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 think that I have answered that. I am doing absolutely everything I can to work with the Finance Minister and Executive colleagues to make sure that we have proper funding for our mental health services. It is not without its challenges. There is Tory austerity; I could list all the issues that we have to deal with. We do not have an unlimited pot of funding, but we have a commitment to parity of esteem. We have a legacy of underfunding in mental health; I want to change that picture and am committed to doing that.”
“I am still looking at that because I wanted to take a fresh look at the organisations that we fund, some of which may disappear. I am fearful, particularly in relation to advocacy, about how those groups will be supported in the future, and I am considering that. I want to get the innovation fund out the door because I know that people are very anxious, given the decrease in their funding over the last number of weeks. I intend at least to initiate the applications for the innovation fund before the end of the financial year to allow people to bid in. Alongside that, I am looking at whether there is any potential or scope to support the community and voluntary sector and the particular groups that we need, because we know the value that they bring to all the people who use their services.”
“I thank the Member for her question. I do not have a full understanding of the services for victims of sexual crime, but I will certainly look into it and make sure that that is included in taking things forward. <BR /> <BR />You are absolutely right about core funding: the community and voluntary sector does excellent work. The health service has given some core funding for that in the past, but it is probably nowhere near what it takes for them to run the services. If the health service tried to do that itself, it would find itself stretched to the limit. We have to recognise the excellent work that is out there in the community and voluntary sector. The previous Minister obviously decided to end core funding and develop an innovation scheme.”
“Do not be shocked, but be assured that I am doing everything I can to make sure that we change the services that we provide. I am doing everything I can, along with Executive colleagues and the Finance Minister, to make sure that we deliver the funding that we need to invest in psychological therapies.”
“I was not shocked, and I do not think that the Member should be shocked. We all know that there is a legacy of underinvestment in mental health services. I do not know how aware you are of mental health services and how they are delivered but, certainly, it is no shock to me that there is a waiting list. It is no shock to me that we need to invest more in mental health services. It is no shock to me that we need to invest in all those areas which I have just highlighted, areas where we need to do more. <BR /> <BR />We have a very challenging situation and, as I said in the first answer I gave, there is a legacy of underinvestment and increased demand for services. Psychological therapies are working, so people want them, and rightly so. We have a big demand on our service and we need to deliver for the people who need our service.”
“There are so many things that are key and really important which we need to do, but we need to come at it from a planned system change point of view and that is going to take a bit of time to do. What is most important is that we work collectively — community and voluntary sector and government — to make sure that we provide first-class services for those people when they need them. <BR /> <BR />I said that waiting lists are always unacceptable. The length of time that some people are waiting for services across health and social care is totally unacceptable to me. That continues to be the case, and when I publish the plan for how I am going to bring elective care under control, in January, I will look forward to discussing with Members of the House how we can improve that picture.”
“So, let us make sure that every service that we invest in is about delivering better health outcomes and making a meaningful difference. Over the time ahead, we are going to have decisions to make to plug the gaps between needs and service provision, but the Bamford review is really key in pointing out some of the areas where we need to do more. <BR /> <BR />I am particularly interested in making sure we do more to support young people, particularly those with a dual diagnosis. I want to do more to establish a regional perinatal service for people with mental illness. I want to do more around eating disorder services, psychological therapies, mental trauma and personality disorders.”
“Recovery colleges have been established and they are really practical examples of how people with lived experience — those who have had mental health problems — have actually helped to design and improve services and work with others who find themselves in the same scenario. They have then been employed by trusts to provide those services. I want to do a lot more of that in pursuing and enhancing the recovery culture which we have. <BR /> <BR />Thirdly, involvement by people, as I said, with lived experience is key. <BR /> <BR />The fourth principle is around service development where our resources allow us to do so. We are going to have to prioritise. We do not have an unlimited pot of money. We are going to have to prioritise services and what we take forward.”
“As I said, we are at an opportune time as we have the Bamford evaluation but, first and foremost, the commitment has to be about moving towards parity of esteem. I have said that I am firmly committed to moving towards parity of esteem. <BR /> <BR />Secondly, it is really important that we develop and sustain a recovery culture. Whenever I talked, in the last number of weeks, about how we are going to transform health and social care, one of the things I talked about was co-designing services and planning services along with patients, carers and families. This is an area where mental health is already ahead of the field.”
“They actually take pressure off the acute end of mental health services. They are giving people first-aid. They are talking to people from very early on, and maybe preventing them from having to move through further areas of the health service. <BR /> <BR />I recognise that we need to do more of this, and I am actively engaged in conversations with the Finance Minister on how we can fund psychological therapies in the future. I believe in them. I believe they are the right thing to do. I believe they work and in terms of doing more — we have to do more — we have a certain level of investment, which has been very positive, but we certainly have a long way to go to improve the picture for absolutely everybody who may need psychological therapies.”
“No, I will not get into specifics in relation to the South Eastern Trust in this debate but I am very happy for the trust to pick that up directly with the Member in relation to what it is doing operationally. <BR /> <BR />The same things that I have just said actually stand for every trust. We have to get to the point where you get the same access to services no matter where you live in the North. It is unfortunate that at this moment in time, depending on where you live, you may have better access to psychological therapies, and that is what we are talking about today. That is not acceptable to me. We need to have a regional standard. We need to make sure that you have full access no matter where you live. <BR /> <BR />We have a psychological strategy in place. Clearly, there is a recognition that psychological therapies work.”
“We have a lot of lessons to learn, but the evaluation of the Bamford review points to all the gaps that are there, and I want to work with the Health Committee and all Members to put plans in place to improve things across the piece. Clearly, whilst the Programme for Government indicator talks about a five-year plan, the feedback that I am getting from health professionals and others who work in the field is that we need to chart a way forward — similar to Delivering Together — for the next 10 years so that we can start to improve things.”
“I always say now that no one has the option of working in silos; we all have to work together. If we are all serious about delivering better outcomes for people with mental health problems, I know that the community and voluntary sector is up for that. <BR /> <BR />In relation to EDs, we should always keep that under review. A number of years ago, after a campaign by families that had been bereaved, the "card before you leave" system was brought into play. There are simple things that can make a real difference, and it was a lifeline for some families. We need to do more such things, but the only way to learn about them is by talking to service users — the people with lived experience who have needed the support of the health service.”
“That is exactly the approach that we need to adopt. Often, a lot of people will not even present to an ED but will go to people they know in the local community group that is involved in supporting people with mental health problems. I had a very similar experience in relation to understanding the work that they do. There is certainly a role for the community and voluntary sector. <BR /> <BR />In terms of shaping our services, we have just finished the consultation on the Protect Life strategy — the suicide strategy. One of the things that is very strong in that is the need to work with the community and voluntary sector. I am very open to strengthening how things happen and how the statutory agencies interact with the community and voluntary sector, because they have a role to play.”
“I will use that work, and when we put that together with the recent work commissioned by the Royal College of Psychiatrists in Lord Crisp's review, we have a real body of evidence that points to what we need to do differently. <BR /> <BR />As I said, I intend to set out, in line with the Programme for Government indicator, how we transform mental health services in the years ahead. We will have to do it incrementally, and I think that we can do that. I always say that a lot of good things are happening in the health service, but we have a long way to go in terms of challenging where we need to do things better. We have the information and the evidence that allows us to support a case to transform mental health services in future.”
“The board has set out its stall in relation to the challenges that we have in recruiting staff. That is not just symptomatic of issues in mental health but right across health and social care. All those factors have led to a situation where we have a long way to go to improve mental health services. I said that it is a priority for me and that it is an issue that I want to champion and run with. <BR /> <BR />Just last week, I received the evaluation of the Bamford review, which looks back over the last 10 years at how the Executive and all Departments have worked to improve services for people with mental health problems. It has pointed to a number of gaps in services and where we need to do better.”
“There is an increasing demand for services and a recognition that psychological therapies are an excellent way of supporting people. That means that more people are aware of psychological therapies and that more people are requesting them and being referred for them. That is a good thing.”
“<BR /> <BR />There are a number of issues that I need to tackle, and a number of factors point to the current state of play, particularly the fact that we have a legacy of underinvestment in our mental health services, which is something that we need to address over time. Doing that will be particularly challenging, given the budgetary issues that we have to deal with.”
“I will pick up on your point about external organisations first. I presume, for example, that you are referring to the community and voluntary sector. Earlier today, I had a meeting with the Niamh Louise Foundation, which I am sure the Member is aware of. It provides excellent services in the community, and its staff will quite often describe themselves as being first-aiders when dealing with mental health issues and people who feel suicidal. We have to continue and enhance the role that we have across government, and also with the community and voluntary sector, in order to tackle successfully mental health issues in our society.”
“It is also important to note that, even if all the money required right across mental health services was immediately available, there would be a delay in utilising it fully, given the need to recruit highly skilled staff.”
“Although I am actively making the case for more money for mental health, it is incumbent on us all to get the best value for the money that we already spend, and that is why the board is working up proposals for a managed care network to better utilise existing expertise across trusts and to promote uniformity and better continuity of care. That also demonstrates why fundamental reshaping of the health and social care service is so vital. It will enable money to be released across the system so that it can be targeted at those areas that need it most. <BR /> <BR />I am fully aware of the significant mental health challenges that face us. I am committed to improving services. It will be a long-term effort and, given the current budgetary position, there will be a need to prioritise.”
“Of the £10 million that is invested in psychological therapies, around £2 million is invested in the development of primary-care talking therapy hubs. I acknowledge that a further £3 million is needed to complete the programme. At the moment, nine hubs are operational across the region, providing treatment and care at a community level to over 7,000 people. A further five hubs are in development. Recovery colleges have also been established in each trust area. I also allocated a further £180,000 to continue the development of a comprehensive mental trauma service, which is based on the psychological therapies stepped care mode. When fully established, it will employ over 40 specialist staff. <BR /> <BR />Clearly, we face a challenging budgetary situation.”
“<BR /> <BR />The draft delivery plan for the Programme for Government improving mental health indicator is out to consultation until next month, and it recognises that psychological therapies is an area that needs further investment, together with a wide range of specialist services, such as perinatal mental health. It currently envisages that it will take five years at the very least for us to start to see an appreciable movement in mental health on a population level. A 10-year programme is probably more realistic. <BR /> <BR />I have adopted six principles to improve mental health, with a first step of committing to a move towards parity of esteem to ensure that mental health receives the time, effort and resources required to meet local needs.”
“I am grateful for the opportunity to address this important issue today. Compared with other regions, we have a higher than average prevalence of mental health issues, and it is that, together with an increased awareness of psychological therapies and a legacy of unmet need, that has contributed to increased waiting times. Since I was appointed, I have consistently said that mental health is one of my key priorities. I have been working hard to identify the needs and the gaps in services to be addressed and to formulate a plan for action.”
“Does the Member agree with principle of co-production and co-design and actually listening to service users and patients and ensuring that we give them ownership of the care pathway that they take?”
“I look forward to working constructively with all Members who want to deliver better positive health outcomes for all who may need our health and social care systems in the months, years and weeks ahead.”
“I reaffirm my commitment to update the Assembly every six months on the progress of the transformation process. We must all realise that change cannot happen without investment. Investment not only takes the form of pounds and pence but is about political and system-wide leadership, finding the time to change and making a conscious effort to break down silos to move to regional and all-island approaches where necessary. <BR /> <BR />All of us have an important role to play as we embark on this journey. I will not shy away from the difficult conversations and decisions. I ask all Members to match my resolve. In Delivering Together we have a once-in-a-lifetime opportunity to transform our HSC into a world-class service.”
“That is only the beginning, as I plan to ramp up this type of engagement. <BR /> <BR />I have committed myself to chair an advisory board that will provide the strategic leadership and oversight required to deliver the transformation. Membership of the board will be drawn from the field of independent experts, unions and user representatives, along with the permanent secretary of my Department. The structure will also include a transformation implementation group responsible for driving forward the transformation programme led by my permanent secretary. I will continue to work with Executive colleagues and Members to secure the additional funding necessary to facilitate transformation, manage backlog and maintain current services.”
“<BR /> <BR />I have been really encouraged by the positive response that I have been receiving to the vision document 'Delivering Together', but I want to ensure that everyone has the opportunity to have their say on the criteria for the sustainability of services, which, if adopted by my Department, will be at the heart of informing future decisions about reconfiguring services. Since the launch, I have spent considerable time engaging with staff and service users across a range of locations and settings, including Craigavon Area Hospital, the Ulster Hospital emergency department and Old See House, an integrated community mental health centre. Their reaction to my vision and the expert panel's report have been overwhelmingly positive, and they tell me their appetite for change has never been stronger.”
“Later this month I will launch a new diabetes service framework that will realise a vision of care designed to transform services for people living with diabetes or at risk of developing diabetes, subject to securing the necessary investment. I will launch a public consultation on proposals to modernise the delivery of pathology services. That will involve building a sustainable, high-quality pathology service designed to support the vital area of diagnostics well into the future.”
“<BR /> <BR />This week, I will be launching my Department's paediatric hospital and community-based services strategy and the paediatric palliative and end-of-life care strategy. Those documents will set out the approach for further improving the delivery of services over the next 10 years, subject to securing the transformation investment required to implement the strategies. Both strategies will be taken forward fully aligned with the priorities and objectives for transformation set out in Delivering Together, with the clear aim of delivering better health and well-being outcomes for children in the North.”
“I am determined that Delivering Together should not be put on a shelf and forgotten about but is used as intended, which is as the road map for transformation. As the Health Minister, I will lead this work with energy, passion and pace. Last week, I launched the public consultation on the criteria for assessing the sustainability of health and social care services as recommended by the expert panel in its report. The consultation will run longer than the normal eight weeks to take account of the Christmas period and will include a series of consultation meetings right across the North to allow as many people as possible to contribute. Further information on the dates, venues and invitation arrangements for those meetings will be announced shortly.”
“We should have a system that encourages innovation, and, where there are good pockets of work that are co-produced and show high-quality patient outcomes, we should be able to scale those up at pace. <BR /> <BR />I am determined to realise the potential that modern information technology provides. Making better use of technology and data is essential if we are to move forward to a model focused on service users, utilise our entire information resource to better inform the treatment of patients and free up health professionals' time to care. <BR /> <BR />I have said it before, and I will say it again: it is a privilege to be the Minister of Health, and I am committed to this programme of transformation and the principles of co-production.”
“By further developing ambulatory assessment and treatment centres, we will allow health and social care professionals to assess, diagnose and, where appropriate, provide same-day treatment to patients. Elective care centres will be developed to carry out less complex planned treatments right across the North. The establishment of those dedicated centres will be a resource for the region, and the way they operate will be designed around patients. It is well-evidenced that that type of configuration of services can reduce waiting times and prevent the system backlog we experience today. <BR /> <BR />I want to see a health and social care system that is efficient and sustainable, where best practice is the norm and investment is made in areas that will positively impact service users.”
“Hospitals are not always the most appropriate place for all care to be received, and, where it is safe to do so, people should expect to be treated in a setting closer to home. For some, attending medical appointments or receiving treatment can be a daunting and sometimes stressful situation. There is strong evidence that concentrating specialist procedures and services in a small number of sites produces significantly better outcomes. It is the opposite in our current system, where emergency and planned care services are mixed together because they are located in the same facility. That perpetuates our long waiting lists, and system-wide backlogs are created.”
“I have already embarked on a period of engagement with those who use services and with staff right across the HSC to listen to their views on the future of health and social care services. <BR /> <BR />We need greater collective clinical and professional leadership throughout the HSC supported by skilled and able managers. That is why I have asked my officials to develop a system-wide HSC leadership strategy to be produced by next summer and why 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 />We must all accept that the role of hospitals will fundamentally change.”
“The experiences and needs of service users and their families will, therefore, be at the forefront of shaping our new service model. I am committed to ensuring that the HSC works in partnership with service users to design and implement the lasting and meaningful changes we need to improve health outcomes for our population. That is what I mean by the term "delivering together". <BR /> <BR />This new way of engaging patients is built on the principle of co-production. That will underpin how we engage service users in the future in designing new services and treatment pathways or at the point of care. Patients and service users have a vital contribution to make to transformation.”
“<BR /> <BR />I am committed to investing in the workforce of the health and social care system. Our staff are our greatest asset, and I recognise that they are under significant pressure. I have witnessed over the last number of months the outstanding work of HSC staff and the positive impact they have on people's lives. I am, therefore, committed to developing a workforce strategy by spring 2017 and a range of other immediate actions to start to address some critical workforce challenges. However, I recognise that some of the long-term systemic workforce issues we face will take time, leadership and sustained effort to resolve. <BR /> <BR />Securing better health and well-being outcomes for patients and other people who use health and social care services will be at the centre of the transformation programme I have announced.”
“<BR /> <BR />By implementing new models of care and increasing our regional and all-island networks for specialist services, we will not only deliver better outcomes for patients but alleviate pressure on vital acute services. That will include reducing hospital admission rates, speeding up hospital discharges and reducing the lengths of stay for those patients who need to go into hospital. To begin this journey, I have already set out some key actions. I have agreed to increase the number of GP training places to 111 — 12 next year and 14 the year after that; commissioned five training places on the advanced nurse practitioners programme; and continued investment in practice-based pharmacists. I am also reviewing the role that physician associates could play in our system.”
“It will require whole system transformation across primary, secondary and community care, and a radical change to the way in which we plan, design and provide services. Holistic transformation will allow new and innovative ways of working and for patient-centred models of care to flourish. Moving away from a model of activity-based performance to one of performance measures based on patient outcomes will allow health and social care staff to provide the right care at the right time and in the right place. We will explore where all-island services can be further developed to bring mutual benefit for patients on this island. We have already initiated a programme of work with counterparts in Dublin to explore all-island services, including transplantation, rare diseases and perinatal mental health services.”
“Health is a basic human right, and I believe in a universal health service based on need and free at the point of delivery. My overriding ambition is for all of us to lead long, healthy and active lives. I want a future in which people are provided with the necessary information, education and support to enable them to keep well in the first place. When care is needed, it should be safe and of a high quality. Those who use services and, indeed, those who provide them should be treated with dignity, respect and compassion. I listened to Mr Allister's comments about quality and safety. Patient safety has to be paramount and the first consideration in any service that we provide. I will very much be guided by that principle. <BR /> <BR />My vision, and the transformation journey that we have embarked on, is ambitious — rightly so.”
“Obviously, I totally agree with that. It is very easy to stand on the sidelines, chirp away and say, "This is what we should be doing", and write to me all the time about waiting lists and how unacceptable you find them. However, if we do not have real and meaningful transformation or concrete plans to transform the piece, we will not be able to assist all those people — mothers, daughters, sons — who find themselves waiting to be seen by our health service, so transformation is absolutely key. <BR /> <BR />It is not my intention to paint an overly pessimistic picture of health and social care, but I want to emphasise to Members that, if transformation does not happen, we can expect to see health and social care services in further significant decline.”
“<BR /> <BR />Like those who came before me, I have invested in front-line service development and improvement initiatives. While that has alleviated some of the pressure on the system, it has by no means fixed the underlying issues. Current delivery models continue to have a negative impact on the quality and experience of care across the North. Those models of care are not only outdated but unsustainable. If we continue to do more of the same, by 2026 the HSC will need 90% of the Executive's budget merely to stand still.”
“An ageing population is good news for us all and is testament to the hard work and dedication of all those working in our health and social care system, but it also presents capacity and demand issues. Our system was designed to meet the needs of a population in the 20th century, so it is logical that it is struggling to cope with 21st-century needs and expectations. Waiting lists have continued to grow — I have always said that that is totally unacceptable — but that is only a symptom of the problem that we face. Health inequalities, which some Members referred to, continue to divide our society. In 2016, it is absolutely unacceptable that our socio-economic status dictates our health outcomes, whereby those living in the centre of this city can expect to live nine years less than those who live a few miles up the road.”
“I am grateful, as I said, for the opportunity to set out once again the key elements of the approach. Many Members have read and had time to digest both documents over the last number of weeks, although I question whether some Members have read the report in its entirety. I have heard some of the contributions and comments, and I very much doubt that they have, because a lot of people are missing the point. I will take the opportunity again today to rehearse some of the key issues in order to make sure that Members are fully briefed and absolutely understand the direction of travel, but I will not rehearse all the detail that I have gone into on previous occasions. <BR /> <BR />We all agree that the case for change has been very well made.”
“I have been to the Health Committee — I know you were in China at the time — but we discussed it then, and we discussed it here on 25 October, the day that I launched the report. <BR /> <BR />I launched my ambitious 10-year approach to transforming health and social care, Health and Wellbeing 2026: Delivering Together, as well as the expert panel's report, 'Systems, Not Structures: Changing Health and Social Care'.”
“Go raibh maith agat, a Cheann Comhairle. I am a bit hoarse, so bear with me. I thank the Members who have contributed in a positive and constructive way today. I am very keen to keep talking and to keep coming back to this conversation as we transform our health and social care. The prize at the end of that transformation will be better patient outcomes, and that is the prize that we all need to work towards. <BR /> <BR />I very much welcome the fact that the Alliance Party has brought forward an amendment, because it puts a bit of meat on the bones, as the original motion merely notes the publication of the report. I will correct the Member who proposed the motion and said that this is the first time we have had the opportunity to debate the issue. I think you will find that it is not.”
“I will try to summarise. Recent incidents underline the need to address the mental health problems that exist in our prisons. I have said that mental health will be a priority for me, and I am considering a number of policy proposals, but, in the interests of time, I will write to the Member to give him a more detailed breakdown of the assessment.”
“I will continue to keep in touch with the Member on this.”
“I can, and I will be in a better position to update the Member after I meet Minister Harris tomorrow, as this will be one of the areas that we will be discussing at the North/South Ministerial Council in relation to progress to date and what the challenges and barriers are. We have set out our stall on the phased basis, but there are capacity issues in the hospital in Dublin. That was all part of the plan; we knew that. As quickly as I can possibly get to the stage where we are providing full capacity on the island for families such as yours, it will be a true positive outcome. <BR /> <BR />I am committed to making sure that we do everything we can, working with the Children's Heartbeat Trust, because families come together to talk about, and share, experiences and lobby for the service to happen.”