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 65 of 107.
“To me, that sums up the commitment and care that the staff put in.”
“I thank the Member for her question and her point, which is absolutely central. When we talk about the health service, we think about buildings, equipment and medicines; we do not think enough about the people who are the National Health Service and the Health and Social Care staff. In the first instance, I want to assure them that I have my definition of a "good job", and it includes not only terms, conditions and remuneration but how they are treated and respected and how we understand what they do. On a personal level, I go back to my dear mother's final few days in the Ulster Hospital. I mentioned the member of catering staff who had been off for a week and who came into the room where Mum was and burst into tears, because Mum had physically deteriorated significantly over the course of those seven days.”
“Members will probably be aware that, during the COVID crisis, at times, the uptake of vaccinations was quite low, and people had to go to the likes of a GP surgery. When vaccinations were taken into the heart of the community, the uptake rate went up. There are precedents for what I am thinking about. I do not think that I am reinventing the wheel; it is more a question of emphasis. It is about making sure that people, particularly in communities that are perceived to be in areas of deprivation, get the services as close to where they live as possible and that those services are as accessible to them as possible. I suspect that that will make a real difference.”
“I do not want to frustrate the Member by again saying that it is a little early for me to lay out a definitive plan, but, during the short period building up to taking over the Ministry, I visited a community pharmacy in Killyleagh, which is in my constituency, and got a good briefing from a practitioner on the issues and some suggestions for potential solutions. <BR /> <BR />With regard to what the Member said about tackling health inequalities, I am passionate about that subject. When people want a health service, we tend to go to that service: to a GP surgery, a hospital or some other facility. I am starting to pose this question to colleagues: to what extent can we reverse that direction of travel and take the facilities and resources to the community?”
“I thank the Member for those comments and look forward to working with him in the remainder of the mandate. As I said, I came here because I wanted to give the House its place before engaging in any substantive way with the media. However, I hope that Members will understand that, as this is day five of my being in post, I am not down into the weeds and the great detail. I am still receiving pretty high-level briefings. It will be a short number of weeks before I am across the fine detail, so I am reluctant to make any substantive decisions. However, I understand that the Member asks me simply to commit to looking at it, rather than to come to a conclusion, and, on that basis, I am absolutely more than happy to make that commitment.”
“That needs a strategy, and, as I said, it will be a priority for me. I look forward to bringing it to the Committee in due course.”
“It is not just about attracting the workforce; it is about making the environment attractive to people and making sure that the remuneration is as good as it can be. I want everyone who works in the health and social care sector to be as well paid as they can be. <BR /> <BR />There has been a debate in the Economy Committee and the Department about what constitutes a "good job". I was fearful that there might be a kind of elitist definition of that. I do not think that there will be, by the way. From my point of view, a good job is a job that means that, when you wake up, you look forward to going to work to do your shift, you feel valued, your terms and conditions are good and you feel that your job is worthwhile. That is a broad definition of what I would want every job to be for everybody working in the HSC in Northern Ireland.”
“I thank the Chair of the Committee. I enjoyed our engagement earlier today, and I very much welcome your good wishes, Chair. <BR /> <BR />On your specific question, I cannot give you a time frame, but I can certainly commit to trying to establish a time frame. I assure you that it is a priority for me. I have already met some of the trust chiefs and their financial directors, and it is clear to me that there are some really intractable problems with workforce. I think particularly of the Southern Trust and the Western Trust, which are closest to the border, the impact of Sláintecare and the fact that there are consultants, for example, who can easily migrate not a huge distance and certainly without spending an awful lot of time travelling to find themselves in a good post on the other side of the border earning considerably more money.”
“<BR /> <BR />I look forward to early engagement with not only Minister Murphy but other Executive colleagues to look at what our priorities will be and at how we can all input our resources, thoughts and energies to make these things happen so that we can finish the mandate with Northern Ireland and its people in a better place than they were when we began it.”
“<BR /> <BR />The one area that I discussed, albeit briefly, with the Minister of Finance this morning was the role of Health in trying to boost the economy. I think particularly of people who are economically inactive. As the Member will know, our rates of economic inactivity are shocking, at 26%-plus. There are a number of factors for that, one of which is the lack of accessible, affordable childcare, but top of the list of inhibitors for people being in a position where they are neither in nor seeking work is health issues, both physical and mental.”
“I thank the Member for his question and for his welcome, and I very much look forward to working with the Health Committee. <BR /> <BR />The Member asked about discussions that I have had with the Executive. He will understand that I have been in post for less than a week. I have met just one other Minister, and that was the Minister of Finance, whom I met earlier today. I impressed on her the fact that I want to work in a collective manner to deliver both for Health and a full Programme for Government. I have always been a fan of the idea of a results-based Programme for Government, and, in order to do that, we have to get out of departmental silos and think about cross-departmental working.”
“<BR /> <BR />I recognise that I must play my part, alongside all Executive colleagues, to help deliver a hugely challenging Budget, but, for that to work, they and the Members of the House also need to be willing to look at the real challenges facing Health and Social Care and, therefore, the most vulnerable in our society. Let me be clear: cuts with catastrophic impacts? Not on my watch. <BR /> <BR />Meanwhile, I am also actively planning for reform, building on the work already done, and will bring forward more detailed proposals as soon as I can. I have a dual purpose: to offer Members a realistic assessment of the challenges but to try to meet those challenges by working with them. The situation is far from ideal for my Department or that of any other Minister. As the novelist, Ivan Turgenev, puts it:”
“Even then, my Department calculates a very significant gap once those savings are made, and the only way that the gap can be closed is to deliver a break-even budget through taking the high- and catastrophic- impact decisions. That is the reality of the Budget that the House passed less than a week ago. Those decisions would require reductions in acute beds, home care hours and care home beds, all having significant and sustained consequences for elective care, hospital discharges, patient flow, emergency department overcrowding and ambulance handover times. In short, catastrophic cuts will simply make the situation worse. Pressures on services and staff, already at severe levels, will be significantly intensified. It also means that, as we stand, there is no feasible route to affording pay awards.”
“I am afraid that I have added an unwelcome phrase to my lexicon in the last few days: joining the assessment of cuts with low, medium or high impact come cuts whose impact will be "catastrophic". Again, those are not my words or the words of my party: that is how our health trusts have categorised them. <BR /> <BR />In my first few days, I have met senior trust and departmental officials and have heard at first hand about the rigorous, ongoing work to deliver hundreds of millions of pounds' worth of savings that will have a low or medium impact. Of course, we will continue to strive to do more, but those savings are at an unprecedented level. They will be challenging to deliver and will have some impact on patients and service users. I warn MLAs that some will not be without significant controversy.”
“We need to remember that health and social care is about the service to the public, not the party designation of the Health Minister. I knew, coming into the role, that the financial outlook was dire, but I have been stunned by the budget briefings that I have received. I encourage MLAs to engage with their respective trusts; the chief executives would welcome that. <BR /> <BR />I fear that the House or parts of it may not fully understand the consequences for healthcare. The stark reality is that, if I implement the current budget, the consequence will be that many patients will suffer harm. Indeed, I note the joint letter from the collective HSC chairs in which they state that the potential that some cutbacks:”
“It is a matter of regret that, when it comes to the Department of Health's budget, need is not mentioned. The argument becomes, "But, sure, you are getting over half of the total funds."”
“The main parties of the Assembly have all argued, with some success, that the UK Government should review our block grant and fund us based on need, rather than on population.”
“<BR /> <BR />For me, health inequalities represent the overarching issue for so many of the critical challenges facing Health and Social Care. I do not want a two-tier system where timely access to treatments is the preserve of those who can afford to go private. I do not want to live in a society where those who live in deprived areas have such pronounced lower life expectancy, greater health struggles and worse outcomes. That, of course, is a challenge for all parts of government. I want to work with my ministerial colleagues and the resources that I have to develop a plan to do more to address health inequalities at a community level. I will bring back more detailed plans in due course. <BR /> <BR />In conclusion, I must return to the Budget.”
“<BR /> <BR />Both as a broadcast journalist and when I served as a Commissioner for Victims and Survivors of the Troubles, I saw the horrific impact of poor mental health as a legacy of what we so euphemistically call "the Troubles". Again, if you take a map of the hotspots of the conflict, measured by bombings, shootings and murders, and you superimpose a contemporaneous map of hotspots for mental issue issues, measured by attempted and completed suicides and by drink and drug addictions, you will see a match. It is no accident that those hotspots are often areas of deprivation, where health inequalities are most pronounced. I am therefore working to develop an initiative that I expect to be able to announce in the very near future.”
“<BR /> <BR />When I started campaigning for better mental health and well-being provision after first being elected in 2011, the response was, frankly, underwhelming. Some MLAs were not entirely convinced; many others simply did not get it. My motion to appoint a mental health champion was defeated in the House. I am happy to acknowledge that that has changed. The battle for awareness has been won. Now we need to fund the action plan to make a difference. Having spoken recently to the mental health champion, Professor Siobhán O'Neill, I know that the budget meets only one eighth of this year's delivery plan. Mental health is also a personal issue for me. My wife endured an episode of clinical depression many years ago. The answer was not merely pills and tablets; human engagement with skilled professionals was critical to her recovery.”
“I will continue to drive through those improvements forcefully, wherever and whenever possible. That includes reform, and reform needs funding that yields a long-term, irreversible impact. That needs, frankly, parallel funding to reduce lists and to ensure that they do not grow again by addressing the fundamental issue of closing the gap in demand versus capacity. <BR /> <BR />Sadly, the impact of cancer on our fellow citizens is growing, not least because people are living longer. It is projected that, by 2040, rates of cancer will rise by 45% among men and by 58% among women. I will pause for a moment to allow the House to think about how many family members, friends and constituents will be affected by that.”
“As I said last week, it is a stain on my record that I cannot wash away. <BR /> <BR />As indicated, I have begun my conversations and consultations on the future of the health service in Northern Ireland. I have three years to make a difference. My key areas of focus should not be a surprise to those who know me. The most stubborn challenges are these: delivering reform; tackling waiting lists; investing in social care; addressing mental health; and confronting persistent health inequalities. Of course, those are not mutually exclusive categories, and they will need primary care and social care as much as they will need secondary care. <BR /> <BR />We have detailed plans in place for waiting lists, and where those have been funded, the proof is there that they work.”
“I saw a young doctor who perched herself on the edge of my mother's bed, took her hand and, with beautiful professionalism, made sure that Mum knew that she was not going to recover from her condition. What I did not see was the staff member who came back on rota after a week off and burst into tears when she saw how badly my mother had deteriorated in the intervening days. Those are two very different roles — a doctor and a member of catering staff — but both of them were totally committed to performing their roles in what they clearly and rightly define as "good jobs". <BR /> <BR />I have to say that I am glad that my mother passed away before I made one of the worst decisions of my life — the decision to disregard COVID regulations. I can only continue to repeat the apology that I offered at the time.”
“I hope that you accept that it is not a boast but a testament to the sheer brilliance of the health professionals who helped me that I left school with an Irish international athletics vest. OK, it is a boast. <BR /> <BR />In recent years, I developed a heart condition. I do not think that I am being melodramatic in stating that it was my GP who started a process that may well have saved my life. I stand here today with two stents, a pacemaker and a defibrillator, so some could call me the bionic Minister. My mother passed away in March 2020 in the Ulster Hospital after a short illness, from which I gained a huge insight into the professionals who are the health service.”
“I want them to feel that they are making a positive difference and that they are appreciated and valued. I understand from my initial meetings with senior HSC figures and a number of the royal colleges that workforce planning and workforce remuneration are issues that continue to need urgent attention. I intend to build on Robin Swann's transformational work in that area. <BR /> <BR />For me, the job of Health Minister, which I am honoured and humbled to hold, is personal. My life, like those of so may others, has been bookended by health challenges that have been met by great people in good jobs in our health service. As a young man, I had significant breathing difficulties. I remember many sessions at the Ulster Hospital, trying to unblock my lungs.”
“I have been asking myself a couple of key questions. Is the health and social care system in Northern Ireland the best that it can be in respect of the service that it delivers and its value for money? Are the people who are the health service — the doctors, nurses, social care staff, allied health professionals and the multitude of important support staff — as respected and rewarded as they should be? On the first point, the current 2024-25 Budget assessment, which was published last week, clearly indicates that the answer is no, in the service that is delivered. I shall return to the Budget in a moment. On the latter point, I promise that I shall value every single member of the HSC family who is working to deliver good outcomes for patients. Everybody working in our health service has a place, and every place should be valued.”
“That is my direction. <BR /> <BR />I say from the get-go that reform means many different things to many people, but it is primarily about securing better outcomes for our population by changing the way in which Health and Social Care works and meeting the needs of our population better. There are, of course, key enablers, such as developing the full range of roles in our workforce and using digital technology to improve the safety, quality and capacity of our system. It is not primarily about cutting costs or saving money, but if that is the by-product — in some cases, it should be — that is all well and good. Cutting costs is not the primary objective. In addition, I make it absolutely clear that it is not about closing hospitals. <BR /> <BR />Meanwhile, there is the here and now, which is my second great challenge.”
“Balance will inevitably lead to a debate, a judgement call and an element of subjectivity. Even in an ideal world, in which we had limitless budgets and resources to keep people healthy, others would still get sick, so we would still need healthcare professionals, who would need facilities, equipment and medicines. I want to populate that blank map with the best projection of the ideal health service for today and tomorrow, including the people, the resources and, yes, the budget required to keep as many people healthy for as long as possible and offer whatever care and support they require. If we were to superimpose today's map of health provision, it is certain that you would not have a match. The long-term challenge is to figure out how to get from A to B in manageable and affordable steps. That is my "vision thing".”
“So do I, and my "vision thing" goes like this: I invite Members to close their eyes, virtually, and imagine a blank map of Northern Ireland. Imagine that there is no health service. Imagine that there are no hospitals, GP surgeries or ambulances. The health map is blank. Now ask yourself a series of questions. First, do you want a health service? I am pretty sure that it is a yes to that from everybody. The next question is a little more challenging, and it is this: why do you want a health service? There are at least two answers to that: to heal the sick, and to keep healthy people healthy. Both of those are, of course, valid aspirations. Neither are they mutually exclusive. It is not one or the other; it is, of course, both. Immediately, however, we have introduced the question of balance.”
“In three short words, my ambition is this: for better outcomes. Obstacles to better outcomes include short-term challenges, the current unprecedented funding shortfall, excessive waiting times and damage to public confidence, as well as a workforce that has suffered much too much from the regular absence of supportive leadership coming from this place. <BR /> <BR />Then comes my longer-term ambition, or what David Trimble famously called "the vision thing." In his speech accepting the Nobel Peace Prize with John Hume, David said:”
“I also acknowledge all those who came before Robin: Bairbre de Brún, who, like Robin, served two spells in office; Michael McGimpsey; Edwin Poots; Jim Wells; Simon Hamilton; and our current First Minister, Michelle O'Neill. <BR /> <BR />From the start, I state that I have no intention of engaging in criticism of any previous Health Minister, because I do not see how such criticism improves the prospects of a single patient. I am sure also that each and every one of them had at the forefront of their mind, as I will, improving patient outcomes, along with promoting and advancing a respectful, positive working environment for each and every member of the Health and Social Care (HSC) family. <BR /> <BR />I refuse to accept the fatalistic narrative coming from some that the National Health Service is spiralling towards inevitable failure.”
“I assure Members that, having served in this place for 13 years, I am happy to affirm that the House is the ultimate authority and decision-making body of devolution, and I commit to giving it its place. As a minor example, I decided to make these remarks in the Chamber before speaking in any detail to the media, and I look forward to forging good relationships with the Health Committee, albeit my first act was to bring the Chamber to a standstill for a quarter of an hour. <BR /> <BR />I begin by offering profound thanks to my immediate predecessor, Robin Swann, who not once but twice stepped forward to undertake the enormous and multiple challenges of being Northern Ireland's Health Minister and providing stalwart leadership.”
“I begin by apologising for the tardy release of the statement. As you know, Mr Deputy Speaker, the Order Paper indicated that I would not be on my feet until 4.00 pm. I was in a series of meetings, culminating in one with the Finance Minister, and I was unaware of the supreme efficiency with which the Chamber was discharging its business since it first sat earlier today. <BR /> <BR />Before I get into the subject of the Department of Health and health and social care, I offer my profound condolences to our colleague Colm Gildernew, who has so tragically lost his nephew. A very good friend of mine drowned 25 years ago this year, and it never leaves you. My thoughts are very much with Colm. <BR /> <BR />I am grateful to be able to come to the House at the earliest opportunity to offer Members a sense of my vision as Minister of Health.”
“As a collective, we agreed that we would take that OBA approach sometime in the middle of the last decade. His book, which details how to do it, is entitled 'Trying Hard Is Not Good Enough'. In other words, it is not about the effort; it is about the outcomes. Outcomes are best delivered through cooperation. We are learning that, and we increasingly understand that few issues are dealt with in a departmental silo. We need to cooperate to tackle things like educational underachievement or to deliver childcare. I regret that the Budget is all about departmental budgets, because, ultimately, we need to share and cooperate in order to succeed.”
“<BR /> <BR />I heard a Member say that it was disingenuous to talk about the starting position compared with the finishing position, but I note, as a former member of the Economy Committee, that, in an exchange between the permanent secretary of the Department for the Economy and the Chairperson of the Committee, the permanent secretary indicated that the Department's budget for 2024-25 is largely positive and that it is hoped that the opening positions for arm's-length bodies would largely match the closing position from 2023-24 — ie include all the 2023-24 in-year allocations. That is not disingenuous; that is a valid assessment of the position. <BR /> <BR />I will conclude by referring to Mark Friedman, the man behind outcomes-based accountability (OBA) programmes for government.”
“That is not an alphabetical list of those seven priorities, so it is either random, which would be a rather sloppy way to respond to a Member's request, or it is in rank order, in which case "reducing waiting lists" came second. However, the only money set aside for waiting lists is the £34 million that has come from the UK Government. Whether we say that it is a 6% increase on last year's starting position or a 2·8% decrease from the finishing position — I note that the esteemed BBC commentator John Campbell says that it is both — in my opinion, neither represents the prioritisation of health.”
“The Member maybe misunderstands what "Vote on Account" means. It means that Ministers are free to make decisions in the meantime. <BR /> <BR />My party, during all the talks that preceded restoration, was clear in its understanding that all the other parties that were going to form the Executive wanted to prioritise health. I refer to a response that I got from the Executive Office earlier this month to a question for written answer about the Programme for Government. The answer stated:”
“<BR /> <BR />I am a little disappointed at the number of contributors who are calling us "reckless" and saying that we do not have an alternative. We had an alternative. The alternative was to wait a few weeks. We know from the Department of Finance that June monitoring will yield £200 million or maybe even as much as £300 million. That would have done no damage to the working of the Departments because we have already passed a Vote on Account, so they would be solvent in that time. We had an alternative, which was to wait, see what the £200-plus million could do for the Budget and go from there. <BR /> <BR />I give way to the Member for Fermanagh and South Tyrone.”
“As I said, I have been here for 13 years, and I have never been more optimistic about what we might achieve. The mood is different since we restored, and I am optimistic. Every one of the 90 MLAs knows that, if it collapses this time, it is gone, and fewer than a handful of MLAs would like to see that result. Perhaps that was in our political psyche and we had to take it right to the brink of destruction before we realised that there is no alternative to power-sharing and to learning to work together. I am optimistic despite the fact that we have a legacy of disaggregated working, with a single-year Budget divorced from the Programme for Government and divorced from the legislative programme. However, that is where we are, and that is what we have to work through.”
“Maybe the outcome of a debate such as this is to make progress, particularly in this consociational system of government that we have, or power-sharing, as it is known colloquially. With five parties — in this case, four — in government, it is difficult to rub along together, but, surely, that is ultimately the objective.”
“I feel moved to begin by thanking the Chair of the Economy Committee for his very generous words when he opened his remarks, and I want to reciprocate. I have been on a few Committees during my 13 years in the House, and I think that the Economy Committee is particularly collegial and coherent. I wish it every success for the remainder of the mandate. I also note that Ms Ní Chuilín thought that I was staring at her during her remarks. I will do my best to be less attentive in future. <BR /> <BR />My starting point is to ask this: what is the purpose of a debate such as this? It seems to me that a lot of people think that it is to win the argument and then win the vote. I put it to you that there is an alternative: progress.”
“In his capacity as head of Operation Kenova, Jon Boutcher was the last person to recommend an annual day of reflection. What are the First Minister's thoughts?”
“It was a delight to meet the students earlier this morning, and I wish them well as they prepare to return to the United States.”
“In 2018, I had the pleasure of being a guest of Oxford College, which is part of Emory University in Atlanta, Georgia. The occasion was a debate involving Colum Eastwood, the leader of the SDLP, Patricia O'Lynn of the Alliance Party and me. We were speaking to students after a screening of the remarkable film 'John Hume in America', which documents Mr Hume's remarkable efforts over a number of decades to engage American opinion in this place. Of course, those efforts resulted in huge American influence in bringing about the Belfast/Good Friday Agreement in 1998, the engagement of President Clinton and the chairmanship of Senator George Mitchell. I am delighted to say that a study group from Oxford College is with us today.”
“Is the Republic considering joining NATO? I will leave that as an open question. I support the amendment.”
“What is different between that and article 5 of the North Atlantic Treaty, which states:”
“Of course, that is different from having a strategic interest in the defence of Northern Ireland. We also have to figure in the fact that the Republic of Ireland is neutral on such matters. Thinking about that, I was reminded of something that I heard in Washington when the then Taoiseach, Leo Varadkar, in referring to Ukraine, said:”
“Mr Beattie talked about escalating the capacity and capability of the RAF station at Aldergrove and about the importance of the Royal Navy's being based in the north-west. I know that that will not please every Member of the House, but, on hearing that, I am reminded of the late Gerry Anderson on Radio Ulster, with his whimsical reminiscences about sailors based in what he called "stroke city" during the Second World War. <BR /> <BR />Geopolitics is important. Just over 30 years ago, the British Government said that they had:”
“I thank the Member for his intervention. I will leave his comments on the record. I acknowledge that this can be a difficult issue depending on one's political perspective, but, as I said, I understand that the motion and the amendment are focused on improving our economic conditions. <BR /> <BR />There is one other issue, which Mr Beattie raised, and it is the fact that we have many geopolitical issues today. They are many and varied, but they have a common ability, in that they are dangerous and pose a threat to the United Kingdom, to Northern Ireland and to world peace. As the Defence Secretary, Grant Shapps, said not so long ago, we have moved from a post-war environment to a pre-war environment.”
“According to the Assembly, we have 3·4% of England's population, so that would give us £1·94 billion — very nearly £2 billion — of the Ministry of Defence's spending. I do not think that the Barnett formula is the way in which to look at it, however. <BR /> <BR />Is there a more appropriate argument? It may be more fitting to consider our expertise. As has been recorded, we have capacity and capability in shipbuilding, and we have Spirit AeroSystems. As the Minister says, we have about 100 companies involved in the sector. As the nature of warfare changes, and cyberattacks increasingly become an aggressor's weapon of choice, Belfast, based, to a large degree, on the Centre for Secure Information Technologies (CSIT) at Queen's University in Belfast, is a globally recognised cybersecurity centre of excellence.”