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 7 of 107.
“Practical improvements are under way. A regional transition protocol for children and young people with a learning disability, including children and young people with co-occurring autism, has been developed. Subject to the availability of funding, departmental officials will facilitate a pilot of that protocol to support full regional implementation. Children's and adult learning disability services across the health trusts remain committed to enhancing that transition process. <BR /> <BR />In parallel, last month, the Department held a phase 1 workshop on transition pathways between child and adolescent mental health services (CAMHS) and adult mental health services. The focus was on exploring low-cost or no-cost improvements that can realistically be implemented within the current service constraints.”
“I recognise the very real challenges facing autistic people and those who support them. I completely agree with the findings of the Independent Autism Reviewer's first annual report: more must be done. We must recognise and address the fact that, while activity is evident, reliable delivery is not as evident. As on many issues, I want to push for standardised regional services that do away with postcode lotteries. As Members have mentioned, autism is part of daily life, and, indeed, it is part of daily life for members of my family. <BR /> <BR />The motion seeks clarity across a number of areas and Departments, so I will respond to each in turn, starting with transitions. Transition from children's to adult services remains a recognised area of challenge, not least for young people with a diagnosis of autism.”
“That places a responsibility on all Departments and public bodies to ensure that we are equipped and informed in our understanding of autism and in the delivery of the appropriate services. We need to strive to ensure that engagement enables autistic people, and their families and carers, to feel supported and to live fulfilling lives. That is the ethos of the autism strategy, which was published alongside the first delivery plan in December 2023. The strategy also focuses on the implementation and requirements of the Autism Act (Northern Ireland) 2011, as amended.”
“Thank you, Mr Speaker, and thank you to all the Members who have contributed in the debate. I absolutely agree: we need to ensure that all those seeking autism services have access to the right type of service at the right time. I am fully committed to the full implementation of the Autism Act (Northern Ireland) 2011, as amended. Indeed, many of the issues that are being debated today are a focus for the Department of Health. Work is actively ongoing to try to address many of those challenges. However, I must also emphasise that all Departments need to work together to address the issues faced by people with autism. We have a growing prevalence of autism in our society.”
“Principal Deputy Speaker, the dental amalgam changes that were discussed in that debate arise from an international meeting held in November 2025 called a Minamata Convention conference of parties. It agreed to set 2034 as the global date for phasing out dental amalgam, and that is an international commitment that applies UK-wide. It is not a product of the Irish Sea border, as the Member claimed. I am happy to put his record straight.”
“On a point of order, Madam Principal Deputy Speaker. I believe that Mr Gaston made a point of order earlier in which he questioned whether I had misled the House with regard to dental amalgam. Hansard records that, on Tuesday 28 April, Mr Gaston said:”
“I hope that the GPs are getting a sense of the potential offered by shift left to give them the rewards, resources and funding that they have been calling for over a number of years. I am proud to report on one initiative, and it is a shameless replication of my decision to ask Professor Mark Taylor to lead the waiting lists initiative. We can all agree that that has been an outstanding success. I have decided to replicate that, and I am pleased to say that Dr David Ross, who is a well-known and respected general practitioner, has agreed to replicate that role in the roll-out of the neighbourhood model.”
“I absolutely will. I believe that it was a one-handed practice, and the GP decided to retire. I am pleased that the Department was able to work with partners at pace to provide a replacement service. The paperwork is being processed as we speak, at which point the strategic planning and performance group will write out to the patients who use the Silverbirch Medical Practice in Bangor to let them know about the new arrangements.”
“Absolutely. It has a key role to play. We look to GPs, community pharmacists and everybody delivering primary care. We look to local councils and everybody who has a stake in community development. On the collaborative issue, the community, voluntary and charity sector will be prime and central to that group of people.”
“It was an absolute privilege to visit Knitted Knockers, and it was energising to see the enthusiasm in the room. I agree with the Member. In fact, before my role as a politician, I was a commissioner at the Commission for Victims and Survivors. Early on in that tenure, it became clear to me that the only people who were making a difference to victims and survivors on a practical, day-to-day basis were those in the voluntary and community sector who looked after the ordinary, day-to-day needs such as getting children to and from school, doing a bit of shopping or trying to find some resource for them. I cannot speak more highly of the community and voluntary sector. As we move to a neighbourhood model, I hope to reward and embed it in the new system.”
“You have to book a theatre. You have to rota staff. You have to persuade staff to give up an evening or maybe a Saturday morning when they have other pressures on their life, not least family life and work-life balance. The lack of a budget is doing real damage and putting very much at risk the progress that we have made to date. The history of such things says that, when you ring-fence money for waiting list initiatives, the waiting lists come down, and, when you stop spending the money, they go back up. That is what will happen without the reform that I am trying to bring forward and embed in the remaining months of the mandate.”
“On the first point, there seems to be a great deal of cynicism about the statistics. There are about 70,000 people working in Health and Social Care, and a significant number of them have been working on the waiting list initiative, which has delivered around three times the Programme for Government target. Being so cynical and sceptical about the statistics, as if the Department is making them up at random, does nothing for the morale of those people. Those people are working long hours, including nights and weekends, and are making a real difference on the waiting list initiative. <BR /> <BR />On the second point, there is no Budget. We are therefore losing momentum on the waiting list initiative, and that is potentially disastrous, having done so well in the 2025-26 financial year. It takes up to six weeks to schedule additional work.”
“I thank the Member for his question. I can give him some statistics now. We had 262,773 episodes of delivery to the end of February. That took place over 11 months. There was a 68% reduction from peak endoscopy waits. There was a 98% reduction in patients — in real terms, that is 5,287 people — for named procedures, primarily targeting longest waits and some paediatric services. From March 2025 to March this year, there was a 16% — 15,500 — reduction in patients on an inpatient or day-case list.”
“I am more than happy to check, but I imagine that, if such letters are being issued, they are being issued by the trusts, not the Department.”
“That is a level of detail that I do not carry in my head, but I am more than happy to write to the Member.”
“I am certainly happy to go back to the Department and ask whether a review of current safeguarding procedures is required.”
“The Member is referring to information that, as he said, has just come into the public domain. The Department and the trusts will need some time to look at that. I assure the Member that the identification of abuse is a core part of training across the Health and Social Care system.”
“They have made it clear that they do not have the capacity to offer CAR T-cell therapy to patients in Northern Ireland at this time and that, if they were to set about trying to increase their capacity, it would take longer to do that than is scheduled for the opening of the new haematology ward at Belfast City Hospital.”
“CAR T-cell therapy has proven to be very successful. It will be introduced once we have the new haematology ward at Belfast City Hospital. Progress is being made on that, but it will be a number of years before the ward is available. The CAR T-cell procedure can operate only in particular clinical conditions. I believe that the respiratory conditions — the air around the procedure — are very important. <BR /> <BR />Members have called for an all-island approach. I reiterate that we have discussed this with colleagues in Dublin.”
“I thank the Member for her question. I am not across the detail of that, but I would be more than happy to write to the Member. If she wants to focus her supplementary question on the information that she is seeking, I would be grateful.”
“The Member seems to think that the Department has some role in drawing up the vision: the Department has no role in drawing up the vision. I have asked the Western Health and Social Care Trust to draw up the vision. If the Member believes that some sort of brake is being applied by the Western Trust, my question to her is this: what discussions has she had with the senior manager of the Western Trust on that?”
“The Member will be aware of the process. A consultation was under way, but I was not happy with it, so I contacted the Western Trust. I could not instruct the trust to pause the consultation, but I am grateful that it agreed to do so and that it eventually decided to scrap it. I then encouraged the trust to come up with a broader vision for the South West Acute Hospital, because, as I have said in the House, it is a pity that we put an exclusive — I stress the word "exclusive" — focus on one service that is not available in the South West Acute Hospital at the expense of celebrating the many successful processes and procedures that take place there.”
“The fact that we have an £800 million shortfall in our funding for 2026-27 is a clue.”
“Without an additional £800 million, I will struggle in that area, as I will in many others, but I am focused on it. On 2 March, Independent Health and Care Providers (IHCP) issued correspondence to my permanent secretary about its significant concerns about the structure, cost and workforce profile of the Southern Trust's home care model. The correspondence was further to a freedom of information request that IHCP sent to all trusts about their home care services. <BR /> <BR />The Member is on the Committee for Health, which has a statutory duty to assist and advise. I am all ears.”
“<BR /> <BR />Despite ongoing pressures associated with workforce, rising demand and rising levels of clinical acuity in the children referred, the data returned by the trusts demonstrates progress in recent years. I remain committed to supporting trusts to reduce waiting times for children and young people across Northern Ireland further.”
“Improving access to child and adolescent mental health services remains a key focus for the Department. The information provided by trusts demonstrates that average waiting times have fluctuated over the past five years. The average wait was 49 days in the 2021-22 financial year. It then dropped to 46, increased to 60 and improved again to 47. The data for 2025-26 shows a further reduction, with an average wait of 42 days. <BR /> <BR />The use of regional averages as a performance metric does not reveal the degree of variation across the trusts. Each trust has encountered challenges in meeting the nine-week target for initial assessment in CAMHS. There have nonetheless been significant improvements in some areas: for example, in the Northern Trust, the average wait time of nine weeks in 2021-22 fell to six weeks in 2025-26.”
“I acknowledge how difficult it is for those parents. What we traditionally call "burn out" is very common, and I get it. I have met many parents and carers and not just those who we now call the "Spotlight mums", whom I have met on a number of occasions. However, it is a rather emotive way to phrase the question. There are a lot of people in the Department and across the health and social care geographic trusts who are trying to do their best. Therefore, I do not agree with the language that the Member has used. I agree with her, and I imagine that she would agree with me, that we can and must do better.”
“As ever, the answer has to be predicated and ring-fenced by the budget, but I thank the Member for welcoming the investment in her area. Recruitment is very challenging in that area, and the Member may well be aware of that. We will press on with trying to get the right workforce in the right place as soon as possible. It is important to say that I am also committed to supporting the parents and carers of young people with disabilities. Let me write to the Member if I have more detail from the Department.”
“I will ignore the accusation of being cynical and address the fundamental. The five trusts have confirmed final funding for the financial year 2025-26 across a range of proposals. The amount of funding, which is rounded up, is as follows: Belfast Trust, £2·2 million; Northern Trust, £1·4 million; South Eastern Trust, £2·1 million; Southern Trust, £1·4 million; and Western Trust, £2·2 million. That is a total of approximately £9·4 million, so, therefore, there is approximately £3·7 million of slippage against the original funding of £13·1 million. I apologise for that, but I do not apologise for the ambition in securing £13·1 million, and it is recurrent funding.”
“It will be necessary to address the significant gap that exists in residential provision alongside preventative community-based services, in order to protect the availability of short-break services. Further sustained investment, in capital projects and workforce development, will be required over several years.”
“I can confirm that there has been increased service provision across all five geographic trusts that has supported improved access to short breaks, either via day supports or overnight provision. I advise Members that, as a result of the children with disability investment, approximately 869 additional overnight short breaks were provided across the region between January 2025 and the end of January 2026. That is in addition to the development of a variety of valuable community and family support services that further enhanced children with disability services. <BR /> <BR />Whilst the regional investment is beginning to address key areas, I need to reiterate to Members that short-break services for children with disabilities remain fragile. The longer-term development of a comprehensive continuum of services will take some time.”
“The additional regional funding provided for the children with disabilities service is being spent on a range of initiatives to improve family and community support for children with a disability, with the aim of increasing short-break provision and expanding specialist care programmes. The trusts have increased contracts with voluntary and community providers, securing additional support for families through a broad range of service initiatives. <BR /> <BR />I remain very mindful of the urgent focus on overnight short-break provision for children with disabilities. However, it has to be recognised that the provision of short breaks for children with disability is much more expansive than solely overnight provision.”
“My Department has not carried out an assessment of the postal service currently utilised by the health and social care trusts, so no assessment has been made on the use of Royal Mail's economy postal services.”
“It is not the fault of the patient that their appointment is missed because Royal Mail did not get the communication to them on time. As I just said to Linda Dillon, we have that integrated elective access protocol, which gives you up to four weeks to get yourself reinstated to where you were on the waiting list. I do not have any vires over Royal Mail or any postal service. I am in charge of the health and social care system in Northern Ireland. However, I would encourage Royal Mail and others to think very carefully about the impact of not delivering HSC literature and communications in a timely manner.”
“There is a protocol. Trusts are required to follow the integrated elective access protocol (IEAP). That has been developed to define the roles and responsibilities of all those involved in the elective care pathway. IEAP outlines good practice to assist staff with the effective management of waiting lists. The protocol aims to ensure that a consistent approach is taken across all trusts. In compliance with the guidelines, patients who do not attend their appointment due to unforeseen or exceptional circumstances, such as postal delivery delays, have a four-week period to contact their health and social care trust to be reinstated on to the waiting list from the original date of their appointment. That will prevent patients from being disadvantaged because of missed appointments. I hope that that reassures the Member.”
“To help reduce the number of "did not attends" (DNAs), the trusts frequently use text messages as reminders, alongside sending appointment letters to notify patients of upcoming appointments. The My Care app enables patients and service users to securely access a subset of their care record, including information such as appointment letters, with the aim of reducing DNAs. That aims to provide a timely and convenient method of communication, especially when postal services may be delayed, giving patients the opportunity to cancel or reschedule, thereby ensuring that valuable appointment slots can be offered to others.”
“My Department is committed to working with the health and social care trusts to continually improve communication methods with all patients, ensuring that they have the best possible experience and access to care. The trusts maintain oversight of postal delivery performance through established contractual and supplier arrangements. Where concerns have arisen regarding delays in patient correspondence, those can be raised through appropriate channels, including contract management discussions and engagement with contracted postal service providers such as Postal Sort. Ongoing monitoring is in place to help identify and address delivery issues. The aim is to reduce the risk of missed appointments and ensure timely communication with patients and clients.”
“I do recognise the significant challenges that EDs face, and I am acutely aware that the current level of use of non-designated clinical spaces, or corridor care, is too high and has to be reduced. I accept that it is reflective of the current pressures on the wider health system. The impact on patients and staff in that environment is not acceptable to me as a routine matter, nor, I believe, is it sustainable. Therefore, work is already ongoing that will address that, subject to resources as always. For example, there is the diverting of patients to more appropriate pathways, more timely discharge, an increased focus on self-care and the utilisation of pharmacy support and GP services. We are doing all that we can to try to address those unacceptable pressures.”
“We will do whatever we can. I will not be able to remember this off the top of my head, but a charity looked at hospital waits in emergency departments in England, and those figures were also absolutely shocking. So it is not as if we are doing something or not doing something that is not happening elsewhere. This is a very sticky problem, and I will continue to do what I can in the remaining months of the mandate to address it.”
“As the Member is aware, there has been an ongoing problem in the workforce for that particular specialism. What the Member is asking for is not something that I can make up on the hoof, because I have not given consideration to how that money is re-profiled. We have an £800 million shortfall, so I have no doubt that officials will say to me that I have to put all the money that I can towards closing that gap. I would be very reluctant to take a single penny out of the money that is put in for training and workforce.”
“The first thing that I am doing is Release to Rescue. That started last week, and the results are very favourable. There were, I think, only eight occasions when an ambulance handover took longer than two hours. That is a really concrete and positive deliverable in tackling that very sticky problem.”
“I hope that the Member acknowledges that the problem has not arisen in just the most recent financial year; the numbers are roughly similar for the year before that, and the year before that. I am acutely aware of the impact of those ongoing relentless pressures in what is already a very challenging environment on the physical and mental well-being of not just patients but all clinical staff working in emergency departments.”
“There is no quick or easy fix; achieving the improvements required involves a complex interplay of services in and across the wider HSC system and an investment in hospital and community capacity, which is dependent on funding being made available to me.”
“<BR /> <BR />The continuing expansion of Hospital at Home and same-day emergency care services, alongside additional support for the Northern Ireland Ambulance Service (NIAS) and the strengthening of consultant capacity in EDs, will also help to deliver further improvements. NIAS introduced Release to Rescue on 27 April, with the aim of ensuring that no patient waits for longer than two hours in an ambulance outside an ED. My officials continue to work with the Ambulance Service and the trusts as Release to Rescue is implemented. <BR /> <BR />Ultimately, improving the outcomes and experiences of emergency departments is about whole-system flow and the timely, appropriate discharge of patients who no longer need hospital care, thus freeing up inpatient beds for those who need them the most.”
“I thank the Royal College of Emergency Medicine for its report entitled 'The State of Emergency Medicine in Northern Ireland'. It reinforces our understanding of what needs to be done to address the pressures in our emergency departments. As is highlighted in the report, despite challenges with improving individual causality, there is clear evidence that extended delays in EDs increase overall clinical risk. My Department continues to act to improve hospital flow and reduce congestion in EDs. We have urgent care centres, minor injury units and phone-first services that are fully operational across the region and help to appropriately divert demand away from EDs.”
“I am certainly in favour of women's health hubs, but the Member must be aware — I started Question Time by referring to it — of the £800 million gap in funding. I cannot make a commitment that I cannot fund. I am afraid that, at this stage, I cannot foresee my getting the funds for a women's hub in this financial year, as much as I would like to.”
“I thank the Member for his question. Our lifespan gender service model is not a new service; rather, existing services are being merged into one. Nothing is changing in the criteria or the parameters from the model of care that has been commissioned for over a decade. However, the new service will take account of the Cass review, which called for multidisciplinary teams to be developed in regional centres. That investment will ensure that that recommended approach is taken in line with other United Kingdom jurisdictions. The creation of two senior psychologist posts will greatly bolster the multidisciplinary team, and I will rely on them to make the right calls.”
“As well as hoping that the next Minister will commit to a strategy that includes dealing with medical misogyny, I will put in place quite a radical reform of how we fund the health and social care service.”
“That is a very important issue. I have to say that the scale of medical misogyny is difficult to quantify. It is essential that women feel listened to, respected and treated fairly when accessing the health and social care system. The action plan will consider the need for improved awareness of, training for and understanding of women's health issues across the full range of healthcare settings. <BR /> <BR />I do not accept that the health and social care system is failing every woman on every issue, but it is clear that there is a level of misogyny. The Member is correct to identify it as a cultural issue. I think that all of us in the House recognise that cultural change is the highest bar to set for any organisation. However, that is not an obstacle to doing it; it has to be done, and it will be started on my watch.”
“That happened in April last year as part of a managed transition involving a substantial programme of work to update existing clinical protocols and minimise waste of the existing infusion product. It is in three of the five; I hope that it will be in all five as soon as possible.”