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 her question. I have some rather good news in that regard. Keytruda is already used in Health and Social Care (HSC) for many different forms of cancer, in line with recommendations from the National Institute for Health and Care Excellence (NICE). The manufacturer of Keytruda has recently launched the injectable form that we are hearing about in the news outlets. I recognise the benefits of rolling out such innovations to patients in Northern Ireland in saving precious time for those receiving treatment for cancer as well as in releasing valuable time for clinicians to care for more people. As of today, three of the five trusts have already rolled out injectable Keytruda.”
“I have not finished there, however. Once the design team has finished, I will press for an earlier opening than 2028-29. I may not be successful, but I am going for it.”
“After the debate, it was clear to me that the mood and will of the House was to look at an interim measure that was good and safe, not necessarily one that was best practice. From the Royal College, we know that best practice means proximity to an adult inpatient centre and obstetric-led maternity services. We looked at a couple of sites and discussed them internally. The five directors of mental health from the five geographic trusts wrote to me as one to say that they would not support the interim solution that we had in mind and that we had to stick to best practice. That is why we are going for the Belfast City Hospital site. As I made clear, I was originally told that, if we started now, we could have it open in 2031. I found that entirely unacceptable, so the deadline is now no later than the financial year 2028-29.”
“I regret the fact that we are the only nation or region of the United Kingdom not to have such a strategy. I am very much in favour of having one. It was only time constraints that led me to the position of wanting to have an action plan first. I hope that a strategy will follow during the next mandate. The Member is aware of how tight things are with funding. There is upwards of £800 million of a shortfall in this financial year. As well as publishing the action plan and saying that I very much hope that the next Minister will commit to a women's health strategy, I am in the foothills of developing another initiative, which, I think, will be a real game changer. I look forward to updating the House on that in due course.”
“The action plan will also aim to encourage positive dialogue on women's health and well-being in our health and social care system and in society more broadly. I look forward to updating the House in due course.”
“We are also in the process of establishing two regional endometriosis centres, one in the Western Health and Social Care Trust and the other in the Belfast Health and Social Care Trust. <BR /> <BR />Too many women are still waiting too long, but the position is improving. Compared with the end of September 2025, by the end of December 2025, 3,000 fewer women across Northern Ireland were waiting either for treatment or for their consultant-led first outpatient appointment for gynaecology, and I expect that progress to continue. <BR /> <BR />When it is published, the action plan will describe the wide range of policy and service developments that are supporting women's health, what has been achieved to date and what is achievable in the years ahead within current resources.”
“<BR /> <BR />I understand the level of anticipation around the action plan, which is about recognising and responding to the significant disparities that women continue to face in health outcomes and access to care. Much work is already under way within current resources. We are trying to reduce waiting lists and change how we deliver key services to better meet women's needs. Last year, for example, my elective care framework's implementation and funding plan included £3·5 million in recurrent funding to provide over 4,000 additional assessments and 900 treatments in gynaecology. That funding is helping improve patient pathways, enhance diagnostic capacity and provide additional theatre and outpatient sessions.”
“With your indulgence, Mr Speaker, I may require an extra minute to answer, because this is an important issue of some depth. <BR /> <BR />Work on a women's health action plan is advancing, with policy and service developments ongoing across many areas. I intend to publish the plan later this year, after we have received and considered the final report of the public listening exercise that my Department helped fund. The exercise is now complete, and I am very grateful to the thousands whose voices are helping shape the final action plan. The final report on the listening exercise is expected by the Department in the coming weeks.”
“I accept that it is a crisis in dental services, but I ask Members to accept that my ability to rise to that challenge is constrained primarily by a budget that is currently forecast to be between £750 million and £800 million light, which means that some very hard choices will have to be made. The Chairman of the Health Committee said that stabilisation is not good enough; I agree with him, but it is the essential first step.”
“The first of those was paid in December last year, and the second is scheduled for payment in May this year, following the next practice allowance payment. <BR /> <BR />Mr Durkan talked about orthodontic assessments. I have to say that there are additional payments for those. Mr Gaston talked about dental amalgam and blamed the issue on the Irish Sea border. He is entirely wrong — he is entirely wrong. It is UK-wide, following an international agreement. I am happy to put that correction on the record.”
“The first thing that I need is evidence of it, and I repeat that I am being told by my officials in dentistry that, while there is evidence of it happening in Great Britain, there is no evidence of it here. If the Member can bring me evidence — if it is happening, it is incredibly serious — I will talk to officials about how best to handle it. <BR /> <BR />I want to touch on the issue of payments, because it was raised by Members. An additional £2·5 million was allocated to general dental services on a recurrent basis to support the increase in National Insurance contributions. That is being distributed in line with the proportion of practice allowance received by practices in the 2025-26 financial year. It is being paid in two instalments, and that is aligned with the practice allowance payments for the 2025-26 financial year.”
“My officials have no evidence of that happening in Northern Ireland, but, if it is, I am very much open to hearing about it. I want to talk also —.”
“I am also putting in place the evidence and the framework required for the much-needed long-term reform, but I cannot pretend that those measures alone will reverse decades of structural pressure. I want to be clear with Members: the pace of reform is constrained not by any lack of willingness or ambition on my or my Department's behalf but by the absence of the financial envelope that is required to act at scale, which is what we need to do. Frankly, without an agreed and realistic budget, the scope for accelerating reform remains highly limited. Protecting health service dentistry requires funding decisions that are aligned with the realities of delivering the service. <BR /> <BR />I will turn to a couple more points that were made by Members. Some Members talked about DIY dentistry.”
“In addition, the dental access scheme continues to provide weekday access for patients with a pressing or urgent oral health need. <BR /> <BR />The sustainability of health service dentistry is inseparable from workforce issues. Recruitment and retention challenges are evident right across Northern Ireland and continue to affect dental services. To help address that, the funding package will also support six additional dental foundation training places this year, helping to retain newly qualified dentists, addressing workforce shortages and strengthening the sustainability of health service dentistry in the years to come. <BR /> <BR />I am taking action now, within the limits of the resources available to me, to make targeted improvements.”
“I recognise the need to improve access for not only registered patients but those who are currently unregistered, particularly where there is an urgent clinical need. Schemes such as emergency dental clinics and the dental access scheme are therefore essential components of the current response. In that context, it is vital that the limited resources available are targeted where they can have the greatest impact. That is why this investment also includes funding for the establishment of a new emergency dental clinic in the western area, where registration rates have historically been and remain lower than in other regions. The new clinic will provide additional access at weekends and public holidays for patients in need.”
“I can also tell Members that, between June 2024 and March of this year, 76,493 children were registered with the enhanced child examination scheme. <BR /> <BR />I am acutely aware that access to affordable dental care is not distributed evenly across communities. Barriers to access can disproportionately affect those on lower incomes, older people, individuals with disabilities and those who live in rural or socio-economically deprived areas. The point has been made about that health inequality. In terms of dental decay, the inequalities follow socio-economic gradients. That is a global issue and is not particular to us.”
“That investment will fund the continuation of the 30% enhancement to the fees associated with fillings, extractions and root canal treatment; the continuation of the enhanced child examination scheme; an increase to the activity support payment that was introduced last year from £1·6 million to £2 million; the commissioning of an emergency dental clinic in the Western Trust area; and an additional six dental foundation training places. I can say to Mrs Erskine that it is planned that the centre — the emergency unit — will be housed in her constituency of Fermanagh and South Tyrone.”
“I also recognise and accept the importance of balancing the need for urgent stabilisation measures with longer-term reform. <BR /> <BR />Members will be aware of the extremely challenging financial context in which we are operating. My Department faces a projected deficit of towards £800 million in this financial year — £800 million — but we are currently working without an agreed Budget. That places a very real and unavoidable constraint on my ability to do all the things that I want to do or to move at the pace at which I would like to move. <BR /> <BR />Despite those constraints, and in the full knowledge that this cannot, on its own, resolve the underlying problems, I made the decision to prioritise an additional £8 million investment in health service dentistry this year.”
“I have directed officials to continue to engage closely with the author and to work at pace to complete the necessary assurance and consideration processes. Furthermore, any changes to the payment system must be financially sustainable, deliver value for public money and support improved access and outcomes for patients. <BR /> <BR />I recognise the call to develop an action plan for reform. As already detailed in my three-year plan for health and social care, that action plan will be in place by the end of the financial year and will provide a road map for the future of general dental services. Alongside the cost-of-service review, the work of the general dental services reform advisory group will play a key role in shaping the development of an action plan for reform.”
“I also fully recognise the fact that accurately estimating the cost per hour of delivering health service dental care is inherently complex. I expect to go into negotiations with dental representatives about the conclusions. Dental practices vary significantly in size and have different staffing models and patient mixes. Any robust cost assessment must take proper account of that complexity and diversity. <BR /> <BR />Although the report remains in draft form, it is an important piece of work that will, I hope, ensure that any future reform is grounded in accurate and robust evidence. I do not wish to pre-empt any conclusions, but I stress again that it is an urgent matter for me and the Department.”
“<BR /> <BR />I recognise the sense of urgency that Members have around the publication of the review report, given its importance to both the dental profession and the Assembly. I share that sense of urgency. My officials have received a copy of the draft report and have been actively scrutinising its contents, as one would imagine they would. They met with the author, Professor Ciaran O'Neill, on Friday past and sought clarification on a number of issues. I am told that certain areas of the report need a rewrite so that it is user-friendly and as clear as possible in its thoughts and conclusions. The report remains in draft form, subject to that further clarification and assurance, but I want to have the final version in a matter of weeks.”
“The pressures have contributed to a contraction in health service dentistry across all trust areas in recent years at a faster pace than elsewhere in the United Kingdom. That has been compounded by workforce challenges, including difficulties with recruitment and retention, and by the increasing attractiveness of having a private practice as a mechanism for some providers to manage their rising costs. I commissioned the cost-of-service review precisely to provide a robust, evidence-based assessment of all those challenges. The purpose of the review is to ensure that decisions on dental payment reform are informed by a clear and accurate understanding of the costs that are involved in delivering health service dental care in Northern Ireland.”
“<BR /> <BR />At the same time, dental practices have reported increases in operating costs, including staff costs, the cost of clinical supplies, energy prices and the ongoing costs associated with regulatory and contractual compliance. <BR /> <BR />Members have raised concerns about the sustainability of the current general dental services payment model. The GDS contract has been in place largely unchanged since 1990 and was not designed for the cost-based workforce reality or patient demand that exist today, so I am determined to look at that in the remainder of the mandate. <BR /> <BR />It has been widely acknowledged that rising operating costs have placed the payment model under unsustainable strain.”
“Like many other healthcare services, dentistry was significantly impacted on by the pandemic, resulting in a backlog of unmet need, disrupted patterns of attendance and registration and, for some, an increased reliance on private care, further widening inequalities in access. <BR /> <BR />I am particularly conscious of, and share Members' concerns about, registrations lapsing due to non-attendance. While that may be understandable in the context of the disruption caused by the pandemic, it can create significant additional barriers to individuals who are seeking urgent or preventative care, especially where access options were already limited.”
“Those trends present real challenges not just for patients but for dental professionals and for the sustainability of the entire system. <BR /> <BR />Against that backdrop, it is important to place the issues in context, to outline the factors that have contributed to the current position and to describe the work that is under way to address immediate pressures and the longer-term structural issues in general dental services (GDS). <BR /> <BR />The decline in registrations and activity is the result not of a single failure or decision but, rather, a number of interrelated and cumulative pressures that have built up over time.”
“Thank you, Madam Principal Deputy Speaker. I thank the proposer of the motion, the proposer of the amendment and, indeed, all Members who contributed. I begin by fully acknowledging the strength of feeling not just in the Chamber but amongst the public regarding access to health service dentistry. The concerns are legitimate and widely shared. <BR /> <BR />The figures highlighted in the motion are stark, as are the scale and pace of the decline in dental registrations in the health service here. Over the past two years, the proportion of individuals registered with a health service dentist has declined significantly, and the volume of treatment being provided is lower than it was before the COVID-19 pandemic.”
“If we came together as an Executive and an Assembly and tried to tackle them, think of the impact that we could have in areas of deprivation. Think of the real change that we could make to people's lives, how that would make us think of ourselves as legislators and how the public would think of this place. It would be a magnificent thing to do, and I encourage those who will be here after May 2027 to give it consideration.”
“Certainly, if you take a map of the conflict and fill in the hot spots of the conflict measured by shootings, killings and bombings, and if you then take a contemporaneous map of the hot spots of mental health issues measured by completed suicide, attempted suicide, substance misuse and all the rest, you have a match, and North Belfast is as bad as it gets. I am very aware of that. I will not be around for the next mandate, but if I were, I would encourage the next Executive to think about the social determinants of health and ill health — poverty, housing, jobs, education — and about the social determinants of educational underachievement and of economic inactivity. They are the same social determinants across those three great evils, which are really sticky problems.”
“Thank you, Deputy Speaker. <BR /> <BR />GPs, amongst others, will be at the heart of the delivery of the neighbourhood model. <BR /> <BR />The final thing that I will say is that the MDT roll-out in North Belfast will continue. There is no freeze. I know that it will be well utilised by local communities. It will continue to embed the important general practice for its people, and it will ensure that the GP practice continues to be the heart of the local community. <BR /> <BR />I will finish with some words on community, because Carál Ní Chuilín talked about North Belfast and the legacy of the conflict.”
“I thank the Member. Yes, the uncertainty of not having the Budget is resulting, for example, in us losing momentum. We had good momentum in tackling the waiting lists, so, yes, I would welcome the certainty of a Budget as soon as possible, and preferably a multi-year Budget. <BR /> <BR />With my remaining time, I will touch on a couple of other points. Nuala McAllister talked about support for GPs. I hope that she is aware that we are now negotiating the next contract with the BMA's Northern Ireland GP committee. That can certainly be part of a broader consideration of how we support GPs.”
“Indeed, many continue to see the GP as the first point of contact when they feel the need for healthcare intervention. It is right for people to focus on general practice as a front door to health services. However, with the introduction of MDT specialists, people can access them through the GP route without the need to see the GP. <BR /> <BR />The programme will not sit in isolation of wider primary care reform. It is an integral part of the new approach to healthcare through the introduction and implementation of the neighbourhood healthcare model.”
“<BR /> <BR />It is anticipated that the annual MDT consultations will increase to over one million by March of 2033, with over 222,000 consultations in Belfast alone as a whole. That will be a significant contribution to providing closer-to-home access to much-needed services that can be accessed directly through the GP practice. Currently, 51% of referrals to MDT professionals are made directly without the need to go through a GP, freeing up valuable time for appointments. <BR /> <BR />The MDT programme is an integral part of the reform of health services. It brings services to a local level and reinforces the value of general practice in delivering such services in primary care. Historically, people across Northern Ireland have revered and respected the role of the GP.”
“The funding for MDT roll-out is in place, and we are moving as swiftly as we can, given the labour market challenges. To that end, the transformation funding supports critical planned investment for university training places above and beyond the existing intakes, providing a workforce pipeline in key professions that the MDT programme recruits from. Ninety places were agreed annually for 2024-25 and 2025-26. Those additional places comprise 40 social workers, 30 physiotherapists, 10 occupational therapists and 10 mental health nursing places. Phase 2 of the MDT implementation plan will run from 2029-2030 to 2032-33. It will see the completion of phase 1 federation areas and the full roll-out of the remaining five areas.”
“In the current year, a further 10·5 whole-time equivalent staff will be recruited to North Belfast practices, further increasing the number of patients who can access those vital services. That will increase year-on-year, in line with agreed implementation plans, resulting in an additional 45·6 whole-time equivalent staff being employed in North Belfast, with an additional 114,000 patients having access to all services by the 2029-2030 financial year. <BR /> <BR />The Department of Health acknowledges that the workforce is a key enabler for success, and the recruitment plan is cognisant of the very real challenges in the labour market and the vacancy and recruitment issues that are being experienced already across the trust.”
“We have increased access for 928,000 patients, which is 46% of Northern Ireland's population, to one or more core MDT services, and that includes a total of 276 MDT staff and an additional 107 nursing staff across the region. Some £2·5 million has been invested across the five federation areas that are next to benefit from the roll-out in 2025-26. Approximately £500,000 of that has been spent in the North Belfast Federation area. <BR /> <BR />The roll-out is well under way in North Belfast. During quarter 4 of the last financial year, 8·4 whole-time equivalent staff were recruited to MDTs, which means that about 90,000 patients currently have access to an MDT in North Belfast.”
“<BR /> <BR />Phase 1 of the implementation plan runs from the 2025-26 financial year to 2029-2030 and will see MDTs being completed in 12 federation areas, including North Belfast. The remaining five will continue with the MDT implementation plan, which runs through to 2033. I know that that is a long time, and I share Members' frustration that it is taking so long to roll it out fully. Mr McGrath talked about the inequity of it being in some places and not in others. Ms Ní Chuilín will be aware, from her work in the former Ad Hoc Committee on a Bill of Rights, of the concept of progressive realisation, and that is where we are at with MDTs. <BR /> <BR />As of 31 December 2025, working with the GP Federations, practices and the local trusts, my Department had implemented the MDT model across 136 GP practices.”
“As it is at a local level, the model is responsive, accessible and consistent with my desire to shift left into prevention and early intervention. <BR /> <BR />Members will, I hope, be aware of my commitment to reform and transformation. I am particularly pleased that we got the £61 million that Mr Kingston referred to from the transformation fund for the next phase of the MDT programme. That gives us the opportunity to commit to expanding the implementation of the programme. Indeed, the North Belfast Federation is currently benefiting from that additional resource, as it continues with its MDT implementation journey. I have to say to Mr Kingston that he needs to have a word with his source, because the idea that that has been frozen is simply not true. We are continuing to implement over the three years of the plan; there is no freeze.”
“<BR /> <BR />There is an issue with many GP surgery premises not having the space to expand to take multidisciplinary team members on board. I say to the Member that I will contact the Minister for Communities about the Clifton Street surgery to see whether his Department can give some much-needed certainty on Girdwood. I applaud the Member's devotion to her constituents, which I saw in action at the weekend on another matter. <BR /> <BR />MDTs are currently available in seven federation areas, and we continue to increase the service in a further five areas, securing a rate of 63·5% of patients being handled in primary care in those federation areas. We are avoiding referrals to secondary care, and, personally, I am delighted that that is already happening.”
“Thank you. Let me begin by trumping Mr McGrath, because North Belfast was my first home. I spent my first five years in a house on the Lansdowne Road off the Antrim Road. <BR /> <BR />I welcome every opportunity to discuss MDTs, particularly in North Belfast, so I thank the Member for bringing that into focus. I also welcome the GPs who are here to listen to the debate. I understand entirely that, while MDTs are really good for patients and service users, they do not ease the burden for GPs one iota. In fact, it can be argued that they make life more difficult. Do you want to refer somebody to a physio in another setting, or do you want to manage a physio who has joined your team? Arguably that can make life a little more difficult for GPs, but it is really good for patients.”
“For those reasons, I commend the Hospital Parking Charges Bill to the Assembly and ask Members for their support at Final Stage.”
“I hope that that will be secured in the next 14 working days, so that we can avoid the potential disruption from car parking charges being abolished temporarily on 12 May. To try to avoid that, I have written to the Secretary of State, the Attorney General and the Advocate General requesting that they provide the necessary assistance in their respective roles to expedite Royal Assent's being secured. I am very grateful for the positive response that I have received. I hope that that bodes well for the next, and very final, stage of the legislative process. However, in the event that car parking charges are abolished temporarily, I ask Members to support the trusts as they seek to minimise the inevitable disruption that will follow.”
“OK, Deputy Speaker. Just to finish that off, though, thrombectomy is not, by far, the only area where there is a compelling case to invest to save. <BR /> <BR />To keep to the subject of the Bill, as the Deputy Speaker, quite rightly, insists, when it comes to concessions, it would be a very poor Minister who made up policy, or made promises, on the hoof. I have heard what Members have said about what they do not want to hear me say, so I will just park it there. Mr Carroll's final question was whether there had been a vote on this at the Executive. Mr Carroll is perfectly entitled to seek the minutes of Executive meetings. <BR /> <BR />This completes the Final Stage of the Bill's progress in the Assembly. As we know, it does not become law without Royal Assent.”
“I appreciate Mr Donnelly's intervention, but he will have to concede — I am sure that he knows this — that there are a lot of rules around how we spend money in Departments and a lot of legal obligations. If you do not have the money, you cannot spend it. It is very hard to justify the spend when you are saying that we are £760 million short of what we want. It is impossible to bring in a 24/7 service without the budget, and we do not have the budget now. As I give way to Mrs Dodds, I say to her, as I say to all Members from the four Executive parties: let us get the Budget done so that we can at least make those things possible.”
“I will give way to Mr Donnelly and then to Mrs Dodds.”
“— are very much towards the top of that list.”
“I assure Mrs Dodds that I have a very long shopping list of things that I would like to introduce over the rest of the mandate, and thrombectomy services —”
“Thank you, Deputy Speaker. <BR /> <BR />There are a few matters arising from Members' comments. I emphasise that the £7 million is not additional money or new money. It is simply a question of saying that we currently forecast a shortfall this year of £760 million. That prevents it from becoming £767 million. <BR /> <BR />I share Mrs Dodds's desire to see 24/7 thrombectomy care for stroke patients. We are talking about up to 160 people a year who miss out because the service is not 24/7, and they live the rest of their lives with the impact of that stroke, whereas, with a 24/7 service, up to 160 people could be in and out of hospital on the day, undergoing a 15-minute procedure and leaving with no side effects.”
“Officials are working closely with trusts to ensure that contingency arrangements are in place should there be any short transitional period. <BR /> <BR />Being in Government requires making decisions that are not always popular but that are necessary and responsible, particularly in times of severe financial pressure. The Bill does not abandon the Assembly's original intent. However, it does recognise the current reality and seeks to strike a balance between fairness and financial sustainability. On that basis, I urge Members to support the Bill.”
“Eligibility information should be clearly communicated through leaflets, posters and trusts' websites. While I appreciate the desire to further extend the eligibility criteria, that would result in a loss of income and thus defeat the purpose of the Bill. Similarly, hypothecating the income from car parking charges for a new service, however beneficial, would simply mean that less funding is available for existing services that are already under severe pressure. <BR /> <BR />I hope that Members will appreciate that the timetable for the passage of the legislation has been extremely tight. Executive approval was secured later than anticipated, making accelerated passage necessary to avoid the 2022 Act coming into force on 12 May without appropriate financial safeguards.”
“A regional eligibility matrix applies free parking not only to patients but also, where appropriate, to next of kin, partners and visitors for those receiving radiotherapy, chemotherapy, renal dialysis and critical or high-dependency care. Trusts are given discretion to extend those exemptions in other circumstances, particularly where the frequency or duration of visits would otherwise result in significant parking costs. <BR /> <BR />In response to concerns expressed by Members at the Second and Consideration Stages, departmental officials wrote to the trusts' operational leads on 14 April to reinforce the need to monitor uptake of exemptions, target areas where uptake is low and ensure ward-level staff actively advise patients of their entitlements.”