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.”
The complete record
Every one of 5,312 lines we hold for Mike Nesbitt, in date order, each linked to its source. Free to read, in full, without an account. Page 27 of 107.
“That is the exact point that I was trying to hint at in my first answer. I am not sure whether that organisation, the Singapore-based GenderGP, is the same as the one that I had in mind, but, as I was working my head around the puberty blocker ban, I was made aware that there was one prescriber who, I believe, was a native Spaniard but was based in Romania and was prescribing through Singapore. How on earth do you exercise any quality control or safety over that? <BR /> <BR />As with all medications, it is particularly important to take great care when buying medication online. Many websites that sell medicines online are based overseas and are not regulated by the UK authorities. Obtaining prescription medications from unauthorised sources will significantly increase the risk of getting substandard and fake medicines.”
“It was essential to secure the indefinite ban on the supply and sale of puberty blockers to under-18s. That ban was based on expert advice, which very clearly cited the insufficient evidence of the safety and effectiveness of those puberty blockers. I would be concerned by any efforts to bypass that ban by using alternative medical drugs, especially those that are based on very little medical foundation. One of the reasons for my going for a gender service is that, when I spoke to the families of young people who were on or wanted to be on puberty blockers, they told me that, because the service does not exist except in name, we were effectively forcing them to seek out international providers. There is absolutely no safety regime that we can put in place in order to guarantee the safety of those medications.”
“I can certainly make that commitment, yes.”
“That is quite a technical medical request. I am not sure that I am equipped to answer it, so I commit to the Member that I will take it away. Perhaps, in her supplementary, she will be as specific as possible about the information that she seeks.”
“<BR /> <BR />I talked about a phased opening of the maternity hospital. In order to manage expectations. I will clarify that, if there is to be a phased opening, it will be for ambulatory services only.”
“For clarity, I do not think that any review that I have commissioned has caused a day's or even a minute's delay in the process. Even when I said that I wanted an independent assessment of the trust's preferred option, the trust was given permission to go ahead and plan the design phase as if the option were going to be confirmed. It now has been confirmed. The trust has been working on that. <BR /> <BR />Another report, which is looking at the timeline, is not complete. I put a lot of store by that. I am hopeful that that will answer the Member's question about where any finger of blame should be pointed. I asked officials today to ascertain when that report will be complete. As the Member may know, there have been some difficulties with compiling all the information and evidence.”
“I have asked officials to look at a phased opening and to explore whether there are services that could be started in the new hospital before it is fully open. I have not had a definitive answer to that. Certain services have been ruled out, but some are still in play. I discussed that as recently as lunchtime today with the key officials. I remain optimistic that we will see some services rolled out on a phased basis.”
“Some weeks ago, a number of options were put to me for how we fix the water issues at the maternity hospital. I was not content to simply accept the advice that I was given, so I asked the Belfast Health and Social Care Trust to commission an independent review of that advice. That has now completed. The independent reviewer concurred with the option that the trust had come forward with. That is now in the design phase. The trust is commissioning the design for the remediation work, which will include a separate water system for the neonatal unit, where the most vulnerable babies will be, so it is incredibly important that we get that right. That is the chief reason why it will take so long to complete.”
“We have worked with the University of Exeter on that. Given the current financial pressures, we have to take a forward-looking and strategic view of how we deliver those services in the future.”
“I thank the Member for his supplementary question. The hyperacute stroke project board is currently leading on the process to identify the optimal configuration for any future hyperacute stroke services in Northern Ireland.”
“A costed model is being completed that estimates that just over £5 million of recurrent funding is required in order to deliver a 24/7 service. That funding could deliver up to 160 additional procedures every year and increase capacity in other areas, such as stroke and interventional neuroradiology. My officials are developing a strategic outline case to refine the estimate further. It is important to note, however, the current financial challenges that my Department faces. Following the approval of the final Budget for this year, my Department was left with a funding gap of over £600 million. In that context, and although I remain committed to introducing a 24/7 thrombectomy service, I am currently unable to allocate the required additional funding.”
“I can assure the Member that the clinical guidance — CG168 — from the National Institute for Health and Care Excellence, as well as the views of a range of stakeholders, clinical and non-clinical, informed the effective use of resources policy for the treatment of varicose veins. NICE interventional procedures guidance was also considered. Further to the direction outlined in 2022, owing to pressures, a decision was taken in 2023 that assessment and treatment could be provided only to patients with severe varicose veins.”
“In the past 12 months, 2,142 patients have been removed from the vascular varicose vein outpatient waiting list owing to a change of criteria, with 976 patients remaining on it. I recognise the disappointment of the patients who were removed from the waiting list. The fact that many patients had been on it for a number of years, however, is evidence in itself of the pressures and demands on the service. Similar to other services, waiting times for vascular surgery are lengthy and, sadly, growing. In 2022, the Department of Health updated the effective use of resources policy, following a review of the evidence-based commissioning position across a broad range of procedures and treatments. Subsequently, certain procedures are commissioned in Northern Ireland only for patients who meet the criteria.”
“We have increased numbers of specialist nurses. The Member is making a party political point.”
“I want to see an expansion of the number of specialist nurses and advanced nurse practitioners, because that will improve patient care. It will reduce the waiting lists for assessment and treatment. I have visited primary care surgeries at which advanced nurse practitioners are making a magnificently positive impact. <BR /> <BR />Additional funding has been identified through the elective care framework implementation and funding plan to help increase the numbers of specialist nurses, particularly in the areas of cancer and urology. Other specialist nursing areas, including advanced nurse practitioners, will be considered, but that is subject to the consideration and approval of fully costed business cases.”
“Some proposals that have come out of the big discussions that took place this year may not see the fruits returned this winter, but it is important that we look at short-, medium- and long-term actions that can be taken to relieve those additional winter pressures.”
“I share the Member's frustration with the delay in the winter preparedness plan's being published. The fact of the matter is that I saw a draft, and I wanted some work completed on that. I am very optimistic that it will be published this month, that is, October. I am not sure whether I agree with the Member that the delay is having an impact on staff morale. We are way ahead of where we were last year, but are we in the right position? <BR /> <BR />To manage expectations, we are not simply looking at making everything right this winter. That is an overly ambitious position to take.”
“I acknowledge that that is key, and I do so with pay on the agenda, which is clearly the headline in the court of public opinion. Everybody should have a reasonable expectation of career progression during their time, and the evidence very much suggests that that is not the case for band 5 nurses.”
“<BR /> <BR />It means that only patients who need to see an ENT consultant will remain on the waiting list. It is a standardisation of clinical pathways. It is being implemented by the Belfast Trust and the South Eastern Trust but will be rolled out right across Northern Ireland. Therefore, we are doing what we can.”
“I accept that the waiting times for services and treatment are extremely frustrating for patients and their families. I assure the Member that my officials and I have been working to address paediatric waiting lists and to modernise and standardise practices and pathways right across Northern Ireland. <BR /> <BR />The Belfast Trust and the South Eastern Trust have validation exercises under way. Those lists are being amalgamated. As well as validating lists, the exercise involves consultants clinically e-triaging referrals. That is to determine whether the referral requires the patient to see a consultant in outpatients or whether they could go directly to surgery, diagnostics, audiology or to another professional, or, indeed, whether they should be returned to primary care, where they might be managed by primary care with advice.”
“My Department is very aware of the challenges facing the South Eastern Trust in providing ear, nose and throat services. The trust has had difficulty recruiting consultants in recent years, and, in July 2025, there were three vacancies. To address that, my officials have been working closely with the Belfast Trust and the South Eastern Trust to develop a greater Belfast ENT service. <BR /> <BR />I am pleased to advise that that collaboration has recently secured the recruitment of four new consultants. In time, they will provide significant additional capacity in the wider Belfast Trust and South Eastern Trust catchment area.”
“I agree with the Member that it is an incredibly sensitive and, potentially, traumatic moment for families, and they certainly should have a dedicated space where their privacy and dignity are respected. I have visited some of those areas in some of our hospitals. I know that I have responded to questions for written answer on the facilities that are available across Northern Ireland. If the Member knows of specific hospitals or health facilities where that does not happen, I encourage her to write to me, and I can use that. However, I will separately task officials with a full review across Northern Ireland.”
“I am very keen that we explore that area, because there have been developments that could be of great benefit to families who go through such a traumatic time. They involve using imaging and other approaches, rather than a full post-mortem examination. I should stress that the approaches are relatively new and are used in a small number of specialist centres, but I am keen to understand the feasibility of adopting those in Northern Ireland if they can mitigate the need for remains to be transported to Alder Hey. I have asked a task and finish group to consider the feasibility of non-invasive and minimally invasive techniques. I will provide further advice as it emerges.”
“The report contains 21 recommendations that are aimed at improving the service and care, including enhancements to reporting, communication, clinical education and follow-up for parents. I have accepted the 21 recommendations, and those are being actioned.”
“Members will be aware that perinatal and paediatric pathology services are provided through a service-level agreement with Alder Hey Children's Hospital Foundation Trust in Liverpool. That has been the case since January 2019. I accept that it is not the preferred service model, but I assure the House that it is delivering in a timely, sensitive and appropriate manner. <BR /> <BR />My Department commissioned an evaluation of the service that was completed earlier this year by Queen's University Belfast. The work was supported by my Department and the Public Health Agency (PHA), as well as by stakeholder representatives, including Sands and Cruse Bereavement Support.”
“I am unaware of that medication. I will certainly take that question away and ask the Chief Pharmaceutical Officer and other senior colleagues. We will get back to the Member.”
“I say to them that, while the waiting lists are not what they should be, the services are of a very high quality. Some people say to me that Health and Social Care is broken; I do not agree with that. However, I accept that some of the pathways and access into Health and Social Care are very badly damaged. I assure them that autism is on my radar. It is in my family community, if I may put it that way, so it is not as though I am unaware of it or uncommitted to trying to do what we can to tackle the waiting lists, which are quite shocking.”
“I hope that that provides some assurance to the Member that her trust is doing what it can in that area.”
“The Western Trust undertook a waiting list initiative last year. That delivered 20 additional assessments for individuals who were approaching 18 years of age. It plans to use identified non-recurrent investment this year. That should help deliver a further 13 assessments across children and adults. Its autism services for children and young people and adults maintain highly efficient processes for organising clinics and appointments. All assessments follow National Institute for Health and Care Excellence (NICE) criteria, and vacant posts are filled as quickly as possible.”
“My secret is out, obviously. <BR /> <BR />As is the case across other areas, the Western Trust continues to experience significant demand for autism assessments. I am afraid that the latest figures show that just over 3,000 people are awaiting assessment. That includes 2,517 children. The trust currently completes around 420 child and 50 to 60 adult assessments each year. Therefore there is a huge mismatch between demand and capacity, and, of course, the result is growing waiting times, with some people now waiting for over three and a half years for assessment. I fully recognise the impact that delayed diagnosis can have on individuals and on families, and I am committed to trying to reduce those waiting times.”
“One of the other issues is the real living wage. I am keen to secure that for social work. I will make a general point to the Member on bureaucracy. Health and social care can be a complex area to work in, but I am very much of the opinion — I have stated this almost from the get-go — that we have overcomplicated how we deliver health and social care. Therefore, any moves that we could take to remove democracy — bureaucracy, rather, and make it simpler to deliver would be welcome.”
“I am pleased to say that we have. We have been successful in recruiting newly qualified social workers into trust vacancies, particularly in the past three years. My Department continues to work closely with senior managers in the trusts, and we are developing a recruitment process for social workers that is both quick and efficient. It has resulted in almost 700 newly qualified social workers taking up post in trust services since June 2023. That is an unprecedented number. We hope to repeat the mass recruitment of newly qualified workers in the coming years in order to bring some relief to workforce pressures.”
“I am pleased to say that the Department is steadily increasing investment. First, there were 15 additional places at the Open University in 2019, and, in 2021, 10 more were added, bringing the total to 285 per year. Since then, I have secured additional investment to further increase social work training places. In September, we commissioned 163 places at Ulster University, 127 at Queen's and 54 at the Open University. That is a very significant total of 344 — the largest number commissioned to date. That is from a baseline of 260 in 2019.”
“I assure the Member that thought is being given to alternative arrangements in the event that Birch Hill does not go ahead as planned. I was at a meeting in that regard as recently as late this morning. However, I will not go into detail at this stage, because I do not want to raise false expectations.”
“I have been to Holywell Hospital and looked at the plans. There is a mock ward that you can walk around and view. A world-class facility is being planned. Can we afford to fund it? I do not know the answer to that, because we have yet to see the capital budget's release from the Department of Finance. When we do, we will have a better idea, but I have to manage expectations and say to the Member that it is a very costly project. To do it on the timeline that currently exists is doubtful. I anticipate that there could well be a delay of, perhaps, a year, maybe even more, so I want to manage the expectations. However, the current facility is not really fit for purpose; it is way past its use-by date. That is one of the many challenges that we face with our capital build.”
“I thank the Member for his comments. The mental health strategy was published alongside a 10-year funding plan. That plan outlined that, over 10 years, £1·2 billion was needed to implement it in full, so the direct answer to the direct question, "Is it being funded in full?", is "No".”
“I believe that I have given the Member quite a long list of services that are available in that area. The people in the workforce who deliver those services are extremely committed and dedicated. However, as with most if not all of Health and Social Care, demand currently outstrips capacity. I do not see that ending any time soon. The focus also has to be on demand, and the Department will, before the calendar year is out, look at ways in which we ask the public to look at the demands that they are putting on the Health and Social Care service.”
“In the mid-Ulster area, mental health services are provided by the Northern and Southern Trusts, as well as community and voluntary groups. Both trusts provide community mental health teams and teams that look after the mental health of older people. In the Mid-Ulster Hospital site, patients can access crisis resolution or home treatment services, community addiction services, perinatal mental health services, psychological therapy services and, where appropriate, the Regional Trauma Network. A recovery coach with lived experience offers one-to-one sessions, and an opiate substitute treatment clinic operates once a month in Cookstown. The Recovery College and Bereaved by Suicide services are also available locally, while a child and adolescent mental health services (CAMHS) team is based in Magherafelt to care for our younger population.”
“To be clear to Mr Carroll, I am less optimistic than I was a couple of weeks ago, but I still think that the situation will be resolved. Even if it leads to strike action — I pray to God that it does not — at some point, the pay issue will have to be resolved. If we allow it to go to strike action, it will have an impact on service delivery, on waiting lists and on staff morale. The bottom line is that, when it is resolved, it will cost more than it would cost to sort it out today. <BR /> <BR />Why does it happen year-on-year? Despite the fact that there is £8·4 billion in the budget, it is not sufficient, and we need to reform how we deliver health and social care so that we can be more efficient, which will make those pay awards more affordable.”
“I am open to doing that as we move into a multi-year, presumably three-year, Budget. We will certainly run that as an exercise, and we will have to make a best guess at what the pay bodies will recommend, because the Budget will come ahead of next year's pay award recommendations. We will then have to see what services will be included and what impact that will have on health and social care delivery. I am positively minded to what the Member suggests.”
“That is a valid question from the Chair of the Health Committee. I did, indeed, commit to providing the real living wage for social workers from September, so we are through that deadline. Unfortunately, that has become part of the mix in how we address what is a £600 million funding gap for the Department of Health. I understand the real living wage to be a commitment at Executive level, and I have discussed at Executive level whether my colleagues want to prioritise honouring the real living wage commitment or, perhaps, to delay the real living wage for social workers until the start of the next financial year. That would put some £25 million towards that £600 million shortfall.”
“I hope that the Member recognises that I cannot answer that question, because my permanent secretary has made it clear to me that we do not have the funds available, hence the ministerial direction. I have to say that I disagree with the term "dithering". Every Minister and every Department is struggling badly with their budget allocation, and that has an impact on service delivery across the board. However, on the list of our priorities, paying our nurses, doctors and other Health and Social Care (HSC) workers must surely be the number-one priority.”
“As Members are aware, I issued a ministerial direction to implement the pay recommendations for 2025-26. That has been referred to the Executive for consideration and decision. The decision has not yet come. I have raised the issue at several meetings. Two weeks ago, I stood in the Chamber and was quite optimistic. I am not just as convinced today, but let me be clear: if we do not act soon, there will be strike action. I understand that the Royal College of Nursing (RCN) has a key meeting this Thursday that will, I anticipate, rubber-stamp strike action.”
“Are we talking about somebody giving a sample of their substance to be tested in real time and being given a result there and then? That is one thing, but it might be difficult to achieve. Alternatively, is it more about issuing a more general warning, perhaps on big screens, to concertgoers that a certain substance is in circulation and people need to be wary of it? We really need to tease that out. If it were the former, where you might be saying to somebody, "The substance that you had me test is OK for you to take", that would raise an ethical issue, a moral issue and a legal issue. It would also raise an issue about possible false negatives and false positives. There is a lot of consideration yet to be given to that issue.”
“That is important, as the wider budget position means that we cannot fund any such development. Any resources would have to come from existing services that already support people in need. I will make a commitment, however, to ensure that our precious resources are used to best effect. This is not an issue for my Department to lead on in isolation: we need to work with our partners in Justice, the community and voluntary sector and local government and with people with lived and living experience of substance use to make a real difference. <BR /> <BR />The question has arisen of whether, if testing were available on-site, that would encourage people not to indulge in substance use until they got there. That would depend very much on what type of testing we put in place.”
“<BR /> <BR />It is also important to be clear about what is available in this area across the UK and Ireland. The approaches in England, Scotland, Wales and Ireland are different, and it is not fair to say that we are the only place across the UK and Ireland without a testing and alert system. As I have clearly set out, we can do that when required under DAMIS, and, while festival testing is undertaken in England and Ireland, I am not aware of it happening in Scotland or Wales. We can all learn, however, and we will continue to explore all available possibilities, including future cross-border and UK initiatives where they offer the potential to reduce harm. That will, of course, take resource. <BR /> <BR />As yet, the substance use strategy is not fully funded.”
“We fully recognise that the issue knows no borders. What happens in Ireland, the UK, Europe and, indeed, around the world has clear implications for here. I therefore reassure Members that we work closely with our colleagues in Ireland, sharing information as appropriate; in fact, we will be meeting colleagues to get a better understanding of their Safer Nightlife programme, which includes testing at festivals in Ireland. PSNI colleagues also share information and take joint action with their counterparts through the joint task force. We also work closely with colleagues across the UK, and we share information and alerts where concerns exist. The Justice Minister and I recently met the four UK Ministers, as I said, and it was a helpful meeting to share learning and best practice and to look at where we can do more collectively.”
“The messaging notes the health and legal risks of taking any illegal or illicit drug. However, the PHA also acknowledges the fact that illegal substances are available and that a proportion of the population actively use them. Therefore, the PHA's social media substance use messaging, alongside harm reduction advice, plays a critical supporting role as part of the overall prevention approach, enhancing public understanding of substance use and related risks, encouraging safe behaviours and facilitating community-led prevention efforts. We know that stigma can stop people from seeking help, so it is vital that we provide evidence-based information that people can use and that can support them to engage with services. That can and does save lives. <BR /> <BR />The motion also calls for greater collaboration with the HSE in the Republic.”
“I thank the Member for his intervention. If he can bear with me, I will come to that later. It is a very important point. <BR /> <BR />Any alert system is only as useful as the advice that it generates. I know from Assembly questions that concerns have been raised about the harm reduction advice that the PHA has provided before and after festivals. Mr Frew mentioned that when moving the amendment. The PHA takes a public health approach to the prevention and reduction of harms that are associated with substance use, enabling it to work with partners across Northern Ireland to promote key prevention messages that are sent to individuals, families and communities so that the population is as aware as it can be of the inherent dangers of substance use and can make informed choices.”
“We have not properly acknowledged in the debate that on-site testing will not save the life of somebody who may have imbibed their substances before they got to the concert venue.”