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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“I thank the Member. Officials in my Department maintain regular contact with the Belfast Trust's management to oversee that the proposed actions are taking place. Officials schedule regular meetings with senior trust representatives, and the main aim is to ascertain the current waiting times and to discuss any issues arising that may cause delays. Officials work with the Belfast Trust's senior team and with other trusts to consider options and to ensure that the progress that has resulted in the reduction from 92 to 27 children can be maintained. The trust is a crucial partner in the regional child health partnership and in paediatric surgery, and that is a standing agenda item at those regular meetings. PEG insertion procedures will be discussed at that forum.”
“I thank the Member for his interest and his follow-up question. If I can, I would certainly like to engage with the parents. It is a situation that became intractable for quite a time, and I was concerned about why the list became so long. It was a result of capacity at the Royal Belfast Hospital for Sick Children, and that was due to demand and the availability of a number of theatres. There has been a lot of good work in the coordinated approach that the Member has outlined and in the validation of the list. I am pleased to see that there has been a significant reduction in that waiting list. However, given the fact that they are young people and it is such a serious condition, really the only acceptable number on the waiting list has to be zero. That is the target.”
“South Eastern Trust is also in a position to carry out some less complex procedures. However, the private sector is not an option. <BR /> <BR />I assure Members that departmental officials and Belfast Trust colleagues are working hard to deal with the issue, but the ongoing pressures on the service and the demand for theatre capacity mean that it will not be solved immediately. We will continue to assess and gauge progress, with the aim of ensuring that all children and young people receive the care that they require as quickly as possible. The actions that have happened and are planned are having tangible impacts on the waiting list. We have seen a reduction from 92 children last April to 27 children on the waiting list now.”
“Percutaneous endoscopic gastrostomy insertion for children and young people is a very complex procedure. It requires specialist clinical and nursing input that is prior to, during and post procedure. Officials have been working with Belfast Health and Social Care Trust to identify measures in order to address the issue. The trust scheduled additional clinics and theatre sessions to reduce paediatric waiting times, and additional PEG procedures have occurred. The trust now has a weekly list to carry out PEG insertions. <BR /> <BR />Belfast Trust explored the potential for another NHS body to carry out the procedure and approached the private sector to see whether we could address some of the backlog. An NHS provider has outlined that it will be able to carry out some procedures.”
“I do not think that £3·6 million will cut it, and I do not think that the Member does either. <BR /> <BR />We should really be on the same page here. The voluntary and community sector is absolutely essential to healthcare delivery, but I do not think that the motion is appropriate. I do not think that it does justice to my views and my desire to help the voluntary and community sector.”
“With respect to the Chair, that does not answer the question. The motion:”
“Again, I will give way. How much? What is the quantum? Anybody? Can I remind you that section 29(1)(a)(ii) of the Northern Ireland Act 1998 gives you a statutory obligation to "advise and assist" me. Quantum, anybody?”
“He says that it is a game changer. I believe that it is as well. It could be a game changer for the core grant if we were able to provide it on a guaranteed basis for, maybe, three years. <BR /> <BR />My final point is that the motion calls on me”
“<BR /> <BR />By the way, there is an idea that £1·8 million is not enough: the £1·8 million was announced before we reviewed the scheme, not at the end. I am puzzled that people are coming at the end of the scheme and saying that £1·8 million is not enough, because they could have gone to the first workshop about the redesign of the scheme and said, "I do not want to participate in this. We must shout louder that £1·8 million is not enough". I agree that it is not great; it really is not great. As Mrs Dodds said, it has real and serious consequences, but what in healthcare provision does not have real and serious consequences, up to and including life-threatening consequences? <BR /> <BR />I heard the Finance Minister say that this should be the last single-year Budget. I very much hope that that is the case.”
“I engaged meaningfully during my time on television and then as a victims' commissioner. It was voluntary and community sector groups that, on a daily basis, delivered positive differences to the thousands of victims and survivors of the conflict that we so euphemistically call "our Troubles". As a victims' commissioner, I developed a deep appreciation and admiration for the work of the community and voluntary sector. The motion calls for me to "engage meaningfully with stakeholders", when the first thing that I did when I was told about the core grant was meaningfully engage with NICVA to say, "We have got to make this scheme fit for purpose. It has been going for 20 years. We have got to open it up so that everybody can apply".”
“<BR /> <BR />The motion goes on to urge the Minister of Health "to engage meaningfully with stakeholders". Does that imply that, previously, I have not engaged meaningfully? That is how I read it. In the context that self-praise is no recommendation, I have been engaging meaningfully with the community and voluntary sector for decades. One of the privileges of having a high profile because you are on TV a lot is that charities come to you and ask, "Will you help us?". I have helped many charities, big and small. I have been patron of Action Cancer for many years. I was also patron of a much smaller charity that I was very fond of called Shine A Light. I worked with Children with Cancer, organising trips and treats for the children. I have raised thousands of pounds personally for charities.”
“Some applicants were successful, and some were not. I was surprised that so few groups were successful. I was particularly surprised to hear that it was some of the smaller charities who said, "Do not exclude the bigger charities. If they are best placed to deliver services, let them apply". It has skewed the outcome, and I want to review it. Since the scheme was announced and completed, I have spoken to NICVA and the Coalition of Carers. We have decided that we will look again at the scheme for next year. In the meantime, everybody will get feedback on why they were unsuccessful and what they might have done to enhance their chances. However, if we are going to tweak the scheme — we may, at least, tweak it — they need to have that information as well about what more it means.”
“At a minimum, find me the £1·8 million that it had last year and the year before that." I was then shocked to be told that the scheme had been in place for 20 years and was therefore a closed shop to the organisations in receipt of the funds. Any charity that had been established in the 20 years since the core grant scheme began could not even apply for money. I said, "That's not good enough", and I contacted Celine McStravick and asked her if NICVA would facilitate the workshops that would lead to a redesign of the scheme. That is how we got to where we are today. <BR /> <BR />I take exception to some of the language that I have heard about the exclusion of groups, the defunding of groups and funding being pulled from groups. We had six new criteria drawn up by the voluntary and community sector.”
“<BR /> <BR />When I took up the post in late May, the core grant came up in the first-day briefs in early June, and it was clear to me that it was moribund. It was also clear to me that the Department's advice was that I should let it die off because such were the financial pressures that I would have to consider endorsing catastrophic cuts in my health budget; for example, closing an intensive care unit bed in an acute hospital, which could have cost somebody their life. Like Robin Swann before me, I said that I would not sign off on catastrophic cuts. However, I was advised, "Let the core grant scheme go. There's no budget against it — nothing — so just let it go and concentrate on other things." I said, "I'm not prepared to do that.”
“I am not putting anything back on the voluntary and community sector. You are entirely disingenuous to say that. I simply asked members of the Committee whether they knew what we paid in commissioned services last year. The answer is £53 million. I want to be clear: the core grant is not the beginning and end of the financial transactions between the Department of Health and the voluntary and community sector. <BR /> <BR />The first time that I read today's motion, I was a bit taken aback, because it begins by expressing "disappointment" at the number of groups that were successful in their application. That reads to me that Members are expressing disappointment with the voluntary and community sector, which drew up the six criteria for the new scheme. The Department did not do that; the voluntary and community sector did.”
“Mr Robinson said that nothing had changed. However, the name of the Minister has changed, because the call is no longer on the Minister of Finance: the call is on me. I suppose that is fair enough. My Department continues to support and rely heavily on the sector, as it has done for many years. What I found interesting was the fact that not one speaker in the debate made reference not to the core grant but to the commissioned contracts that are paid to the voluntary and community sector every year. I will certainly give way to any Member who knows what that figure was for the financial year 2024-25. Nobody?”
“Thank you, Mr Deputy Speaker. From the get-go, let us consider the irony klaxon to have been sounded. It is exhausted. <BR /> <BR />As Mr Robinson pointed out, we were here relatively recently. The amended motion that was passed that day is interesting. It reads:”
“I will stop short of suggesting that we missed a trick with clinical trials, but if you speak to experts, such as Professor Ian Bruce at Queen's University or my Chief Scientific Adviser, Professor Ian Young, they will make that point. There is a lot of potential here: it is good for patients and healthcare professionals — not least for workforce retention — and it is potentially also good for the budget, and that can all be achieved under the regulations while continuing to prioritise patient safety. Once again, I commend the regulations to the House.”
“If you are going to undermine confidence, you need to back that up with evidence and not just a survey result. The clinical trials that we are doing will provide solid scientific evidence. I firmly believe that the change will help modernise and strengthen the United Kingdom's position as a global leader in clinical research, that it will support the fostering of innovation and that the highest safety standards will be maintained.”
“Thank you very much, Mr Deputy Speaker. <BR /> <BR />I particularly thank the Chair and the Deputy Chair of the Health Committee for their remarks. The Deputy Chair was particularly clearly well across all the detail of the issues and the importance and benefits of clinical trials. I regret Mr Gaston's remarks, because they could be interpreted as trying to undermine confidence not just in the Northern Ireland Executive but in the Department of Health and in people's view of the health services that we provide for them.”
“The Health Committee subsequently indicated at its meeting on 6 March that it was content that the draft SI be laid with the Northern Ireland Assembly Business Office to allow for today's debate. It is with the Committee's support, therefore, that I bring the SI before the wider Assembly and its Members. <BR /> <BR />I commend the motion to the Assembly.”
“While the legislation streamlines processes and removes some barriers to innovation, it prioritises robust oversight of clinical trials, ensuring that the safety of trial participants is never compromised. <BR /> <BR />I am pleased to confirm that the Health Committee initially considered the policy intent of the SI at its meeting of 13 February of this year and again on 6 March, when it confirmed that it was content with clarification given by officials that the distinction drawn in the amending SI between the EU Commission directive 2003/94 in respect of Great Britain and the EU Commission delegated regulation 2017/1569 in respect of Northern Ireland would have no differential impact on clinical trials here.”
“The reforms will also bring benefits to Health and Social Care (HSC) and the wider National Health Service. Evidence shows that hospitals that undertake research have better patient outcomes and improved staff retention. Improved efficiency in conducting clinical trials will enhance research efforts and foster innovation, prevention, diagnosis and treatment across various conditions. Those conducting clinical trials will also benefit from a streamlined and risk-proportionate regulatory framework, thus reducing delays and administrative burdens. The reforms will stimulate growth in the UK's life sciences sector and position the UK as a global hub for clinical trials. <BR /> <BR />I re-emphasise that participant safety remains paramount.”
“Those changes will build public trust in research by improving access to information about ongoing research, thus enabling informed decisions to be made.”
“The UK will remain aligned to global standards, ensuring that trial data is recognised internationally and strengthening our position as a preferred site for multinational clinical trials. The fourth is the cementing of the UK as a destination for international trials. Streamlined processes will simplify applications and deliver globally competitive approval timelines. Finally, there will be increased transparency. We want to ensure that trusted information about clinical trials is publicly available. That will be for the benefit of all. <BR /> <BR />New legal requirements will be introduced to register a clinical trial and publish a summary of results, including an easy to read summary for participants.”
“The current legislation no longer aligns with the rapid advancements in medicine and technology. We have the opportunity to create a world-class regulatory environment for clinical trials and deliver a modernised framework that supports the safe development of innovative treatments. To that end, I will outline the key aspects of the reforms. The first is risk-proportionate regulation. Regulatory requirements will align with the risk level of a clinical trial. Low-risk trials will receive faster approval through automatic authorisation without compromising patient safety. The second is future-proofing. We have removed duplicative and granular legal requirements in favour of tailored guidance, ensuring flexibility for future innovations and moving beyond a one-size-fits-all approach. The third is international alignment.”
“<BR /> <BR />Clinical trials are vital for developing safe, effective medicines, especially for those with limited treatment options, such as the estimated three million people who are living with cancer in the United Kingdom and the 17·5 million people who are managing long-term conditions. To support innovation, our clinical trial regulations need to be flexible and proportionate. This legislation will do just that by delivering streamlined and efficient regulations, removing barriers to innovation and creating a patient-focused research environment. The reforms will support the development of new, life-changing treatments for those in need and strengthen the UK's position as a global leader in clinical trials. <BR /> <BR />I now turn to why the change is necessary and, indeed, timely.”
“Thank you, Mr Deputy Speaker. I am seeking the Assembly's approval for the making of the draft statutory instrument (SI), which will amend the Medicines for Human Use (Clinical Trials) Regulations 2004. The aim is to improve and strengthen the UK's clinical trials legislation, with the aim of helping to make the UK the best place to research and develop safe and innovative medicines following the UK's exit from the European Union. I am grateful to have been given the opportunity to debate the regulations today. They represent the most substantial reform of UK clinical trial regulations in over two decades.”
“Undoubtedly, the positive engagement that has taken place between officials in my Department and the Southern Trust will help to expedite approvals. However, no assumption should be made that Craigavon Area Hospital or any other hospital will retain its current role or clinical service provision, as my ambition is for the entire hospital structure across Northern Ireland to be clinically efficient to ensure the best outcomes for the entire population of Northern Ireland.”
“The output of that initial stage will inform the redevelopment strategy, including estimated capital and revenue costs, and the timescales, which will then be further refined through appropriate business cases for each subsequent phase of work. That phased approach to implementation, beginning with that initial exploratory phase, will allow the Department and the trust to take stock at key checkpoints before committing further resources to the programme. <BR /> <BR />When the trust commits the programme business case to the Department, it will be reviewed by officials. The proposed expenditure on those exploratory activities will be subject to normal value-for-money and affordability considerations. I am unable to approve or provide funding for that programme business case until that process has concluded.”
“The Department hosted a productive workshop with trust colleagues at the end of February, and the programme business case is being updated by the trust to reflect those discussions. <BR /> <BR />It is important to acknowledge that the programme business case is not designed to articulate definitive costs and timescales for the entire redevelopment. Rather, it should make the case for expending capital money up front on investigative activities, including the establishment of the trust's programme team, healthcare planning activities and the procurement of a design team to assess feasibility. That initial work will inform the strategic service needs at the Craigavon site and how those can be accommodated.”
“I appreciate that Craigavon Area Hospital is one of our long-standing healthcare facilities. With its construction commencing in the 1960s, the main acute block is now over 50 years old. An outline business case for the redevelopment of the Craigavon Area Hospital site was submitted to the Department of Health in 2016. As Members have made clear, that was not progressed to the point of approval, and that was because of capital budget constraints. <BR /> <BR />Recognising the developments in the policy landscape, construction price inflation and changes to service delivery models since the previous master plan was completed, my officials have been advising the Southern Trust on the development of a programme business case that should clearly establish the need for investment in Craigavon Area Hospital.”
“<BR /> <BR />In acknowledging the fact that Craigavon Area Hospital has not benefited from a major redevelopment, my Department and the Southern Trust have been proactive in making investments to keep the hospital operational. A total of £8·9 million was invested in the new paediatric ward, which opened in 2018. A new aseptic pharmacy suite costing £3·6 million was opened in 2020. There was investment of £7·6 million in a new dual CT scanner suite, which opened in 2023. The Department has invested £5·8 million in upgrading the hospital's low voltage electrical infrastructure, which is an ongoing project that will be completed this year. <BR /> <BR />Finally, I turn to the part of the motion that expresses concern that the development of Craigavon Area Hospital has not commenced, and calls on me:”
“With 155 beds planned, the hospital is expected to provide high-quality care for a significant number of young patients — up to 45,000 annually — thus ensuring timely and effective treatment across the variety of paediatric specialities. <BR /> <BR />Of the £2·88 billion of capital investment made in the past 10 years, £2·23 billion was allocated across the six health trusts, including the Ambulance Service, representing over 77% of the capital investment. During that period, the Southern Health Trust received capital budget allocations totalling £257·1 million, so, on average, the Southern Trust has received 9% of the available capital budget over the past 10 years.”
“That means that some trusts, owing to their population size, demand pressure or outdated facilities, may require more funding than others. <BR /> <BR />It must also be recognised that, although specific trusts lead on them, many of our flagship capital projects are regional in nature, serving the entire population of Northern Ireland. A good example is the new children's hospital that is under construction at the Royal site in Belfast. That regional facility will be a state-of-the-art, 10-floor building to enable the delivery of comprehensive paediatric care. It will offer the full range of services, including a dedicated emergency department, multiple operating theatres and specialised diagnostic and treatment units that are tailored to meet children's unique needs.”
“The Department has historically invited the trusts to submit bids for their capital priorities. The Department scores those capital project bids against criteria that are used to prioritise the projects in each category. Review groups have been established, with representatives from finance, the healthcare commissioners, policy leads, nursing, the Public Health Agency (PHA) and our health estates carrying out the exercise. <BR /> <BR />The strategic investment committee that I referenced, because there is not sufficient capital or resource available to deliver all requirements, is now having to carry out an overall prioritisation exercise across the spectrum of the previous categories. Capital bids are considered alongside other capital investment priorities and are dependent on budget availability, value for money and affordability.”
“When it comes to allocating investment across Northern Ireland's trusts, the Department must prioritise health outcomes over geographic equality. It is not simply a matter of dividing funding equally among the five geographic trusts. Instead, we must target investment at where it will have the greatest impact on patient care and system-wide efficiency. My focus is on maximising the efficacy of the entire health and social care system to deliver the best outcomes for the whole population within the constrained budget. That is why I talk of a hospital network in which not every hospital delivers every procedure. <BR /> <BR />Budget allocations are issued to health trusts based on need, as is evidenced by approved business cases rather than by being based on regional allocations.”
“The draft budget allocation does not provide the funding that is needed in order to commence work on all the projects required to protect health services. <BR /> <BR />The increasing pressure on capital investment budgets means that my Department must carefully prioritise proposed schemes, progressing those that demonstrate the most urgent need and the best use of public money in order to deliver better outcomes within budgetary constraints. It would be remiss of me not to advise Members that my Department has established a strategic investment committee, which is made up of senior officials, spanning various directorates in the Department, who will review the current capital plan in light of capital and resource funding constraints. <BR /> <BR />I will now address the part of the motion that asks the Assembly to note:”
“It has to be diversified into other assets and technologies that can keep people fit and healthy and, thus, mean that they do not require to be in a hospital setting. We must also provide assets that are efficient and flexible enough to have the ability to meet the changing future healthcare needs of our population. <BR /> <BR />My Department has invested £2·88 billion of capital funding during the 10 financial years from 2014-15 to 2023-24. The draft capital budget allocation for 2025-26 is £391 million. That is less than what is required to fund all our envisaged Executive flagship projects, meet our current contractual commitments, progress projects in design and development and fund the continued maintenance of our existing assets.”
“Those requirements will present challenges, and the Assembly must ensure that funding frameworks, planning policies and procurement strategies support those environmental obligations while maximising delivery impacts. <BR /> <BR />Ultimately, while I support investment in our healthcare infrastructure, it has to be strategic, transparent and accountable. Every project must demonstrate that it enhances patient care, improves efficiency and delivers genuine public benefit. Our healthcare infrastructure must not just grow; it must evolve in a way that secures the best possible outcomes for the people of this place. That means that investment cannot simply be funnelled into traditional hospital buildings.”
“I recognise the importance of the investment strategy for Northern Ireland, which stresses that capital projects must be planned with long-term sustainability in mind. The focus should be on creating modern, energy-efficient facilities that are adaptable to future healthcare demands. <BR /> <BR />Ensuring that we have a sustainable and resilient healthcare system in Northern Ireland will require balancing our commitment to high-quality medical infrastructure with the ambitious targets set by the Climate Change Act and our net zero strategy. As we move towards a legally binding net zero goal by 2050, new healthcare capital investments must align with stricter carbon reduction measures, energy efficiency standards and sustainable construction practices.”
“That means that capital funding may go towards not just traditional hospital expansion but innovative solutions such as regional elective hubs, improved digital infrastructure and community-based alternatives that reduce pressure on our acute services. I trust that Members are with me in wishing to see real movement in the drive to shift left, putting more emphasis on prevention and early intervention through primary and community care rather than our hospitals. <BR /> <BR />I opened a public consultation on hospitals, Creating a Network for Better Outcomes. It aims to describe our hospital system and provide a strategic context for future hospital reconfiguration decisions.”
“<BR /> <BR />Ultimately, our capital investment ambitions will be dictated by budget allocations, and we will need to make allowances for emerging considerations, such as net zero requirements, which have not been mentioned in this debate. My Department's future capital plans must align with our policy vision, such as in Delivering Together, the strategy to transform how care is provided, with a focus on efficiency, sustainability and patient outcomes and an emphasis on providing care in a community setting wherever possible. <BR /> <BR />The Bengoa report and resulting elective care framework make clear that hospital investment must support a system that reduces waiting times, makes better use of resources and prevents duplication.”
“for the Craigavon Area Hospital redevelopment project to come forward. I will take each of those in turn, beginning with "sustained capital investment". I fully support sustained capital investment, of course. We all agree that a modern, well-equipped health service is essential for delivering high-quality care. However, it is crucial that infrastructure investments are strategic, and that is why I consulted the public on the idea of looking at our hospitals as a network. We clearly cannot afford to fund every hospital to provide every procedure. We must demonstrate clear value for money and be shaped by evidence-based policy, because we want to deliver the best possible outcomes for all.”
“Deputy Speaker, thank you very much, and I thank Mrs Dodds for proposing the motion. <BR /> <BR />Buildings, of course, are important for healthcare delivery, but I gently suggest that the workforce is even more important, so I begin by putting on record my eternal admiration for and thanks to the workforce at Craigavon Area Hospital. <BR /> <BR />The motion principally deals with three topics, namely, first:”
“Let me assure the Member that I am not waiting until everything is ready.”
“I thank the Member for giving way. A quotation on the wall in my ministerial office reads:”
“Every day, corridors filled with patients to the extent that they had specific corridor care teams. In the other ED that I visited, they said that their ambulances queued up daily to hand over. Therefore, it is not just a problem in Northern Ireland. <BR /> <BR />The motion calls for money. Sinn Féin's amendment calls for investment. My final message is a simple one. This is planet earth calling the Northern Ireland Assembly. There is a £400 million gap in the projected budget for the Health Department. We cannot commission new services.”
“On my visits to the EDs post Christmas, many of the workforce talked about having to make decisions that were the "least worst option", but I gently suggest that that is substantially different from making "highly risky decisions". <BR /> <BR />Mr Robinson moved amendment No 1. He clearly gets it: a whole-system solution is required. It is about the flow, and I absolutely agree with him that, while we have five separate geographic health trusts, we need standardised regional protocols and to have the five trusts operating as though they were one. <BR /> <BR />Mrs Dillon talked about looking elsewhere. When I was in Washington earlier this month, I visited a brand new $800-million facility, an enormous emergency department in which corridor care was a thing.”
“The Audit Office report was clear on the need for urgent action — I hear that call — but I stress yet again that we will be limited in the impact that we can make without additional budgetary support, and that impact will be much less again when I am being asked to make additional baseline reductions. I have accepted the challenge to transform the system, as outlined in my recently consulted on 'Hospitals — Creating a Network for Better Outcomes' document, but the long-term, meaningful change that is required to see results must have cross-party support in the Executive, and that must be backed by adequate resources. <BR /> <BR />Mr Durkan moved the motion. He made just one comment that I take issue with. He talked about the workforce making "highly risky decisions": I do not recognise that phrase.”