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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“Importantly, if financial sustainability is achieved sooner than expected, the legislation allows the 2022 Act to come into operation at an earlier date. During the deferral period, staff parking permits will remain free of charge, and a needs-based system will continue to operate to ensure that those with the greatest need have access to on-site parking. The deferral of the Act means that staff will continue to be able to access the public car parks, which I know was a concern. <BR /> <BR />On the impact on the most vulnerable, the Department's current car parking policy already provides for free and concessionary parking for patients on specific care pathways.”
“Rather than specifying a single new commencement date, the Bill provides for the date to be set subsequently by regulation subject to the affirmative resolution procedure. That will ensure that the Assembly retains oversight and has the opportunity to debate and improve the timing of implementation. It will be informed by the reports to be prepared on the cost implications of the 2022 Act and its delay. That follows an amendment that Mr Colin McGrath proposed that was accepted at Consideration Stage. The Bill allows for deferral for up to three years, with May 2029 acting as the backstop.”
“<BR /> <BR />I reassure Members that the deferral is not being sought because the trusts are unprepared; on the contrary, the trusts have worked responsibly to prepare for the implementation of the 2022 Act. Significant investment has already been made in traffic management systems designed to control parking, protect blue-light routes and safeguard designated spaces once charging is removed. That investment will not be wasted. The new traffic management systems will be required when charges are eventually abolished. In the meantime, they will provide valuable data to help trusts improve the management and efficiency of car parks. <BR /> <BR />I turn briefly to the details of the Bill.”
“<BR /> <BR />The projected deficit facing my Department is approximately £760 million in the current financial year, and that deficit is expected to grow further in subsequent years. Although we pride ourselves on having a national health service, the reality of the Budget proposals published by the Minister of Finance is that the funding available for health services in Northern Ireland in the coming years will be relatively lower than that in England, Scotland or Wales, even though it has been confirmed time and time again that need here is higher. That means that difficult and responsible decisions are unavoidable. In that context, proceeding with the abolition of parking charges at this time would simply be unaffordable.”
“Members will be acutely aware, however, that the financial context facing the health and social care sector has changed significantly since that Act was passed. In response, the purpose of the deferral is to protect front-line services from the immediate and unmanaged loss of income that the abolition of parking charges would have entailed. Their abolition would have removed approximately £7 million each year from trusts' budgets. In the current financial environment, that loss would inevitably have to be offset through making reductions elsewhere, which would directly affect the services provided to patients and families. That is the context in which we are working: unprecedented wider financial challenges facing Health and Social Care (HSC).”
“Thank you, Mr Deputy Speaker. Today's Final Stage debate concludes the legislative process for the Hospital Parking Charges Bill in the Assembly. I thank all Members for the contributions that they have made to the process. <BR /> <BR />The purpose of the Bill is to defer the abolition of hospital parking charges, as provided for in the Hospital Parking Charges Act (Northern Ireland) 2022. To be clear, it is not a reversal of principle, nor does it reflect any lack of readiness on the part of the health and social care trusts to implement the 2022 Act. The Act was agreed with the best of intentions to reduce the financial burden on staff, patients and visitors. That remains a legitimate and compassionate aim.”
“I do not have a geographical breakdown, but I can certainly ask whether one can be made available or whether we can do the research to provide the Member with one. To be clear, when I said that there has been a small decrease, I said clearly that that was not a trend. It is not good enough. Yes, we say that those figures are shocking, but they are very similar to those for last year and the year before. In one sense, they should not be shocking, but they are shocking because of their scale.”
“There was corridor care throughout it, with trolleys head to toe. I asked the clinician, "Has something happened? Is this unusual?", and he said, "No. This is a day-to-day occurrence, to the point where we have corridor care teams. We have doctors and nurses, and all they do is corridor care". That illustrates how difficult this will be. I do not want anybody to be waiting in a corridor, on a chair or on a trolley, so, yes, there is an ambition to see the back of it as soon as possible.”
“That is certainly an ambition. Corridor care is not unique to Northern Ireland. I think that I have said that I was in a brand new build in Washington DC — a new wing of the Georgetown University Hospital — that cost in the order of $700 million. It has a very large emergency department, compared with ours, in terms of its physical size and its capacity.”
“We are working on the Release to Rescue initiative to try to improve ambulance waiting times. There is a proposal that we start to roll that out on 27 April, which is only a week away. I have engaged with stakeholders, trade unions, the Ambulance Service and, more recently, the chief executives of the trusts. We are a little shy of certainties and reassurances. One thing that we need to do is to start to discuss how we might perform Release to Rescue emergency department by emergency department and hospital by hospital. To be clear, the intent of Release to Rescue is that no patient will wait for more than two hours in an ambulance before being handed over to the trust.”
“All we need is one patient to leave an ED and self-harm or harm somebody else and we will have another crisis and another moment at which people describe the health and social care system as "broken". I do not think that it is broken. Many of the pathways into it are badly damaged, hence the long waiting lists, but I believe that, once a person gets to the point at which care is administered, it tends to be world class. There are exceptions, of course, where things go wrong, but, by and large, it tends to be world class.”
“I do not have that number, but I am sure that it exists and will certainly try to get it for the Member. <BR /> <BR />On the issue that the Member spoke about, my focus is on the desire of the Police Service of Northern Ireland to move at pace — I think that it wants to move more quickly than before — towards a system called "Right Care, Right Person". The Police Service says that its officers are not trained in mental health matters, so they need to withdraw, and that they should not be spending many hours sitting in EDs with patients. I get all that, but I remain concerned that there may be a hiatus between the police withdrawing and the health service being able to fill the gap.”
“I am hoping for a Hail Mary pass — some sort of miracle — along the way, but I am not for walking away, because challenges should not be viewed as insurmountable obstacles that justify inaction.”
“As with last year, however, should we come to a position in which the question, "Do you support this allocation, even though it leaves you hundreds and hundreds of millions pounds short of what you think you need?" is put to me, my answer will be "Yes, but", and the "but" will refer to the fact that my budget is short of what I need and that something will need to happen between now and the end of the financial year or there will be an overspend. <BR /> <BR />Last year, as the leader of the Opposition knows, what happened was the loan on the Treasury reserve. I got the thick end of £200 million from that. Had I not got it, we would not have been able to balance the books by that amount. It is worse this year.”
“A multi-year Budget would be much better than a one-year Budget, but a one-year Budget would be much better than the position that we are in. I am not unique among Ministers in saying that the budget allocation that the Finance Minister has proposed is not enough for me to do everything that I need to do, never mind everything that I want to do. I am not an outlier in saying that. It just happens that my quantums are a lot bigger than anybody else's, even those of the Department of Education.”
“In an ideal world, I would be with Mr Carroll in saying that the delivery of health and social care would be done entirely by Health and Social Care (HSC). We are far from being in an ideal world, however. For example, to tackle waiting lists through the initiatives that we began with last year's budget and that we hope to continue when we get a budget for this year, we will inevitably have to go to the independent sector, because we would otherwise not have the capacity in the HSC. Yes, I get what the Member says. His argument would be, "That is because you are putting money into the independent sector rather than investing it in building capacity", but, if we were to do that, tackling waiting lists would slow down and people would suffer, and the logic of that is that more people would die.”
“We have a growing population and an ageing population, however, and, if anybody can crack how to better deliver care for the elderly, they will crack most of the problems in the health and social care system.”
“I am not aware of the circumstances of the particular case. I very much regret that that happened to the individual and her family. Unfortunately, the case is probably not an outlier. I am sure that many if not all Members have similar stories of constituents who do not get the service that we would want them to get. I am frequently contacted by people who make the point that Mrs Dillon made, which is that they are taxpayers and pay their National Insurance and that they have done so not just for years but for decades. They therefore believe that they are entitled to a better service, and I do not disagree with them. <BR /> <BR />I do not know the specifics of the challenges that the South West Acute Hospital faced that meant that it was over capacity on that occasion.”
“When I invited Professor Rafael Bengoa to come back in 2024 and reboot his report, 'Systems, Not Structures: Changing Health and Social Care', he gave me a valuable piece of advice. He said, "Be really tight on what you want to achieve, and articulate it clearly so that people understand, but be very loose about how you achieve it, because you are not a nurse, domiciliary care worker, GP, surgeon, clinician or hospital administrator. Go and ask the people who understand how the system works how we make it better". That is what I did with the Big Conversation: we had four workshops that led to the winter plan for the winter just past. If the Member wants to say that those experts do not know what they are talking about, she can fill her boots.”
“For example, you may have four resuscitation beds in an emergency department, but five or six patients needing resuscitation, so you are making a horrible decision about which one or two patients can be left in the emergency department and outside the resuscitation unit. I do not believe that those nurses and doctors are trained for that. When I am in emergency departments, I ask the nurses and doctors whether they were trained to expect such situations, and the answer is no.”
“The staff, particularly those working in emergency departments — I have visited emergency departments a lot in my time as Minister — suffer a moral harm, in that they have been trained to a high level to deliver world-class healthcare. Whether it is a nurse, doctor or allied health professional, they find themselves in such a pressurised position that, often, although they know exactly the best thing to do for patient after patient, because of the pressure and the environment in which they are operating, they are not able to deliver the best that they know they can deliver; rather, they are making decisions on the basis of what the least worst option is for the patient.”
“For anybody who values the peace process, the 1998 agreement and the subsequent agreements, it should be a matter of the utmost concern that the public are losing faith in the devolved process, which is the only way to go in this place.”
“I agree with the Member that we need to ask the United Kingdom Government to look again at our Budget provision, because, if you look at Scotland, you will see that it is being funded above assessed objective need. Wales is also being funded above and beyond assessed objective need, and we are arguing that we are not. That, clearly, is not fair, because, as the Member says, we pay our taxes, the same as the Scots and the same as the Welsh. We as an Executive have not given up. <BR /> <BR />The Member will, I think, be aware that a letter was sent to the Prime Minister asking for a meeting with the four parties of the Executive so that we could eyeball the ultimate decision maker and make the case that it is not fair. The shortage of money plays into the public perception that devolution is not delivering.”
“That is on me, but being able to afford to put in more senior decision makers depends on budget, and you can argue that that is on the Executive.”
“I am not sure that we should be posing an either/or question. Certainly, I am working within my brief and my responsibility, and, on health and social care, the buck stops with me. How you fashion the delivery and the improvements that are required depends on certain aspects that can be provided by the Executive, and one of them is budget. We are currently in a financial year, which started on 1 April, with us facing, by the current estimate, a shortfall of £760 million. Something that would be very important in EDs would be to increase the number of hours in the day when there are senior decision makers in the ED because that really helps, as we know from previous periods of industrial action. When you have senior decision makers making those decisions, that helps the flow in an ED.”
“Urgent care centres offer treatment to patients with urgent medical conditions that are not immediately life-threatening but require face-to-face assessment and/or timely access to diagnostics within a 24-hour period. That is a viable alternative to ED attendance. In the absence of a physical structure that is capable of accommodating one or more urgent care services or streams, those are individually referred to as streams that sit within or alongside other units of our healthcare services. My Department has successfully commissioned urgent care centres and streams in all trust areas. We also have same-day emergency care, and we have a number of alternative pathways.”
“There are several. When you factor in the number of people who visit those centres, that maybe talks to what Mrs Dodds referred to: the fact that the number of people presenting at EDs has not radically increased. One of the reasons for that has to be the fact that we are providing so many alternative pathways for them. Approximately 40 rapid-access clinics have been either established or enhanced across all the geographic trusts. The pathways offer around 100,000 appointments per annum, and those can all be scheduled. Therefore, they offer timely access to specialist opinion and investigation, and they are fundamental to providing ED alternatives, with referrals from GPs, Phone First and our urgent care centres.”
“If I have the budget to increase capacity, of course I will increase capacity. If I was not clear, let me say that when I talked about introducing the real living wage, that was the first step that I was referring to. I want to make that clear. It is not the be-all and end-all, but with budget, it will be the first thing that I can do with relative ease. Yes, we need to increase capacity. We need more people providing care at home — so-called domiciliary care — and we need more beds in care homes within the community. That will take time, but it will also take budget and commitment.”
“I accept that it is about the flow, as I said to Mr Donnelly. I cannot give you a timeline for the fix, because it will require investment. The more investment that is put into it, the quicker the fix will be realised. <BR /> <BR />You said that there were 1,032 excess deaths last year. The year before, the number was 1,122. The year before that, it was over 1,000 again, at 1,063. That was in 2023. So there is a trend there, although we have not introduced a trend of reducing that number. I looked at the last report that I am aware of from the Royal College of Emergency Medicine on the NHS in England. In 2023, 1·5 million-plus people waited for over 12 hours in emergency departments in England. That led to nearly 300 excess deaths per week. The situation is not right in England, it is not right here, and we are struggling to find the fix.”
“However, the problem is at the back door. It is about — the Member has used my phrase — community capacity. What are we doing about it? We are looking at a long-term solution, because you cannot flick a switch and fix it. The Member is well aware that the first thing that we need to do is get to a point where we can introduce the real living wage — something that I wanted to do last September. I stand ready to do that and to backdate it to 1 April. However, to do it, I need a budget, and, as yet, the Executive have not yet come to an agreement on a Budget for this year nor, indeed, on the much preferred multi-year Budget.”
“I agree with the Member, and I have made the point several times in the Chamber. It is about flow through the hospitals. On many occasions, the focus of the media and the House has been on the front door, including delays in ambulance handovers and delays in getting patients, about whom there had been a decision to admit in the emergency department, into a bed in an acute hospital.”
“Alongside that, my Department has worked with trusts to improve flow through the unscheduled care system, contributing to a small improvement in category 1 ambulance response times in the Belfast area. While that is welcome, performance remains below the required standard. <BR /> <BR />My Department continues to act to improve hospital flow, reduce ED congestion and ensure that patients receive timely, safe and effective care. Urgent care centres, minor injury units and Phone First services are fully operational across the region, helping to divert appropriate demand away from EDs. Funding has also been provided to expand hospital-at-home and same-day emergency care services, alongside additional support for the Ambulance Service, strengthening Hear and Treat and See and Treat pathways.”
“Although it is difficult to establish direct causality between waiting times and outcomes, there is clear evidence that extended delays in EDs increase overall clinical risk. The Getting It Right First Time (GIRFT) review of emergency medicine here highlighted the significant patient safety risks associated with ambulance handover delays and prolonged waits in EDs. <BR /> <BR />In response, my Department is working with the health and social care trusts, including the Ambulance Service, to implement Release to Rescue guidance to try to ensure that no ambulance wait is longer than two hours for a handover at an ED. My officials have briefed the Royal College of Emergency Medicine on that guidance, and we hope to begin to implement it from 27 April.”
“The Royal College of Emergency Medicine (RCEM) report, 'The State of Emergency Medicine in Northern Ireland', highlights the serious risks associated with prolonged waits in our emergency departments (EDs). Those associated risks include avoidable harm and death. The report estimates that long waits could be associated with 1,032 excess deaths in 2025. While my officials would point out that that is a slight reduction compared with the figures for 2024 and 2023, the level of preventable harm remains unacceptably high, and the reduction is not a trend. <BR /> <BR />I am very conscious of the concerns raised in the report about the clinical risks linked to prolonged waiting times.”
“We have a draft Budget, and within that, there are many, many lines of budgetary commitments. Let me write to Mr Brett rather than try to recall hundreds of lines of budgetary commitments off the top of my head.”
“We need a Budget. Every Department needs a Budget, and preferably a multi-year Budget. We need a Budget, because we are well into the financial year already.”
“The cost of service is extremely important, because the Department and the BDA are not on the same page when it comes to that critical area. Mr Brett quoted, I believe, that more than 70% of BDA respondents said that they were not appropriately rewarded. That in itself explains why the cost-of-service report is so important. Let us get on the same page as the BDA. We also need to explore something more than investing in the current regime. We need a new regime, but achieving that will be very challenging in the current financial constraints. The third point is to try to inject a little hope. I hope that the announcement of an £8 million investment, including the increase from £1·6 million to £2 million that Ms McAllister asked for clarification on, will do just that. <BR /> <BR />I will finish with this note of caution, however.”
“Officials continue to target engagement with the dental profession through the BDA and the recently established GDS to form an advisory group whose aim is to better understand where access pressures are most acute and to direct resources accordingly. That includes improving our understanding of local access in areas such as North Belfast. <BR /> <BR />I want to be clear with Members that I fully recognise the real difficulties faced by patients in North Belfast who are struggling to access health service dentistry. I also recognise that those pressures are being felt elsewhere and that general dental practitioners are operating in an increasingly challenging environment. <BR /> <BR />In conclusion, I will make three points, if I may.”
“My Department is facing a projected deficit of approximately £800 million — £800 million — in this financial year. Like last year, that is unprecedented and, frankly, unmanageable, and it will place a significant constraint on my ability to deliver immediate and meaningful reform. <BR /> <BR />Members will be aware that, in December 2024, I commissioned a cost-of-service review. The Department has now received that report. I say gently to Mr Kingston that I have not received it yet, but the Department has. I would like to think that I will receive it in days rather than weeks. We have that draft report, and officials will undertake detailed analysis and present it to me. <BR /> <BR />In the immediate term, my focus is on stabilisation, as I said, while longer-term reforms progress.”
“The dental access scheme also remains in place, providing access for unregistered patients with a pressing or urgent oral healthcare need. Separately, last year, I also allocated a recurrent £2·5 million to practitioners to offset the costs associated with increased employers' National Insurance contributions. <BR /> <BR />Although I hope that those investment measures will be welcomed as meaningful and tangible steps in an extremely challenging financial context, I am also acutely aware that a financial envelope of £8 million is not enough to address the significant challenges facing general dental services. Sustaining and improving health service dentistry will require longer-term reform that is underpinned by additional investment if the service is to be placed on a stable and sustainable footing.”
“<BR /> <BR />Moreover, the enhanced child examination scheme is demonstrating that children in the most deprived quintiles represent the biggest registration figure. The enhanced child examination scheme is helping 76,493 children up to 10 years of age who are registered. Children who, owing to medical conditions, are unable to access care in general dental practice may be referred to community dental services. Miss McAllister mentioned preschool children, and she may wish to note that there has been an expansion of the Happy Smiles programme to children in P1, P2 and P3 in the 20% most deprived areas in Northern Ireland. The recommendation is for a child to see a dentist by their first birthday, as soon as their first tooth appears.”
“<BR /> <BR />I have taken tangible steps to support and encourage the profession to continue providing health service dentistry in recent years. In 2025-26, I invested an additional £7 million in general dental services, and I have just agreed a further investment of £8 million for this financial year. That includes the continuation of a 30% enhancement to the fees for priority treatments, the continuation of the enhanced child examination scheme to encourage new child registrations, and £2 million of direct support for dental practitioners who continue to provide health service dental care. To answer Nuala McAllister's question, that is an increase on the £1·6 million that was provided in 2025-26.”
“They proposed a payment reform model to address the current instability and the continuing loss of dentists to private practice. They are looking for a reduced, or core service, model, but that is a reform that would require significant investment. At present, the current budget cannot meet that requirement, because no Budget has been agreed. Although I recognise the necessity of payment reform, the reality is that reform on that scale is dependent on funding decisions that have not yet been agreed. Reaching agreement on the Budget as soon as possible is essential if we are to progress meaningful reform of general dental services. Until then, I am afraid that difficult constraints will remain, and my focus will remain on stabilising the service and protecting access wherever possible.”
“That, Members may think, appears promising, but the registration rate in North Belfast has reduced by 27·9% in the past four years. It is clear that, although there are a sufficient number of dentists, the type of work that they are doing has changed. They are reducing the level of health service work that they are carrying out and increasing their private work. The pattern is the same right across Northern Ireland. The reason that is given for that is that the fees that are paid for health service treatment are insufficient to maintain practices' financial viability. <BR /> <BR />In January, I met representatives of the British Dental Association, and they were unequivocal in saying to me that the current system is unsustainable and nearing collapse.”
“Historically, some areas of the region have had lower registration and treatment rates, often reflecting geography or population size, and North Belfast faces a combination of wider workforce pressures and reduced health service provision that mirrors trends that are being seen across many of our urban areas. Members will be aware that general dental practitioners are self-employed, independent contractors and are therefore free to choose where they practice and the proportion of their time that they wish to dedicate to the health service. <BR /> <BR />The number of practices and practitioners registered to provide health service care has not changed markedly in recent years. In North Belfast, there are 82 practitioners across 27 practices, and that is the fourth-highest number across all Assembly constituencies.”
“That percentage does not include those who are registered with a private dentist or who are receiving dental treatment through trust-based services, but the figure is still very concerning.”
“Thank you, Deputy Speaker. I thank Phillip Brett for raising the issue and thank the Members who contributed. The debate highlights the very real and ongoing issues being experienced in Mr Brett's constituency. However, access to health service dentistry is a challenge across the entire region, not just North Belfast, so I will address concerns in the wider regional context. <BR /> <BR />I have made it clear that improving access and sustaining health service dentistry is a key area of focus for me. Access has reduced significantly over the past number of years, and in my update to the Health Committee earlier this year, I noted that official statistics now evidence that the percentage of our population currently registered with a health service dentist has fallen below 50%.”
“As you know, Mr Speaker, when there is a debate involving more than one Minister, only one Minister can respond, and that is why I have not spoken in the debate. As I am on my feet, however, I want to offer an unconditional apology to the families concerned for the 24 hours of unnecessary stress and distress.”
“Madam Principal Deputy Speaker, thank you very much. I thank the Chair and the Deputy Chair for their comments. I am sure that Members will agree that the COVID-19 vaccination campaigns in recent years have been a success. They have helped us to move out of the pandemic to live a more normal way of life. I firmly believe that these provisions are vital to help enable the delivery of vaccination campaigns. Therefore, I am pleased to commend the motion on the regulations to the Assembly.”
“Safety is at the forefront of the COVID-19 and flu programmes. Important safeguards have been put in place to ensure that the flexibilities provided by the amendments do so safely and effectively. All COVID-19 and flu vaccinations, as well as other vaccines that are available as part of a national programme, are entirely voluntary. No one is forced to receive a vaccine. <BR /> <BR />My officials attended the Health Committee's meeting on 5 March this year to outline the policy intent of the draft SI and respond to any questions that the Committee raised. I am pleased to confirm that the Committee raised no issues on the content of the draft regulations, and it is with the Committee's support that I bring the SI before the wider Assembly today. I commend the motion to the Assembly.”