non-specific, often appearing only in the advanced stages, when the cancer has spread. Early detection is crucial for survival as it increases treatment options and leads to better patient outcomes. The Public Health Agency works closely with the Department, trusts and other partners to support a range of activities to raise awareness of cancer symptoms and routes to earlier diagnosis. I accept, however, that we no longer spend money on paid advertising. The effect of that is certainly questionable, and, at times, I wonder whether it is a false economy. <BR /> <BR />In my remaining time, I will touch on the cancer research strategic framework. Members have said that it is overdue.”