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 regret the fact that it is such a long wait, but I hope that the Member will understand the logic of what we did in bringing in a regional service.”
“I absolutely am. It is something that he is addressing. It is not a question of saying to somebody, "You've done really well", but to somebody else, "You haven't done quite as well" or "You're not doing what you should be doing". I spoke to Mark at some length before he went out on the ground, in post. The fact that he is a clinician and a surgeon is extremely useful in allowing him to engage with clinicians and surgeons across Northern Ireland. There is mutual respect. He is not saying, "Somebody's doing your procedure 10 times a day in another hospital, but you're only doing six. You've got to do 10". It is more a case of Mark saying, "This is the variance. Let me understand why there is a variance, and let me see how I can help you get up to the best that we can achieve".”
“I am absolutely delighted to know that I have the right people in the right places looking at the issue.”
“I thank the Member for his question. As the Member will know, Professor Mark Taylor has become the first elective care lead in the history of healthcare in Northern Ireland. He is looking at waiting list initiatives, particularly, but, within that, we want to try to address some of the issues regarding clinical variation. Delivering consistent clinical outcomes across Northern Ireland is complex. My ambition is to get to a point where we deliver standardised regional services, whatever the service has to be. The action is also being led by the Chief Medical Officer (CMO), Professor Sir Michael McBride, so we have two really experienced people looking at this area. If we can start to make solid improvements, that will deliver better outcomes and address the idea of postcode lotteries and variance in clinical delivery.”
“We have done that to the best of our ability, and I believe that all the key stakeholders are now relatively satisfied. They are not absolutely delighted: who would be? You cannot expect everybody to be delighted with a strategy. However, I believe that we have got to a place where we can have confidence that we are doing the right thing by the people whom we are trying to serve: the patients and service users for whom we are trying to deliver better outcomes.”
“I will respond to the Member in a couple of ways. There is no point in having what, we think, is a solid strategy if it does not have buy-in from stakeholders. As well as the need for buy-in, we have to be sure that, if we are going to have a strategy, we will be able to follow it up not just with an implementation plan but with one that is fully costed and deliverable. <BR /> <BR />The Member will know that I pointed to the cancer strategy, rather than the cancer research strategy, and the mental health strategy as two gold-plated 10-year strategies that we cannot afford to implement in full. The feedback that we got some months ago was that some key stakeholders were not buying into the document as it was written up then, so it was important that we stepped back, re-engaged with them, listened to them and reacted positively.”
“He knows my view: we came out of Europe without thinking through the consequences, and, sadly, some of the consequences impact on health and social care delivery.”
“I can be specific only about the clinical trials regarding that ball that goes down on a string for Barrett's oesophagus. The MHRA is now saying that the EU regulations do not apply, so we can go ahead. We cannot start it immediately, because we must make sure that we have the right governance arrangements in place in the Belfast Trust. I would like to think that they will now proceed at pace, because we should all be slightly embarrassed, although it was not our fault but that of the MHRA across the water. At that, it was a one-year delay that was unnecessary. Let us show the public that we will make up lost ground on that. <BR /> <BR />On the application of other EU regulations for developments in health and social care, I can give the Member no assurance.”
“I happen to think that we are missing a bit of a trick by not becoming global leaders or, certainly, UK-wide leaders in the field.”
“<BR /> <BR />At the Patrick Johnston facility on the Queen's site in Belfast City Hospital, I have seen in action the ball that goes down the throat to look for Barrett's oesophagus. It is magnificent. It is so quick, it is cost-effective and it delivers better outcomes, so it is a matter of regret that we have had that one-year delay. <BR /> <BR />On how we tap into the rest of the UK, I was at the launch recently at the Ulster Hospital of the Northern Ireland commercial research delivery centre. That is a clinical trial centre. It is brand new, and it will link us in to a UK network. That is really good news, because we have clinicians who are incredibly passionate about clinical trials and Northern Ireland is of a size that is almost perfect for clinical trials. When we do them, we do them really well.”
“To be fair to the Belfast Trust, the Department of Health and our arm's-length bodies (ALBs) rely, on such occasions, on the advice of a UK-wide body, which is the Medicines and Healthcare products Regulatory Agency (MHRA). It originally gave an opinion that we had to conform to specific EU regulations — the EU in vitro diagnostic regulatory conditions — and that therefore we could not proceed with the trial. It now appears that MHRA has reviewed its analysis, and we are good to go as long as we have the right governance structures locally through the Belfast Trust. That was unfortunate, because it has led to a delay, but I do not think that it has led to any patient safety concerns.”
“However, I recognise that many clinical trials open only in a small number of sites around the UK and seek to recruit only a limited number of patients who have very specific characteristics. Therefore, not all trials will open in Northern Ireland or, indeed, in any other part of the United Kingdom.”
“The Department of Health facilitates access for patients to clinical trials through the work of the Health and Social Care (HSC) research and development division in the Public Health Agency (PHA). The division oversees participation in UK-wide clinical governance and trial approval processes. In addition, it funds core research infrastructure, which, in turn, supports access to clinical trials. That includes the Northern Ireland Clinical Research Network, a cancer trials network, a clinical trials unit, a clinical research facility and research offices in each of the trusts. Approximately 80% of clinical trials taking place in Northern Ireland also have research sites in other UK nations.”
“I am afraid that I will not dream up policy on the hoof. However, I certainly accept the logic of what the Member seeks to address. I hope that she knows that I am looking for standardised regional services that take a holistic approach and that we want to end the silos, whether it is over diagnoses, procedures or postcode lotteries. All those things need to be addressed so that we smooth things out and people know that, if they have to wait, it is not a longer wait than that of anybody else and, if there are difficulties that need to be overcome, they are not bigger difficulties because they have autism compared with some other condition.”
“I thank the Member for the question. I was not particularly aware of direct payments when I took up post 18 months ago, but, very quickly, I was made aware that it is a pretty complicated process. It puts a huge onus on those who are receiving direct payments, because, effectively, they become employers. That is maybe the last thing that they want to do when they feel vulnerable. Therefore, I have asked for a review and am actively chasing that up. Members will know my view: the public sector — I include the Department of Health — is not necessarily built for speed on such issues, and, yet, if you are looking for help, speed is, of course, of the essence.”
“I thank the Member. I am not particularly keen on committing to timelines, because, as the Member may be aware, there have been a number of initiatives, such as the cancer research strategy, where we have said that we had put a timeline on it but then have not delivered on it, so I do not want to continue to raise expectations. However, in this case, particularly with adults — the Member mentioned adults — I meet parents of children with learning disabilities and parents of children with autism or ADHD, and one of the common themes that keep them up at night, as the Member will know, is, "Will they be OK after I am gone?", so it is a matter of urgency.”
“In relation to transitions, the model sets out a framework to support people transitioning into day services, carers support, independent living, healthcare and specialist mental health services. In addition, a transitions protocol has been developed to standardise the planning process across the trusts. In the draft children’s emotional health and well-being framework, transitions are a key area of focus. I want to ensure that young people with a range of neurodevelopmental needs, including autism, are supported and prepared as they navigate the shift from child to adulthood. A public consultation for that framework closed on 26 September 2025, and responses are currently being collated and analysed. Transitions are a long-standing challenge, not just in the Department of Health.”
“We are progressing a number of pieces of work to improve transitions for autistic children as they move into adult services, particularly a new learning disability service model that is currently out for consultation. It is fully applicable for autistic adults with a co-occurring diagnosis of learning disability.”
“I am sorry to say to the Member that nurses and other hospital staff are well accustomed to looking after more patients than they are supposed to look after. It has happened previously: it happened last winter, and it does not just happen in the wintertime. They manage. I am very grateful to them for managing, but I wish that it was different.”
“The answer is that it will not happen. If they are not paid what they are due, I expect them to continue to ballot for industrial action. I expect them to take strike action. As I have told the House before, the Royal College of Nursing has made it clear that, this time, there will be no derogations. The Chief Nursing Officer has told me, effectively, that she is not sure how we could possibly manage that. That is why, as we sit here, I have officials working on a small number of options to restore pay parity. It is my ambition that health and social care workers will get their payment and that the only disadvantage that they will face this year will be a delay in that payment.”
“I very much regret the experience of Mrs O'Neill. I cannot say anything that will satisfy the Member.”
“I am very sorry to hear that. It is probably not a unique experience in our type 1 emergency departments. I simply say this to the Member: if we were to go across the water, we would see the same. When I was in Washington in March, I visited MedStar Georgetown University Hospital. I believe that it was built in 1947, but an extension has just been added, at a cost of over $800 million. The emergency department is comparatively massive, but every corridor had trolleys with patients on them. We are not outliers; we are struggling, just as many health services are struggling. I am doing whatever I can to try to get to a position in which no patient walks out because they have had enough of waiting.”
“It works financially as well; it is cost efficient. It is a good thing. I accept that it is maybe just the start of something, but at least it is a start.”
“I am not making such a claim. I expect that the additional winter pressures will result in people's waiting for far too long in emergency departments to be seen. I do not think that we will eradicate the idea of corridor care this winter. I do not think that we will do away with the fact that, if you were to walk into an emergency department, you would meet people who have been in a chair of some description for 12 hours, 24 hours or, maybe, even longer. <BR /> <BR />The Member can certainly say that it is only 10 beds and is only the introduction of Hospital at Home, but I welcome it, because it is a start. It is something that we are going to build on. I have seen Hospital at Home in operation and have spoken to patients who get it. They much prefer it to spending time in an acute bed or elsewhere in an acute hospital.”
“I have visited the emergency department at Altnagelvin, and I recognise absolutely the need for a new-build ED in Derry. It is the oldest of the type-1 EDs, and it looks it. However, some of the performance statistics that I looked at this morning suggest that its performance is not the worst of all the type-1 EDs. That is a testament to the staff and the workforce who operate that ED because they are operating in far-from-ideal circumstances. <BR /> <BR />On an assurance that the plan will deliver, all I can say to the Member is this: we had four workshops at which we brought in representatives from every nook and cranny of the health and social care system. I am not about to say that they do not know what they were talking about, or that they do not know how to do things better. That is the foundation of the plan.”
“It is a system-wide challenge, and I have tasked my Department with leading the coordinated action that is required to deliver those improvements. That will have a profound effect on outcomes and on patient satisfaction because the longer that they wait in ED, the more frustrated that they get and, indeed, the more likely it is that a less-than-ideal outcome will be delivered.”
“Obviously, ambulance handover times have to be a key focus because the ambulance handover is, basically, the start of the flow through the hospital setting. We have to get the whole thing working in tandem. The trusts and NIAS had a visit to a hospital in London to learn from its approach to releasing ambulances more quickly and, because of that, were asked to adopt a similar model. To support that, £12 million has been allocated to trusts to implement targeted interventions by the end of the month, and this is the twentieth of the month. Our immediate goal is to eliminate ambulance delays of over two hours by 1 December. All trusts signed up to that goal at the workshops, and once that milestone is achieved we will move towards a much more ambitious 15-minute handover target.”
“Funding of £2·5 million has been made available to support GP practices to increase their capacity to meet the anticipated increase in demand this winter. We anticipate the delivery of around 10,000 medical care plans for patients in nursing and residential care homes, and over 8,000 additional sessions to help manage winter pressures in general practice. We have also engaged on the development of the Northern Ireland local enhanced service to manage winter pressures for 2025-26. The £2·5 million is, I understand, fresh additional money.”
“I agree with the Member. I went out and met some social workers — I think that it was in Altnagelvin — who made the point to me that the regime and the criteria for direct payments are overcomplicated. That is one of the many areas in which we have overcomplicated the delivery of health and social care. I have asked for a review to see whether we can do it more effectively and in a more patient- and service-user-centred way. Some of the examples that I was given involved unfavourable comparisons with how things are managed in the Republic of Ireland. If there are lessons to be learned from the South, they will be learned.”
“Those actions are all things that we have learnt and that came out of the four seminars that made up the big discussion.”
“We need a pathway for that, because it is particularly important — I have just been upstairs, hearing about osteoporosis — to reduce deconditioning, but we also want to avoid unnecessary conveyance following falls. <BR /> <BR />Action plan 6 is on advance care planning, and number 7 is a specific one:”
“which is about learning from past experience. <BR /> <BR />Number 5 is:”
“will be informed by the Committee's report on palliative care. <BR /> <BR />Number 4 is:”
“That is probably about boxing smarter rather than introducing additionality. <BR /> <BR />Number 3:”
“The Member is quite right: we need to learn year-on-year. The lessons have been trapped in the seven actions that have been identified. Action plan 1 is:”
“There are some fundamental issues that I do not yet understand about low uptake, particularly among the HSC workforce.”
“I agree with the Member. Where a vaccine is available, I encourage everybody to avail themselves of it. I have looked at some of the uptake percentages. Overall, they have dropped year-on-year over the past three years, and they are particularly low amongst the workforce. I have asked for a piece of work to try to understand the reasons for that. It would be easy to say that it is about vaccination hesitancy, and, if I had to make an informed guess, I would have put that at number one, but I suspect that, when we have bottomed it out, that will not turn out to be the case. However, if it is about accessibility, for example, care homes get vaccination offers at their front door, so, for staff, particularly those who are on duty on the day, it could hardly be easier.”
“I say two things in response to the Member. All trusts review domiciliary care packages frequently to ensure maximum efficiency. Sometimes, somebody who has a domiciliary or home care package needs it to be enhanced because their condition has deteriorated, but, at other times, it is possible to claw back and redistribute some hours. That is the first thing. Secondly, as the Member will be aware, the Northern Health and Social Care Trust has not, to date, had a Hospital at Home service. A total of £845,000 is being made available to the trust to establish such a service, which will help.”
“I accept that the flow through a hospital is determined largely by the lack of community capacity in domiciliary care packages and care home beds. I absolutely accept that and have never questioned it. You cannot magic up that level of resource in a single month or year. It therefore remains a problem, but I assure the Member that it remains a focus for me. The four workshops that I talked about — the big discussions — were very focused on practical steps that could be taken this winter, into 2026, and in preparation for winter 2027. The Member rightly identified things that are missing, but it would be wrong to put them in the plan and raise expectations that they can be dealt with within the existing workforce and resources.”
“I have asked officials to urgently work up options, and I hope to meet the Royal College of Nursing, the trade unions and the other professional bodies perhaps as early as tomorrow but, certainly, as soon as possible. I intend to say to them, "This is the situation. Here are one, two or three options". I want to do the one that suits them the best, because I want to demonstrate to them how much I value their presence. As I often say, you need buildings, beds, equipment and medicine, but, unless you have the workforce with you, all the rest is as nothing.”
“The Member will be aware that we follow advice on vaccinations from the Joint Committee on Vaccination and Immunisation (JCVI), and we stick with its advice. It has changed a bit on the availability of the COVID-19 vaccination in particular. <BR /> <BR />I am disappointed that I have not been able to action the real living wage as yet, but that is a function of the £600 million pressure on the Health Department's budget. On pay, the Member will be aware that the Executive are releasing £100 million, which is approximately 50% of what I need to fulfil the two pay recommendations for Agenda for Change staff and for doctors and dentists. I need to find £100 million.”
“The point is that, back in January, as the Member may recall, in reacting to last winter's additional pressures, I said that I wanted all the stakeholders in the room with a blank page. I asked the Chief Nursing Officer and the Chief Medical Officer to lead a series of events. It was not just a one-off; it was a series of four big discussion meetings about the whole system flow. Each meeting was oversubscribed, so I am confident that every section of Health and Social Care was consulted about the plan.”
“<BR /> <BR />I reiterate that the publication of the plan was not the starting point. Planning for this winter started many months ago. In many areas, the actions in the plan have already been implemented. I point to some of the recent progress made on ambulance turnaround times as an illustration of that. To navigate the upcoming winter period successfully, it is vital that we all play our part in making sure that HSC services are ready and available for those who need them the most.”
“The measures include tackling ambulance handover delays through a new approach to collaborative working between the trusts and the Northern Ireland Ambulance Service (NIAS); vaccination programmes against diseases such as influenza, COVID-19, shingles and respiratory syncytial virus (RSV); Community Pharmacy initiatives such as the Living Well and "Stay well this winter" campaigns; the provision of Pharmacy First services across community pharmacies, including the sore throat service, which offers advice, clinical assessment and treatment of sore throats without the patient having to wait for an appointment with a GP; additional assistance for GP practices, with the provision of 10,000 medical care plans for patients in nursing and residential care homes and over 8,000 additional sessions to help manage winter pressures; improving mental health and learning disability bed pressures to reduce demand on EDs by ensuring that the right care is available in the right place; supporting social care delivery in the community and improving system flow from hospitals; and avoiding ED attendance and admission for end-of-life care for those who have a preference to be at home.”
“I published the overarching winter preparedness plan on Thursday 16 October. It had been my intention to publish it at the Northern Ireland Confederation for Health and Social Care (NICON) conference on the Wednesday, but I took a decision to delay by one day, because I wanted to allow for further consideration of the publication of the individual trust plans, trusts being the operational leads on emergency departments (EDs) and hospital flow. <BR /> <BR />The plan published last week includes a series of measures to help mitigate the additional pressures experienced across Health and Social Care (HSC) in the winter months. I stress the additionality, because those pressures are now experienced 365.”
“It is the Passover, literally, to say, "Pass me by, please: I am OK". That is no way to run a health service. <BR /> <BR />I will finish where I began. I look forward to working with Mr Gildernew and to visiting Woodlawn and speaking to the appropriate people.”
“I say to Mr Tennyson that we have yet to bottom out the potential impact of that, but, clearly, it gives me huge concern about the retention of international colleagues but also about their recruitment. We have recruited a lot of doctors from India to the Southern Trust in particular; I met a lot of them at Daisy Hill Hospital, and there are some who work at Craigavon Area Hospital, and they are really good people. If you are sitting in India or somewhere else, and you are asked by a recruitment campaign whether you would like to come to Northern Ireland, you will go on your social media or use your search engine and see that it is not a very attractive proposition. To have to put a sign in your doorway or front window that says, "I am a Filipino", or, "I am working for Health and Social Care", is truly biblical.”
“Families were engaged in the process and will continue to be engaged. The trust has commissioned additional beds in other units. Those will not be suitable for all families, but they have been offered to and accepted by some. Lastly, where possible, self-directed support has been used to provide alternative support to families in lieu of short breaks. I assure Members that my Department will continue to monitor and request regular updates from the trust on progress towards restoring full service delivery at pace, but that has to happen with a safe and appropriate level of staffing. <BR /> <BR />In my remaining time, I will turn to the impact of societal unrest on our international colleagues.”
“Band 2 trainee posts are also being introduced to recruit individuals who are keen to work in the care sector. It is envisaged that they will progress to become band 3 nursing assistants or healthcare assistants in due course. <BR /> <BR />Additional processes have been put in place to promote the safety of the people who are supported and of the staff. Enhanced governance structures, senior management visibility and staff engagement have been put in place to better understand the staffing issues and to inform changes to the services and to future recruitment. Weekly allocation meetings are in place to ensure that provision is prioritised on a clinical and social basis. That is not a desirable position, but it is needed to ensure that people can access a short break where that need cannot be met elsewhere.”
“<BR /> <BR />Since that point, the trust has undertaken several exercises to address the staff deficit, restore provision and, where possible, find alternative placements across other residential and nursing units. Officials have received an update from the trust on the current position and the work ahead to fully remobilise the service. Three additional band 5 nurses have been recruited, and they took up their posts this month. That is good news. The trust also used bank and agency staff. However, regulations and standards are clear that the service needs to be delivered by substantive staff to ensure continuity of care and reflect the complex medical needs that Woodlawn supports. The trust has plans for further band 3 recruitment, and an open day will be held in Woodlawn on 16 October, which is this Thursday.”