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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“Believe me, I share its frustration that, year after year, there have been inadequate budgets for health and social care, but I must question the wisdom of tabling unachievable demands at a time when budgetary pressures are at an all-time high. I also have to respectfully wonder what it hopes to achieve by treating an ally of primary care as an adversary. All, of course, is fair in love, war and funding bids, but those tactics make absolutely no sense to me. <BR /> <BR />By way of background, I will start with an issue from last year's negotiations: the question of indemnity, which has been allowed to become toxic over a number of years. Last year, my Department offered £5 million repurposed from the existing funding baseline as a short-term fix pending agreement on the full and final settlement.”
“Members will be well aware of my ambition as Health Minister — the so-called shift left — to focus on prevention and early intervention, switching focus from our acute hospitals to concentrate on primary, community and social care. I am not saying that, as Minister of Health, I am the best friend that GPs could have hoped for, because I am sure that every Minister has cherished primary care, but I hope that they understand that it is a key focus of mine. <BR /> <BR />That said, I did not come into post to make promises that I could not keep or agree to demands that the budget cannot satisfy. Regrettably, I have been faced with such a demand by the British Medical Association Northern Ireland General Practitioners Committee (GPC) in relation to the GP contract for 2025-26.”
“I thank you, Mr Speaker. When I took up post, the last thing that I was looking for was a fight. I have huge respect for the tens of thousands of wonderful colleagues who deliver excellent healthcare every day in Northern Ireland, including, of course, GPs. In fact, I could argue that a GP saved my life, because it was my doctor, fresh into post, who had the professional curiosity that alerted him to the possibility that I had a heart condition. He sent me for tests, which ended with my being fitted with two stents, a pacemaker and a defibrillator. Please believe me when I say that I have a personal interest in supporting primary care. <BR /> <BR />That personal interest is matched by a professional one.”
“I thank the Member for giving way. Let me be absolutely clear: the reason for the timing was the fact that Encompass went live in the final two of the geographically defined trusts on Thursday 8 May. That was the reason.”
“I thank the Member for giving way. I ran out of time, but I should have it made clear that I very much welcome your clarification that any ring-fenced money for cancer treatment should be additional and not come out of the existing budget. Thank you.”
“She may want to get her DUP team in order, because, since I made the announcement and since she made it clear that she is not a supporter of the scheme, one of her MLA colleagues has written to me asking for more details about it, as has her Member of Parliament, Mrs Lockhart. Indeed, if I had time, I could quote Mrs Dodds's support for bringing in external help.”
“The ongoing challenges are with consultant recruitment for dermatology, which, sadly, has resulted in a long wait for red-flag outpatient appointments across most trusts. The Western Trust in particular is reliant on a single-handed consultant. The Belfast Trust has seen a significant reduction due to leavers. Recruitment exercises have been undertaken but have generally been unsuccessful, I am afraid to say. <BR /> <BR />Finally, I know that Mrs Dodds is no fan of the waiting list reimbursement scheme. She is absolutely wrong to say that it is not about providing additional procedures, because it will. I imagine that there will be over 1,000 procedures, if all the money is spent.”
“Finally, the motion calls on me to engage proactively with the Executive's delivery unit on how best to apply ring-fenced funding. We submitted three bids to the public-sector transformation fund, and the one for multidisciplinary teams was successful. I welcome all opportunities to work with Executive colleagues and, indeed, the delivery unit, but, as Professor Bengoa reminded us, it is systems, not structures, that matter. <BR /> <BR />A couple of other questions were asked of me, one of which was about elective theatres in Belfast City Hospital (BCH). I believe that there are a total of seven theatres in BCH. Theatres 1 and 2 were refurbished 18 months ago, and the plan is to continue to roll out refurbishment over the next two to three years. <BR /> <BR />Mrs Dodds asked about skin cancer.”
“The level of funding will, of course, determine the speed at and the extent to which the reforms are taken forward.”
“In a few weeks' time, I expect to publish the next three-year cancer strategy implementation plan for 2025 to 2028. That will further the reforms that are needed in order to modernise and enhance cancer services.”
“The next highest was via the emergency presentation route, at 23·3%, which is far too high. <BR /> <BR />Cancer treatment is frequently and rapidly changing, not least by way of new medicines, with approximately 50 drugs per annum, alongside merging technological advancement and innovations in gene therapies, as well as earlier diagnosis and interventions. That makes it a very dynamic clinical space, which requires a robust workforce strategy and training programmes that keep pace with advancements and service demands. Investment in cancer services is required in order to enable transformation to more-sustainable models of care that will be resilient to more-effectively meet current and projected demand. <BR /> <BR />I have always been clear that the implementation of the strategy is a priority for me.”
“The reliance on non-recurrent funding and the need for substantial and sustained investment in core service provision and equipment also contributes to the challenges. <BR /> <BR />A recent report that was published by the Northern Ireland Cancer Registry, 'Routes to diagnosis of cancer', reported that only one third of those who were diagnosed between 2018 and 2021 presented via a GP red flag referral. Other routes included urgent and routine referrals, emergency presentation and screening programmes. Therefore, a whole-system approach will be required. Miss McAllister mentioned that too many people were presenting at emergency departments. The latest stats, for the financial years 2018 to 2022, reveal that of the most common routes to diagnosis amongst cancers, excluding non-melanoma skin cancer, the highest was 33·5%.”
“<BR /> <BR />Those collaborative efforts aim to alleviate pressures on the cancer diagnostic pathways overall, ensuring that patients receive the care that they need as efficiently as possible. I hope that Miss McAllister will greet that as good news, given the questions that she put during her remarks. <BR /> <BR />While I recognise the fully unacceptable performance and do not want to understate that in any way, I note that, once diagnosed, 88% of patients received their first definitive treatment within 31 days and that the overwhelming majority of patients received an excellent standard of care. I must pay tribute to our medical and nursing staff and all those who provide the service, who have been working tirelessly to meet the increased demand. <BR /> <BR />Workforce vacancies limit the system's ability to respond promptly.”
“We have the development of in-house HSC capacity and continued investment in staffing, building our internal capacity and investing in our workforce. That is essential for sustainable improvements. The rapid diagnostic centres aim to provide faster diagnosis for patients with suspected cancer. Those centres currently offer the vague-symptom pathway with several clinical pathways under consideration. <BR /> <BR />Funding was secured for a CT and MRI scanner at each RDC location in order to support a portfolio of diagnostic pathways. The MRIs are anticipated to be operational from the summer of this year and will provide an estimated 6,920 MRI scans during the 2025-26 financial year. CT capacity is estimated to provide an additional 9,000 scans.”
“Those centres have increased access to endoscopy for all trusts, supporting the diagnostic part of the cancer pathway. We have three elective overnight stay centres at Daisy Hill Hospital, Mater Hospital and South West Acute Hospital, which have increased access to diagnostic tests and to procedures. We have two rapid diagnostic centres (RDCs) at Whiteabbey Hospital and South Tyrone Hospital, which will enhance regional CT and MRI diagnostic capacity. Service reviews of general surgery, urology and gynaecology aim to set the direction for improvement in key tumour sites under significant demand and capacity pressures. <BR /> <BR />Furthermore, we have the introduction of mega-clinics, which are designed to maximise patient throughput and efficiency.”
“The imaging academy will deliver an overall increase in imaging capacity in HSC for the benefit of all clinical specialists and support the reduction of excess waiting lists for diagnosis and treatment, as well as meeting the demands for unscheduled care. <BR /> <BR />In the difficult financial environment, we continue to tackle our lengthy waiting lists with the resources that are available to us, and we strive to improve the effectiveness and efficiency of the service. In May 2024, we launched the updated elective care framework, which outlines the strategic direction for the development and implementation of effective and sustainable elective care services in HSC over the next five years. <BR /> <BR />Today, we have two dedicated day procedure centres at Lagan Valley Hospital and Omagh Hospital.”
“If patients wait beyond two weeks for an imaging test, the chance of meeting the 62-day standard is reduced. Plans are in place within the Department's 15-year capital plan for a significant investment over the next 10 years to expand the equipment base, which includes additional MRI scanners. Again, that will be subject to funding approval. <BR /> <BR />My Department is aware that the imaging workforce in Northern Ireland is constrained. A costed workforce plan for imaging services, including diagnostic and interventional radiology, has been developed. A multi-professional imaging training academy for Northern Ireland will address the radiology and advanced practitioner radiographer workforce deficit.”
“There is a significant demand/capacity gap across elective care, imaging and endoscopy services that delays the initial diagnosis. The increase in unscheduled care has further strained the system. Additionally, the phased introduction of Encompass since November 2023, as expected, has had an impact, but it is now expected to deliver greater benefit as the system embeds and provides opportunity to work more effectively on a regional basis. I welcome the fact that Encompass is now live in all five geographically defined trusts. <BR /> <BR />Together, those challenges have compounded the difficulties that we face in providing timely access to diagnosing patients. To tackle the challenges, we must focus on improving the entire pathway from referral to diagnosis, including endoscopy, imaging and pathology as well as treatment.”
“The most recently published statistics on cancer performance waiting times, which were for the quarter ending December 2024, reported that, against a target of 95%, 34·2% of patients began their first definitive treatment within 62 days following an urgent GP referral. I join Members in asking the question that Mr Dickson asked: why? <BR /> <BR />The poor performance in general is due to several interrelated factors. First, regional red-flag referral trends show a significant increase of approximately 39% in the five years from 2017-18 to 2022-23, without the required resource to meet that growing demand. The ring-fencing of approximately £85 million will allow health and social care (HSC) investment, and that will be in core services that previously relied on non-recurrent waiting list initiative funding to help bridge the gap.”
“It will consider whether changes are required to how breast services are structured in order to ensure that those who are referred with suspected breast cancer are seen quickly and that those who are diagnosed are treated in a timely manner. That will ensure that we can deliver the best possible outcomes for those with breast cancer. <BR /> <BR />I acknowledge the profound impact of poor cancer waiting times on patients and their families, but I can do that no more eloquently than Mr Dickson already has. Regrettably, he knows what he is talking about. It is important to be clear about the full extent of the problem.”
“The new system will ensure that everybody referred for breast assessment across the region experiences a similar wait. Most people will still be seen at their nearest hospital, but some may be offered an earlier appointment at another acute venue. That will equalise the waits. I acknowledge that there is still more work to be done to address the demand/capacity gap and increase the number of breast assessment clinics across Northern Ireland, but I consider this to be a positive advancement. <BR /> <BR />Trusts will continue to work with the Department to address the backlog of waits through the provision of additional waiting-list clinics, and further capacity will be sought from the independent sector. I expect to publish the next phase of the breast review later this year.”
“Those same figures also illustrated the wholly unsustainable levels of variations across the trusts. The waiting times for breast cancer services have been a particular concern. To address that, I announced a review in September last year. That review is considering how regional breast cancer services can be reconfigured and developed to deliver timely and appropriate care for patients. The first phase of the work was the creation of a regional waiting list for red-flag breast cancer assessments to address disparities in times across the geographic trusts. I am pleased to announce that the new regional booking system went live across all five geographically defined trusts last Thursday, 8 May, for patients referred with suspected breast cancer.”
“and, in particular, the fact that in quarter 3 of last year:”
“It will set out the details of how up to £215 million will be invested. <BR /> <BR />The motion highlights the:”
“However, that, of course, means that £165 million has to be found from within the existing allocation. As I highlighted to Executive colleagues, that will inevitably have consequences for wider provision, and, if I am being honest, that means my ability to fund reform and to balance the budget by the end of March. As that was an Executive-wide decision with which I fully agreed, I hope to get the support of Executive colleagues in managing all the challenges. <BR /> <BR />The £215 million breaks down into £85 million for red-flag and time-critical care; £80 million for building capacity to address long-standing mismatches; and up to £50 million to start tackling the backlog. As I promised last week, my Department will provide later this month an implementation plan for the elective care framework.”
“I could say, "Let us have a witch-hunt to see the lost opportunities", but I will not. The reason why I will not do that is because it would not improve the potential outcome for a single patient who is on a cancer waiting list today. Let us be future-focused about it. That is where my mind is. <BR /> <BR />I have been clear that, in order to clear the backlog of patients, we need recurrent, sustained and significant effort, as well as sustained intervention and funding that will be required over a period of five years. As I announced in the House last week, we have made a start. I fully support the Executive's decision to prioritise waiting lists, and I welcome the ring-fencing of up to £215 million in this year's Budget for activities in waiting list reductions. That includes £50 million of additional allocation to the Health budget.”
“Principal Deputy Speaker, thank you. I have a lot to get through in 15 minutes. Mr McGuigan kindly referenced the fact that today is International Nurses' Day. I join him in thanking nurses for everything that they do. He was too modest to say that he was at the Stormont estate on Saturday to take part in the Stormont parkrun. The parkrun was dedicated to International Day of the Midwife, which was last Monday, and International Nurses' Day, which is today. Mr Donnelly also took part in the parkrun, as did Minister Muir. I commend all three. <BR /> <BR />For the avoidance of doubt, I agree that cancer waiting times are completely — completely — unacceptable. Mrs Dodds made the point that they have been that way since 2012. I could list all the Ministers who have been in post over the past 13 years.”
“Among all the elements of the cocktail, my priority is our own health and social care workforce and the health and social care system.”
“I thank the Member for his comments. The fact is that we do not have the capacity exclusively within our health and social care system to tackle waiting lists in a timely manner. As I said, there has to be a cocktail within which money will go to the independent sector. Is that really good news? No. I would much rather all the money were devoted to our own workforce, our health and social care system and our six trusts, including the Ambulance Service. In an ideal world, we would not have a reimbursement scheme in which people are reimbursed for going outside Northern Ireland. We would not have an independent sector. However, that is so far from reality that it is hardly even aspirational. We have to do it as we can.”
“I thank the Member for his question. As I have just said, our issues and challenges are not particular to us in Northern Ireland, so I do not accept that premise. The waiting list reimbursement scheme is based on the cross-border directive, which allowed patients to be reimbursed for treatment outside Northern Ireland. Other work is ongoing with independent sector providers within Northern Ireland. We are also looking at the capacity in Health and Social Care, not least building up our workforce, because it is primarily, although not exclusively, by building up the workforce that we will become less reliant on the independent sector.”
“That is a brand-new facility in the United States. I have also had correspondence from somebody in the Algarve in Portugal who spent two days on a trolley before having what they considered to be lifesaving surgery. It is not just us, but of course I support the principle of having the resources, the workforce, the equipment and the medicines to deliver world-class healthcare free at the point of delivery.”
“Let me stress again that the cross-border scheme represents £10 million out of £215 million. Nearly every MLA in the House has contacted me about reinstating it. I am conscious of the equity issue that, if you cannot afford private healthcare, you are at a disadvantage relative to people who can afford to pay up front. I gently disagree with the idea that everybody now believes that they have to go private to get elective care. It is not particular to this place. For example, in March, when I was in Washington, I visited Georgetown University Hospital. It was built in 1947 but recently had an $800 million extension, including the biggest ED that I have ever seen. Every corridor of that ED had trolleys backed up, with patients lying on them. When I asked what was going on, I was told, "This happens 365 days of the year".”
“<BR /> <BR />At the moment, I do not have the detail on where the mega-clinics will be located, but I see no reason why Daisy Hill should not be on the list of prospective venues.”
“I welcome the Member's comments. Will Daisy Hill be a mega-clinic? If the question is, "Will there be mega-clinics at Daisy Hill?", the answer will probably be yes. The only mega-clinic that I have visited was at Belfast City Hospital. It is about using space and workforce on a Saturday. In the clinic that I saw, for example, a lot of patients who had been on waiting lists for a long time had come for validation, basically, to be asked, "Do you still need the procedure?", and, "Have you got worse over the years?". Patients also had their pre-operative anaesthetic consultation there. The patients whom I observed on that Saturday at Belfast City Hospital were told, "You will be in the Mater Hospital next week"; it is that good.”
“We are working urgently, which is why I say that the scheme will open next month, but, on what we will offer from next month and the sequence of procedures within that, we are not there yet in our negotiations with the Republic. I am sorry not to be more definite, and I understand what it is like to sit there, having committed maybe £15,000 to a procedure that is coming up in July, and wonder, "Could I save that 15 grand for my children or my grandchildren?". I get that, and we will get the answers as quickly as we can.”
“I thank the Member, who raises an important point. Unfortunately — it is unfortunate, I think — there are no arrangements for patients who have already spent money on private treatment to be reimbursed, because the scheme will be open only to pre-authorised treatments, so we cannot work retrospectively. Like the Member, as a constituency MLA, I have been approached by constituents who ask, "I am on a waiting list for the private sector. I am about to spend a significant amount of money on a procedure. Should I hold fire?". I am not, I am afraid, in a position to offer that level of advice. <BR /> <BR />We are working with the health authorities in the Republic, so, clearly, we cannot simply book blocks of its resource, and, as I said, we are still in the foothills of organising this.”
“I thank the Member for her question. As I said, this is an opportunity to reassure communities, not least those in Enniskillen, Coleraine and Newry, that their local hospitals are here to stay and that they have specific roles. In the case of the South West Acute Hospital, it is important to stress that there are not only two uncommissioned theatres but two uncommissioned wards and that, as an elective overnight stay centre, it is therefore in an ideal position to start to do a lot of good work in tackling waiting lists, if we can get the workforce together to utilise those theatres and wards.”
“I thank the Member for his comments. In response to his question, I cannot guarantee the spending of the £10 million, because it will be spent whenever people come forward and ask to be included in the initiative. This will never happen, but, were nobody to come forward, the £10 million would have to be reallocated. I imagine that we will not have any particular difficulty in spending the £10 million during this financial year, but we shall see.”
“I thank the Member for his question. I mentioned the SWAH. I also want to see a significant amount of the money being invested in the Causeway Hospital and Daisy Hill. I say to Members that no hospital will close on my watch. We need every square yard — every square metre — of available HSC space not just to deal with the unacceptably long waiting lists but for a great number of procedures. The theory and principle behind separating emergency and elective surgery are sound: it means that there should be a minimum number of cancellations and maximum efficiencies and productivity. I look forward to updating the Member with more detail on what part of the £215 million will go to the Causeway Hospital.”
“I thank the Member for the question. He is aware that I have campaigned on mental health issues since being elected a number of years ago. I am aware that we are yet to address that. I assure the Member that the fact that my remarks did not cover that area does not mean that it will not be covered or that I have in some way lost interest in it. I recognise the fact that it is a very important area, and we will seek to do what we can on it over the next 11 months.”
“If you had seen my mailbag over the past 11 months, you would know that nearly every Member has called for the reinstatement of the cross-border scheme. That is being done according to the will of the House.”
“I thank the Member for her question. The waiting list reimbursement scheme is just one of a number of mechanisms, as I outlined in my remarks. It is part of a cocktail that will involve using HSC capacity and the independent sector to expand. I point out to the Member that the budget for the waiting list reimbursement scheme is £10 million, which means that there is up to £205 million to be used in HSC and the independent sector. <BR /> <BR />I agree that there is an equity issue: you have to be able to afford the treatment outside our jurisdiction to be able to claim the money back. To be clear to Members: we reimburse only what the cost of the procedure would have been under HSC; it does not cover travel or accommodation, including that of, say, a partner. However, it is a good scheme.”
“I thank the Member for her interest in cancer, which is another area of focus that I identified 11 months ago when I took up post. There is £85 million in that £215 million that is going to be for red-flag and time-sensitive matters, including cancer care. As I said, it will take up to five years to get all the lists back to acceptable levels, including those for the various cancers. There will be more detail in the implementation plan, which you should have before the end of the month.”
“I thank the Member for the question. I hope that I can give him that assurance. The fact is that this is May 2025 and we are due to have an Assembly election in May 2027, so I have to proceed on the basis that I have a maximum of two years left as Minister of Health. As the Member knows, we have a new permanent secretary in Mike Farrar, who is going to be with us for at least a year. I am hopeful that we can extend that to two years so that we can work together to try to deliver on the quadruple challenge that I have outlined. In order to do that within 24 months, the bottom line is that you have to approach everything that you do with the utmost urgency.”
“Obviously, we will be open and transparent in measuring the effectiveness of any implementation plan. This is big money. These are people who are either extremely vulnerable and/or who have been waiting for far too long on waiting lists. It is extremely important to me that everybody, not just Members but every citizen of Northern Ireland, understands how well implementation is being carried out across health and social care delivery.”
“I thank the Member for her question. I want to make it clear that I want regional standardised services right across health and social care delivery. As I have said to the chairs and chief executives of the trusts right from the very beginning, they may be five geographically located trusts, but, in my mind, they operate as one trust. That standardisation and regionalisation is very important in ensuring that we do not have a postcode lottery. <BR /> <BR />Was there another point that I missed?”
“I thank the Member for her question. As I have said before, tackling the waiting lists will require a cocktail of actions. You have the cross-border scheme, which is being turned into a waiting list reimbursement scheme, will be Europe-wide by the time that it is fully functional and will have a requirement to use the independent sector. However, the first port of call is to see what more we can do in our own health and social care system. When we were made aware that up to £215 million was being ring-fenced for tackling waiting lists, one of the first points that I made to officials was that in the South West Acute Hospital, there are two wards and two theatres that have not yet been commissioned. I want us to look at how we maximise their capacity and use them.”
“I am afraid that introducing new services is not top of the agenda at this time.”
“I thank the Member for the two questions. On the question about the £2·9 million, we hope to treat 16,500 patients with that. It will be for the implementation plan to break that down further, so you should be able to study that by the end of this month. <BR /> <BR />Commissioning new services is not on my agenda, with exception of the waiting list reimbursement scheme of £10 million, which is pretty much the son of the previous Republic of Ireland reimbursement scheme. However, as I said, it will be expanded beyond the Republic to all European Union countries. <BR /> <BR />I still have the quadruple challenge of mitigating the decision to ring-fence £165 million for waiting lists and funding the reform, because if we spend money on the waiting lists and bring them down but do not do the reform, the waiting list numbers will go back up.”
“I thank the Member for his question. Encompass is a marvellous system. It needs time to bed in. I know that there is frustration — I feel it too — when some trusts are unable to report the data that we would like to see. On his substantive point, of course, I want to be open and transparent about what we are doing with £215 million. I would have thought that, at least, a monthly update would be appropriate.”