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 question. The additional funding of £13 million begins in the next financial year. This financial year, the quantum is more in the order of £2 million. As I have said, it is intended not just for short-break respite for families but for expanding family therapeutic and behavioural support across the community and all five geographical health and social care trusts. On the Member's specific interest, which is aligned with his geographical representation, he should ask the Southern Trust about supporting the likes of Gateway and about exactly where that money will be spent.”
“We now have a new scheme, and, in the next financial year, I hope to find a little more money to go into that. Currently, it sits at £1·8 million per annum. I would like to see that increased in the years ahead.”
“I thank the Member for her question. I believe very much in the power of the community and voluntary sector to deliver. That goes back to my time as a victims' commissioner, when dozens of community and voluntary groups were providing day-to-day assistance to victims and survivors of our long, 30-year conflict. Certainly, in the provision of health, if the community and voluntary sector were to collapse, it would have a profound impact on our ability to deliver healthcare in Northern Ireland. <BR /> <BR />The Member may be aware that I worked with the Northern Ireland Council for Voluntary Action (NICVA) on a redesign of the core grant scheme. That is a scheme that had basically been closed to new organisations that had come on stream in the past 20 years.”
“I thank the Member for his question. Directly, the answer is no, I have not personally been involved. I would be more than happy to meet, but the Member will be aware that my officials meet all sorts of groups every day, and, if there were proposals, I would expect them to come to me in the normal course of work.”
“Also, I was taken by the fact that there is a potential for some form of match funding, should I be able to find funds to increase what the Northern Ireland Executive put into the hospice through the Department of Health. While I can make no absolute promises to the Member, I will say to him that it is very much on my radar, and, if I can, I am determined to do so.”
“I thank the Member for his question, and, indeed, I applaud his continued interest in and support for the Children's Hospice. As he said, I visited that facility, as well as the Northern Ireland Hospice, a few weeks ago. I was impressed with the facilities. I was impressed with the level of joy at the Children's Hospice in particular. That may seem an odd statement to make when there are children there who are suffering from life-limiting and life-threatening conditions. However, there was pure joy in the air, and I came away with a determination to do what I can in coming years to increase the funding for the hospice. That is before we look at the increase in costs that will develop for hospices, not least with the national living wage and the increases in National Insurance.”
“I thank the Member for her supplementary question. It takes me to a point that I came to early in my tenure as Minister. We have five geographical trusts for what is a relatively small geographical area and, indeed, a relatively small population, at just under two million people. Rather than introduce what might be the distraction of a major reform to create one geographical trust for the whole of Northern Ireland, I have told the chairs and chief execs that, in my mind, I look at the five trusts as one, so I want an end to competition and to see more collaboration and cooperation. That is particularly important in this area, where resources and the very buildings where respite care may take place are in such short supply.”
“As that process takes time, it will be challenging to ensure that co-design is meaningfully built into the allocation of the recently announced additional funds this year, but I hope to see better as we move forward.”
“<BR /> <BR />My officials have established a monitoring framework for children's disability. It monitors capacity, workforce and need and supports accountability discussions with health and social care trusts. It will be expanded to ensure that the additional funds deliver their intended outcomes. <BR /> <BR />My Department recognises the importance of co-design and the value that it adds. The framework for children with disabilities has been developed with the views of families and providers to set the priorities for my Department and the trusts. However, it is recognised that further work will continue to be needed to ensure that those who use the services are better involved. Meaningful co-design requires capacity and relationship building with families.”
“On 23 October this year, I was pleased to be able to approve additional regional funding for the children with disabilities service. That funding is intended to assist with increasing short-break capacity and with expanding family, therapeutic and behavioural supports. Following that announcement, the strategic planning and performance group (SPPG) met trust directors as a collective and individually to robustly assess their proposals and delivery time frames. On 7 November, there was a workshop to review the progress of the children with disabilities work stream. Representatives of the Children's Law Centre and Parent Action attended and participated in the children with disabilities work stream as part of the children's social care strategic reform programme.”
“I repeat that we will look to see what the UK Government do or do not say in their response to the 2023 consultation and test that against the provisions from the Government of Ireland in order to ensure that we deliver best practice and close off any potential loopholes.”
“Under the Consumer Protection from Unfair Trading Regulations 2008, it is an offence for traders to treat consumers unfairly through misleading actions, misleading omissions, aggressive practices or failing to adhere to the standards of professional diligence. <BR /> <BR />In summary, I am committed to considering measures to ensure that the products are safe for the people of Northern Ireland who use them and that those products are administered by appropriately trained practitioners. I will therefore continue to make the case for additional resources for my Department in order that, in the interests of public safety, it can respond to the new challenges.”
“That may involve developing new legislation or reviewing existing legislation in parallel with public health messaging but also considering the issue more widely to assess current responsibilities with a range of organisations — in addition to the RQIA and my Department — such as the councils. That is because some cosmetic services and therapeutic treatments would normally come under council enforcement for health and safety reasons. Then there is the Health and Safety Executive for Northern Ireland (HSENI), which is the enforcing authority when these are carried out under the supervision or control of a registered medical practitioner, and trading standards.”
“I will come to councils in a moment, if I may. The figures are local figures, which come from the Department's medicines regulatory group. <BR /> <BR />We are working to ensure compliance with existing laws and guidance. Where evidence or information suggests unlawful practice, the HMR are enforced and, as I said, there have been some successes. We are committed to taking decisive action to combat the illegal promotion, supply or misuse of medicines and to alerting the public about the dangers of misuse outside of the regulated supply chain. I am determined that we will remain vigilant and continue to work with key partner agencies in order to monitor the illicit marketplace. <BR /> <BR />We will continue to take effective action where necessary in order to protect public safety in Northern Ireland.”
“I thank the Health Committee Chair for the point, which is well made. I am just making the point that if the UK Government are going to announce their way forward in a reasonable time frame, it is worth looking at that. However, we will, effectively, have to quality-assure that against what is happening on the rest of this island, in the other jurisdiction, in order to make sure that we have as much of a seamless way forward as possible and that there are no loopholes that will jar.”
“Work is under way, but a self-financing proposal is certainly one that I am prepared to take under consideration.”
“I thank the Member for his intervention. By way of a response, it would be timely to say that it is not the case that nothing is happening on interventions. When it comes to enforcement, we rely on the Human Medicines Regulations (HMR) 2012. I can tell the Member and the House that between 2022 and 2024, my Department's medicines regulatory group conducted 65 focused investigations into the unlawful possession, importation, advertisement or supply of unlicensed prescription medicinal products for use in the non-surgical cosmetic sector. To date, three persons have been successfully prosecuted, and a further four prosecutions are pending. In that period, the medicines regulatory group has issued 24 formal advice and warning letters and has seized over 4,000 units of unlicensed Botox and fillers.”
“We will continue to engage with DHSC to keep up to date with the proposals and the progress being made throughout the rest of the UK. That will help us to assess how the approach in Northern Ireland should develop. Currently, as I said, the UK Government are yet to respond to the consultation that was undertaken last year by the previous London Administration, and, given the capacity constraints on my Department, which I have mentioned, it is sensible to await the outcome of the UK Government's thinking on the way forward, unless, of course, that thinking is subject to undue delay.”
“In that context, other critical and priority projects are having to progress ahead of the work on the regulatory policy framework and the review of the regulations here. However, I can assure Members that that remains an important issue for me and the Department.”
“As Members will appreciate, the Health and Social Care system across Northern Ireland is working to address a number of the many profound challenges that it is experiencing. That work, regrettably, has been made many times more difficult by the very constrained budget, and my Department is regularly left with no choice but to make decisions in relation to the work that can be delivered within current resources.”
“The passing in March 2022 of an amendment to the Health and Care Bill gave the Secretary of State for Health and Social Care the power to bring into force a national licensing scheme for aesthetic, non-surgical cosmetic procedures in England. The treatments in question are many and varied and can include things like dermal fillers and other injectables, chemical peels and laser hair removal, to name a few. <BR /> <BR />I am acutely aware of the wider changing and challenging health and social care service delivery environment, including in relation to cosmetic treatments. Prior to the COVID-19 pandemic, my Department had developed a new draft regulatory policy framework. However, further development work is required. That will include public consultation on a draft policy.”
“The new Government are still to set out their position following the consultation in 2023, which was undertaken by the previous Administration. <BR /> <BR />As Members have heard, in England it is a criminal offence to administer botulinum toxin — Botox — or a filler by way of an injection for a cosmetic purpose to a person under 18, even if they have the permission of somebody who is over 18 years of age. Currently, there is no set minimum age at which a person can avail themselves of the treatments in Northern Ireland, nor is there an age limit in Scotland or Wales. It is essential that people are fully aware and cognisant of the potential consequences before undergoing procedures that could have such long-term effects.”
“<BR /> <BR />To give Members a fuller sense of the concerns from other public bodies around these issues, I can advise that, in recent years, the Department has also been contacted by several local councils on the issue of regulation of cosmetic treatments in Northern Ireland and the introduction of a licensing scheme for non-surgical cosmetic procedures. That is the clear direction of travel in the rest of the UK; indeed, as Members have pointed out, the issue was debated in the Scottish Parliament in October last. My Department therefore recognises the public interest in the area and notes the advocacy by some of the need for statutory regulation. We are aware that the issue of greater regulation is being actively considered by the United Kingdom Government, who have stated a commitment to taking action to address the safety concerns.”
“It is an important issue and one that can impact on vulnerable people, in particular. It needs to be addressed if we are to reduce public harm. <BR /> <BR />I note the significant volume of complaints that Save Face, which registers accredited practitioners and clinics, received in 2022 regarding unregistered practitioners. I have no doubt that those issues have prevailed since 2022. Therefore, it remains important that action be taken to increase public safety and awareness of what can happen when the procedures are not undertaken safely. In April this year, my Department wrote to Save Face regarding high-risk, non-surgical procedures and treatments on those under the age of 18. We acknowledged the importance of the issue to Save Face at the time, and it is a matter of concern to me that there is no minimum age limit.”
“Deputy Speaker, with your indulgence, I shall deviate from the motion just for a moment to acknowledge that my counterpart in the Government of Ireland, Stephen Donnelly, the Minister for Health, lost his seat in the general election over the weekend. It is a matter of regret for me, because, over the last six months, we had been building a positive relationship and discussing specifics in terms of service delivery on an all-island basis. I look forward to working with the new Government of Ireland when formed. <BR /> <BR />To the debate, and I thank the movers of the motion and, indeed, of the amendment. I fully empathise with anybody who has been affected in any way and has suffered harm and injury as a result of accessing non-surgical cosmetic products and procedures that have not been administered appropriately.”
“I thank the Member for giving way. The new issue is with the medical gas pipework. I am told that the scale is limited. However, I am entirely dissatisfied that a new issue has emerged, and I am particularly dissatisfied that I only learnt about it today. Let me assure the House that I will seek further analysis of the issue with the medical gas pipework and further assurances on the fix.”
“I have to say that, when I went to bed last night, I was not in favour of that, not least because the cost and time that are associated with a further independent inquiry could be in the order of £3 million per annum, with a significant time impact and no guarantee of improvement. It could also stymie progress. However, as of 8.00 am today, I have become aware of another issue. I know that Mrs Dodds is very well informed on those issues, so I will set her this challenge: I give her 24 hours to discover what the latest problem is with the maternity hospital. It is another totally shocking revelation. <BR /> <BR />I will just say in conclusion that £1 that is wasted in delivering healthcare is a pound that could go towards tackling the social determinants of ill health in education, communities, rural affairs and the rest.”
“As a result, the trust commissioned an independent expert to provide a report into the water systems in the building. <BR /> <BR />As my time is running short, I will switch to the last part of the motion, in which the signatories ask that I commission:”
“<BR /> <BR />To date, the flagship maternity and children's hospital project has delivered the completed new maternity building, phase B1, and the associated enabling works; the office and logistics building, which is known as non-clinical support; the Bostock House demolition; and a series of demolitions and site clearance-enabling contracts, ducts and complex services on which the overall flagship project is dependent. <BR /> <BR />Pseudomonas in the maternity hospital is a further and serious cause of delay on the project, and it is being investigated by independent experts. The new maternity hospital was handed over to the Belfast Trust in March this year. After a steady-state period post-handover, the trust sampled all outlets in the building and detected pseudomonas.”
“Nevertheless, referring to the specific issue at hand, projects that are located on acute hospital sites are inherently complex, each being unique and bespoke, with complex building services, installations and systems having to be coordinated and commissioned. In addition, the projects making up the overall flagship maternity and children's hospital project are interdependent, with a delay in one enabling project having a consequent impact on subsequent projects.”
“<BR /> <BR />A recent report that the Strategic Investment Board produced, 'The Root Causes of Delay and Cost Overruns in Major Capital Projects', states:”
“The Audit Office's follow-up report on major capital projects, which was published in February and which the Member mentioned, did not make easy reading. It set out significant cost and time overruns on projects across different parts of the public sector, including transport, health, education and sport. In short, government here has a very poor record when it comes to delivering major capital projects. I want the Executive to address that collectively and to look again at previous recommendations from the Public Accounts Committee. That includes examining, again, the case for a single Northern Ireland oversight body with responsibility for the central monitoring of major capital projects. I have written to the First Minister and the deputy First Minister encouraging them to give fresh consideration to that proposal.”
“Let me be very clear: I am deeply, deeply, deeply uncomfortable with what has happened. The public purse deserves much better. Speaking frankly, I have called a number of very challenging discussions about what has happened and about the best way forward. Those discussions will continue; in fact, there was a very tense meeting in the Department early this morning. I want to know how all this happened; what went wrong; what was done; what was not done; and whether alternative actions were available, discussed and actioned. Importantly, the Belfast Trust needs to determine what needs to happen next to put all this right. <BR /> <BR />Of course, there are wider issues. Taking a view as an Executive Minister rather than just a Health Minister, I point out that these delays and the overspend are far from unique across the public sector.”
“At its heart, that work is about how we can improve the sustainability of hospital services and, ultimately, provide an assurance that none of our acute hospitals will close. The framework is underpinned by a number of existing service reviews and strategies. Those were clinician-led and developed in partnership with those who use the services. <BR /> <BR />I recall Mrs Dodds describing the document as "underwhelming". I could return the sentiment in respect of her discharge of her statutory duty as defined in section 29(1)(a)(ii) of the Northern Ireland Act 1998, which requires any member of the Statutory Committee to, "advise and assist" me. I am not sure whether deploring me is advice or assistance. <BR /> <BR />I turn now to the part of the motion that touches on the maternity and children's hospital project to date.”
“<BR /> <BR />In my first remarks to the Chamber, I said that I would not criticise any former Health Minister because I did not think that doing so would improve the health outcome of a single patient or service user. I stick with that promise, but I equally believe that more radical reform is required and should have come before now. However, such realities do not sit easily with the political motivations of the motion, so I am not surprised to see that they are not reflected in it. <BR /> <BR />The Department has also launched its public consultation, 'Hospitals — Creating A Network for Better Outcomes'. The document aims to describe our hospital system and provide a strategic context for future hospital reconfiguration.”
“In May of this year, my Department published an updated elective care framework plan. It sets out a clear plan to address waiting times, with a focus on areas where the impact will be greatest. I have referenced elective care centres and rapid diagnostic centres as examples. I should add post-anaesthetic care units to reduce reliance on intensive care units, high dependency units and elective care. In addition, my Department is working continuously with trusts to increase productivity and efficiency through the use of a wide range of best practice service improvements. I am in the foothills of a debate on a new funding model for health, particularly for the geographic trusts.”
“That £76 million is not sufficient to deliver work on patients who are waiting for a long time; it is just what is needed to stand still. My Department has continued to seek the provision of additional funding to assist with addressing those waiting lists. A £10 million bid was submitted as part of October monitoring, but, again, the decision, supported by Members, was that the bid should be unsuccessful. My Department estimates that, in addition to that £76 million, a further £80 million a year is required to support elective care and reduce the demand/capacity gap, and £135 million a year for up to five years is required to remove the waiting list backlog.”
“<BR /> <BR />Prior to the restoration of the Assembly and the Executive earlier this year, all parties spoke openly about their desire to put healthcare first, yet, although tackling waiting lists is one of its priorities, the draft Programme for Government makes clear that lists will get worse before they get better. All the earlier promises of genuinely prioritising health and the many thousands of people stuck on waiting lists fell away at the first opportunity. <BR /> <BR />Not a single penny was allocated to tackling waiting lists this year. I, however, have approved investment of £76 million. The focus will be on supporting those red-flag and time-critical waiting lists: in other words, cancer and life, limb and sight issues.”
“Given the Health budget, and the long-standing MO for how it is allocated, there is simply no choice but to make stabilisation and optimisation of existing services a dominant theme in our planning for this year. <BR /> <BR />We are all aware that elective care waiting times in Northern Ireland have significantly increased in recent years. I have been clear that that is entirely unacceptable. I have, however, also been clear that many factors are contributing to the situation, not least the overall financially constrained environment and the scale of the gap between funded health service capacity and patient demand.”
“The scale and pace of reform is, of course, dependent on the amount of funding available, and we need to be realistic about what is attainable in the immediate future, considering the 2024-25 Health budget. <BR /> <BR />Although the allocations in the June and October monitoring rounds were welcome, they failed to address fully the joint pressures of balancing the books in this financial year and delivering the national pay-parity awards that staff deserve. I have likened it to trying to be physically in two places at once, but now the signatories to the motion want me to add accelerated reform to those budgetary pressures: in other words, in three places at once.”
“In five simple words, the motion trashes the excellent work delivered day in, day out by health and social care workers right across Northern Ireland: 70,000 people rubbished in a single, short phrase. Every day, the vast majority of patients and service users enjoy excellent care from HSC staff. <BR /> <BR />On the question of reform, my Department has published progress reports on 'Health and Wellbeing 2026: Delivering Together'. The most recent was published in July of this year. The progress reports set out examples of progress made across a wide range of areas: population health; primary and community care; social care; mental health; and secondary care.”
“In the negotiations with the UK Government that led to the restoration of devolution, the DUP repeatedly made much of the fact that it had successfully argued that the block grant should be based on assessed need rather than on a simplistic headcount, and it singled out Gavin Robinson MP as the person who led on that argument. When it comes to delivering healthcare, however, assessed need goes out the window, and the DUP reverts to a simplistic cry that the Department of Health gets over half the money. <BR /> <BR />We then come to the truly offensive phrase, which is the claim that all the funding has the outcome that the people of Northern Ireland:”
“On the question of underfunding, I have heard Mrs Dodds use the word "obscene" to describe aspects of the health service. The first time that I heard "obscene" used in connection with healthcare was when her former party leader and First Minister Peter Robinson used the word in February 2011, when he said that it was obscene of the then Health Minister, Michael McGimpsey, to call out the gap in the health budget. Of course, Michael was right, and I would not be the only one to argue that underfunding at that time was the start of the problems that we have today. <BR /> <BR />Here is where the motion lacks a little logic.”
“transformation of healthcare delivery. That ignores the impact of multidisciplinary teams on primary care. It turns a blind eye to what is happening in secondary care with day procedure centres, elective overnight stay centres, rapid diagnostic centres and, indeed, mega-clinics, to name just some of the major reforms. It is simply not correct to state that there has been a lack of progress and action. <BR /> <BR />There is then the old chestnut that the Department of Health budget absorbs so much of the block grant. It is as if the signatories to the motion expect that the health and social care system should handle demographic change, growing demand for care, increased acuity, and chronic and persistent underinvestment without recourse to additional funds.”
“<BR /> <BR />I can point out Members who are happy to vote for wholly inadequate Health budgets while, in almost the same breath, demanding more Health spending in key areas or in their constituencies. For example, almost daily, I respond to Members' letters asking whether I intend to reintroduce the Republic of Ireland reimbursement scheme. Oh, the irony. The bids for funds for that were rejected. <BR /> <BR />The motion is not just shameless but, in part, factually wrong, so let us deconstruct the text. First, it:”
“<BR /> <BR />I acknowledge that we have many deep-rooted and serious problems to address in health and, indeed, in public services, but it seems to me that there are two contrasting ways to approach them. We can tackle them collectively, as an Executive, united in our determination to achieve better outcomes; or we can stay in our silos and let individual Ministers sink or swim, all the while finger-pointing from the Benches. It seems that some in the House prefer a third way: maintain a pretence of joined-up government, with occasional photocalls and warm-sounding words, while, as the spokesman for the Opposition made clear, we see the reality on the Floor and in news releases and other statements.”
“Thank you, Principal Deputy Speaker. I have much more than 15 minutes' worth of comments, so it is unlikely that I will take any interventions. <BR /> <BR />As ever, I am happy to come to the Chamber to debate healthcare, even when the motion is as self-serving and, frankly, in part, offensive as this one. The irony klaxon is sounding loud and clear, as it does every time Members denounce the consequences of their decisions. The motion encourages the Assembly to "deplore" the supposed lack of progress and action towards transformation, yet it fails to even acknowledge the enormous harm done to our health service through the extensive, self-inflicted political stalemate that immediately preceded it.”
“I will finish with a thought for Ken, if he is listening. Ken, you always started revealing things to me by saying, "You know yourself", even when I did not. Ken, I hope you know yourself that you were loved and you are missed.”
“<BR /> <BR />I had the pleasure of working with him for about a decade. We covered so much, especially the long, long build-up to the Good Friday/Belfast Agreement. We covered atrocities, not least the Omagh bombing. We travelled many, many times, reporting from not just Northern Ireland but Dublin, London and Washington DC. In those hundreds and hundreds of live exchanges, we never once rehearsed the questions and answers, because we had trust. More importantly, the public had great trust in Ken: they relied on him and valued his analysis. He was, frankly, for all that time, my broadcasting brother, and I am so grateful to have had that opportunity. <BR /> <BR />My condolences to all but particularly to Liz, to Gareth, Sarah and Sophie, to Summer and Hugo and to the rest of the extended family.”
“No sound, no vision: I think we can agree that that was quite an unusual request for a TV person. A few weeks later, we needed to interview that guy again. By this time, Ken had changed his mind. He said that sound and vision was OK. He had caught the broadcasting bug. That is how it began, but it ended with Ken being the most respected journalist I have ever met — the most respected journalist I have ever known, in fact. Why? Because he was authentic, curious, caring and compassionate. He was totally fair and impartial in his reporting, and he was completely trustworthy. He knew when to tell the audience what he knew and when to hold it up his sleeve. For all those reasons, he had friends on this side of the House, that side of the House, to my left, to my right, in front of me and behind me.”