Debate contribution: Health and Social Care Pay Awards 2025-26

Debate contribution by Mr Mike Nesbitt on 23 September 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

23 September 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Health and Social Care Pay Awards 2025-26

Assembly identifier

Official Report component 5129851

Read the official Assembly record

Text

With your indulgence, Mr Deputy Speaker, before I respond to the debate, I want to respond to some of President Trump's remarks about the use of paracetamol during pregnancy and the MMR vaccine. I can advise that the Medicines and Healthcare products Regulatory Agency (MHRA) is the responsible body for regulating all medicines in the United Kingdom. It monitors continuously the safety of all medicines, including those used during pregnancy, and there is no evidence — I repeat: no evidence — that taking paracetamol during pregnancy causes autism in children. I note and welcome a strong statement backing that up from Ema Cubitt, the Independent Autism Reviewer. With regard to jabs, the Joint Committee on Vaccination and Immunisation (JCVI) is the expert scientific advisory body in that area. It strongly supports the use of the MMR vaccine. The possible links to autism and Crohn's disease have been investigated and proved to be wrong. The MMR vaccine remains the most effective and safest way of protecting our children. I hope that that gives some clarity in the face of those comments from the United States. For the debate, I will make two points by way of context, if I may. First, I understand that every Minister faces massive challenges. No Department has the budget that it requires to achieve what it wants to achieve. I am also aware that every budget for every Department in some way contributes to tackling the social determinants of ill health, whether lack of education, social exclusion or economic inactivity. I get it. I have often said that, to deliver health and social care, you need buildings, beds, equipment and medicines but all that is as nothing if you do not have the workforce. Every week, I am out and about meeting members of the workforce. I am struck continuously by the remarkable combination of professionalism and compassion — professionalism based on training and experience and compassion based on empathy and humanity. Why would we not want to reward that workforce appropriately and in a timely manner? That goes to the core principle of pay parity: it is a matter of principle, fairness and respect. I take the issue seriously because it speaks directly to how we value the extraordinary work that is carried out daily by our Health and Social Care staff. They deserve to be remunerated not just adequately but fairly and because, when we pay our staff fairly, we are not just balancing the books but affirming their value, hopefully, boosting their morale and strengthening the future relationships in healthcare. We can no longer remain in a situation where our staff continue to feel rightly that they are always last in line for consideration of pay awards, well behind the other nations and regions of the United Kingdom. Timeliness is therefore important. I will turn briefly to Mr Carroll's amendment for a moment. If I set aside the major concern that I have about the accuracy of the figures that he was referencing, it might be helpful just to mention that the total waiting list initiative spend from April 2021 to July 2025 has been approximately £347 million, of which £248 million has been spent in the independent sector. The £347 million has enabled 1,205,820 patients to receive an assessment, a diagnostic test or treatment, of which, over half a million were managed by the independent sector. Of course, in an ideal world, I would like to see all that money being invested in core services in HSC. I suspect that Mr Carroll already understands that we do not live in an ideal world. However, the money that has gone into the independent sector has undoubtedly saved and lengthened lives. It must be quite the luxury for Mr Carroll to live in a world of ideology, sheltered from the realities of the challenges of delivering health and social care.

I will move to the main issue at hand. Following approval of the final Budget for 2025-26, the Department of Health received, as Members said, an allocation of approximately £8·4 billion. However, after factoring in inescapable increases — inflation, demand, national living wage commitments, the ring-fencing of waiting list funding, the shortfall in employers' National Insurance funding and the pay body's recommendations — my Department faced a funding gap of over £600 million. Of that, about £200 million is needed to implement pay awards of 4% for doctors and dentists and 3·6% for our Agenda for Change staff. I am on record as saying that I find that differential in awards most unhelpful, and, I believe, the Royal College of Nursing sees it as a slap in the teeth for its members. We are working hard to deliver savings internally. To date, £155·6 million has been identified, but the scale of the challenge means that we cannot bridge the gap alone; it is unprecedented and, we believe, unmanageable. The decision to ring-fence £165 million for waiting lists from within the existing budget rather than provide it as additionality, has intensified pressure on the HSC, with the requirement to make further savings and efficiencies that will inevitably have consequences for services. I acknowledge that the Department received £25 million in non-recurrent funding through June monitoring, but the overall funding gap remains at over £400 million, excluding pay. Without additional support, trusts may be forced to propose measures that have potentially catastrophic impacts on services, with direct consequences for patients. As has been noted, I issued a ministerial direction in May requesting approval to implement the pay award. The Executive have not reached a position that would allow my Department to proceed, but I am hopeful, perhaps more so than I was this time last week. The delay is regrettable. It sends a damaging message to our workforce that its dedication is not matched by political will. It also places Northern Ireland at risk of significant industrial action, with formal disputes already lodged by the Royal College of Nursing, the BMA Northern Ireland consultants committee and hospital dentists at the British Dental Association in Northern Ireland. I acknowledge ongoing engagement with trade unions and professional bodies. Their advocacy on behalf of staff has been clear and consistent, and it is deeply rooted in the desire to protect patient care. We will continue to engage. I will mention a particular meeting. After the previous Executive meeting, I happened to go straight into a meeting with the Royal College of Nursing. Its chief executive, Nicola Ranger, had flown in from London. I met her along with Rita Devlin, the local director. Nicola Ranger is a very personable individual, and I like her a lot on a personal basis, but that meeting was scary. I see, hear and read a lot about health and social care delivery that I could allow to scare me if I wanted it to. I try not to do that, but the meeting was genuinely scary because her simple message was, "We've had enough. This happens year-on-year, and it only happens in Northern Ireland, so we will ballot, not on industrial action but on strike action. We're learning the lesson from the previous strike action, when we thought that we were too soft, putting in so many derogations and mitigations that our message did not land sufficiently. No derogations and no mitigations this time. We will come out on strike, and we will focus on band 5 nurses, who most closely interact with patients". I was scared. I looked at the Chief Nursing Officer, who was sitting beside me, and she looked scared. The Royal College of Nursing is preparing to ballot its members not on industrial action, I emphasise again, but on strike action. The implications are massive. We are over halfway through the financial year. Pay increases have been implemented elsewhere in the UK, but our staff are still waiting. It is not just a financial issue; it is a matter of morale, retention and respect. We often talk about the goodwill of the workforce. Let us be clear: goodwill is a finite resource. Everybody has their limit, and, once you burst through that limit, there is no easy way back. I remain committed to working with colleagues across the Assembly and Executive to try to deliver a fair and timely pay award while supporting the management of our overall budget. I also welcome any engagement from the Committee in helping us to move forward together. If we want a world-class health service, and I do, we must treat our staff with world-class respect. That begins with fair pay, so let us show our workforce not just in words but in our actions that we value them. Let us be not the last to act but the first to lead. I will take a moment to finish by commenting on a couple of specifics that have been mentioned. Mrs Dodds talked about my reaction to the maternity hospital. To be clear and to put it on the record, I signed off on the trust's preferred option to fix the water issues in the new maternity hospital after receiving independent, professional advice. I did not simply accept what was being proposed to me. Mrs Dodds, if I heard her correctly, seemed to suggest that there was the same situation at the acute mental health inpatient centre at Belfast City Hospital. That is not the case. That hospital is still operational. Ms Bradshaw said that it might be better if I were to define my priorities. I first came to the House as Health Minister on 3 June 2024, and I defined my priorities: health inequalities, cancer care, waiting lists and mental health. I am happy to repeat those, but it is simply not true to say that I have not defined my priorities. Those remain my priorities, as well as respecting our staff, and I hope and am confident — much more confident than I was a week or two ago — that we will find the solution that our health and social care workforce deserve.

1,673 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 13:11 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

Disagree with this assessment?

Classifications can be challenged. A person reads every challenge, and any change is recorded publicly above with its reason.

Challenge this classification