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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“On a more general point, it is my impression that issues often come to the Department that I feel should have been dealt with by the boards of the five geographically defined trusts, so I am asking them to take more control over how healthcare is delivered on their watch.”
“If I understand the Member correctly, I do not think that we can draw any inference that anybody who lost their life in recent years because of a cardiac issue should not have lost their life. There would have been serious adverse incident (SAI) reports that would have looked at events on a case-by-case basis. I am not drawing that inference, but I do draw the inevitable conclusion that this is very disturbing for those who are waiting for procedures. What went on, and why was it allowed to go on for so long? Those are questions that I still want to pick up, primarily with the chair of the trust.”
“I empathise with the Member and wish her son-in-law well. Anybody who is waiting for a procedure should be assured that what we are saying about this expert independent report is that, while there are issues of concern, the procedures that are being carried out are still safe. Obviously, however, this colours how patients may perceive what they are about to go through. You asked about disciplinary issues; I am not aware of any. Again, that is something that I will be asking the chair of the trust about when we meet. I can only assure Members that I am about to sign off on a letter that I have written to the chair. To use the local parlance, it does not miss and hit the wall.”
“I thank the Member for his question. I have been in post now for 363 days. I have not come across anything like this in my first year, nor have I received reports of anything similar having been carried out previously. It is rare, but it is incredibly important. <BR /> <BR />As somebody who was on a waiting list for a cardiac procedure, I take Mr Donnelly's point that it is a very worrying time. The heart is a very emotive issue, as a lot of health issues are. I can only speak from my own experience. I am glad that I was blissfully unaware of any such issues, because that would have coloured my anticipation of going into the Royal for that procedure.”
“I thank the Member for his question. I believe that the number of cancelled procedures was very low: off the top of my head, I think that it was six. I think that there were reports that it was perhaps over twice that number; as I understand it, that is not the case. I am not aware of any actual direct impact on planned surgery from the report or the fact that there has been a really bad breakdown in relationships amongst senior members of that trust team.”
“I thank the Member for the question. I am not aware of our having, to date, any direct talks with the relevant trade unions. The Member will know that, in this case, the Belfast Trust is the employer of the staff in the cardiac unit. We have seen the trust put in place bespoke support mechanisms for all staff to ensure that they have the opportunity to put forward their views of the challenges that the unit has faced that have been created by this unacceptable behaviour. Any unacceptable behaviour should be dealt with through human resources policies and practices. <BR /> <BR />In the first instance, as I have said to the House, I need to speak to the chair of the Belfast Trust. Following that, I do not rule out engaging with the trade unions and other representatives whose voices need to be heard.”
“I want to give that assurance to anybody who is about to go for a procedure with that team at the RVH.”
“The Member asked two things, starting with whether I will publish the report and lay it in the Library. I intend to do that; absolutely. The Member also asked how it could possibly have gone on for so long. Let me assure the House that that will be a key question when I meet the chair of the Belfast Trust. It is shocking that it was happening, but it is also shocking that it happened over such a long period. <BR /> <BR />On public confidence and being proportionate about the assessment of risk, the Royal Victoria Hospital is the sole provider of cardiac surgery for the whole of Northern Ireland. While the external team have made a number of recommendations to improve safety, to improve processes and, of course, to improve the culture in the unit, they have also deemed that the service is safe to continue.”
“<BR /> <BR />The expert team has made a number of recommendations based on the findings, specifically around governance arrangements, communication processes and the review of current processes and support and encouragement for those who are raising concerns. Improved team working across the unit must be an absolute priority. <BR /> <BR />The Belfast Trust has accepted the recommendations of the review and is now working swiftly to take those forward. I will meet the chair of the trust shortly to seek his assurance that actions are progressing at pace to address all the findings. An action plan is being prepared urgently. In the meantime, my Department will work with the trust to secure the necessary assurances regarding the management of the ongoing issues to ensure and secure provision of service both immediately and in the longer term.”
“The findings on the culture of the unit and the behaviours of some individuals within it are entirely unacceptable. I expect to see meaningful and lasting improvements in the unit, not least in building a culture of respect for all colleagues at all levels. In clinical safety terms, key data provide important assurances for patients. For the avoidance of doubt, I declare an interest as a cardiac patient. <BR /> <BR />The review highlights that the cultural issues in the unit represent a risk to patient safety, which is of concern. I acknowledge that public confidence in our regional cardiac surgery service cannot be allowed to deteriorate, especially for our patients and their families when they are at their most vulnerable.”
“In December 2024, the strategic planning and performance group (SPPG) and the Public Health Agency (PHA) commissioned an independent, external expert team to carry out a review of the cardiac surgery service in the Belfast Trust. The review concluded in April of this year. The review team was specifically focusing on two principal tasks — safety and team working. The findings in the expert team's final report were presented to the Belfast Trust board at an extraordinary board meeting on Thursday 15 May. <BR /> <BR />As Minister, I want to say this: it was appalling to read of the staff experiences in the cardiac surgery unit in the Royal Victoria Hospital. I want to thank every staff member who engaged in the important review process. I also want to thank the external review team for its work.”
“It is also true that improving health outcomes is not solely within the purview of this Department. Addressing access to services, along with the other issues that were outlined today, will require the full weight of the Northern Ireland Executive.”
“That approach is not only better for patients but more sustainable in the longer term. <BR /> <BR />The challenges to general dental services and other HSC services are not limited to healthcare. The same challenges are evident in education, the economy and infrastructure, both built and otherwise. I have made it clear that, in my time as Minister, I will do everything that is in my power to drive for better outcomes for patients here. The actions that I outlined are evidence of that, as is my commitment to take a wider approach to reducing health inequalities through the Live Better programme. However, it is an unfortunate reality that the budget that has been allocated to me is not sufficient to meet the needs of the current service, let alone to introduce the kind of transformative change that I think that we all wish to see.”
“The development of a new oral health strategy, including a dedicated public dental health expert or expert group, would carry a significant resource cost due to the complex and extended nature of developing a new strategy and a prerequisite oral health needs assessment. That does not mean that oral health is not important to me. The children's and older person's oral health improvement plans were completed last year, and they made ambitious recommendations. However, funding those will be a significant challenge in the current financial climate. <BR /> <BR />I am also very pleased that oral health has been included in my Live Better initiative. I have often stated that my vision for Health and Social Care is to see more care being delivered in primary and community care settings and a move towards a more preventative healthcare model.”
“In 2013, the data indicated that we had achieved 60%, and the 2018-19 data indicated that around 70% of our five-year-olds were decay-free. That was great progress, but I am aware of the fact that more can and should be done.”
“My officials are working at pace to identify the correct individual or team with the necessary skills and expertise to complete the review in the required time frame. <BR /> <BR />General dental services play a key role in improving the general health of the population while reducing pressure on other areas of the health service. Improving oral health is an important aspect of the future sustainability of dental services and has a key part to play in ensuring the delivery of improved outcomes for patients. While I am aware that the Northern Ireland oral health strategy dates back to 2007, I believe that its evidence base and many of its recommendations are still valid. For example, one oral health strategy target was to improve the proportion of five-year-old children who were decay-free — then 39% — to at least 50% within 10 years.”
“<BR /> <BR />While the additional investment interventions are necessary to stabilise general dental services in the short term, I am clear that GDS, as with other services, require sustained effort to ensure sustained ability over the longer term. My Department is committed to advancing work on the long-term future of dental services, with an aim of ensuring that patients can continue to access care when they need it whilst taking measures to ensure that the service is sustainable. In keeping with my Department's long-term plans, I have approved the commissioning of a general dental services cost-of-service review that is to be completed in this financial year. That will provide a robust evidence base to inform how the service will develop.”
“The programme is being expanded to include primary 1, primary 2 and primary 3 schoolchildren in the 20% most deprived wards, reflecting the recommendations in the children's oral health improvement plan's theme 1, 'Improving the Oral and Dental Health of Children'. <BR /> <BR />It should be noted that the investment is being made in the face of a funding deficit of north of £500 million for my Department. That deficit severely limits my ability to implement the kinds of actions that we all desire to see and hampers my Department's ability to sustain and develop services across all areas of health in Northern Ireland.”
“Thirdly, there is the allocation of £1·6 million to incentivise practitioners to maximise time spent providing health service care for their patients. The dental access scheme will also continue to provide access for unregistered patients with an urgent or pressing oral health need. Since it commenced on 1 August last year, the scheme has allowed nearly 18,400 high-need patients to receive treatment. It is funded until 2027. <BR /> <BR />In addition to the investment being made directly into general dental services, funding is being provided to expand the Happy Smiles scheme, which was originally launched in 2016. The aim of the scheme was to improve the oral health of nursery-school children in the 20% most deprived areas of Northern Ireland.”
“The investment provides funding for a number of measures. First, there is the continuation of the enhanced child examination scheme, which provides children aged zero to 10 who have not been registered with a dentist with an examination, individualised oral health advice and age-specific fluoride application to their teeth, all to assist with preventing dental decay. From its reintroduction in June 2024 to April of this year, over 37,000 newly registered children have been seen under the scheme. Secondly, there is the continuation of the 30% enhancement in the fees paid to dentists for health service fillings, extractions and root canal treatment in financial year 2025-26, all to support public access to priority treatments.”
“There continue to be many challenges facing patients, particularly those who are not currently registered with a dental practice. As Members have pointed out, over the past five years, access to health service dentistry has been in decline here. One of the underlying reasons for that is that general dental practitioners spend less time treating health service patients and more time meeting the strong demand for private work. As they are independent contractors, how they allocate their time between their health service work and their private work is at each practitioner's discretion. <BR /> <BR />Access to health service dentistry remains a major challenge, but I hope that that investment evidences my commitment to supporting the service and improving access for priority groups across Northern Ireland.”
“Thank you, Madam Principal Deputy Speaker. I also thank the proposer of the motion, the proposer of the amendment and every other Member who has contributed to the debate. <BR /> <BR />I met the British Dental Association in February. I am grateful to it for its briefing on the challenges that it faces. My officials have continued since then to engage with it on options for supporting the service. Last week, I announced a £7·36 million investment in general dental services for 2025-26, as well as £2·5 million to cover the hike in National Insurance contributions imposed by the UK Government. Alongside the money, there was the expansion of the Happy Smiles programme, which addresses health inequalities. <BR /> <BR />That investment is not a panacea.”
“We have a crisis team that goes in to help any GP service that feels that it is under pressure. So, yes, we look at the underlying reasons and try to come up with workable solutions.”
“Once again, a number are in the situation of considering contract hand-backs. Regrettably, there have been 16 hand-backs since the financial year 2023-24, with 11 in 2024-25. In 2024-25, one contract was removed. I hope that that answers the Member's question.”
“That was important to victims of the conflict — the Troubles — so, from that day forward, I have had a deep respect for and understanding of the work of those organisations.”
“The more visits I undertake, the more impressed I am with the innovation and the clear motivation to help. There is an independent review under way of the scope, scale and capacity of the voluntary and community sector. I expect that one of its clear outcomes will be the creation of a protocol that will help ensure the most effective use of the sector's expertise and resources. <BR /> <BR />I will go back to the role that I had before elected politics as a commissioner for the victims and survivors of our conflict. I had the realisation that, on a day-to-day basis, so many people were suffering poor mental health and would receive their direct help from those in voluntary and community organisations, who were people whom they trusted.”
“I thank the Member. Of course, I fully agree, and I point him to action 17 of the mental health strategy. Action 17 commits the Department to:”
“I thank the Member for the invite, which I was more than happy to accept. Like many of the other visits that I am so blessed to take part in, I really enjoyed meeting Turning Point NI, which is one of the many fantastic voluntary and community sector organisations doing inspiring, fantastic and wonderful work on the ground for people with mental health issues, some of whom are in crisis. It is an invaluable service and is felt as such by the local trust. <BR /> <BR />Turning Point receives no formal HSC funding, but it still takes referrals from GPs, community mental health teams, the community and voluntary sector and self-referrals. I am aware that the community mental health team in Ballymena also sees Turning Point NI as a useful and important partner in the Ballymena area, and I wish that we could do more financially to support it.”
“It is in the hospitals, so, as long as it is in the hospitals, Encompass will trap the data.”
“I think that the Member, if I heard her correctly, was talking about Encompass being in primary care: Encompass is in secondary care.”
“Are you allowed to say that a Deputy Speaker has just stitched you up?”
“Our estimate for that is £3·5 million. As I said yesterday, if it is higher, we will go higher. Again, had we not done that, we would be potentially looking at GP surgeries handing back their contracts. We are trying to do what we can to stabilise primary care.”
“Obviously, it is a tense situation, and I do not want to make it any worse. What I will say about the £9·5 million that I have decided to implement and pay anyway is that some GP services genuinely struggle. We have seen contracts handed back over the past couple of years. I had a grave concern that, for example, indemnity was still a toxic issue. We provided a temporary solution for the last financial year but have now identified a permanent solution. That requires £5 million of additional money to be put in. Had we not done that, more surgeries might have handed back their contracts. They have had a hike in National Insurance contributions imposed on them by the UK Government. They were not expecting that — none of us were. I did not think that it was fair to ask them to take that hit, so the Department has taken it.”
“I thank the Member for his question. We put a number of proposals on access to the General Practitioners Committee. For example, one was to make some appointments pre-bookable, so that, if you are caught in that speed dial-redial situation, you do not necessarily get to the point where, when you finally get through, you are told, "I am sorry, but all today's appointments are gone", and that is it: you go down that big snake and start again the next day. We believe that all those recommendations were very practical and achievable at no cost to GP services. We have asked GPs to implement our proposals anyway. Obviously, the committee has rejected them and the £9·5 million of additional funding. It will go back to its members, and we wait to see what the response will be.”
“I thank the Member for her question. That was put out to public consultation. We have had a vigorous and very welcome set of public responses, which is still being analysed by my Department. We are therefore not in a position yet to give a more detailed vision of the network with regard to which hospitals will provide which services.”
“I thank the Member. I give that assurance. I am very aware of the sensitivities involved, particularly for people living in the catchment area of the South West Acute Hospital. I am more than happy to provide that reassurance. <BR /> <BR />On the point about ambulance capacity, it is my understanding that the Western Trust has daily engagement with the Northern Ireland Ambulance Service with a view to minimising the impact on capacity and including, where necessary, the best use of outside ambulance provision. I still firmly support the RQIA report's original recommendation for:”
“I am aware of the claims, and I find them disturbing. First of all, no decision has been made about a permanent move. That decision rests with the Western Trust, not with me. The trust will make a decision, and I do not know what decision it will make. It will come to me, and it will be up to me whether to endorse it. <BR /> <BR />I want to be clear: as Minister, I categorically state that it is not the case that any additional funding is dependent on the temporary change becoming permanent. Perhaps the rather unfortunate and mistaken reflection in trust minutes relates to the fact that any such request for funding would be non-recurrent, but that simply reflects the fact that the arrangements are temporary. That is completely different from no funding being made available.”
“The most important thing for me, when I visit, is for people to say to me, "Here is the obstacle to my delivering on a daily basis, and here is the fix".”
“I thank the Member, but I do not agree with him on that. There is a reason for that. I visited the urgent care centre and spoke to the staff, including consultants. The questions were asked, "What more we could do?", "What more could you do?" and "What would you change if you had a magic wand?". There was a contentment about the service that is offered at the moment and a realisation that it works well. Rather than people going to the emergency department (ED) at the Ulster Hospital and being referred back to the Downe, which is the locality where they live, it is better that they go to the Downe, where they may be treated and sent home or become an inpatient, and are referred just once. Only the patients who need to go to the Ulster are going there. Therefore, it is working pretty well, but everything is always under review.”
“<BR /> <BR />There is definitely immediate scope to do more in cataract operations. The Downe specialises in cataracts. On my most recent visit, we discussed that, and the staff made it clear that they had spare capacity and could increase their delivery. On the £215 million that we have announced and ring-fenced for waiting lists, I have encouraged the South Eastern Health and Social Care Trust to get in touch with the Department and say, "We are ready and able to go with more cataract operations".”
“I thank the Member for his question. I have been to the Downe Hospital, I think, two or three times, and what I really like about it — if I may use the expression — is the vibe. There is really good feel on walking into that hospital, and that is created by the wonderful staff who work there. <BR /> <BR />I have visited many of the services. A great range of services is already offered in the Downe, including urgent care and minor injuries, which are both Phone First, and that, I think, is working well for them. I visited the facilities for older people: I declare an interest in that. Hospital at Home is a vision of the future, where you get all the services that you can access in a hospital such as the Downe delivered through your front door. Endoscopy is going well, and there are four dozen inpatient beds.”
“I do not have the exact number to hand. We have made great strides in recruitment and getting away from using agency staff, so we are much more efficient. However, I am afraid that I will have to write to the Member with the exact number that she seeks.”
“<BR /> <BR />Despite those efforts, there continues to be an inadequate supply of social workers to meet service demands regionally. My Department reviews regularly and seeks to increase the number of commissioned training places to meet the demand.”
“<BR /> <BR />The trust has implemented a review and monitoring process to ensure the safe management of cases that await allocation in children’s services. The South Eastern Trust participates in a number of Department-led initiatives that are aimed at stabilising the HSC social work workforce, including the fast recruitment of newly qualified workers. It is envisaged that the majority of the 53 vacant band 6 posts in the trust will be offered to newly qualified social workers between June and September 2025. In fact, in the coming months, approximately 240 vacant posts will be offered to newly qualified social workers across all five trusts. The South Eastern Trust has advised that it is prioritising attraction and retention initiatives for social workers and developing the use of a bank of social work staff to fill temporary vacancies.”
“The South Eastern Trust reports that, as of 12 May 2025, 929 social workers were employed across adult and children’s social work services, which equates to 861 whole-time equivalents. On 31 March 2023, there were 784 whole-time equivalent social workers in the South Eastern Trust. On 31 March 2024, there were 807. I am pleased to report, therefore, that, between 2023 and 2025, the number of social workers has increased by 77. The trust has 53 social work vacancies at band 6 and 11 at band 7. An additional 95 staff are absent from work due to sickness. The trust informed us that it is actively managing sickness levels and providing staff with support to enable them to return to work. Vacancy and absence rates can impact on the availability of social workers, leading to the use of waiting lists or unallocated cases to manage referrals.”
“The Member alludes to a slight variation; £400 million to £500 million is not, in my estimation, a slight variation. It is not a slight variation in the view of the trusts, the Department of Health or, I imagine, the Department of Finance. Those are not slight variations; they are major variations. The trusts made an unprecedented £200 million of savings last year. The Member seems to dispute that. If she cares to write to me with the details, I will certainly look into it.”
“I thank the Member for his question. I will take it to officials. I am aware of coeliac disease but only at a superficial or headline level. I commit to checking what service the Department and the health trusts provide in that regard, and whether there is a consistent service across the five trusts, and get back to the Member.”
“On the pay pressures, when working out our budget, we had to make an assumption that there would be a 2·8% pay rise. As I said, the two sets of recommendations — for allied health professionals on the one hand and doctors and dentists on the other — have been received by the Department of Health and Social Care, so we await the publication of those figures and the response of the Secretary of State for Health and Social Care, Wes Streeting. I am no longer confident that we have budgeted a large enough percentage to meet the figures that we expect to be published.”
“While I very much welcome the rather belated Executive focus on waiting lists and the clear direction that that is where Executive colleagues want me to focus, it is clear that, unless the Executive take some shared responsibility, that could, counter-intuitively, be at the expense of that funding by using it to prevent funding cuts across other services.”
“In that context, we are looking at having to make deeply unpalatable decisions about fundamental inescapable cost increases, such as pay and price inflation, as well as the additional costs that are associated with changes to National Insurance contributions and the national living wage. <BR /> <BR />We await the pay recommendations from London for doctors, dentists and allied health professionals. That announcement is imminent. As I have said before, all things being equal, I wish to enact those recommendations at speed. However, I need to make you aware that, while I will continue to do all that I can to build on the unprecedented £200 million of savings that were delivered by HSC last year, the Budget leaves me in a position where I am genuinely struggling to see a way forward.”