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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“Let me put it this way, which, I hope, will be an assurance to the Member: if I were given incontrovertible evidence that that sort of thing was happening and was being promulgated by a member of the workforce delivering gender identity services, I would want to eyeball that person and say, "At least one of us has to go".”
“I do not think so, and I do not think that parents think so either.”
“I acknowledge the statistic that the Member brought up about the five-year-old. I want to be clear that that did not happen on my watch; that was some time ago. I have already made it clear to the House that there will be no attempt to persuade, coerce or force a young person to move towards the most radical and life-altering step of surgery to alter them physically. The service will start with an emphasis on psychological and psychiatric support. There will also be speech therapy. The idea is to try to help. <BR /> <BR />I found that surprising about the five year old, but I suppose the argument is this: if you are a young person and you are really concerned about who you are and are literally not comfortable in your own skin, do you have to be a certain age before you are allowed to talk to somebody about it?”
“On the Member's last point, I have met families who are not happy that the pathway into Knowing our Identity is via CAMHS, because it is a mental health service. I am aware of that, but we have not been able to come up with a suitable alternative, so I am afraid that CAMHS it is. <BR /> <BR />I agree with the Member that we need to move away from the debate about whether it is an affirming service. That is because, first of all, it is not an affirming service. There is no point speculating about it: that is the fact. Secondly, the debate should be about what is best for those young people and their families.”
“I will come back to the Member on the exact number, because I do not have it to hand. Consent is a crucial issue. Knowing our Identity, or KOI, is a service that comes under the child and adolescent mental health services (CAMHS), and, as with all CAMHS services, parental participation and consent are required. The one caveat is that there are such things as the Gillick competence and Fraser guidelines for healthcare. They could — not "will" — be applicable, but that depends on the age and competence of the child. The Gillick competence and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.”
“Who in the House, as a father or a mother, might not think that they would do the same thing? One example that I was given — I think that I am right in this case — was of a private provider who was Spanish, based in Romania and prescribing puberty blockers out of Singapore. Where was the safety or regulation in that? However, because I was being told that the only reason why people are going to the private providers is because our service exists only in name for young people who want to get a new referral to it, I decided that we must find the money to make the service work.”
“I note the Member's comments. The previous Government in London, in which Victoria Atkins was the Secretary of State for Health and Social Care, wanted to bring in a temporary ban on puberty blockers. Eventually, the Executive joined in, extending that ban to Northern Ireland and, as the Member knows, that is now an indefinite ban, pending the results of clinical trials on puberty blockers. When I spoke to some of the families and the young people who wanted access to our gender identity service — Know Our Identity — it became clear that the wait was way too long. In fact, they were saying that there is not even a waiting list: the service was simply not taking new referrals because it was not resourced. The consequence of that was that loving parents, who wanted to do their best for their children, were turning to private providers.”
“It is my understanding that, since the service began in 2014 — the money for it was signed off in 2013 — very few people have been referred to England for surgery. Very few.”
“Just for the record, the investment is £806,000, not the figure that the Member mentioned. That is for the service going forward. Very little has changed except that, previously, we had two services: a children's service known as KOI — Knowing Our Identity — and an adult service. The Member is well versed in health and social care provision, and he will be aware that it is far from unique for a move from one to the other not to mean being in one on a Sunday night and in the other on Monday morning. You hit a cliff edge and go back on a very long waiting list. That is why we decided that we needed the single lifetime service. The big changes are the ones that are Cass-compliant, which put a greater emphasis on psychological and psychiatric interventions.”
“By the way, when I say, "new centres", the Member will be aware that Wes Streeting, the Secretary of State, closed the gender identity service at Tavistock and is now creating six new regional centres in England. Finally, Judith Ellis is a nurse by background. She chaired the original multi-professional review group, which ensured that children and young people who were referred for puberty blockers had been through the appropriate consent, safeguarding and other processes. She has been a chief nurse at the Great Ormond Street Hospital, has had numerous other roles and has a lot of experience in education, quality assurance and setting standards.”
“We have had ongoing consultation with stakeholders on the design of our service but not with Dr Cass. That was my call. For completeness, I will share all the information. Dr Cass is coming with three other experts. Camilla Kingdon is a paediatrician and the immediate past president of her royal college. She is chair of the National Provider Network, the group that coordinates clinical approaches, education, audit and research across the new centres. Julie Alderson is a psychologist and the clinical director of the new Bristol service. She has also been a key figure in training our new staff on the shared holistic assessment framework that is used across all the new centres.”
“<BR /> <BR />In order to tackle the misinformation from people such as Mr Buckley, I decided that the best way to assure ourselves that the gender identity service that we offer is Cass-compliant is to bring in an independent expert to review it, and who better as the independent expert than Dr Cass?”
“I can confirm that the service will not be an affirming one. For the avoidance of doubt, when the Member says "affirming", I think that he means that, if a young person goes to the service and says, "I believe that I am the wrong gender", the service will immediately move to change their gender through surgery. That will not happen. Nobody will be coerced. <BR /> <BR />Why am I bringing in Dr Cass? It is because I heard people, including Members of the House and specifically Mr Buckley, claim or make statements in media commentary that implied that it is an affirming service. Indeed, he did so on the radio in a debate that included Alexa Moore from the Rainbow Project. Alexa made it clear that it is not an affirming service. She said that that is what they wanted, but they did not get it.”
“When I spoke to Dr Cass, I asked her whether she was prepared to come to Belfast in order to conduct a short, sharp quality assurance review of our gender identity service. She has agreed to come with a small team of independent experts to do that in the coming weeks.”
“We talk about rare cancers, and, by definition, that means that each such cancer is infrequent in its occurrence, but there are so many rare cancers that they are, overall, very common. They are anything but rare, and I think that that was a point that Alan Robinson and Nuala McAllister made. The fact that, statistically, they have a very high fatality rate was also pointed out. This is really important stuff, and I thank Members and commend the motion to the House.”
“Mr Deputy Speaker, thank you very much. Once again, I thank everybody who participated in this short but important debate. <BR /> <BR />The Chair of the Health Committee raised one point that I need to come back to. Some time ago, I was made aware that there was an issue with the secondary use of data. It is a fact that there is a flaw in the current legislation. Options to fix that were put to me. I said that the cleanest thing to do is to put our hands up and say that we got it wrong — the drafting was wrong — and basically bring forward a single-clause Bill to correct it. I am a little frustrated that that has not happened this side of summer recess, but I am assured that it is ready to go, and I hope that it will be introduced very early in the autumn when we get back to work. <BR /> <BR />This is a very important thing.”
“A legislative consent memorandum was subsequently laid with the Business Office on 3 June. I am pleased to inform Members that the Health Committee also considered the Rare Cancers Bill at its meeting on 12 June. At that meeting, the Committee confirmed its support for the legislative consent memorandum that had been laid in the Business Office with the intention of progressing with the motion in the Assembly today. Indeed, the Health Committee has reported its support for the motion in its written report. It is, therefore, with the Health Committee's support that I have brought the motion before the Assembly. I ask Members to support the motion.”
“At their meeting on 29 May 2025, the Executive agreed to progress the legislative consent procedure in the Northern Ireland Assembly for clause 1 of the Rare Cancers Bill in respect of:”
“That is achieved through the identification of studies through Northern Ireland Cancer Trials Network's participation in UK and all-island research networks, with relevant details being provided to relevant clinicians in Northern Ireland cancer centres. The Northern Ireland Cancer Trials Network provides support to any clinician wishing to open a trial site in Northern Ireland. Patients are also advised of the opportunity to sign up to be part of research, which allows them to search for and be notified about relevant trials for their condition. <BR /> <BR />The Rare Cancers Bill passed its Second Reading in the House of Commons on 14 March, with early July provisionally earmarked for Committee Stage consideration of the Bill in the Commons.”
“With regard to stakeholder views, I understand that cancer charities that focus on rare cancers have expressed their full support for the Bill and have encouraged people to write to their MPs to ask that they support it in Parliament. Those charities include Brain Tumour Research and Pancreatic Cancer UK. <BR /> <BR />Although I seek legislative consent only for clause 1, which deals with the review and report on orphan medicines, I assure Members that I am committed to working with counterparts across the rest of the United Kingdom to support and encourage research into rare cancers and that my Department, along with the Public Health Agency, has the necessary infrastructure in place to ensure that there will continue to be equitable access to research relating to rare cancer trials for patients living in Northern Ireland.”
“In addition, it is important to emphasise at this point that any proposed amendments to the Human Medicines Regulations 2012 as a consequence of any review that may be conducted by the Secretary of State for Health and Social Care would remain, as provided for under the Medicines and Medical Devices Act 2021, subject to joint consultation and progression on a joint UK-wide basis, with any amending legislation being subject to the draft affirmative procedure in both Houses of Parliament and in the Northern Ireland Assembly.”
“as set out in the Human Medicines Regulations 2012. The review will aim to examine how the current law can be reformed to better incentivise pharmaceutical companies to invest in clinical trials for rare cancers. Such a review will also need to compare regulatory approaches in other countries with the UK's approach, which will be done by assessing international regulatory approaches to orphan medicinal products, with a view to assessing whether the regulations in the UK are considered effective at encouraging research and development into treatments for rare cancers. The clause also requires that the conclusions of such a review must then be prepared and published in a report and that the report has to be:”
“In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) can grant a period of up to 10 years' market exclusivity where the criteria for orphan designation has been met. <BR /> <BR />Clause 1 of the Rare Cancers Bill, as introduced, places a duty on the Secretary of State for Health and Social Care in England to carry out a review of the UK law related to marketing authorisations for:”
“Even if companies succeed in running a clinical trial, and a drug proves to be an effective treatment, manufacturers then face the challenge of selling a drug developed at great expense to such a small market. Ultimately, those companies exist to return a profit for their shareholders, and, given a choice between investment and potential treatment for a rare cancer or a more common one, too often it is rare cancer patients who lose out. <BR /> <BR />To help encourage more research and development, Governments around the world offer incentives for the development of orphan medicines, such as the provision of a period of market exclusivity, during which a competitor's medicines of a similar nature cannot enter the market.”
“In addition, there are also many different types of rare cancers. They include blood cancers, cancers affecting the female reproductive organs or the digestive system, head and neck cancers, and cancers that affect soft tissues, which are known as sarcomas. Orphan drugs are medications that are used to treat rare conditions. They are known as "orphan" because pharmaceutical companies may be unwilling to invest in research and development into new treatments for diseases that affect only a very small number of people. With smaller patient populations, there is an increased logistical challenge in bringing patients together to undertake clinical trials, which are necessary in order to bring a product to market.”
“Rare cancers themselves are types of cancer that affect relatively small numbers. The definition of a rare cancer can vary. The Rare Cancers Bill, however, defines a rare cancer as a type of cancer:”
“If passed, the Bill will introduce three measures, all of which are intended to encourage more research. They are, first, the placing of a duty on the Secretary of State for Health and Social Care in England to promote and facilitate research into rare cancers. That will include the appointment of a national specialty lead for rare cancers in the National Institute of Health and Care Research (NIHR). The second measure is to improve patient recruitment into clinical trials for rare cancers through greater data sharing. The third measure is to place a requirement on the Government to review UK-wide law on marketing authorisations or product licences for:”
“Thank you very much, Mr Deputy Speaker. I very much welcome the opportunity to debate the motion. It seeks Assembly endorsement in principle to the extension to Northern Ireland of clause 1 of the Rare Cancers Bill. The Bill was introduced in the House of Commons on 16 October last by Dr Scott Arthur of the Labour Party. It is a private Member's Bill, the aim of which is to:”
“I conclude by wishing the Committee well as it begins its crucial scrutiny of the Bill.”
“There may be money for court cases involving the new offences that we are introducing. Respectfully, the Committee will, I am sure, look at that issue in much more detail. <BR /> <BR />Nuala McAllister asked whether the regulations would be timely. They have to be timely, otherwise what is the point of this? Again, that is something for the Committee Stage. The Member made the point that the Bill has been a long time coming. One of the reasons for that has been a couple of collapses over the last number of years. It is my impression that, if there is one more collapse of the institutions, they are gone for good. <BR /> <BR />Mr Donnelly mentioned extending the Committee Stage, and Mr Frew referred to independence and NIPSO. <BR /> <BR />That takes me to the conclusion of the remarks that I wanted to refer to specifically.”
“With respect, I will not react by giving an opinion on that, because I do not want to second-guess or direct Peter McBride, but the point is certainly on the record. <BR /> <BR />On costs, Diane Dodds made the point that we have to find the money to do this. I do not disagree with her, but there are so many things that we need to find the money for in healthcare delivery. We need £200 million to maintain pay parity for Agenda for Change staff, doctors and dentists. The Member asked about additional costs and how costs have risen. I am not aware of the original cost to which you refer, so I cannot make a definitive comment on that. In the initial phase, it will cost money to establish the adult protection board. There will be money for training. There may be money for recruitment.”
“I agree: when I look at what has arisen out of the publicity surrounding the cardiac surgery unit in the Belfast Trust, I sense that there is a major issue with whistle-blowing, and that is specific to staff confidence in engaging with the process and a fear that prevents them engaging with the process. Peter McBride has great knowledge of that. He has already started work and will make recommendations to me on that front.”
“Transition becomes an event; it has to be a process. We have to work to make such processes stretch out over time, rather than being an event that is so often a cliff edge. When the Member talked about potential "deficiencies" in the Mental Capacity Act, did he really mean, "Are there parts of that that need to be enacted or to gel with what we are proposing in the Adult Protection Bill?"? If that is the case, yes, we have to look at them. I am not sure that I would have used the word "deficiencies", but I take the point. <BR /> <BR />I very much welcome Diane Dodds' saying that the Committee will look to strengthen what is in the Bill at Second Stage. It is entirely the role of the Committee to assist and advise the Minister and officials in how we go forward. Whistle-blowing is an issue that the Member is fixed on.”
“You would want to go through a complaints process that took you eventually to NIPSO, but, if NIPSO had been sitting at the table making the decision, you would get nowhere. I just gently point that out. <BR /> <BR />Mr McGrath, in referencing the seven principles, went first of all for dignity. I am really pleased that he did. If you look at those seven principles, it is hard to deliver the others if you do not put dignity at the heart of what you do. How can you promote autonomy for a vulnerable person if you do not respect their dignity? How do you empower them if you do not respect their dignity? How do you work in partnership if you do not respect their dignity? <BR /> <BR />Mr McGrath also mentioned the cliff edge of transition. That happens across healthcare delivery far too often.”
“I do not think that it does, because the board has to operate within terms of reference and within the law, and the Bill will, hopefully, become the law. I understand that you are uneasy about that — we would all be right to question, observe and monitor how that is operated — but I see no other practical way of doing business. <BR /> <BR />I will pick up on one thing. If I understood Mr Frew correctly, when he listed all the organisations that would be represented on the board, he then asked, "What about the Northern Ireland Public Services Ombudsman (NIPSO)?". If he is suggesting that the NIPSO should have a seat at that table, he is entirely wrong. What if you then got a complaint about what that board did?”
“How independent is the Commissioner for Older People?”
“As a matter of principle, our strategies are fine, but give me a costed implementation plan over a strategy any day of the week. <BR /> <BR />Mr McGrath asked about the adult protection board, and Mr Frew talked on that as well. Mr Frew listed some of the statutory representatives who will be part of that. The chair will be independent, but that takes us to a philosophical question, does it not? What does "independence" represent? Nuala McAllister mentioned it, Paul Frew mentioned it, so I answer a question with a question: how independent was I when Mr Frew's former party leader, Dr Ian Richard Kyle Paisley, appointed me as a commissioner for victims and survivors in the Commission for Victims and Survivors? How independent was I at that point? It is a philosophical question and the right question to ask; I have no doubt about that.”
“I will touch on some of the comments that were made. Mr McGuigan talked about the implementation plan and, under the current regime, the lack of evidence of outcomes. That is exactly where my mind is, Mr McGuigan. As I said when I first stood in this position just over a year ago, I want to be judged and will judge myself by whether I am deliver better outcomes: better outcomes for patients, for service users and for the 70,000-odd people who deliver healthcare in Northern Ireland. <BR /> <BR />I do not think that there is any intention for a phased implementation plan at this moment, but I would be more than happy for the Committee to engage with the Department and officials on the best way to move forward on that.”
“I understand from the Deputy Chair that the Committee will wish to extend the Committee Stage to March 2026. I would be relaxed about that, but I would be hopeful that we could get this over the line in the 2026 calendar year. I also thank officials, some of whom are in the Officials' Box today, for the consistent work that they have applied to a challenging area of healthcare delivery.”
“Deputy Speaker, thank you very much. What an informative debate . I very much look forward to the next stage, assuming that this stage is approved by Members. I thank the Chair of the Committee, the Deputy Chair of the Committee, Committee members and Mr Frew for their comments. It is clear that this issue is of first-order importance to the House, and I am glad that there is a clear appetite to progress the legislation. I thank the Health Committee for its engagement to date, and I wish it well with the Committee Stage.”
“There are additional duties and powers for those who are entrusted with safeguarding adults at risk; offences that aim to close gaps in the current provision; regulatory-making power to govern the use of CCTV; and provision for establishing a body to coordinate adult protection and investigate failings at a regional level. <BR /> <BR />I hope that we can all agree on the importance of protecting those at risk in our society. The failings that we have seen at places like Muckamore Abbey Hospital and Dunmurry Manor care home should never have happened in the first place and they must never happen again. <BR /> <BR />The Bill is an important step in transforming our social care system. I look forward to hearing what Members have to say about it.”
“Such infringement on anyone's individual human rights is not within the gift of the House, nor would I consider it to be a step that we should take if doing so was within the Assembly's legislative competence. <BR /> <BR />The regulations will place structure around organisations to decide whether CCTV should be installed and direct how it should be managed, monitored and maintained. The content of the CCTV regulations shall be subject to full public consultation down the line. However, where CCTV is installed it will be for the Regulation and Quality Improvement Authority (RQIA) to monitor and enforce its compliance with the CCTV regulations. <BR /> <BR />The Adult Protection Bill is intended to strengthen and underpin the adult protection processes here.”
“<BR /> <BR />Finally, Part 4 confers on the Department the power to make regulations on the installation and use of CCTV systems on the premises of the listed establishments for the purpose of safeguarding resident adults at risk. To be clear, that does not mean mandatory installation of CCTV. I fully recognise the impact that CCTV records had on highlighting the truly reprehensible abuse that took place in Muckamore Abbey Hospital. Indeed, without that evidence, we may not have uncovered the abuse. However, making CCTV mandatory in care settings would mean that that could apply in an individual's own home if they were being cared for in that environment. That could affect one of my loved ones or one of yours.”
“My officials engaged with those families throughout the drafting of the Bill, and I hope that the inclusion of that duty will provide them with some assurance that their views have been fully considered. <BR /> <BR />Part 2 provides for the establishment of an Adult Protection Board for Northern Ireland and places a duty on the Department to establish such a board. The board will operate on a basis similar to that on which the children's Safeguarding Board for Northern Ireland (SBNI) operates and will have responsibility for coordinating and ensuring the effectiveness of adult protection regionally. It will also undertake serious case reviews, which are something new in Northern Ireland. <BR /> <BR />Part 3 introduces offences that relate to ill treatment and wilful neglect. The offences apply to care workers and care providers.”
“<BR /> <BR />In addition to the protection orders, Part 1 includes a power for an adult protection social worker to examine records, including financial records, in circumstances in which there is suspected financial abuse. There are also requirements about the provision of independent advocates to support adults at risk. Additionally, there is a requirement for a trust to establish and have regard to the views of relatives, carers and other interested persons, as well as to keep them informed of the trust's actions with the adult at risk. That aspect was of particular concern to those families whose loved ones suffered abuse at Muckamore and at Dunmurry Manor.”
“Trusts will also be able to apply to a Magistrates' Court for the granting of a range of protective measures. An assessment order will allow the person to be interviewed in an alternative location. A removal order will allow the person to be removed to another location for up to seven days if there are concerns that the person may be at immediate risk of harm. A banning order will ban a person from being in a specified location for up to six months if an adult is being, or is likely to be, seriously harmed by that person. Each of those orders is subject to a number of conditions. Under normal circumstances, they may be used only where the adult at risk has consented to their use.”
“The entirety of Part 1 is written in the context of seven principles that the Bill sets out: prevention; autonomy; empowerment; dignity; proportionality; partnership; and accountability. Part 1 introduces a duty on a health and social care trust to make enquiries in cases in which someone who is suspected of being an "adult at risk", as defined by the Bill, is brought to its attention. <BR /> <BR />Following on from that duty, the Bill introduces new powers for the trusts that will assist them in their investigations. Powers include a power of entry that will enable suitably trained and qualified adult protection social workers to enter a residence for the purpose of determining whether intervention is required in order to protect an adult at risk of harm.”
“During that period, the Department held 19 engagement sessions, and 89 consultation responses were received. It was clear from the responses that legislative change was necessary and that more needed to be done to protect the most vulnerable people in our care. <BR /> <BR />The objective of the Adult Protection Bill is to improve and strengthen the adult protection process across Northern Ireland. The Bill introduces additional powers and responsibilities to support our health and social care system to protect adults who are at risk of harm. Placing adult protection on a statutory footing will also help bring us into line with neighbouring jurisdictions. Such legislation already exists in England, Scotland and Wales, and similar work is currently being undertaken in the Republic. <BR /> <BR />I now come to the Bill.”
“I am delighted to open this first debate on the Adult Protection Bill. It has been a long time coming. In fact, it was January 2020 — five and a half years ago — when the Commissioner for Older People for Northern Ireland published his report, 'Home Truths', on his investigation into Dunmurry Manor care home. Furthermore, in August 2020, an independent review of the leadership and governance at Muckamore Abbey Hospital was published. Subsequent to those reports and the shocking safeguarding failings at Muckamore and Dunmurry Manor, it was recognised that there was a need to review and improve the Department's adult safeguarding policy. <BR /> <BR />In September 2020, my predecessor, Robin Swann, announced his intention to legislate. A public consultation on the legislative options ran between December 2020 and April 2021.”
“My bad. It was Thursday 29 May. I beg your pardon. I commend the motion to the House.”