Nesbitt warns over ‘political three-card trick’ on Budget health spending

The Stormont Executive should be “frank” with people about what has been agreed in the Budget, rather than attempting the “political equivalent of the three-card trick”, Health Minister Mike Nesbitt has said.

Mr Nesbitt, who supported last week’s 2025-2026 Budget, said some commentary was in danger of “misrepresenting and embellishing” what had been agreed on waiting lists.

First Minister Michelle O’Neill, deputy First Minister Emma Little-Pengelly and Finance Minister John O’Dowd announced that the budget had been agreed by powersharing ministers last week, including £16 billion of investment in public services plus £2 billion in capital spending.

They said it includes £215 million towards cutting health waiting lists and supporting investment in elective care.

Stormont’s Programme for Government, published last month, had included a pledge of £215 million to tackle the hospital waiting lists crisis.

Mr O’Dowd made a statement on the Budget to the Assembly on Monday, saying amid limited resources, the Executive “strived to provide a Budget for 25/26 that focuses on providing funding for the delivery of our Programme for Government priorities”.

He told MLAs that health received the biggest share of the Budget with an £8.5 billion allocation, ahead of education (£3.3 billion) and justice (£1.4 billion).

Mr O’Dowd also said he intends this to be the last single year Budget, moving to multi-year budgets as a “game changer” to allow departments to undertake longer term planning of their spending.

In a letter to MLAs, Mr Nesbitt said it was important to “clarify details” of what had been agreed on waiting list investment.

He said: “Some political and public commentary in recent days is in danger of misrepresenting and embellishing what has been agreed.

“To be clear, the finalised budget does not involve £215 million additional investment in waiting lists, nor would it be accurate to claim that it achieves in full the £215 million waiting list investment target set out in the Executive’s Programme for Government.”

Colin McGrath of the Opposition put to Mr O’Dowd that it had “transpired that so-called investment” in waiting lists is “merely the ringfencing of existing money”.

The minister responded: “Let’s be very clear, this Executive has ringfenced £215 million to tackle waiting lists, be under no doubt about that. Things are going to be done differently. We cannot continue the position where we continually uplift the health budget and expect different outcomes and don’t get those different outcomes.

“The Executive has made its position quite clear, we expect a different outcome from this budget, and from this budget we have ringfenced £215m go start tackling health waiting lists.”

The minister said he agreed to the Budget in the “spirit of yes, but…”.

He added: “The yes reflects the fact that, like every Executive minister, I accept the challenge of trying to deliver better with less funding than is needed.

“The but should be taken as a warning that there is no guarantee of success in delivering the triple target of waiting lists, healthcare reform and balancing the Budget.”

Mr Nesbitt said the Executive and the Assembly faced “massive financial challenges” in the year ahead.

He added: “We should be frank with the public about what has and has not been agreed.

“We will not be helped by creative accounting or the political equivalent of the three-card trick.”

Mr Nesbitt said the “bulk” of the investment announced in the Budget was not new or additional funding.

He said: “All but £50 million of it has been ringfenced from within health’s existing allocation in the Executive’s draft NI budget that was published in December 2024.

“Up to £165 million has been ringfenced in this way.

“It is a matter of public record that the draft Budget left my department with a significant shortfall against projected need and pressures.

“Ringfencing some £165 million from within this budget rather than providing it as an additional allocation as per the initial spirit of the Programme for Government commitment, will exacerbate the shortfall.

“This will intensify already severe pressures on HSC Trusts to make further savings and efficiencies and live within their means.

“This will inevitably have consequences for services.”

Mr Nesbitt said his department’s Budget allocation includes £85 million for “red-flag/cancer/time-critical treatment”, which had already been part of his spending plans for 2025/26.

He said: “While the waiting list monies included in the 2025-26 budget add up to £215 million, they do not meet in full the targeted £215 million investment set out in the Programme for Government.

“The PFG was clear that its intention was to reduce waiting lists by treating an additional 70,000 patients a year and expanding elective care capacity.

“The existing £85 million a year for red-flag/cancer/time-critical treatment, while essential, does not contribute to the PfG objective of expanding existing provision levels.”

Speaking to reports at Stormont on Monday, Mr Nesbitt stood by his letter, as it was “important to make the case clear” around what the £215 million “does and does not do”.

“The Executive has decided that tackling waiting lists is a priority for the health department. I’ve no issue with that because I agree with that, but just in terms of the public understanding of what that £215 million represents, it is important to state it is not all new money, £50 million of it is, but £165 million is coming out of the existing budget,” he said.

“I think I said on Thursday it is a triple problem, it is actually a quadruple. First of all, deliver on the waiting lists, secondly mitigate the impact of taking £165 million out of the budget which would have gone on other services, thirdly is the reform piece because we know from history once you spend the money on waiting lists and bring them down, unless you do the reform piece, those waiting lists will go straight back up again, and fourthly I have to balance the budget,” he said.

“So it’s a quadruple challenge, I’m up for it, but I need the public to be aware of exactly what that £215 million represents.”