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.”
The complete record
Every one of 5,312 lines we hold for Mike Nesbitt, in date order, each linked to its source. Free to read, in full, without an account. Page 43 of 107.
“Developing a new strategy would carry a significant resource cost, including having a dedicated dental public health expert or expert group, owing to the complex and extended nature of developing a new strategy and the prerequisite oral health needs assessments. For example, one oral health strategy target was to improve the then 39% of five-year-old children who were decay-free to at least 50% within 10 years. In 2013, the data indicated that we had achieved 60%, and the 2018-19 data indicated that around 70% of our five-year-old children were decay-free. That represents great progress, but I am aware that more needs to be done. <BR /> <BR />I promised to return to the irony klaxon. Mrs Erskine challenged me by asking what steps I would take to introduce financial support and incentives for dentists.”
“Although the pandemic impacted on progress on that work, an out-of-hours working group was established in 2021 to review the future of dental out-of-hours and emergency care provision across Northern Ireland. The strategic planning and performance group (SPPG) is working through the actions emanating from the working group's findings, including engagement with the western LDC and the Western Trust on future arrangements for the west. Funding those actions, however, will be a significant challenge in the current financial climate. <BR /> <BR />Mr McGrath talked about the oral health strategy. I am aware that it dates back to 2007, but many of its recommendations and much of its evidence base are still valid.”
“<BR /> <BR />As for an out-of-hours service, there are currently three emergency dental centres providing emergency dental care at weekends and on bank holidays to registered and unregistered patients. The centres are located in Belfast, Armagh and Ballymena. When they were originally established in the 1990s, it was agreed with local dentists in the west that they would provide emergency cover through local, practice-based rotas covering weekends and public holidays. In 2019, the western local dental committee (LDC) approached the legacy Health and Social Care Board (HSCB) to advise it that it was no longer prepared to operate the local rotas and requested that the HSCB commission an emergency dental centre similar to that in other areas.”
“I have said many times that my vision for Health and Social Care is to see more care delivered through primary and community care and to move towards a more preventative model of healthcare that will be better for patients and more sustainable in the longer term. <BR /> <BR />GDS play an important role in improving the general health of the population and reducing pressure on other areas of the health service. Improving oral health is an important element of the future sustainability of dental services and is central to the delivery of improved outcomes for patients. For that reason, I was pleased that oral health was included in the pathfinder programme for my Live Better initiative in the north-west. I look forward to the lessons learned from that initiative informing our longer-term priorities.”
“Although those additional investment interventions are necessary to stabilise general dental services in the short term, I am clear that GDS, in common with other services, will require a sustained effort to ensure sustainability over the longer term. My Department is therefore committed to taking forward work on the long-term future of dental services to ensure that patients can continue to access care when they need it and that the service is sustainable. As an important first step, I have approved the commissioning of a general dental services cost-of-service review that will be completed in the 2025-26 financial year. The review will, in turn, provide a robust evidence base for informing how the service will develop over the coming years.”
“I have said before that my Department faces a funding deficit of approximately £400 million in the next financial year. That places massive constraints on my scope to take the action that we would all like to see taken to sustain and develop services across the entire Department of Health.”
“Finally, there was £3·9 million for the treatment of high-priority unregistered patients through a dental access scheme. <BR /> <BR />I will give way at the end, if there is time. <BR /> <BR />Officials continue to monitor the performance of those initiatives. The indications are that they have had a positive impact. <BR /> <BR />As I mentioned, I met the British Dental Association last week and discussed the issues facing the industry. Officials held a follow-up meeting today to continue the engagement. The BDA is clear that the current system is unsustainable, so my Department is developing options to increase investment in the service next year but is doing so in the context of a Budget that is entirely inadequate to meet the needs of Health and Social Care services.”
“There is an investment package of £9·2 million, and that has supported general dental services (GDS) in this financial year, including £1 million for newly registered child patients through the re-establishment of the enhanced child examination scheme. That provides children aged nought to 10 who have not been registered with a dentist with an examination, individualised oral health advice and age-specific fluoride application to teeth to assist with preventing dental decay. There is £4·3 million that has funded a 30% enhancement, and that is to fees paid to dentists for health service fillings, extractions and root canal treatment to support public access to priority treatments.”
“That increase has allowed the Northern Ireland Medical and Dental Training Agency, NIMDTA, to improve the geographical distribution of dental foundation training places across Northern Ireland, and, as a result, there are seven fully funded health service training placements in the west of the Province in this financial year compared with just one in 2023-24. Recruitment of educational supervisors for 2025-26 is ongoing. It is anticipated that the geographical spread will continue positively. <BR /> <BR />Access to health service dentistry remains a priority focus for me, and my Department has specifically targeted investment this year at improving access for priority groups across the Province.”
“It is important to remember that general dentist practitioners are independent contractors, so, as such, they are not required to register new health service patients, nor does the Department have a role in deciding the location of new practices. That is a business decision made by the practice owners. <BR /> <BR />One area where my Department has some limited control is in regard to dental foundation training. Recent changes to that scheme have resulted in increased applications from general dentist practitioners wishing to become educational supervisors for newly graduated dentists who are completing their training year.”
“<BR /> <BR />First, I acknowledge the challenges facing many patients, particularly those who are not registered, in accessing dental care when they need it. Access to health service dentistry across Northern Ireland has reduced significantly over the last five years, and one of the underlying reasons for that is that general dentist practitioners spend less time treating health service patients and more time meeting the strong demand for private work, which, as independent contractors, they are entitled to do. I am also aware that some areas of the country have historically lower registration and treatment rates, and that is particularly true of Fermanagh and Tyrone. That is at least partly due to geography. Areas with a low population density tend to have a lower density of practices.”
“Thank you very much, Mr Deputy Speaker. I begin by thanking Deborah Erskine for bringing the debate to the Chamber this afternoon. It is an important debate that reflects a serious problem, one of many serious problems in health and social care delivery. It is a timely debate, certainly for me, because, on 18 February, I met the British Dental Association to tease out some of the issues. <BR /> <BR />I will make some prepared remarks, but I have to put down a warning. In the short number of months that I have been in this position, I have engaged in quite a number of debates in the Chamber, but this is the one where the irony klaxon has sounded most loudly and most often. I warn Members that I will return to that at the end of my remarks.”
“In fact, the Appleby report said that, if we were to include social care, we would need £109 for every £100 that NHS England spends. That is the comparator to get to where the Member wants NHS Northern Ireland, as it were, to get to. The draft Budget for next year puts us at £101·05, so it will not be possible to achieve what the Member wants.”
“The independent Fiscal Council made clear that for us to deliver health and social care services on a par with England would require our budget to go up to £104 to £107 for every £100 spent by NHS England.”
“I thank the Member. There have been a number of initiatives. Consultants have been validating the waiting list. More procedures have been carried out by the Royal Belfast Hospital for Sick Children, which is the regional centre for PEG procedures. Training has been provided by the Royal Belfast Hospital for Sick Children to facilitate those procedures taking place at the Ulster Hospital, which involves making the workforce appropriately trained and motivated. Therefore, some significant effort has been made to address the waiting list. I do not try to deceive the Member: the waiting list is still too long.”
“I thank the Member for his follow-up question. I do not have a specific answer for him on that transition, but, across a number of healthcare services, transitioning to adulthood is far from good enough in my opinion. It is an issue that has exercised me since taking up post. I think, for example, of ADHD and autism. For children with learning disabilities, there tends to be what is commonly known as a "cliff edge" when you transition to adulthood. That should not be the case. It has been so for some time and it is time to say enough is enough, and we need to address it. I thank the Member for alerting me that that also includes the issue of diabetes. It is now on my radar, and I thank him.”
“I thank the Member for his interest in this important issue. I assure him that the strategic planning and performance group (SPPG) is looking at this. One of the big issues is hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes. The SPPG will bring me its recommendations for a future strategy.”
“I am more than happy to provide the up-to-date figures for the Member and my assessment of whether we are moving in the right direction and of what more, if anything, can be done to protect our staff.”
“We must have zero tolerance of attacks. We must be imaginative and generous in what we do to protect health and social care staff.”
“I thank the Member, and I share his concern. Those things are societal issues, I am afraid, but it is a matter of utter regret that they are making their way on to health and social care campuses and that they are happening to health and social care staff beyond the curtilage of hospitals and other health and social care sites. I advise the Member that that issue was first addressed in some depth in recent times towards the end of 2023, when the trusts and the union side came together to agree the paper 'Violence and Aggression in the Workplace' in NHS settings. <BR /> <BR />The pilot scheme for body-worn video in the Belfast Trust is helpful. As a member of the Policing Board, I was impressed with the impact of the use of body-worn video by officers in the PSNI. I would like to see that pilot successfully concluded and rolled out.”
“The cost of a cross-border scheme would depend on the procedures that we commissioned and the number of people we commissioned them for, so there is no set figure.”
“It would be if I had the funding, but I gently remind the Member of what I said earlier. We made a bid of £135 million to tackle our waiting lists. That included a significant sum to treat — the figure of 4,000 patients springs to mind. I would love to be able to do it. It was popular. It was successful. It made sense and it took a big chunk out of a number of waiting lists. What was not to like about it? Unfortunately, all budgets are constrained and limited, and I cannot make it a priority when I have a £400 million gap in my projected spend according to the draft Budget 2025-26. My two priorities, frankly, are to avoid having to make any cuts that fall into the "catastrophic" category, such as closing an intensive care bed in an acute hospital, and to avoid industrial action by staff.”
“I will answer that question with a generalisation. Although we have five geographic health trusts, it is my ambition that the trusts will deliver standardised, regional services that are consistent no matter the condition or issue that they address. One of the challenges that I have put to the chairs and chief execs of the trusts is to find where best practice exists in treating any particular condition, roll it out and make it common practice across the trusts. The logic of that is compelling, and, nine months in, I have yet to fully understand the barriers and obstacles to that happening. They clearly exist, however, because we still have what are commonly referred to as postcode lotteries. We have to stop that. We have to have health equity. Everybody has to be able to get a best-practice service when they need it.”
“That was back in September, and it details good progress, including additional genome sequencing of people living with a rare condition who do not yet have a diagnosis, progression of rare disease care pathways for several paediatric and adult services and success in a number of important bid applications to external research organisations to progress the rare disease information hub and clinical trials. I say to the Member that I will go from the House and ensure that we are looking at a pathway to deal with that condition.”
“I thank the Member for her question, and I found it most interesting to attend that event yesterday in the Long Gallery. I will attempt to answer her question by referring to the rare diseases action plan, because the disease that she is talking about is just one of many rare diseases. The point that I was trying to make in my remarks yesterday was that, although we may refer to rare diseases as those diseases that rarely affect people, in fact, in the totality of rare diseases, we are talking about 110,000 people in Northern Ireland. Well over 100,000 people are, in one way or another, affected by a rare disease. So, let us not consider rare diseases as something that affect only a handful of people. <BR /> <BR />On that basis, my Department recently published the year 2 progress report for the Northern Ireland rare diseases action plan.”
“I assure the Member that I am on that case. It is a matter of coincidence, I believe, that one of the very first events that I went to in this Building after being elected for the first time in 2011 was organised by my predecessor as Minister of Health, Robin Swann. It was a constituency event about Duchenne, so it has been on my radar for a long time. I am now aware that the new drug is becoming available, and I do not want to see it restricted from young men. This young man will lose the power to walk, I understand, in relatively short order if we do not do something.”
“It is my ambition that there be a UK-wide facility that would bring on any drug. NICE and the Medicines and Healthcare products Regulatory Agency give us advice, and that is the advice that we follow. In this instance, it is my understanding that the Belfast Trust makes the decision on whether this young man is allowed that drug. I am following up with the Belfast Trust to further understand its decision-making process. Several Members have approached me about this new drug for their constituents. Although I am not a clinician, on the face of it, it looks as though it is a revolutionary and very positive development, and I am keen to see it rolled out at pace, particularly for a young man such as the one whom you referenced.”
“It just means that I need to be able to go back to my Executive colleagues and say, "Here is really solid empirical evidence that these interventions work. Now we are going to face the test of making them work in rural areas, which are more challenging". That will include cancer diagnosis and treatment.”
“Those areas were deliberately chosen because they are tight urban areas, so the empirical evidence can be collected more easily, which will be much harder to do over a rural geographic spread. That does not mean that we are going to ignore the rural areas.”
“I will take a broader run at answering the Member's question. He will be aware that the area of health inequalities is where I want to put a focus in my remaining time as Minister. The term "health inequalities" is almost shorthand for three things: inequalities, as in outcomes; health inequities, as in access to healthcare; and health literacy, because people in some areas, particularly areas of deprivation, do not know how to navigate the health and social care system in the way that Members might. <BR /> <BR />The rural challenges are greater than the urban challenges. The Live Better initiative to tackle health inequalities is running in two demonstration areas.”
“The Northern Ireland Cancer Registry is now working on a follow-up report for patients diagnosed between 2018 and 2021, which will provide an analysis of their routes to diagnosis and of the differences between those who live in urban and rural locations.”
“The project also examines the cancer stage at diagnosis by the route of diagnosis. The research will highlight any demographic inequalities in the diagnostic routes that need to be addressed. Identifying and addressing those disparities is essential to promoting early cancer detection, improving survival rates and reducing cancer mortality for all. <BR /> <BR />The most recent report of the project, published in 2024, provides findings for patients who were diagnosed in the period 2018-2020. It includes analysis by demographic characteristics, such as age, sex, trust area and social deprivation.”
“My Department is committed to ensuring equitable and timely access to cancer diagnosis and treatment for all residents in Northern Ireland, regardless of location. It is important to understand whether individuals in rural areas face different challenges or barriers compared with those in urban areas when it comes to a cancer diagnosis. We have to understand any differences that exist. Therefore, my Department funded the Northern Ireland Cancer Registry at Queen's University Belfast to develop a research project on routes to diagnosis. <BR /> <BR />That project aims to identify the key event in each cancer patient's pathway that most directly led to their cancer diagnosis, whether that was through a GP red-flag referral, a screening programme, an emergency department or any other route.”
“The challenge is how to get away from the pressures on our acute hospitals outright because that is where all the really expensive procedures take place. Therefore, if you can focus on prevention and early intervention, maybe you will relieve a bit of the pressure on the acute hospitals and release some cash, which can be put into primary care.”
“I have made it clear that my ambition is to rebalance how HSC services are delivered to facilitate a greater proportion of care being provided by primary care, community care and social care to get it as close to people's homes as possible to relieve some of the pressure on secondary care. That will require a combination of investment in the core general medical services contract through the GP contract and in the wider primary care services and workforce. <BR /> <BR />When I first talked about shifting left, there was concern, particularly among doctors and people who work in primary care, that I would be asking them to do more for the same amount of money. That is not the case. I recognise that if we are going to ask them to do more, we will have to pay and commission them to do so.”
“That is exactly the point that I am trying to make. If we can deal with the, as I describe it, fairly toxic issue of GP indemnity and put a long-term solution in place, it gives me, I think, permission, as it were, to go back and ask, "Can we now look at an issue that is very toxic for me and for Members of the House, which is constituents finding it difficult to get access to their GP?".”
“It is my understanding that we are negotiating with practices rather than with individual GPs. I want to be careful in what I say, because we are not over the line, and it is an issue that, in my assessment, has become quite toxic over the past number of years and is affecting the relationship between the Department and primary care. There are other issues in primary care that we want primary care to address. The primary one is access. I am sure that every Member of the House, as a constituency MLA, has constituents coming to them weekly, if not daily, with issues to do with accessing their GPs. With respect to the Member, I do not want to go any further, because those negotiations are not over the line, and, in my mind, the question of indemnity may open up another discussion about access to primary care.”
“I am hopeful that we will be able to reach agreement on that important matter soon. I am aware that representatives of that committee have briefed the Health Committee on the indemnity offer. As that is still the subject of an ongoing negotiation, it would not be appropriate to comment on the detail of those discussions.”
“I recognise that arrangements for clinical negligence indemnity are a matter of concern for GPs locally. My Department has been exploring options for a long-term future for GP indemnity. I recognise that progress in that work has taken longer than expected. However, in fairness, that reflects the complexity of the issue. <BR /> <BR />I had committed to the work concluding with proposals for a long-term solution by the end of the 2024 calendar year. I am pleased to advise that, after careful consideration of a wide range of options, I have identified what is, I believe, the best, most appropriate option to address this key issue for the longer term. <BR /> <BR />As part of the 2025-26 contract negotiations, my Department met the Northern Ireland General Practitioners Committee. We have provided details of the long-term proposal.”
“It is a fact that people who visit emergency departments are not in a good place. The longer they stay, the greater the risk to their health. There are solid statistics for that. I am not aware of the exact statistics on cancer that the Member mentions, but the general point is made and is accepted. It is not acceptable that people have long waits in emergency departments. I can assure the Member that I am not the only one in charge of delivering healthcare who is focused on that and on trying to find solutions.”
“I thank the Member for his interest in the area. I have visited the rapid diagnostic centre in Dungannon. It is a first-class service. I was assured that, if you present with one of those vague symptoms, you will be checked in, you will be assessed, you will have your scan and, within two hours, you will get your result — hopefully, one that is pleasing and agreeable to you. <BR /> <BR />I have no particular plans to expand the service, because, as I have already said, although Members are standing up, telling me to, "Do more here, do more there, expand this, introduce that" — where is the money? Show me the money, and I will do it.”
“<BR /> <BR />On GP referrals, the Northern Ireland Cancer Network has developed a resource for GPs to try to assist them in managing mild to moderate side effects, but I think that the Member is talking about much more serious conditions. I assure the Member that I am aware that more work needs to be done in this area and that that work will be done.”
“I absolutely agree with the Member. After Christmas, I visited seven EDs, including Altnagelvin, which, as the Member knows, is the oldest of our type-1 EDs. Altnagelvin is more than ready for a replacement ED, and I hope that there will be one, although it may be five years before we get to that point. When I was in that ED, I spoke to people who had been in the same chair for four days. That is not acceptable under any circumstances. I met a man there who has since, sadly, passed away. He had cancer. He was on a trolley and had been for a number of days. He made it to a hospital bed for, I think, his last 24 or 48 hours on this earth.”
“Extending the acute oncology service to seven-day working is a recommendation of the Northern Ireland cancer strategy, but, due to budgetary constraints, that has not been progressed. Work is still progressing to assess demand and to develop appropriate pathways, with costed proposals to extend the service being considered, based, again, on available funding.”
“When a cancer patient is referred to an emergency department by their GP, they will be triaged, stabilised and assessed by the ED team based on clinical priority and within the physical and staffing constraints of the emergency department. If necessary, the ED team will contact the relevant oncology or surgical team to assess and admit that patient. <BR /> <BR />In addition, each trust has an acute oncology service that aims to provide a coordinated approach to the care of cancer patients suspected of having a first diagnosis in the emergency setting or of those who are admitted acutely ill due either to the disease or to complications with treatment. That service currently operates on a five-day, nine-to-five model across all trusts.”
“Oncology teams and surgical teams that manage cancer patients strive to minimise the need for emergency department visits. Every hospital trust in Northern Ireland has a 24-hour systemic anti-cancer therapy (SACT) telephone advice service. Patients are encouraged to contact their treating unit through that service if they feel unwell during or within six weeks of completing SACT treatment, or within 12 months of completing immunotherapy treatment. <BR /> <BR />Similarly, cancer patients who have recently undergone surgical treatment receive verbal and written discharge advice, including instructions on how to access the surgical team and advice on under what circumstances they may need to seek emergency care.”
“I thank the leader of the Opposition for those comments. I am more focused on the three-year plan. I do not see what is wrong with reading the three-year plan and seeing that I have targets of 46,000 additional appointments and 11,000 procedures between now and 2027.”
“I thank the Member for his question. I have already published a three-year plan that covers my intentions and ambitions for the remainder of the mandate. We will shortly follow that up with a more detailed and costed plan for financial year 2025-26.”
“We have just allocated the £1·8 million. Those in receipt of a core grant have got their letter, and those who were unsuccessful have been offered feedback. I intend to open up the next tranche of core grant funding in the autumn.”
“I thank the Member for her interest in the core grant scheme. When I took up my post, the scheme effectively did not exist, in that no money had been allocated to it. I was not happy with that position, so, following negotiations with the permanent secretary and others, we identified £1·8 million to go towards the core grant scheme. That is about 50% of what I would have liked that funding to be. <BR /> <BR />The other issue that I had with the core grant scheme was that it had not been reviewed for over 20 years. That meant that any community or voluntary sector group that had come into existence in the past 20 years was precluded from applying for a core grant. I therefore spoke to the Northern Ireland Council for Voluntary Action (NICVA), which kindly agreed to chair a co-design process, and we now have a new core grant scheme.”