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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“<BR /> <BR />I have heard of the tracker to which the Member referred, but I think that there is an issue with it here and do not want to try to recall from memory exactly why that is the case. Let me take that away and come back to you, please.”
“I thank the Member for the question and for that focus on suicide. He is well aware, as are other Members, that we are long past the point at which the number of lives lost to suicide in this jurisdiction since the Belfast/Good Friday Agreement in 1998 well exceeded the number of those who lost their life in conflict-related incidents during what we so euphemistically call the Troubles. At the moment, we are at the stage of sharing information to try to get a better understanding of what is going on. For example, we understand that there is a link between areas of deprivation and rates of attempted and completed suicide. That sharing of information is very important.”
“Ministers noted Safefood’s corporate plans for 2020-22 and 2023-25 and the fact that, having been certified by the Comptrollers and Auditors General (C&AGs) in both jurisdictions, its annual report and accounts for 2023 have been laid before the Northern Ireland Assembly and both Houses of the Oireachtas. The Council also approved the appointment of 11 members to the Safefood advisory committee. The Council noted the Safefood presentation on the new community food initiative programme, which will run from 2025 to 2028. The aim of the programme is to positively influence the eating habits of people in low-income communities. <BR /> <BR />Finally, the Council agreed that the next NSMC health and food safety meeting will be held in autumn 2025.”
“The next noted high-level achievements are the food safety, nutrition and healthy eating promotion work that is done by Safefood through its various food safety and nutrition programmes and networks; and the research carried out by Safefood on a range of topics, including consumers’ use of smart devices, food poverty and food safety advice for vulnerable patients and residents in healthcare settings. <BR /> <BR />The Council approved Safefood’s business plans for 2019, 2020, 2022 and 2023 along with the associated budget and grant provision for each. It approved Safefood’s revised business plan for 2024 and noted the revised budget and grant provision. It also approved Safefood’s business plan for 2025 and recommended the associated budget and grant provision.”
“Noted high-level achievements also include the ongoing Safefood for Business training resources that Safefood provides for businesses across the island of Ireland that produce or sell food, about 80% of which are small food businesses; and the new extended 2025-28 community food initiatives programme that was developed in order to positively influence healthy eating habits, in low-income families especially, through the promotion of greater access to and availability of healthy and safe food, using a community development approach.”
“The Council noted the progress report containing Safefood’s high-level achievements since the previous health and food safety sectoral meeting. They include its new food environment campaign 2024-28 to protect children’s health. That campaign was launched in June 2024 in partnership with the Departments of Health in both jurisdictions, the Public Health Agency (PHA), the Health Service Executive (HSE), the Food Safety Authority of Ireland (FSAI) and the Food Standards Agency (FSA).”
“It is focused on knowledge exchange on child welfare and protection developments; the identification and sharing of information on emerging complex child welfare protection issues and the consideration of their impact on cross-border working; and ongoing cross-border cooperation in relation to child welfare and protection. Ministers noted that the knowledge exchange forum, which brings together child protection practitioners from both jurisdictions, continues to meet to share information in the critical area of social work practice within child protection services. Ministers also noted that there has been significant awareness-raising work in both jurisdictions on the need for the dual registration of social workers in relation to children's cases with a cross-border dimension. <BR /> <BR />Let me now turn to food safety.”
“<BR /> <BR />Ministers received a presentation from the Institute of Public Health (IPH) on the policy interface between Ireland and Northern Ireland, with case studies from tobacco control, breastfeeding and data infrastructure. The Council noted that the IPH is working through evidence, policy and partnership to improve health equity and reduce health inequalities in Ireland and Northern Ireland, and noted opportunities for future cooperation between the two jurisdictions. <BR /> <BR />The Council approved the child protection work programme for 2025-28.”
“Ministers welcomed further cooperation on services provided through the North West Cancer Centre, the collaboration by both jurisdictions in working together to develop projects to improve cancer services for patients across both jurisdictions, and efforts to work together to develop a concept as a collaborative project. <BR /> <BR />The Council noted the existing work of the health sector in supporting biodiversity throughout its estates; the opportunity for the health sector to promote the physical and mental health co-benefits of actions to support biodiversity and address climate change; and the intention of both Departments to develop guidance and awareness-raising materials to support the promotion of biodiversity by both Departments and to report this at the next NSMC sectoral meeting.”
“<BR /> <BR />In relation to cancer, the Council noted the valuable services provided to children and their families by the Cancer Fund for Children and welcomed the progression of the Daisy Lodge therapeutic centre at Cong in County Mayo. Ministers welcomed the awarding of five research grants under the Ireland-Northern Ireland-US National Cancer Institute Cancer Consortium, which will enhance collaboration and innovation amongst cancer researchers and experts across the three jurisdictions. The Council noted the continuing efforts and engagement to improve cancer research and clinical trials on an island-of-Ireland scale and the benefits for patients from the ongoing cooperation and expansion of radiotherapy services at Altnagelvin Area Hospital.”
“<BR /> <BR />In receiving an update on cooperation between the two Departments, the Council noted the ongoing collaboration on issues connected with alcohol and drug use, such as the sharing of learnings through the North/South alcohol policy advisory group; that work on suicide prevention initiatives in both jurisdictions is ongoing, including the exploration of potential opportunities for further joint working to prevent suicide; an update on the all-island congenital heart disease network; an update on cross-border emergency planning and response, where both Health Departments will work collaboratively to seek ways in which to further cooperate in emergency planning and response; the ongoing work between the Northern Ireland Ambulance Service and the National Ambulance Service; that the all-island medication safety conference took place in November 2024, with a further one planned in 2026; the signing of a memorandum of understanding between the Medicines Optimisation Innovation Centre and the Health Innovation Hub Ireland; and that funding of just over €85 million has been awarded to 10 projects under PEACE PLUS to target health inequalities among communities in Northern Ireland and the border counties of Ireland.”
“On health, the Council welcomed the progress that has been made to date in implementing the Council's current work programme in the health sector. Ministers noted that both Health Departments have engaged on additional areas that have potential for further development and collaboration between the health authorities in both jurisdictions. That work is to ensure that the work programme reflects the priorities of each Administration and that a refreshed work programme will be presented at the next health and food safety sectoral meeting. I also took the opportunity to reiterate the benefit of enhancing practical North/South health cooperation and the value that it would have in sustaining and enhancing services in the border region.”
“In compliance with section 52 of the Northern Ireland Act 1998, I wish to make the following statement on the twenty-sixth North/South Ministerial Council (NSMC) meeting in the health and food safety sectoral format, which was held in Armagh on Wednesday last, 14 May 2025. I was joined at the meeting by junior Minister Aisling Reilly MLA, who attended as the accompanying Minister. Jennifer Carroll MacNeill TD, Minister for Health, and Norma Foley TD, Minister for Children, Disability and Equality, represented the Government of Ireland. Minister Carroll MacNeill chaired the meeting. This statement has been agreed with junior Minister Reilly, and I make it on behalf of both of us.”
“I thank the Member for her question. On rurality, there will be an equitable distribution of the funds. The £5 million for indemnity and the £3·5 million plus for National Insurance are not for urban or rural areas; they are for all GP practices. The Member will be aware that, recently, the transformation fund promised £61 million to increase the availability of MDTs, but that will only take the teams to 12 of the 17 GP federations. Unfortunately, it will be the end of the decade before we can realistically look at making MDTs available to every GP in all 17 GP federations.”
“I thank the Member for her question. She made the point that the situation is the outworking of decades of underinvestment, failure and missed opportunities. I have said that I am not going to criticise what has gone before, because it will not improve the outcomes for a single patient or service user. I want to be forward-looking. I have already told you about the 86% increase in GP training places over the past nine years. I made a major announcement last week about pre-registration training right across a range of specialities, and I direct the Member to that statement.”
“I thank the Member for his question. I assure him that there was no accusation — no accusation — in my opening remarks. I regret that we have come to this pass, but it is a pass — it is an impasse — because GPs want £80 million that I do not have; in fact, it is questionable whether that would be the best investment across Health and Social Care. <BR /> <BR />I regret that we are in this position. I emphasise the fact that I have spoken to the chair of that committee today, and we have agreed that we will meet again and discuss a way forward. That is not to say that the negotiations for 2025-26 are still open — they are not — but we need to take a longer-term view for the sake of all the people of this country.”
“I thank the Member. I outlined in my opening remarks some of the measures that we were intending to propose to GPs. We will continue to press GPs to address the serious issues with access.”
“I thank the Member for his comments. Am I unwilling to respond? If you are talking about giving GPs an extra £80 million for doing more of the same, I am unwilling to respond, because I cannot afford to respond in that way.”
“I thank the Member for his question. I cannot quantify how many GPs or surgeries are now beginning to contemplate contract hand-back, but I can tell the Member this: if we had not put the additional £9.5 million in, it is likely that even more would be finding themselves thinking in that direction.”
“I would just draw the Member's attention to the fact that I began by saying that I believe that I am a friend of the GPs because of my emphasis on the shift left. What I have done is state the facts. If the Member does not like the tone, that is a matter for the Member.”
“I thank the Member for her question. Of course, if you want to make becoming a GP attractive, you will put more into GP practices, but the money does not exist. There is a shortfall of half a billion pounds in the current Health and Social Care budget. We are investing, and we are investing in the GP workforce. I say to the Member that, to help primary care to deliver and to grow, which is what her question was on, you have to train, develop and retain the GP workforce. Despite the number of GPs who are on principal salary retainers having increased by about 9% between 2018 and 2023, that has been offset by changing patterns of workforce. The annual intake to GP training sits at 121, and that is an increase of 86% since the 2015-16 financial year. In less than a decade, it is up to 121.”
“The Member needs to realise that there is not a limitless pot of money. One million pounds is not fantastic — I accept that — but no money is worse. We have done what we can, avoiding catastrophic cuts elsewhere in health and social care delivery.”
“If I have understood the Member correctly, he is asking for indemnity for all GP practices. That is exactly what we are providing.”
“I thank the Member. The money that Mr Swann put in was to improve access to telephony and IT services, and there are IT solutions to achieve what she has asked about. On her concern that this may lead to the collapse of GP practices, I suggest to her that, if we had decided to withhold the £5 million for indemnity and the £3·5 million for National Insurance and not put in the extra £1 million, that would have put more pressure on GP practices that are struggling with their finances.”
“I am convinced that we have dealt with, on a long-term sustainable basis, the toxic issue of indemnity, which has become toxic over a number of years. Absolutely, we have done that. We have covered the hike in employers' National Insurance contributions, whether that is £3·5 million or maybe a little bit more. We have managed to put another £1 million into the core funding envelope. I know that that is well short of what the GPs want. Is it a perfect solution? Of course it is not. As I said in my remarks, I would love to give more money to every core element of health and social care delivery, but the budget is not there to achieve that.”
“I find the Member's language inflammatory and far from helpful. Once again, I say that we are implementing, not imposing, the contract.”
“I thank the Member for his question. I made the point in my remarks that we based the £3·5 million on figures from the Government Actuary's Department and the three big indemnity insurance companies, so we have a solid evidence base. I am not sure of the extent to which we have disclosed the statistics to the BMA, but what we have done, which is much more important, is that I have given a ministerial guarantee to that committee that, if GP practices can prove that £3·5 million is not enough, which they should be able to prove through receipts, we will make up the shortfall. Therefore, they should not lose out and should not have to fund a single penny of the additional hike in employers' National Insurance contributions.”
“I thank the Member for his question. Yes, of course I do. As I said in my remarks, one of our proposals on access issues was pre-bookable slots, so that the people who are making dozens and dozens of calls and are sometimes frustrated to be told that all the bookings for the day are gone might be able to pre-book. I think that that would be of great comfort to many of the people who spend a lot of time on redial.”
“I want to fix that, but I cannot fix it with money.”
“I think that the Member is aware that I am very conscious about access to GPs, and we wanted to make access to GPs a part of the negotiations, which would have led to a bilateral agreement between my Department and the General Practitioners Committee. We were not able to get there. In fact, we refined our asks around access; I think that we made them simple and cost-neutral to GPs. At the last meeting that I had, when they said that they were going to ballot their members, I asked the direct question, "Are you prepared to share our latest proposals on access with your members before they vote?". No such commitment was given. We are not in a good place; I accept that, and I accept that, if you cannot get timely access to the GP, the implications for the service user or patient can be extremely severe.”
“I thank the Member for his questions. I would love, as I said in my remarks, to fund the shift left immediately. By the way, I do not necessarily accept the figure of 5·4%, because all these things are open to debate. How do I justify not increasing the money? I justify it because, to fund that, you would be talking about catastrophic cuts. You would be talking about potentially closing an intensive care unit bed. The Member is a nurse, and he knows how catastrophic those cuts would be. I have spoken to the chair today and said, "Let's talk", and she has agreed that we should talk. What is on my agenda is the longer-term view of how we achieve that shift left, but, at the moment, with a £0·5 billion hole in the budget, I cannot find £80 million for GPs.”
“I gently remind the Member that, although she says that this is a strange way to conduct a negotiation, the negotiations are over. I am not conducting a negotiation. The negotiations are over.”
“I have no alternative to taking this course of action, because the money does not exist. Let Hansard record that the statistic that the Member quoted is the response of those who voted. It seemed to me that the Member was trying to imply that it was 99·7% of all GPs, but that was only the responses of the GPs who voted.”
“In return, I ask the Member whether he will take responsibility for his language. We are implementing this: we are not imposing it on the GPs. You are using inflammatory language, which is a matter of regret. <BR /> <BR />I have gone as far as I can go with the financial offer. I have detailed it to you. I am not the first to make it public. The GPs were balloted by the General Practitioners Committee, so they know what the offer was. They know that it was £9·5 million. They know that £5 million of that was for indemnity, that at least £3·5 million was being made available for National Insurance and that another £1 million was being put into the pot. I twice said, "Tell me what you would do for service delivery with an additional £80 million", and I did not get a response, because the answer is that it would only be more of the same.”
“That is another reason why I cannot go any further on the GP contract this year or, indeed, on the so many other parts of Health and Social Care that are crying out for additional funding. <BR /> <BR />I will now listen carefully to what Members have to say. I can only hope that no one will turn it into a party political issue. I commend the statement to the House.”
“My door is always open for genuine engagement and discussions. <BR /> <BR />I remind Members of the importance of distinguishing between GP contract negotiations and pay negotiations. Pay is a separate process, and I await publication of national pay review recommendations on pay increases this year for GPs, other doctors and the wider health service workforce. I have said that, all things being equal, my intention is to implement the pay increase recommendations as promptly as possible. That will put further pressures on my overall budget, particularly if the proposed increases are well above inflation. The likelihood is that my budget shortfall will grow even further.”
“In financial terms, the cupboard is bare, and there is no point in pretending that I can serve up a sumptuous three-course meal. There is nothing to be gained from further contract negotiations, which would only offer false hope that a better offer might be forthcoming; it will not be. We are at the end point for this year. <BR /> <BR />I have, therefore, taken the decision to go ahead and implement the contract on offer. I do so mindful of the pressures that GPs are facing in relation to National Insurance bills and the longstanding concerns about indemnity cover. I want the funding that I have been able to earmark for those areas to be released and to provide immediate assistance. Further delay will help no one. As always, I will continue to engage closely with the BMA and GPs.”
“I think that I am entitled to see concrete proposals from the BMA. The BMA's Northern Ireland General Practitioners Committee has asked to meet me following the ballot result, and I remain 100% committed to dialogue with the BMA and all the other professional groups and trade unions in the health service. My record speaks for itself on that. <BR /> <BR />I met the General Practitioners Committee's chair earlier today. My permanent secretary is due to meet the BMA tomorrow to jointly discuss how we expand and enhance GP services and how we can shift resources gradually but steadily from hospitals to community-based services. I had to tell the chair that the GP contract on offer for 2025-26 is at the very limit of what I can do.”
“I also wanted GPs to establish patient participation groups to give patients a voice in how they are served by their practices and for practices to undertake patient satisfaction surveys. Some of the proposals had already been included in the previous year's contract, with the only changes being to some of the wording. Yet, instead of agreeing to those, the BMA offered only to join a new working group to consider them. That was not acceptable to me nor would it be acceptable, I suspect, to most Members. Furthermore, I asked the BMA to commit to sharing with its members our latest proposals for addressing the now wholly untenable access issues. Regrettably, they gave no assurance that they would forward that paper. <BR /> <BR />The time for general open-ended discussions on improving access is over.”
“Some of those things are simple to implement and do not involve any additional cost to practices, such as making sure that practices make some of their appointment slots bookable so that patients do not always have to call back another time when the daily capacity has been reached; making sure that practices make the most of the digital functionality that they already have to make ordering repeat prescriptions easier; and making sure that, when patients walk in to make an appointment, they do not have to buzz their way into the practice and are dealt with appropriately by a member of staff there and then, rather than having to go outside and phone in.”
“Over the past 12 months, MLAs from across the House have written to me to highlight the challenges faced in accessing some practices. We still have many exceptional GP practices, but, from the messages that we receive directly from patients, I can see that some people are still having to phone hundreds of times in the hope of securing an appointment to see their GP. That is not sustainable. <BR /> <BR />My Department's contract proposals included a number of small but significant changes to help improve patients' experience of accessing services.”
“We asked it this direct question, "Will you advise your colleagues on which way to vote?". The GPC was equally direct, saying that it would simply state the facts. "Our members will decide" was its position. Two days later, its chair was publicly urging members:”
“<BR /> <BR />To summarise, there is £5 million of new money for indemnity, £3·5 million of new money for employers' National Insurance and £1 million of other new money. That is £9·5 million in total. That £9·5 million was hard to source. The Health budget now has a shortfall of in excess of half a billion pounds. I repeat: the shortfall is north of £500 million. I face the quadruple challenge of tackling waiting lists; mitigating the damage being done to other services from the diversion of £165 million from my existing budget to tackle those waiting lists; funding further reform of healthcare; and balancing the books. <BR /> <BR />I met the BMA NI GPC on Tuesday 29 April. It was clear that it did not like the offer and was determined to ballot its members.”
“It would simply be for more of the same. Given the sheer scale of the pressures facing public services across all Departments, that is not a realistic approach to take. That is therefore the position. Giving GPs another £80 million to do what they are already doing, with a vague promise that they will sit down to discuss the severe access issues, is not an option that I can contemplate when there is already a funding gap of half a billion pounds and more in the Department of Health's budget overall. I have been consistent in stating that I will not sign off on catastrophic cuts in order to reduce that funding gap. For the avoidance of doubt, "catastrophic cuts" are cuts that put lives at risk, such as closing an intensive care unit bed.”
“I have already confirmed that the total investment in GP services this year will be over £414 million and will include pay uplifts from last year and the recently announced investments in multidisciplinary teams (MDTs) and in the primary care elective service. I expect to make a further increase of £10 million to £20 million, or perhaps of £20 million to £30 million, once the pay review body recommendations are decided on for this year. <BR /> <BR />We have already offered a further unconditional £1 million, yet the BMA NI GPC told me that it wanted £80 million. On at least two occasions, I asked its chair to give me a one-pager outlining what new services it would offer in return. That never came. The extra £80 million is not being demanded for reform or expansion or, indeed, for measures to improve public access to GP services.”
“When GPs said that that may not be enough, I promised that, if they could produce evidence for that — receipts that proved that it was not enough — I would make up the shortfall. That is another offer that the BMA has rejected. <BR /> <BR />The third GP demand was for more money. Let me be clear: I wish that I had far more money to invest in primary care. I wish that I had more money to invest in all the really important areas, but the financial realities of repeated Budget settlements that Members endorsed and approved prevent me from doing that. It is simply not the case, however, that extra investment is not being made or, as I read in a public statement last week, that money is even being cut from primary care. In the 2023-24 financial year, the total investment in general practice across Northern Ireland was £388 million.”
“Indeed, in March this year, the Public Accounts Committee questioned whether the Department of Health was incentivising GPs to work as locums, to the detriment of the service. I trust that colleagues from that Committee will therefore be supportive of the approach to fund practices directly for the costs of indemnity. The BMA's GP membership has now rejected that offer. <BR /> <BR />That was one of three key demands. The second concerned the hike in employers' National Insurance contributions. I take the view that it is deeply unfair to ask GPs to fund those increases, so, despite the deficit position that my Department faces, I had already decided that it would not be fair or reasonable to ask practices to meet the extra costs. That is why we put £3·5 million on the table to cover the full costs.”
“It is therefore entirely appropriate that the support we offer be targeted to those practices.”
“I recognise that the BMA states that £5 million is not sufficient to cover the full costs of indemnity, but let me explain to Members that the value of the offer on indemnity is based on data on the actual subscription costs paid by GPs in Northern Ireland. The data was provided by the three medical defence organisations that provide the overwhelming majority of cover to GPs here, and it was subject to external expert analysis provided by the Government Actuary's Department. I am content that the offer that my Department has made on indemnity is fair and meets the needs of the service. <BR /> <BR />As to criticism from GP representatives that the offer is not open to locums, I make no apology for that. My Department contracts with GP practices for the provision of services to the population.”
“When I took up post, GPs were accusing my Department of unilaterally changing the agreement in the letter of offer. My officials were insistent that that was not the case, and, from reviewing the agreement and the letters exchanged at the time, I tend to agree. However, I offered independent arbitration, promising to make good any financial shortfall, should the GPs be right. The GPs did not take up that offer. I still do not understand why not, but the suspicion has to be that they recognised that they were seeking to shift the terms of a deal to which they had previously agreed. <BR /> <BR />This year, the offer is to put that £5 million back into the pot to use for core services and to provide a new, fresh, additional £5 million for indemnity. That is a good outcome.”