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 for his supplementary question. I agree that there is an irony in the fact that, despite being warned of its potential impact on healthcare delivery, Members will vote for a Budget and then write to me almost daily to request that I consider additional funding for a new service here — bowel cancer screening, for example — and a new service there. At least one Member a week writes to me about the cross-border initiative. That initiative was so successful that we wanted to do it again; in fact, it formed part of a £135 million bid for waiting lists that was submitted to the Department of Finance but not supported by the Executive. From memory, that meant that around 4,000 people failed to get procedures. Yes, the irony klaxon sounds daily in the Department of Health.”
“As a result, my Department projects a funding gap of some £400 million for the financial year 2025-26, with Health and Social Care system being asked to deliver in the region of £200 million in new savings for the second year running. Even then, it is anticipated that significant in-year monitoring round allocations will be required to break even. The assumption that savings on that scale are achievable is not without considerable risk. It will inevitably have consequences for service delivery, including waiting times. With the draft Budget allocation, I challenge the Assembly and the Executive to consider honestly how they can expect us to achieve a reduction in waiting lists.”
“That is despite the fact that waiting lists are one of the nine priorities in that draft document. This will be the second consecutive year where no such money has been provided by the Executive. <BR /> <BR />Overall, my Department's proposed allocation for the financial year 2025-26 represents a small increase in funding compared with 2024-25. However, it will not be sufficient to cover the significant increases in costs that we will face. That is due to a number of factors, including pay and price inflation; the increase in National Insurance contributions for GPs, pharmacists and social care providers; and, of course, rising demand.”
“The draft Budget allocation does not align with the draft Programme for Government, as it provides no additional funding for waiting list reductions, despite waiting lists supposedly having been identified as an Executive-wide priority. Indeed, the draft Programme for Government states:”
“I have been talking with officials with a view to expanding it, and that is part of the three-year plan that I published recently. It is dependent on budget and finance and on workforce. I would like to see it offered from the age of 50 upwards, and that is an ambition that I will work towards within the confines of budget and workforce.”
“I then consider and make my decision on screening policy in Northern Ireland on the basis of the advice, as I said, of the UK National Screening Committee and, indeed, the Northern Ireland committee.”
“I thank my colleague for the question. The Department is guided, as I have said, by the UK National Screening Committee. It is an independent committee that advises Ministers and health services across the four UK countries on all aspects of screening. Its recommendations are evidence-based about whether to introduce, continue, change or withdraw screening programmes for a variety of conditions. In addition, there is a Northern Ireland screening committee that considers recommendations from the UK National Screening Committee. It is chaired by the Chief Medical Officer and provides policy advice to me and has a specific focus on implementation issues in Northern Ireland.”
“I thank the Member for her remarks. The awarding of the contract was the appropriate and best way to go forward. I accept that there have been workforce issues. There has also been an issue with some equipment, but, as I said in my previous answer, any issues with accreditation are more about technical and administrative issues than with the quality of what is being done. It is, of course, a matter of regret that some of the tests had to be exported to get the results expedited, but we are moving in the right direction to providing that screening.”
“I join the Member in encouraging women not to be shy and not to be put off going for screening because it is important that they do so. The issues about Belfast's accreditation I will characterise as more technical than real issues with regard to the quality of the screening, and that is being addressed. <BR /> <BR />For the overall picture on screening, we follow the advice of the UK National Screening Committee, so I am satisfied that everything that should be done is being done to ensure the quality of screening operations in Health and Social Care (HSC) in Northern Ireland.”
“Why did it go wrong? Who was responsible for it going wrong? What steps can we put in place to ensure that it never happens again or, at least, to minimise the chances of it happening again?".”
“I thank the Member for her interest in the issue, which goes much broader than a protocol. I have no doubt that she was shocked, as was I, at the time that passed before there were the right interventions. <BR /> <BR />The screening programme encompasses a range of services provided by the trusts, GPs and the Business Services Organisation (BSO). We have had a number of reports on what went wrong with the occurrences in the Southern Trust. I await some quality assurance reports, and I will then decide on the way forward. The point is that it does not matter what protocols are in place; it is whether they are effective and are followed. Clearly, something went badly wrong and affected a really large number of women. I am determined that we will get to the bottom of it. The questions that we must ask are, "What went wrong?”
“<BR /> <BR />Individual learning events are discussed at regular meetings between the PHA and the trusts, and a summary of learning events is reviewed at regular regional quality assurance meetings with an emphasis on sharing lessons learned with other, unaffected trusts, identifying trends that require further investigation and agreeing mitigating actions to reduce the chance of recurrence. The learning event protocols are regularly reviewed and updated accordingly.”
“Any issue, regardless of its impact, including near misses, should be reported immediately by the trust to the relevant screening team in the PHA. The team will then work collaboratively with the trust to investigate, review and implement any actions recommended because of the investigation. For more serious incidents or if more than one trust is involved, an incident management team will be established with involvement from relevant stakeholders. Serious adverse incidents (SAIs) are notified under the regional procedure for the reporting and following up of SAIs.”
“Trusts are responsible for delivering the screening services that they provide. They have a statutory duty of quality. Each trust is responsible for maintaining internal structures to support quality improvement and local coordination of screening services. They are also charged with ensuring that their workforce is appropriately trained. The Public Health Agency provides oversight and external quality assurance for screening programmes. It is also responsible for maintaining structures to support quality improvement and coordination of the screening programmes across Northern Ireland. <BR /> <BR />Screening programmes have a learning event protocol that sets out the arrangements between the trusts and the Public Health Agency to support a culture of shared learning in order to improve the quality and safety of the programmes.”
“It is a matter of pride for them, for veterans, for this party and for the Assembly. <BR /> <BR />In all the years that I have known Andy, there has been not a scintilla of self-pity but endless determination. If I may, Mr Speaker, I suggest that it would be entirely appropriate were you to host a reception to welcome back the four-time medallist, Andy Allen.”
“At 20 years of age, he lost both his legs to above-knee amputations, and his sight was severely impaired, as a result of being caught up in a Taliban IED in the Helmand province. <BR /> <BR />As party leader, I was delighted, some years ago, to co-opt Andy into the Chamber to replace his predecessor, Michael Copeland, who retired due to ill health. Andy has gone on to become a four-time MLA, having been elected in his own right in 2016, 2017 and 2022. He has also been a great public servant not only in this place but for veterans. Andy Allen's veteran service support group was set up to help veterans and their families, and he did so well that he received an MBE in 2019. His family, including his wife, Natalie, and his three children, will be very proud of his achievements in Whistler.”
“I am sure that Members will have noticed the absence of one of our colleagues in recent days. I refer to the Ulster Unionist Party Member for East Belfast, Andy Allen MBE MLA. He has not been idle. He has been in Whistler, Canada, participating in the Invictus Games. He entered four events and achieved a medal in all four: a full suite of gold, silver and bronze. He won a bronze in the Nordic cross-country sit skiing; two silvers, one as a member of the UK wheelchair rugby team and another in his own right for the one-minute sprint rowing event; and a gold medal, again in rowing, for the four-minute endurance. He is a sprinter and an endurance athlete. Those are remarkable achievements for a man who suffered such life-threatening injuries while serving Queen and country in Afghanistan in 2008.”
“He confessed to being a former smoker, as, indeed, did Mr McGrath, Mr Robinson and Mr Donnelly. What can I say, Mr Deputy Speaker? I join that club, having given up smoking in 1998 in the car park of Castle Buildings when I was reporting on the lengthy negotiations — the endless negotiations — that led to the Belfast/Good Friday Agreement. I still ask myself whether it should have been where I took up smoking, given the stress of reporting those negotiations, but that is where I quit.”
“I thank the Member for his intervention. It is my intention that we will continue with test purchasing. We will continue to monitor it and ensure that we employ best practice. I am not saying that test purchasing activity will not change, but, if it does, it should be changed on the basis of evidence that shows that we can do it a little bit better than we are doing at the moment. <BR /> <BR />Today is a good day for public health in Northern Ireland. As I said in my opening remarks, smoking is one of the behaviours that makes up 30% of the challenge of addressing health inequalities. I look forward to continuing that work. Finally, it would be remiss of me not to welcome Mr McGuigan to his role as Chair of the Health Committee. I look forward to working with him.”
“It is worth making one small technical point when we talk about the smoke-free generation, which includes anybody who was born after 1 January 2009. One Member may have said that it will be illegal for them to purchase tobacco. Rather, it will be illegal for anybody to sell them tobacco. The emphasis is on the vendor, not on the purchaser. I make that distinction for the sake of completeness.”
“In my opening remarks, I made very clear the impact of smoking in particular on public health and the potential impact of vapes. It is not for me to convince the House, however. This is United Kingdom Government legislation, and it is for the UK Government to make sure that the Tobacco and Vapes Bill is compliant with the Windsor framework. <BR /> <BR />Mr Donnelly asked about enforcement. As he knows, age-of-sale restrictions already exist in Northern Ireland, while enforcement is councils' responsibility. My Department, through the Public Health Agency, funds tobacco control officers, who carry out test purchasing activity and engage with retailers to support compliance with tobacco legislation. That will continue.”
“Like Mr Gaston and others, I wish that the European Union did not have any potential to interfere in our legislative process. I accept that, under article 5.4 of the protocol, we have an annex that lists EU provisions that apply, and the European tobacco products directive is one such provision. Article 24.3 of that products directive states:”
“Smoking rates among 16- and 17-year-olds dropped by almost a third. I would gently suggest to Mr Carroll that that evidence base is perhaps a little more relevant than going back to the speakeasies of the Prohibition era in the United States 100 years ago.”
“If Mr Carroll were here, I would simply point out that, much more recently, when the smoking age in the United Kingdom was increased from 16 to 18, the consumption of illicit cigarettes, which is, I think, more pertinent, fell by 25%.”
“Thank you, Mr Deputy Speaker, and thanks, of course, to everybody who has taken part in the debate. What I found pleasing was not just that we were almost unanimous, with the exception of People Before Profit, in supporting the legislative consent motion but that people were not prepared to simply let it go through on the nod, and everybody made significant and considered contributions to the debate. That is to be welcomed. <BR /> <BR />I should perhaps touch on a couple of points that Members made. People Before Profit brought up prohibition in the United States — the prohibition of alcohol — as a reason for refusing to support the LCM.”
“The Bill is an opportunity to save lives. I urge Members to take that opportunity.”
“<BR /> <BR />I ask Members to support the motion in order to best serve our families, our friends and future generations.”
“This UK-wide Bill offers the best opportunity to introduce the measures in this mandate and allow us to keep pace with the other UK nations. The Bill offers a huge opportunity to save lives and enable people to stay well for longer. <BR /> <BR />The response to the public consultation showed overwhelming public support for the measures. The Executive Office and Health Committees were briefed, and they agreed that we should be included in the UK-wide legislation. It is the right thing to do, and we would face considerable public criticism if we were to reject this once-in-a-generation opportunity. I am grateful to Professor Sir Michael McBride for his support for the Bill; indeed, the Bill is supported by all four UK Chief Medical Officers (CMOs).”
“The Institute of Public Health found evidence of a gateway effect between e-cigarette and subsequent tobacco use, so robust measures are needed to address the appeal of the products to children. <BR /> <BR />In respect of costs arising, the smoking measures are not entirely new, so we are not starting from scratch. While the exact costs will need further analysis, in the long term, some expenditure is justified, given the huge personal and economic costs of smoking. Some may be concerned that there are different legislative frameworks on either side of the border. However, the fact remains that we have a common goal of reducing smoking prevalence and tobacco harm. The case for consent remains as when the Assembly gave consent to the previous Bill.”
“The Bill's generational approach to eliminating tobacco use offers a groundbreaking way in which to address that public health threat. Smoking also impacts on non-smokers who are exposed to second-hand smoke and on families who have to deal with the illness or death of loved ones. Smoking affects us all. <BR /> <BR />Members will be all too aware of the financial pressures facing our health service. In 2019-2020, Northern Ireland hospitals spent £218 million treating smoking-attributable conditions, and there were 38,617 smoking-attributable hospital admissions. There are growing concerns about the harms of vaping. Recent data shows that, among year 12 pupils, vape use doubled from 11·7% in 2019 to 23·6% in 2022.”
“The tobacco retailers' register will be extended to include retailers who sell vapes or other nicotine products. The Bill will also provide a power to introduce a licensing scheme. Each of the four nations will have powers to extend smoke-free places and to designate them vape- and heated tobacco-free. <BR /> <BR />Why do we need those measures? It is because smoking kills. It is the number-one cause of preventable illness and premature death. Each year, 2,200 people in Northern Ireland die from smoking-related conditions. It increases the risk of over 50 serious health conditions. As I said, smoking is also a major cause of health inequality. Smoking rates in the areas in which deprivation is highest are three times those in the least deprived areas.”
“<BR /> <BR />Last year, the House voted to support Northern Ireland's inclusion in the previous Tobacco and Vapes Bill, which, unfortunately, fell on the dissolution of Parliament. The new Tobacco and Vapes Bill, which was introduced last November, is broadly the same as the previous Bill. It will create a smoke-free generation, making it an offence for anybody born on or after 1 January 2009 to be sold tobacco products. Going further than the previous Bill, it seeks to address the deliberate marketing of nicotine vapes and non-nicotine vapes to children. Consequently, the Bill will ban the sale of vapes and other nicotine products to under-18s, including from vending machines. It will ban advertising and sponsorship as well as free distribution.”
“Among the many and varied challenges that I accept as Minister of Health, addressing health inequalities is perhaps the most difficult, as nobody has shifted the dial on healthy life expectancy since devolution in 1998-99. I repeat: that challenge is an Executive-wide one. The international standard that we are working to indicates that clinical health initiatives contribute 20% of the solution; socio-economic initiatives contribute 40%; environmental initiatives contribute 10%; and the remaining 30% are down to individual behaviours, such as alcohol consumption, drug use and smoking. It is in that context that I seek the support of the House for the legislative consent motion (LCM).”
“<BR /> <BR />Finally, the proposer of the motion said that efficiencies were cuts: what an extraordinary statement. If none of the £200 million saved this year by the trusts is not an efficiency, no efficiencies are needed. The debate is worthless because the Health and Social Care system is perfect. Who would go for a cut before an efficiency? Yet, you say that they are all cuts. <BR /> <BR />That is why I have found the debate a little disappointing. Some of the comments that I have heard do not stand up to first contact with logic; in fact, I will have a glass of what you are having, without the water.”
“If you look at the resistance to change in the Northern Trust over one proposal to move one service from the Causeway Hospital to Antrim Area Hospital or the resistance in Fermanagh to the temporary closure of one service that was being moved from the South West Acute Hospital to Altnagelvin Hospital, you get a measure of how difficult it is to achieve reform. When you listen to Mr Gaston pointing out the really invaluable service delivered by a community and voluntary sector group in his constituency, he emphasises the fact that all healthcare is not just personal but local. People want everything locally, but we cannot do that because we cannot afford to do it, and nor is it the right thing to do, because we need areas of specialism. When you need a service, you will go somewhere where they do it daily.”
“I say to her, gently, that it is not possible for me to do what she suggested, because these changes are effected by the trusts, not by the Department, and the trusts have a legal obligation to consult.”
“Although cutting waiting times is included in the Programme for Government, I hope that Members have noticed that no additional funding has been made available for that purpose — not a single penny. Indeed, the narrative from the draft Programme for Government makes it clear that things will get worse before they get better. When MLAs from all parties write to me, as they do daily, asking for things such as the reinstatement of the cross-border reimbursement scheme, I ask them to realise that their decisions on the Budget have unavoidable consequences. Just for the record, I would love to bring back the cross-border reimbursement scheme: it works. <BR /> <BR />Mrs Dodds talked about too much consultation.”
“If there are any that have closed on my watch, I will be very happy to hear about them. <BR /> <BR />Let me stress that we are not unique in the United Kingdom. The Westminster Government recently published a health service plan that reflected similar themes and challenges to ours. This opens up great opportunities for cross-jurisdictional working. I have already met counterparts in England, Scotland and Wales, and the Government of Ireland, to discuss mutual concerns and share issues, and I will continue to do so, with regular engagement at official level as well. <BR /> <BR />As I have said, reform is already happening. However, it is inevitable that the pace of reform is going to be impacted on by the level of funding available.”
“As for going to your GP and going back and the pathways being overcomplicated, GPs are already beginning to direct patients to urgent care units, not acute hospitals, so bypassing EDs. The Regulation and Quality Improvement Authority (RQIA) report on the temporary dislocation of general emergency services, moving them from the South West Acute Hospital (SWAH) to Altnagelvin, made the point that we have to move away from double ED assessments. If you get assessed at the SWAH and sent to Altnagelvin, you should not have to go through a second assessment in the Altnagelvin ED; you should go straight to the part of the hospital that you are supposed to. <BR /> <BR />Mr Carroll surprised me by talking about the closure of urgent care centres. I have been at only the opening of urgent care centres.”
“Members will recall that I have already said that we took £2·3 million off a trust for the non-delivery of 100% of commissioned sessions. In the most recent plan, I have challenged health and social care trusts to deliver 46,000 additional outpatient assessments and 11,000 additional treatments annually by the end of the mandate. <BR /> <BR />Somebody talked about pathways. Mrs Dillon talked about two things that she wanted to be prioritised: recruitment and retention. I absolutely agree with her, and that is one of the reasons why I am committed to introducing, within this calendar year, the real living wage to social care. That will have a significant impact on recruitment and retention. Mrs Dillon also mentioned pathways, but I have to say to her that we already validate waiting lists. That does happen.”
“I am focused, and it is important to be clear that root-and-branch reform is not something that can happen quickly. We need to involve those who use the services and those who deliver them when we develop and implement changes. I will return to Diane Dodds's comments in a moment. <BR /> <BR />My Department has already taken further action to deliver my ambitions. For example, in elective care, we have established more mega-clinics and more elective care clinics, and we are investing further in two rapid diagnostic centres. We are driving forward targeted measures to ensure that trusts are delivering 100% of all commissioned sessions and that efficiency and productivity across the elective care centres is maximised.”
“I absolutely agree. This year's action plan has provision for a spend of £42 million. The actual spend is £5·9 million. I have to warn Members that, next year, the gap between what we can spend and what we are hoping to spend will widen. We might get up to just over £6 million, but the plan is for delivery of over £75 million in the financial year. <BR /> <BR />Members will recall that, last October, I welcomed back Professor Bengoa, and he reflected on whether Northern Ireland was on the right trajectory. Some Members think that the Bengoa report has sat on the shelf since 2016: it has not. His view is that we are heading in the right direction. Hearing from him that Northern Ireland is not an outlier in international terms was heartening, but I am very clear that it is not an excuse to relax or take the focus off what needs to be done.”
“<BR /> <BR />I will give way to the Member briefly.”
“I am going to make some headway now. <BR /> <BR />For the three-year plan, I am committed to publishing an annual implementation plan once budget allocations have been agreed. I previously identified my priorities for the mandate, which are delivering reform, tackling waiting lists, improving cancer services, addressing mental health and, above all, confronting persistent health inequalities. Those priorities are based on three pillars, which are driven by the finances in the budget. <BR /> <BR />Stabilisation comes first. Can we preserve what we already offer, and then can we achieve reform and delivery? That will require more investment in all parts of the system: primary; community; social care; and secondary care. Stabilisation of services includes mitigating the inevitable challenges as a result of budgetary pressures.”
“My three-year plan was published less than two months ago. It outlines my ambition for the health service for the remainder of the Assembly mandate. Moreover, there are several other detailed plans in place: for example, the elective care framework, the cancer strategy and the mental health strategy. <BR /> <BR />As for costings, those, too, have been produced.”
“I am aware that, before the restoration of the Executive, all the parties appeared to prioritise Health. I heard Jayne McCormack of the BBC say this morning that, in her first conversation with the First Minister and deputy First Minister, they said that if they could achieve anything and do one thing well in this mandate, it would be childcare, which is not part of Health. <BR /> <BR />The motion calls for yet another plan. I am surprised at that. I thought that Members, especially those from the Opposition, have had enough of plans. I certainly have. From the day that I entered the Department, I have made it clear that I want the focus to be on delivery, not on plans, promises and strategies that do not have the budget for the annual delivery plans. To be clear, I already have a plan.”
“Thank you, Madam Principal Deputy Speaker. I will not hang about, then. <BR /> <BR />I normally welcome debates in the House but not so much today. The tone and content were a bit disappointing. I have never, ever argued that it is all about the money. Many of the issues are the result of over a decade of Tory austerity, repeated instability and stalemate in this place and, frankly, decisions that were made in the Division Lobbies, such as voting for the 2024-25 Budget despite being warned of the consequences for health delivery.”
“I thank the Member for that frank response.”
“My Department will closely consider the recommendations in the APG report as part of any policy development and will continue to engage with the relevant colleagues and stakeholders as required, including members of the all-party group. <BR /> <BR />Finally, there was a direct plea from the leader of the Opposition to insert something in the Programme for Government. I say to the Member, respectfully, that it is not for me to adapt the draft Programme for Government. Rather, any changes should be as a result of the analysis of the responses to the consultation on the draft Programme for Government. On that basis, I ask whether the SDLP has responded to the consultation in the terms that the Member outlined. If he can do that in 10 seconds, he is in.”
“I am also grateful for the support that has been offered by the APG members and experts from other jurisdictions on what those services could look like. <BR /> <BR />I finish my formal remarks by reiterating my acknowledgement that gambling can, indeed, be harmful to health and that there is work to be done in Northern Ireland to understand the prevalence, the implications and the population needs in relation to that. My Department would have a key role to play in adopting a public health approach to gambling. If that approach is taken, however, in order to be truly successful in tackling harms and to deliver what is needed, it is vital that such an approach is cross-departmental and collaborative.”