Michelle O'Neill
Mid Ulster · Sinn Féin · Northern Ireland
“We are shocked and deeply saddened for both the victim of the horrific incident in north Belfast and the people who have been impacted on by the disorder that we have witnessed since. There is absolutely no justification for racism, violence or intimidation.”
“It is the latest chapter in a political psychodrama. It has been playing out in Westminster for forever and a day but particularly over the past 10 years. Tomorrow is the 10th anniversary of Brexit, which inflicted so much damage to the wider economy. We are now on the verge of having a seventh British Prime Minister in 10 years.”
“We cannot look at things in isolation. Whether it is the refugee integration strategy, the framework or the legislation, all those things need to move together and at pace.”
“I agree with the Member about the ugly language that was used to describe some people in our community. Like the Member, I have met many people from the black and ethnic minority community in recent times. I do that on an ongoing basis, but I did so recently given what happened over the last number of weeks.”
“There is not just one answer to it, as the Member knows. We need to come at it from every angle. That could be a policing response initially, for which additional funding was secured. I agree that this is the third year in a row in which we have had that type of racist behaviour on our streets. Likewise, I would describe it as a pogrom.”
“Building on that progress, the Executive Office is contributing £3·3 million towards the Derry on the North Atlantic Museum, which is due to open in 2027 and will further enhance Ebrington’s role as a heritage and tourism destination. <BR /> <BR />Ebrington is also continuing to develop as a vibrant events space.”
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“I am considering how funding from the Department can best support the voluntary and community sector to deliver vital services in line with my vision of securing better health and well-being outcomes for patients. It is important that we support groups such as Positive Life, which is unique in the work that it does and in the contribution that it makes to those living with HIV. I made the commitment today that, in relation to what comes next in the innovation fund, we will get the information out there as quickly as possible so that groups can plan for how they can be part of that. I know that Positive Life celebrated its thirtieth anniversary this year, and I am sure that we will all congratulate it on that and wish it many more successful years into the future. <BR /> <BR />I have probably picked up on all the issues.”
“<BR /> <BR />For that reason, I wish to acknowledge, like every Member, the work of Positive Life and other groups, but particularly Positive Life, which I met earlier today. It provides a range of information and support services, including a helpline, counselling, complementary therapies, one-to-one support and peer support groups. I am looking forward to having an opportunity to visit Positive Life at a future date. <BR /> <BR />There are concerns about funding going forward. The Department has always awarded core grant funding to Positive Life over the past number of years. However, in recognition that this funding stream has not been open to all voluntary and community organisations, it is being reduced on a three-year phased basis and is due to cease in March 2018.”
“The regional centre for HIV care and management, based at the Belfast Trust, provides excellent services and support to people. <BR /> <BR />Better survival rates, combined with the growing numbers of new diagnoses, mean that the number of people living with HIV is rising. The latest figures indicate that over 930 people in the North are receiving HIV-related care. HIV therapies are complex and can be extremely demanding, which has major implications for planning and integrating our HIV services in the context of strengthening the wider health and social care system. Treating people living with HIV holistically to support their needs is an important step in this regard.”
“The Choose to Protect Yourself: Always Use a Condom campaign aims to promote good sexual health and contribute to reducing sexually transmitted infections, including HIV. Aimed at young adults, the campaign is supported by social media activity and a new sexual health website that provides accurate information and advice. <BR /> <BR />While the vast majority of men who have sex with men do not have HIV, those men continue to be the key population group most affected by HIV infection here. The Choose to Protect Yourself message applies to the whole population, including men who have sex with men. However, for this priority group, there are also targeted interventions such as outreach information and testing sessions.”
“Also, Positive Life had a recent petition calling for a new sexual health promotion strategy. <BR /> <BR />I have asked officials to keep me informed of the recommendations and potential actions coming out of a recent sexual health workshop involving the regional sexual health improvement network. That exercise, involving key stakeholders from the statutory and voluntary sectors, should help to identify areas where we need to intensify our efforts in the future. I will certainly give my careful consideration to the recommendations and to the need for a strategy, should that be the best way to address these issues. I will also use the contributions to today's debate. <BR /> <BR />The Public Health Agency’s current campaign will run until January 2017.”
“<BR /> <BR />Some Members referred to the campaigns in the early years of the HIV epidemic, particularly the AIDS: Don't Die of Ignorance TV adverts and the leaflets with tombstones, which brought fear and dread. The stigma and secrecy around HIV has been fuelled by that approach. <BR /> <BR />There is still no cure or vaccine available for HIV, but it is a condition that is treatable, and accurate information will help to raise awareness, promote openness and prevent transmission. Raising public awareness and HIV prevention are included in wider sexual health campaigns, but, throughout the debate, Members have been calling for a new sexual health strategy and asking when it will be published. I am very aware of the calls, and the Chair of the Committee has raised this with me on a few occasions.”
“World AIDS Day is Thursday 1 December, and it provides another excellent opportunity to highlight the issue and lessen the stigma experienced by those living with HIV. I know that a number of noteworthy events are being promoted by voluntary, community and social enterprise organisations to mark the day. I am sure that everybody in the House will wish them every success with these events. I am also pleased to publicise the screening by the Belfast Trust’s sexual health training team, in conjunction with the Belfast Film Festival, of two topical films on World AIDS Day to support those with HIV and help to put an end to HIV stigma.”
“During the debate, Trevor Clarke stood up and said that, a number of years ago, he could not have imagined taking part in this debate or speaking positively about the need to address stigma. That shows that we are a society on a journey, and we need to get to the destination quickly because we need to address the inequalities in society. That was significant and a positive moment in the conversation we are having today. A fear of stigma and marginalisation can create barriers to accessing tests and services. It is essential that we address this and help to empower people to access treatment and support. <BR /> <BR />HIV awareness training for HSC staff is delivered in the trusts with the aims of addressing stigma, providing effective support from front-line services and improving the accessibility of services.”
“In this regard, it is positive to note that HIV testing undertaken by GPs increased by 23% from the previous year. Although HIV testing continues to increase, and we have a low prevalence of HIV relative to other countries, we cannot be complacent. The consequences of increasing new HIV diagnoses must not be underestimated, and the personal impact, in particular, is considerable. <BR /> <BR />Many Members referred to the issue of stigma, and stigma is a barrier in the fight against HIV. Many people living with HIV continue to suffer from ill-informed stigma, often causing social exclusion and discrimination. That is unacceptable, and a few Members picked up on examples.”
“I acknowledge the Members’ concerns that the annual number of people diagnosed with HIV is rising. Early diagnosis with appropriate treatment improves health outcomes and helps to prevent onward transmission. HIV testing is, therefore, routinely offered and recommended to all patients attending antenatal clinics and genito-urinary medicine (GUM) clinics. The latest published figures show that more than 60,000 HIV tests were carried out — an increase of 15% on the previous year — which shows that there is awareness and that people are looking to be tested. <BR /> <BR />Increasing the uptake of testing for HIV is critical in reducing the number of late diagnoses; that is, after the point at which treatment should have started. Obviously, better uptake will also reduce the number of people with undiagnosed HIV infection.”
“It is important to note, as many Members did throughout the debate, that they also need societal support, so they need people to have a different attitude. We need to allow people affected by HIV to live their daily life free from stigma and discrimination.”
“There is a lot of homework still to be done on whether it will best serve the population. I am happy to do that. <BR /> <BR />For me, this is an equality issue, and respect has to be at the heart of how we do our business. We all need to deliver for all our people and communities, so I am grateful for the fact that we are having the debate and are able to raise awareness of HIV and show our support and care for those living with HIV. As many Members have said, HIV treatment has vastly improved, and most HIV-positive people live longer and stay healthy on treatment. However, the needs of those living with HIV are not only for treatment, because they require a range of health and social care services.”
“We have had a useful debate up to this point. We should not be distracted from the fact that we are discussing a serious issue. For me, it is very much an equality issue, and it is great to see the Assembly discussing it. That has been long overdue. <BR /> <BR />We should build on the positive: the fact that everybody around the House has spoken in favour of the motion and the amendment. I have some concerns, but with regard to the way that the proposers of the amendment have set it out in relation to PrEP — I will use "PrEP" in case I get the word wrong — whilst we are not saying we can deliver it tomorrow, we can work towards it if the evidence is there to suggest that it is the best thing to do to support individuals with HIV. I support the amendment in that regard, so we can work towards it and build our evidence.”
“<BR /> <BR />I anticipate that the transformation process will lead to a revision of the structure of services across the North and the development of regional programmes of care, which will deliver better outcomes for individuals. These are significant factors that we will need to consider carefully when assessing future medical workforce needs, the associated medical education requirements and how best we will deliver them. <BR /> <BR />In conclusion, I welcome the concept of a north-west medical school. I very much welcome this opportunity to focus attention on our undergraduate medical provision. I am committed to exploring the feasibility of the proposal and ensuring that we train the right number of future doctors to meet the needs of a transformed health and social care system that delivers better outcomes for all our population.”
“I am, therefore, committed to developing a workforce strategy early in 2017 and a range of other immediate actions to start to address some critical workforce challenges. <BR /> <BR />There will be a new approach to learning and team working. I want all those working in Health and Social Care to feel able to effect change and improvement in care rather than concentrating power at the top. We need greater collective clinical and professional leadership throughout the HSC, supported by skilled and able managers. That is why I have also asked my officials to develop a system-wide HSC leadership strategy to be produced by next summer. Resources will be invested to support staff and leaders to develop the necessary skills and behaviours that will be crucial as we move forward.”
“<BR /> <BR />Central to the consideration of this important issue is my transformation agenda. Last month, I launched my vision for the transformation of health and social care. We are about to embark on an ambitious transformation journey that will radically change the way in which we plan and deliver health and social care. As I have said, under the transformation process, I am committed to investing in the HSC workforce. Our staff are the greatest asset, and I recognise that they are under pressure. Over the last number of months. I have witnessed the outstanding work of all the staff, not least our medical staff and the positive impact that they have on people’s lives. The compassion and dedication of our staff continues to astound me.”
“I thank the Member for her intervention. You may be stretching it, but all politics is local. You and Jo-Anne Dobson have raised the issue, and I assure you that I am acutely aware of the issues that are unfolding in Portadown and have asked for an update this morning on all that is being done. There are locums in place, but we need to get to a stage at which we have a sustainable health service there and people feel confident in it. I assure you that we are doing everything that we can. <BR /> <BR />I hope that it is evident from my comments that I see considerable potential in a north-west medical school. I would like the issue to be explored further, and, as I outlined, a number of issues need to be considered in the time ahead as a way of advancing the proposals further.”
“I believe, however, that we can overcome such challenges. A lot of potential could be realised for the people of the north-west, and I am committed to working with the university and the Department for the Economy and other Departments to taking it forward. <BR /> <BR />Mr Speaker —”
“My officials will work with the University of Ulster to take forward that analysis and make sure that we complete all that work. <BR /> <BR />Of course, consideration will also have to be given to the challenges associated with establishing a new medical school and placing it on a sustainable footing. We must not shy away from those challenges. The recruitment of suitably trained clinical academic staff will be challenging. The regulatory and accountability challenges of setting up training programmes, which, under the proposal, will stretch across two professional regulatory regimes, should also be recognised and will take time to work through.”
“<BR /> <BR />The strategic outline case submitted by the University of Ulster is a first and early attempt to assess the financial implications for my Department. The proposal explains some, but by no means all, of the investment that a completely new school would require. Initial predictions of capital costs for the Department for the Economy are in the region of £20 million, and the annual revenue pressure for my Department is placed at around £17 million. However, that assessment needs to be reviewed rigorously. Much further work will be required to understand the extent of the future medical workforce need and the likely costs, including additional costs, that would be incurred in any corresponding expansion of postgraduate training, particularly at foundation level.”
“That testifies to the value of the medical careers offered. However, it perhaps also demonstrates that there is a desire among many of our young people to serve the communities in which they have grown up and with which they have deep roots and empathy. A north-west medical school has the potential to tap into that. <BR /> <BR />That said, the next generation is likely to be the most mobile workforce yet, and the highly regarded doctors whom we train here will be much in demand, particularly across the English-speaking world. That requires us to engage purposively with our future medical graduates to ensure that we harness their skills for the benefit of the HSC in the future. Notwithstanding the real potential that a north-west medical college presents, the proposal is at an early stage and will take time to develop.”
“I also support the work of officials from my Department and the Health and Social Care Board, in close liaison with local GPs, to ensure that people living in south-east Fermanagh continue to have access to high-quality, sustainable and resilient GP services. <BR /> <BR />The motion raises the specific question of whether an additional medical school in the north-west could help to fill the current vacancies in junior doctor positions and the challenges of recruiting to GP practices in some of our deeper rural localities. I think that a medical school in the north-west has the potential to do that. It is noticeable, if not exceptional, for example, for healthcare systems across these islands, that about 80% of medical students graduating in the North go on to pursue a career in HSC here.”
“I consider that effective workforce engagement and planning are key enablers to securing the needed transformation of Health and Social Care (HSC). <BR /> <BR />My Department is working closely with the North’s Medical and Dental Training Agency to ensure that all medical trainees across the HSC are valued and supported appropriately and that they are provided with up-to-date, high-quality medical training. I know that that is being reinforced by action by local medical management in the individual employing trusts. The key will be to make the HSC an employer of choice, and I am committed to ensuring that a workforce strategy to give substance to that objective is developed by May 2017.”
“I share the concern expressed by Members about the challenge of medical recruitment to these services and wish to assure the Chamber of my commitment to resolve and address those issues. <BR /> <BR />I fully recognise the current challenges that we have in attracting junior doctors to fill all the medical training positions that we have available across the North. It is troubling that medical graduates from Queen's University are not taking up all the 267 foundation posts available. Furthermore, and increasingly, foundation doctors are not progressing into speciality training programmes. In 2015, for example, only 150 of our output of 250 foundation doctors entered speciality training. The reasons for that noticeable trend, which is by no means unique to here, are multifactorial and will require persistence if we are to address them.”
“At the outset, I want again to pay tribute to the dedication and commitment of all our front-line staff, who play a vital role in the delivery of high-quality care to our population across all sectors and settings. I cannot stress enough how greatly I value and appreciate the work that our medical staff do in the face of increased demands and the unique contribution that they make to the lives of patients, clients, and families daily. <BR /> <BR />The underlying issue that the proposal for a medical school seeks to address is the need to ensure a sustainable supply of well-trained doctors to serve in primary care and secondary care, particularly in the north-west of this island.”
“Accordingly, I view the comments registered in the Chamber today and, indeed, the proposal for a medical school in the north-west, as positive.”
“I start by welcoming the debate that we have had today. I thank Members for their contributions throughout the debate, particularly those on the positive impact made day and daily by health and social care staff in the course of their work. All Members realise that our healthcare system must change so that it can meet the challenges that we will face in the future. There is also a desire to engage creatively and positively in addressing those challenges. That is the correct approach. As I explained in 'Health and Wellbeing 2026: Delivering Together', which sets out my vision for the transformation of health and social care, we all have a responsibility to work together to ensure that we develop a system that delivers better health outcomes for people and which is sustainable into the future.”
“You are right. I have had indications and individuals have told me that a lot of the pharmacy companies will relocate to wherever the agency relocates to. I think there will be implications. I am aware that the Dublin Government are engaged in conversations about the potential of it coming to Ireland. Obviously, there would be potential knock-on implications for us too.”
“When it comes to designing services, at the heart of Delivering Together is designing services with patients, staff and carers. Whether it be palliative, emergency or GP care, we have to listen to those who have lived experience. I am very committed to that, and that is at the core of Delivering Together. We will design services with those people because they have that lived experience. They bring to it a new expertise that has never been taken into account, I believe, fully in the past. We have a real opportunity for people to be very bought-in and understanding of how we deliver services.”
“I intend to try to announce the way forward before the end of this financial year. As I said, the current process is not transparent enough. People do not know how to access it properly, and it seems to be quite problematic. The review has looked at all that and at how we can improve the process to make it more streamlined. What I am saying is that, before the end of March, I intend to bring forward the new process for how it will be developed for the next financial year.”
“Yes, I see a pivotal role for them. We can also be more innovative about working in clusters, with a number of centres working together. If we have multidisciplinary teams in communities, that is all about investing in primary health. I believe people need to see that change in their community before we can make all the bigger changes that will need to happen. I am very committed to that. <BR /> <BR />I am going to visit the Member's constituency on Wednesday. I have a range of engagements that he may already be aware of. I am sure that the people of the area will make sure that their views are well known to me before I leave.”
“I will be very serious about co-production and co-design, and that means going in to consult right at the heart of communities on any changes we take forward. I will be very mindful of the needs of rural people when we take those decisions.”
“The Member will know I brought forward that legislation, so I am passionate about it. I will make sure that everything we do in decision-making will be rural-proofed and that we will apply the legislation. More than that, I want to go right into the heart of communities. If we are going to transform services, we need people to understand why and get them on board. There needs to be full understanding that this is not about stripping services from anybody but about how we can invest more in our community and build up primary care. I talked about that in the previous answer. How can we invest more in our GPs and make sure front-line services are in communities and closer to people's homes? We know people want to stay at home instead of going into hospital, so how can we do more of that?”
“If we are going to transform health and social care and take the focus out of hospitals, we have to invest in our communities, and that is very much at the core of what I am trying to do with Delivering Together.”
“Fair play to the Member for fighting the corner of the area in which he is elected, and rightly so. I consider all capital projects. I am not sure where it is in relation to the trust's capital priority list, but I am happy to look at that and respond to the Member in writing about where it sits. I am a big believer in investing in primary care. I think that we do need to build services in our communities.”
“I do not have the detail on that, but I am happy to write to the Member to give him more detail on the future plans.”
“If he wants to send me an email or write to me about it, I am very happy to receive that.”
“I wish the individual well, and I hope that they are recovering. No, I do not find it acceptable if the ambulance did not get there in time to support the individual. If the Member wants to write to me on the individual issue or wishes to take it up with the Ambulance Service Trust, I am very happy for that to happen. <BR /> <BR />Let us be very clear about our ambulance staff and personnel. They are doing everything that they can, working in difficult situations. I referred earlier to the figures on the target and how the Ambulance Service is delivering. It is under a lot of pressure. It is responding to more calls. I do not think that it is acceptable if someone had to wait for longer than they should have done for their care, but, again, I am very happy to take on board what he has raised with me.”
“I will be bringing forward proposals in the new year.”
“It also took into account the views of other interested parties who responded to the recent Justice consultation on the matter of fatal foetal abnormality. On the time frame; I have said that we will bring proposals forward early in the new year. We are almost at the end of the year now. Now that the First Minister and deputy First Minister have also had sight of the report, we will work on it collectively —”
“I was very interested in the work of the working group. I think that it was a very important piece of work so far as it sought the views of woman and their families who have been directly impacted by a diagnosis of fatal foetal abnormality. That had to be a core element of the work that the group did. I very much welcome the input that it has provided, and I want to take the opportunity to thank the group's members because I appreciate what they have done. I also appreciate the upset that lies behind their own personal experiences. It is not easy to share your own personal story. <BR /> <BR />I believe that the work has been invaluable. The group also sought views of health professionals, including midwives, gynaecologists, nurses and GPs and views from the royal colleges.”
“The Justice Minister and I received the report of working group on fatal foetal abnormality on 11 October. The First Minister and deputy First Minister have now seen the report, and the Justice Minister and I will continue to work closely on the matter. We hope to bring forward proposals early in the new year.”
“I could never give a cast-iron guarantee to anybody, and it would be irresponsible of me to do so, but I will give a guarantee that I will work every day to deliver better health outcomes for individuals. If I have to redesign services anywhere, I will do it in conjunction with local representatives, patients and staff. That is the difference that we have never seen before in relation to the health service. My guarantee to the people of Newry, the people who use Daisy Hill Hospital, is that I will deliver first-class health and social care for everybody who needs it.”
“It would be foolish of me to stand here and say that nothing will ever change; I cannot say that to any Member. If we are serious about transforming health and social care, we have to be serious about how we deliver that care. I am open to designing services with staff, patients and locally elected representatives because I think that we will have to have some hard conversations. <BR /> <BR />We are standing here having a conversation about waiting lists, and we have to change the picture in relation to waiting lists. We have to see people more quickly and we have to bring waiting lists down. In order to do that, we have to transform how to deliver health and social care. We cannot keep doing things the same way.”
“We are finding it very difficult to recruit consultants, particularly for emergency departments, so we have to look at new and innovative ways of attracting people to the posts.”
“I understand and am aware of the problems that the Southern Trust has had in trying to recruit. Despite it having been out three times, it has been found to be really difficult, so we are looking at additional measures to allow us to make the post more attractive. You will be aware that the Daisy Hill service has been wholly dependent on one doctor who has been providing an excellent service there, and you are right that he is about to retire. I assure you that the trust is doing absolutely everything it can to make sure that the doors are kept open and services are still provided. If we have to use locums in the meantime, that is what we will have to do, but it is about delivering services. It is reflective of the challenges that we have across the health and social care workforce.”
“Delivering patient outcomes is at the core of everything that I do. I am not interested in cheap headlines; I am interested in doing a job.”
“We can all share the desire that patients be transferred as soon as possible, but the overriding factor has to be patient safety and making sure that patients are not compromised. So, if the handover takes a bit longer, that is what should happen if it makes the patient safer. I am not sorry for that; it is the right thing to do. The ambulance crew will remain with the patient until they have been handed over to the relevant clinical person in the hospital and can alert the emergency department staff if a patient's condition worsens. <BR /> <BR />I have answered the Member's question. However, I think that the Member has a tendency, quite frequently, to run away with herself and try to make a cheap headline out of a story for the day. Really and truly, I am only interested in delivering excellent patient health outcomes.”
“During October 2016, almost half of ambulances arriving at hospitals were turned around within 30 minutes of arrival, and 95% within one hour, against a background of increasing demand for ambulance services. In 2015-16, the Ambulance Service answered 202,325 emergency calls, an increase of 5·5% on the previous year. Improved patient handover and ambulance turnaround times remains a priority for Health and Social Care. The Ambulance Service is working with the board and the trust to improve turnaround times at all hospital sites. Turnaround times at type 1 emergency departments are monitored very closely on a live basis, and appropriate action is taken by the Ambulance Service to ensure that waiting times are kept to a minimum.”
“I can absolutely give that assurance. That is what it is about: designing the service with them. The reason that I put in the independent facilitator was to build that trust again, because confidence in the trust had completely broken down. There is a job of work to be done there, and the only way in which we will be able to do that successfully is through independent facilitation. That is the way to go. It will ensure that everybody is involved in the decision-making and the processes.”