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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“My Department is facing an extremely challenging financial position in this financial year. Members will recall that, compared with the level of need that is being driven by increased demand, health inflation, pay and trust deficits, among many other factors, my Department was facing a £400 million shortfall this year. That position has changed but, regrettably, not for the better. The additional pressures that the final Budget has added by ring-fencing £165 million of the Department's existing budget for waiting lists and the difference in the allocation for the rise in National Insurance contributions compared with the original planning assumptions mean that the latest assessment of the funding gap is that it is now over £500 million.”
“I assure the Member that I am acutely aware of the need for regional balance and that not a week goes by that I do not look at waiting lists and issues and say, "Why is best practice in one trust not being replicated and put into common practice in all five trusts?". I put in the proviso that the Belfast Trust offers a lot of regional services, so there will be a weighted bias towards people who work in the Belfast Trust, because they are delivering for the whole of Northern Ireland. The issue that she mentioned is really important. It is not just about making sure that we have the right distribution. If people come to Belfast to train, there is a possibility that they will say, "I kinda like it here, so I'm going to stay". I assure the Member that that is on my radar.”
“I thank the Member for his question. We have been looking at the legislative programme that we can introduce in the remaining two years of the mandate. I can assure the Member that it is my desire that the safe staffing legislation come forward before the end of the mandate. I cannot commit to an exact month yet, but it is one of the top three pieces of legislation that I desire to bring to the House.”
“I thank the Member for his question. I am not going to be definitive in my answer. He was very specific about the review that he has in mind, so I will take that away. Broadly, however, we look at the gaps on a trust-by-trust basis and even on a hospital-by-hospital basis. I hope that the Member is aware that, although we have five geographically defined trusts, it is my intention and my drive that everything that we do in those trusts be delivered on a standardised, regional basis. We have to look at the workforce and at how it is distributed in order to make sure that it is best placed to deliver on that basis. I will get back to the Member on his specific request.”
“There will be 65 places for paramedics, which is a 30% increase on last year. Fifty-six places will be available for speech and language therapy, which is a 100% increase on last year's training numbers. There will be 35 places in dietetics, which is up 66% on last year. There will be 27 places in podiatry, which is a 35% increase on last year. <BR /> <BR />The numbers represent an overall increase of 100 places on training courses commissioned in 2024-25. Those roles are critical to delivering care and enabling service transformation in hospital, community and home settings and will help free up more experienced staff to take on advance practice and leadership roles.”
“I thank the Member for that. The AHP cohort forms the second-largest block in healthcare after nursing, and it is really important. As I said, a record 505 allied health professional preregistration training places are to be commissioned by my Department in this financial year. The breakdown, in which the Member may be interested, is as follows. There will be 110 training places in physiotherapy, which represents a 37% increase over the past two years. There will be 25 places in radiotherapy — sometimes referred to as "therapeutic radiography" — and oncology, which is a 56% increase compared with last year. Ninety-four places will be available in diagnostic radiography, which is a 38% increase over the past two years. Ninety-three places will be available in occupational therapy, which is a 69% increase on last year's commissioned places.”
“It means that we remain on the path towards securing the workforce across Health and Social Care to help us meet rising demand for care and also support the transformation of services, particularly in primary and community care.”
“The investment will also provide for the delivery of 378 places on the Northern Ireland medical foundation programme. A place will be provided for every graduate from Queen's University Belfast's school of medicine and for the first cohort of graduates from Ulster University's graduate entry medicine (GEM) programme. Collectively, the total number of medical training posts across all the programmes that my Department has commissioned from the Northern Ireland Medical and Dental Training Agency (NIMDTA) now stands at 2,219. Our health and social care workforce is our greatest asset, and, without its skill and dedication, there is no service. The investment that I have announced forms a key part of my Department's ambitious three-year plan to stabilise, reform and deliver more sustainable and effective healthcare for everybody.”
“I have also approved 24 new medical specialty training posts, which are made up of 13 posts in internal medicine, five in core psychiatry and six in other specialties.”
“Last week, I was very pleased to announce a significant package of investment in Northern Ireland’s Health and Social Care workforce. The measures that I have announced will bring annual investment in the commissioning of workforce training places to £160 million. This year, my Department will commission 1,065 nursing and midwifery places, a record 505 allied health professionals (AHPs) and 330 social work preregistration training places.”
“That process is ongoing, but I expect the final two reports to be published in the coming weeks. We will then approach the end point of our review of what went wrong.”
“I thank the Member for the question. I am not aware that outsourcing is something that we want to do. I think that we had to do it as a short-term measure when we consolidated on the Belfast Trust site. <BR /> <BR />I want to reassure people that every effort is being made to review what happened in the Southern Trust. We have had a number of reports, and there are two more to come. At that point, I will make a final decision, but the following questions need to be answered. What happened? Why did it happen, including who was responsible for it happening? What steps have been taken to ensure that it will never happen again, or, if it is not possible to give that absolute guarantee, what steps have been taken to try to ensure that it is very, very unlikely to happen again?”
“I thank the Member for that. She will be aware that I have officials working on a women's health action plan, and education will be a core part of that. Looking ahead, I would prefer to have a women's health strategy, but, in the meantime, the important thing to do is to get an action plan that enables us to take definite actions on certain conditions that are particular, perhaps, to women. I could not agree with the Member more on the idea that education is absolutely core.”
“The big measure for me, as I always say, is healthy life expectancy.”
“I thank the Member for his question, which is in two parts. Yes, being timely is of the essence. It is all very well having the buildings, the equipment, the staff and the protocols, but, if testing is not actioned in a timely manner, the risk, obviously and self-evidently, is that we miss problems or allow problems to deteriorate to the point at which they could even be life-threatening. <BR /> <BR />On the Member's point about people who live in areas of deprivation, he will be aware that tackling health inequalities is one of my primary focuses. Over the next two years, I hope to do enough to encourage the next Minister of Health to continue on that journey of tackling health inequalities. That would mean that we will have had seven years of focus, and, after that, you should really see improvements.”
“I thank the Member for his commentary. The question was how confident I am: I would like to think that I am very confident, because I think that, when you have had issues on the scale of those experienced by patients and service users in the Southern Trust, everybody involved in the screening, whether in cytology or for HPV, which is now the primary testing route, will be absolutely on their best game at all times. It would be a complete shock to me, if we were to return to the sort of situation that we had with the Southern Trust.”
“I thank the Member for his question and understand that it is rooted in previous serious issues. Yes, I encourage women to take up the offer of cervical screening when invited to do so. Over 99% of cervical cancers are caused by HPV. Primary HPV testing is an automated test that identifies the presence of HPV. It is recommended by the UK National Screening Committee because it is a more accurate test and will save more lives than cervical cytology. The Public Health Agency continues to monitor awareness, confidence and barriers to participation in cervical screening and will continue to use that information to inform future activities. Coverage data, used as a measure of participation in the programme, is now available for the financial year 2023-24. It shows an increase in age-appropriate coverage across all trusts compared with 2022-23.”
“I thank the Member for that follow-up question. There have been some issues around the timeliness of reporting; I accept that that is indeed the case. Last week, though, I was pleased to hear that work is being done to address that. We look at a range of weeks in blocks in terms of how long it takes to report to people who have been tested with their results. The Public Health Agency (PHA) has informed the Department that waiting times are improving week on week. At 4 May, 90·2% were authorised within four weeks; 0·7% took four to six weeks; 2·3% took six to eight weeks; and 6·8% took over eight weeks.”
“I assure Members that the regional laboratory is fully operational and, between 3 November 2024 and 4 May 2025, the regional laboratory processed and reported approximately 43,000 HPV tests for the Northern Ireland cervical screening programme.”
“The equipment located in the virology laboratory is in a room used only for cervical screening. <BR /> <BR />With the implementation of primary HPV testing in December 2023, it was necessary to consolidate the laboratories to a single site to ensure that performance standards and minimum requirements of screeners and reporting staff are met and that public confidence in the screening programme is maintained. That is due to the marked decrease in demand for cytology testing and is in line with other UK regions. Even operating as a single-site model, the anticipated volume of screening samples will see the Belfast Trust laboratory as the smallest in the United Kingdom.”
“The new regional cervical screening laboratory in the Belfast Health and Social Care Trust has been operational since November 2024. The Belfast Trust was awarded the regional contract following an expression-of-interest process that considered submissions from trusts against a range of key criteria. The Belfast Trust scored highest in the process and was awarded the contract. While some of the human papillomavirus (HPV) testing equipment is physically located in the virology department in the Belfast Trust and not in the cytology laboratory, it is on the same site, and all testing is being undertaken by the cervical screening laboratory team. The arrangement of a piece of equipment being located in a different location within one site is not uncommon and is recognised as acceptable practice in national guidance.”
“Yes, I am particularly keen to address those waiting lists and the capacity in mental health, including CAMHS.”
“Yes, it is. The Member will be aware of the fact that, since I was first elected in around 2011, I have campaigned on the broad theme of mental health. I came to that from being a victims' commissioner, because it was obvious that our excessive rates of poor mental health — let me put it that way — are a direct result of the legacy of the conflict. It is one thing to say, "Here is a service such as CAMHS", but, if you cannot access it in a timely manner, it is almost cruel, because you know that it is there. It is the same with how some strategies are gold-plated and the best that we can think of, but we then do not have the money to fund the action points year-on-year. Again, it is Tantalus-like, saying, "Here is what you should have had".”
“If the Member is enquiring whether there should be a separate, bespoke training regime and system in place for dealing with autism, my officials say that that is not necessary and that interventions can be done within the mental health services but in a bespoke way that is directed towards a person-centred pathway of care.”
“I am not sure whether it will be mandatory. I will have to check that and get back to the Member.”
“My understanding is that it will be available to all those working in Health and Social Care and not just to mental health practitioners. Sorry, what was the second part of the question?”
“<BR /> <BR />That training is key to ensuring that appropriate adjustments are made for each autistic person and that our mental health service, which includes cognitive behavioural therapy and other therapies, is person-centred, adapting treatment and care at every point throughout a person's journey. It is important that the health service is equally accessible to all; therefore, the autism and neurodiversity awareness training will be available for all Health and Social Care staff, not just mental health staff.”
“The second is providing supportive environments, which gives an insight into how the environment can impact on a neurodivergent service user. An analysis of the difficulties experienced by the neurodivergent individual across a series of likely environments and interfaces is reported. Supports and materials to provide and create more supportive spaces are included. The third topic is promoting a neuro-affirmative culture, helping staff to understand how to integrate neuro-affirming practices into their work environment from the language used to the culture in the workplace, both for the service users and the team members.”
“I thank the Member for the question. I am happy to advise that my Department has engaged with Middletown Centre for Autism in order to develop autism and neurodiversity awareness training. It will be available on the Health and Social Care (HSC) learning platform in the coming weeks. Not only has that training been co-produced with service users, parents and carers with lived experience but over 30% of the content is delivered by them, so users should expect a really authentic feel. <BR /> <BR />The training covers the following three topics. The first is autistic differences, which provides an insight into how autistic people experience the world, giving staff an opportunity to reflect on how an autistic person might experience the service and environment of Health and Social Care.”
“I want to clarify a point of detail from last week's Assembly debate on cancer waiting times. During the debate, I made reference to the Western Trust in particular being reliant on a single-handed dermatology consultant. That is the case, but it does not mean that the Western Trust has the worst waiting lists, and there was no intention to make such an implication. My point was to give some examples of some of the recruitment and service resilience challenges that are faced. To be clear, the Western Trust has some of the best waiting times in Northern Ireland for dermatology red-flag outpatient appointments. I am happy to put that on the record and to thank staff for their work.”
“On a point of order, Madam Principal Deputy Speaker. May I make a point of clarification?”
“I am glad that the Member is sitting down, because the answer is no.”
“I think that the Member has answered his own question. I did not raise the issue at the North/South Ministerial Council meeting in sectoral format for health and food safety because it is an issue for the Executive Office.”
“In the broad area of alcohol, I wanted to discuss the benefits, as I see them, of minimum unit pricing for alcohol. Scotland and Wales have minimum unit pricing. The research that I have seen suggests that it works. The very esteemed health inequalities expert Professor Sir Michael Marmot agrees that minimum unit pricing works. I want to introduce legislation in this mandate to introduce minimum unit pricing for alcohol in Northern Ireland. To do that, I need Executive agreement, and I am afraid that I do not have that. I encourage the Member to reflect on why that may be.”
“I very much regret the fact that Northlands is not in receipt of core grant funding, but it is wrong to say that we "stripped" it of that funding. <BR /> <BR />I am more than happy to work with the North/South Ministerial Council and with Jennifer Carroll MacNeill and consider whether that is an area in which a pitch to the Shared Island Fund would be appropriate. The fact that Northlands is up by the border makes it attractive.”
“I take a little exception to that last use of language, where the Member said that Northlands was "stripped of its core funding". We redesigned the core funding scheme, because it had not been reviewed in 20 years, which meant that any charity that had been established in that two-decade period could not even apply for core funding. The point was also made that core funding was an annual thing and that, just because you got it one year, you should not expect to get it the following year. It was redesigned at my request, and that was facilitated by the Northern Ireland Council for Voluntary Action (NICVA). Stakeholders were the co-designers of the scheme, and Northlands was unsuccessful. We used six criteria, I think, and they were not the Department's criteria but the stakeholders'.”
“We missed a deadline — hands up to that — but it will be worth it, because, when we get the strategy over the line and when I am satisfied with it and stakeholders are happier with it, it will be a more effective document.”
“Yes, I acknowledge the east-west link. That was also discussed on the fringes, at least, of the conference at Croke Park in Dublin that I mentioned. <BR /> <BR />I previously promised, because it was my expectation, that the cancer research strategy would be published by the end of the previous financial year. I was given the proposed strategy in time for it to be published before the end of the previous financial year, but I thought that more could be done to improve it. I wanted slightly more engagement with stakeholders so that I could be assured that they are satisfied with the strategy. Therefore, additional work is being carried out.”
“I hope that, certainly during this calendar year, we will green-light it.”
“The detail was more on the food safety side of the fence. It is a matter of public note that we had hoped to make a successful pitch to the Shared Island Fund for the mother-and-baby unit. However, it was unsuccessful. That was when Stephen Donnelly was the Minister. With hindsight, perhaps we waited too long and gave them too much detail, because the answer that I got was a definitive no. Therefore, if we are pitching to the Shared Island Fund, we should not send in a 20-page, fully detailed proposal. It should be a one-pager to see whether it is interested, because, if it is just going to say no, there is no point in wasting that resource. If they say yes, you then go away and get down into the fine detail. The mother-and-baby unit will be based at Belfast City Hospital. We are at a pretty advanced stage with the business plan.”
“I thank the Member. There was no detailed discussion on hospice care during the sectoral meeting. Previously, as I said, I met Jennifer Carroll MacNeill, the Minister for Health in the Government of Ireland, down in Dublin. After that, I visited a hospice in Dublin. I got a briefing on the different funding arrangements, which are obviously much more advantageous to hospices in Dublin. I understand that former Taoiseach Leo Varadkar was instrumental in establishing that funding stream. I am a bit remiss, because Leo Varadkar has encouraged me to reach out to him to discuss the issues, and I have not done that yet. It is on my to-do list, and, if I am really honest, I have been a bit slow on it.”
“I thank the Member. I found it hard to hear her — I think that she was a little bit off-mic — but I got the gist of what she said. I will certainly share the two pieces of information that she listed. <BR /> <BR />We were keen to discuss the fact that, when there is a tragic incident, we have to learn the lessons from it, not just through a paper exercise but by figuring out how we strategise and implement protections. I was very encouraged; Minister Foley is well across her brief, and we had a detailed discussion. Officials will continue to work, mindful that every incident is one that should never happen and has devastating consequences.”
“We are only in the foothills of that, so I do not want to raise expectations, but the Minister mentioned something to me, and we went into quite a detailed discussion about health inequalities. They are the same, whether you are talking about Coleraine, Limerick, Dublin, Belfast, Derry — you name it. I hope that, within the mandate, we will make a pitch to the Shared Island Fund for an initiative that could make a real difference in people's lives.”
“I assure the Member that I believe that that is the case. I have now met Jennifer Carroll MacNeill on two occasions. We had a bilateral in Dublin before we visited the new children's hospital, which is an amazing facility. The scale of it is remarkable. Unfortunately, it has faced the same sorts of financial challenges that the maternity hospital at the Royal Victoria Hospital has faced. In talking to the Minister, I could see her determination to make sure that that hospital is up and running as soon as possible. We found a lot of common ground. The issue on which we found the most common ground regarding where we want to go was health inequalities.”
“I will certainly write to the Member about the 10 projects that will get the €85 million of PEACE PLUS funding.”
“I thank the Member for his question, but I cannot get into detail, because I do not have the full detail in front of me, and I am cautious because I may get as far as seven out of the 10 projects and leave some out. I can tell him, however, that all the projects are worthwhile. The Member is aware that I have a focus on health inequalities. The measure that I want to use to judge whether we are making a positive impact is healthy life expectancy. The Member will also know about the most shocking divergence that has been found by that measure, which is between two females who are born in Belfast and grow up a mile apart, one in the area of most deprivation and the other in the area of least deprivation. Their healthy life expectancy will vary by 14·1 years. That is utterly shocking.”
“I can say only that I absolutely recognise the invaluable work that they do for health and social care delivery and promise that, in my days, I will do my utmost to support them, by which I mean support not with warm words but with finance.”
“I thank the Member for her focus. Sorry, no pun intended. Daisy Lodge in Newcastle is a fantastic facility, and I really enjoyed my visit there. Apart from anything else, the location and the views are absolutely magnificent, and it is a calming environment for young children and their families. To see that replicated in Cong in County Mayo will be fantastic. <BR /> <BR />When it comes to the support that I can give, I will broaden that to include the community and voluntary sector. We could not deliver health and social care, imperfect as it is, in the manner in which we do without the support of that sector, including organisations such as Cancer Focus. Sadly, we will never have enough funds to give such organisations the maximum amount of money that they could use to maximise their ability to deliver.”
“I was encouraged by what I heard at that summit at Croke Park — it was an inaugural summit and very well attended — and I look forward to building on it through the work of not just the North/South Ministerial Council but the two Departments, North and South.”
“I thank the Member for his question. Before I went to Armagh that day, I was at Croke Park in Dublin for an all-island cancer summit, at which a lot of emphasis was placed on collaboration on the island, not just on research but on clinical trials. We are potentially missing a trick when it comes to clinical trials. We do clinical trials, but there is the potential to do a lot more of them. Given the population and the size of the island, we are pretty ideally placed to do clinical trials on an all-island basis, and I am keen that we do them. The Member will be aware of the work of people such as Professor Mark Lawler and Professor Deirdre Heenan in this jurisdiction.”