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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“It is important that we continue to push forward progress on the surgical side to allow us to have those surgeries on the island as quickly as possible. In the interim, the Belfast Trust continues to operate a service level agreement with Our Lady's Children's Hospital in Dublin. <BR /> <BR />The progress is great, and you mentioned the figure in relation to the spend to date. I do not know what that figure is off the top of my head, but I am happy to provide it to you. I am most interested in getting to full capacity as quickly as possible and that nobody has to travel unnecessarily to receive the treatment. I can only imagine, as a parent, what that would be like. We need to continue to push that project forward. It is a really good example of all-island collaboration, and I want to do a lot more of it to support families.”
“I know that the Member has a keen interest in the issue. The announcement was a positive one that allows families to stay on the island of Ireland when they need to have treatment. Often, the surgery is significant, and people have to leave their families, and perhaps kids, behind and go to England. It is really important that we do all we can to support those families. This is a practical example of all-island collaboration. <BR /> <BR />A lot of good progress is being made to establish the appropriate structures, and securing the necessary funds was obviously a key part of that. I am also very conscious that we remain reliant on the majority of urgent and elective procedures for local children being carried out in England, so we have a few years before we get to full capacity.”
“Yes, I am looking forward to attending the launch on 30 November. The aims of the model, including prevention and the promotion of empowerment and well-being, are very much in line with the direction in which we need to go in transforming the HSC, as I outlined in 'Delivering Together'. I have always said that if something works well we should scale it up and do more of it, so I am really looking forward to getting out to take a look for myself to see how effective this is and to listen to people and engage, because sometimes when you read about something and then actually go to visit it and see it for yourself, it comes alive a lot more.”
“This is exactly the type of project that I want to see developed and explored. I want to see innovative new ways of working being tested and, where projects produce good outcomes for people using services, I want to see those being scaled up. This is a key commitment in my vision for the HSC, and I intend to take that forward.”
“I absolutely recognise the positive benefits of the Living Well model with its focus on health and well-being outcomes for individuals, and also the role that the local community plays in helping to achieve those outcomes. Living Well Moyle, which was established by the Dalriada pathfinder group, aims to improve people's health and well-being and their experience of health and social care, as well as reducing care and support. The pilot will employ a community navigator to work with service users to identify health and well-being outcomes and who will then work with the local community to identify how existing community resources can help achieve those outcomes. <BR /> <BR />It is anticipated that the service will deliver improved outcomes for people using the service as well as savings to the HSC.”
“Yes, I am going to do that. As part of the process, there will be a series of public meetings; there will be consultations right across the North. That will be a real opportunity for people to put forward their views, as well as providing a forum to allow people to ask questions on the criteria and engage directly with the transformation team officials from my Department. I will release details of the consultation meetings, including venues and times, by week commencing 14 November.”
“Therefore, I urge everybody who has a stake in ensuring that we build a sustainable health and social care system to respond to the consultation and make sure their views are heard. I will certainly take all those views on board before finalising my Department's future policy on the criteria as they stand.”
“In the statement I made to the Chamber on 25 October, I announced that I would publicly consult on the criteria. The consultation will begin this week and run through to early January 2017. Patients, service users and all stakeholders will have the opportunity to submit their views in writing on the criteria. <BR /> <BR />I have to say that I have been encouraged by the positive response to my vision to date. Delivering Together has received quite a lot of positive feedback, and I want to make sure that absolutely everyone has their say on the criteria for assessing the sustainability of health and social care services, which, if adopted by my Department, will be at the heart of informing future decisions to be taken about reconfiguring HSC services.”
“That includes things like acute care at home, which allows people to stay in their home more and have the support they need there. We need to do a lot more of that. We also need to invest in primary care and our GPs, and I clearly set out how we will do that. We are going to have a named health visitor, social worker and district nurse working with every GP practice. That will change the whole picture of primary care. <BR /> <BR />We are not going to achieve all those things overnight, but with a fair wind and people really working together and being true to partnership and collaboration, I think we will see a very different picture in primary care. That will help patients to achieve better outcomes, avoid unnecessary admissions to hospital and obviously help with the flow throughout our hospitals.”
“It is really important that we invest in primary care. Very clearly, what I set out last week or the week before in 'Delivering Together' shows how we are going to plan services for the future. We have to do that collectively, and we have to do it holistically. You cannot look at one element of the health service on its own; you have to look at the whole thing in the round. If we are to be successful in dealing with blockages in hospitals and increased numbers going into hospitals, hospitals should absolutely be the last port of call and services should be available in local communities. <BR /> <BR />To transform the system, that is where we have to invest. I have clearly set out my stall about the fact that I will do that. Only then will people feel confident with and feel they have ownership of the new models.”
“It is important we improve discharges so that we can allow the flow across hospitals to be as effective as possible, we are not blocking beds and staff are not frustrated by all that. I think the Audit Office's report allows us to learn lessons.”
“The most common reasons for delayed discharge vary in each trust; there are different reasons in different trust areas. I set out them out previously. They include capacity in domiciliary care, care planning being incomplete and no nursing beds being available. All those things lead to delayed discharges. <BR /> <BR />The report has been published, and lessons are always learnt. It is really important that trusts continue to do absolutely everything they can to avoid delayed discharges. I think they are trying to do everything they can. New initiatives are being looked at for how they can do that; for example, can they have a discharge area that people could be moved to? There are all sorts of issues. There could be family issues or people not being picked up in time. There is a whole raft of reasons.”
“I think that I answered that question during Question Time, but I will comment on the delayed discharges. The Audit Office report that was published today clearly sets out the figures that the Member referred to.”
“If, instead of getting cheap headlines, we do all those things, are positive, work in partnership and support the highly trained and dedicated medical staff, clinicians and all the people who work up there, the people of the area would be better served.”
“The fact that Ulster University is looking at developing a medical school in the area shows that there is a commitment to the long-term future of attracting staff into the area. There are, of course, challenges in attracting staff into the area; that has been known for many years. There is, however, a workforce issue right across the piece. <BR /> <BR />Let us look at other ways. Just because one way that was suggested is not the way that I think that we need to go does not mean that there are not other ways to do it. The fact is that a training school will be up there, and evidence shows that medical staff will stay where they are trained. There is a body of evidence to show that.”
“The short answer is no. It is unhelpful, to say the least, for the Member to try to grab a cheap headline in his local papers for one week in a way that lets staff feel that their jobs will be in jeopardy and that makes patients feel that their services will be in jeopardy, when, very clearly, transformation points to the need to specialise and to the fact that there are opportunities for the South West Acute Hospital, which is not, indeed, what the Member suggested will be the case. I suggest having a wee bit of positivity and support for the staff who work really hard. I think that it is really unhelpful to take the approach that you have taken for a cheap headline. <BR /> <BR />As we go forward, I have set out some of the areas where I think that there is real potential.”
“There are also great opportunities now that Ulster University has produced its strategic outline business case looking at proposals to create a new medical school in the north-west. All those things combined mean that there is a positive picture for the future of the South West Acute Hospital.”
“First, I put on record my thanks to the wonderful staff at the South West Acute Hospital (SWAH) who provide brilliant services every day. I know that the management, the Department, the Western Trust and all the agencies involved are working really hard to make sure that we develop services. <BR /> <BR />As for the direction of travel for some of the areas, there is so much scope in the South West Acute Hospital. Service transformation will provide major opportunities for the hospital, but we are all aware of the challenges we face, including with recruitment and retention. We have to address those challenges, which is why we will do some work on workforce planning.”
“Yes, I can. I look forward to speaking to Minister Harris about that tomorrow. I set out some of the really good work that has already happened, but I think that there is so much more scope and opportunity, particularly with mental health, perinatal mental health and children and young people's services. I think that there is scope there. When Minister Harris and I agree a formal programme for scoping out those areas, I will be very happy to update the House on the work that we will take forward.”
“Our initial scoping has identified opportunities for collaborative working in specialities such as human organ transplantation, services for people who have rare diseases, the emerging field of genomic medicine, a networked approach to major trauma, and, in mental health, particularly in respect of perinatal mental health, eating disorder services, and services for children and young people. <BR /> <BR />I want to commend the substantial work that has been done by the health authorities, North and South, to date and to state my commitment to support them to take their efforts to the next level. At the heart of this collaboration is putting the interests of patients first and foremost by delivering safe, high-quality health services that will provide mutual benefits for patients, North and South.”
“For example, we have committed together over £100m to deliver children’s congenital heart disease services, through an all-island network, and radiotherapy services in Derry for cancer patients from the north-west. <BR /> <BR />My Department has carried out initial scoping of further opportunities that allows us to build on the current work programme to deliver better health and well-being outcomes for people across Ireland. <BR /> <BR />I intend to discuss these further opportunities with Minister Harris at our next North/South health and food safety sectoral meeting, which is tomorrow.”
“The main opportunity for further all-Ireland collaboration is in the delivery of health services and rests in the total size of the population on the island. Increasingly, medical specialities require relatively large population groups in order to meet clinical standards that require higher numbers of procedures to be carried out by clinicians in order to deliver better outcomes for patients. When we look at the population across the island, it is clear that we have a sustainable population base on which to provide many of those specialist services. <BR /> <BR />In addition, the opportunity to combine North/South investment means that we can better afford new health service developments.”
“<BR /> <BR />Whilst work on the development of business cases for new projects has been temporarily paused pending the evaluation of the Lisburn and Newry projects, the Health and Social Care Board has commenced work on the preparation of a regional services needs analysis for respective trusts' local commissioning group areas that will inform decisions regarding the future infrastructure requirements in each area.”
“As well as the pilot projects in Lisburn and Newry, the new centre in Omagh is progressing really well; that is part of the Omagh local hospital project, which had an overall capital investment of £85 million. The new health and care centre opened in Banbridge in January of this year at a capital cost of £16·5 million, and a new £25 million health and care centre opened in Ballymena in February of this year. Both schemes were funded by traditional capital.”
“I owe them the courtesy of talking about their future and where they will be moving. For some time, they have been sitting in limbo waiting to see what happens next. I want to talk to them, but I will keep the Health Committee informed about what happens next. It is my intention to move on that immediately and talk to board staff to bring them up to speed.”
“I can. I have said that the board will close, but I want to do that in such a way that staff are informed and brought along on the journey. There are opportunities for us to streamline how we do things. I set out that 'Delivering Together' was all about changing systems, but there are some structures that needed to change, and the board was one of them, and there was plenty of consultation on it. The board will close, and, over the next number of weeks, I intend to engage directly with board staff about what will go where. <BR /> <BR />There are two things that we need to have a strong focus on: performance management and financial issues. Alongside that we need regional oversight. We could elaborate on the work that the PHA does and incorporate it there, but I want to talk to staff first.”
“The patients' voice needs to be heard as does the local elected representatives', and everybody needs to be part of the conversation. To date, only one GP has expressed an interest in relocating. It is obviously a decision for the others, but they would have to come through a consultation process and they would have to approach the board. I do not envisage that anything will happen in a haphazard way. It will have to be a planned, managed change, if there was going to be a change.”
“I personally have not had any engagement with private providers. I am obviously aware of the situation and aware that one GP has expressed an interest; they want to go. If you are going to have a wholesale move to that site, it is really important that we consult people so that they understand and are on board and think it is the right thing to do. If we are going to plan services together, we have to have that consultation.”
“If further proposals are received from other GP practices in the south Belfast area, this is likely to impact more than the relocation of one practice and, therefore, additional consultation would be likely. The process would include seeking the views of patients and local communities through letters to patients and focus groups to assess impact, including in relation to section 75 groups, and to understand issues and how to mitigate them.”
“Neither the Health and Social Care Board (HSCB) nor the Belfast Trust has any current plans for major primary and community care infrastructure developments in south Belfast that require consultation. The Health and Social Care Board is aware that a number of GP practices in south Belfast have been approached by a developer who intends to redevelop the King’s Hall site at Balmoral. Some GP practices have verbally expressed an interest in moving to the new site, but, to date, only one proposal has been submitted to the HSCB to relocate. <BR /> <BR />The extent of consultation required by the HSCB will depend on how many practices make an application to relocate.”
“I am in constant conversation with the Finance Minister about procurement and how we can secure better terms and conditions when we have to go to the independent sector. If we are serious about supporting the lowest-paid workers in our society, we should ensure that, when we procure services, we do them justice by making sure they are part of the contract. Obviously, we are in a difficult financial situation, and domiciliary care provision is fragile at times. We need to ensure that we do it in a proper and planned way. I am absolutely supportive of domiciliary care workers receiving a fair wage for the work that they do.”
“That leads to problems with recruitment, particularly in rural areas. People cannot go out because they are already on a low wage and the cost of mileage brings it down even further. <BR /> <BR />We can do more. Along with the domiciliary care review and the adult social care review that we will have next year I want to see a changing picture where we have more domiciliary care workers employed by trusts. We should, as far as possible, employ the majority of them. It may not be possible for financial reasons, but I certainly want to change the current picture, where the majority are outside the health service and the minority are inside it.”
“I agree with the Member on the previous question, when the problem of being unable to secure proper domiciliary care packages was highlighted. The Member will also know that, on many occasions, I have said in the House that domiciliary care workers are the backbone of the health service. The workforce is predominantly female, they are the lowest paid in the health service, and, when they pay for their mileage out of their own wages, their wages go down even further. <BR /> <BR />I am about to take receipt of a review of domiciliary care, and I look forward to delving into it. More domiciliary care workers should be employed in-house in the health service. We have a relationship with the independent sector, where the majority of domiciliary care workers are employed, and quite often they do not receive payment for mileage.”
“The HSC joint negotiation forum's executive committee agreed the proposal at its 25 July meeting this year.”
“In line with the collective agreement, a review of mileage rates was conducted in November 2015 using AA information on fuel prices over a 12-month period ending in October 2015. It was found at the time that fuel price changes were insufficient to trigger a change in the mileage rates as there was no change to the mileage rates in use across the HSC. It was not possible for a review to be carried out in May 2016 as intended, as the AA had not published updated information on fuel costs. As an interim measure, the NHS Staff Council put forward a proposal that, if there is a change in rates following the next review in November 2016 — this month — the change would not be backdated, avoiding the need for either the recovery of overpayments if the rate goes down or the calculation of arrears for reimbursement should rates go up.”
“I will not be found wanting in my support for those staff, if there is ever an opportunity for me to feed into the policy development. Obviously, with the AA setting the rates, it is difficult to step outside that. It is also not something that I am being lobbied about by unions, for example, who are part of the staff side negotiation, but let us keep it under review. I want to do everything I can to support the staff out there who do excellent work, and I particularly understand the challenges for those who work and look after people in rural areas.”
“I thank the Member for his question. I have so many requests for meetings that I could not possibly meet everybody, but I gave consideration to your letter. You wrote to me on the issue at some stage in the past. It is important that staff are supported; it is really important that they are supported to do their job well. That was key in Delivering Together and how we go forward. We have to support our staff; they are the biggest asset of the health service. <BR /> <BR />In relation to the policy around the mileage, it is not something that I set. I could give it consideration if it was something that I set. Perhaps, if we had that power devolved and it was in my capability, I could do something about it. The Member has raised the issue that he is concerned about rural workers, and that is a legitimate concern.”
“The mileage rates are not set by me; they are set by the management and staff side representatives from England, Scotland and the North of Ireland in partnership through the NHS Staff Council. The council reviews the rates twice a year on the basis of the motoring costs that are published by the AA, in order that they can be moved up or down in line with the current motoring costs. All HSC employees are reimbursed for miles travelled in the performance of their duties that are in excess of the home to agreed work base return journey. Normally, the miles eligible for reimbursement are those travelled from the agreed work base and back. The current rate of reimbursement for privately owned cars is 56p per mile up to 3,500 annual miles and 20p per mile thereafter.”
“<BR /> <BR />I recognise that there are pressures in domiciliary care and the wider support system. That is why we will bring forward in March next year the reform of adult social care, which is currently being developed with proposals for reform to ensure that we have an effective and sustainable system of care and support in the future. As outlined in my vision, I am committed to ensuring that I consult on the reform proposals in March or April of next year.”
“They include things like new discharge models such as the integrated discharge hub, discharge to access model, domiciliary referral hub and a discharge lounge; full utilisation of intermediate care beds; development of an enhanced care-at-home model that provides higher-intensity care at home for older people; home from hospital domiciliary care pilot; enhanced falls service in partnership with the Ambulance Service; additional clinical staffing to manage periods of peak demand in the emergency department and across the whole hospital site; additional multidisciplinary staff support including extended weekend and evening pharmacy, diagnostic, social work and allied health professionals; and multidisciplinary teams established to expedite the discharge of people with complex needs.”
“The trust is continuing to work to address all the pressures that I outlined. It is working really hard to improve patient flow through the hospital and into the community. Over the past number of years, the trust has been working closely with the board, other trusts, GPs and the south-eastern locality network to develop services in response to pressures on acute services. A number of initiatives have been introduced to help to improve flow and provide services in the community to assist hospital discharge in the north Down area or to avoid admission.”
“If something is not right in the community, it will have an impact on whether people can be discharged, so we have to come at this holistically. That is the plan that we set out in 'Delivering Together', and it is how we will change the whole piece. We cannot concentrate on one element of the system when every other part of the system has a knock-on effect.”
“There is a range of reasons for delayed discharge, including some that are complex. A list would include no capacity among domiciliary care providers; no residential home, nursing home or elderly mentally ill (EMI) beds available; people with more complex conditions needing essential equipment because adaptions to their homes are not complete; and no inpatient palliative care arrangements or home/community-based palliative care arrangements, maybe because not enough suitable step-down beds are available. <BR /> <BR />There is a combination of factors in delayed discharge. We want to try to improve the whole system. When we talk about the future, we talk about whole system transformation, and these issues will be key to that.”
“I commend the Ulster Hospital for the work that it has been doing all year and for the improvements that it has made since the inspection. It will continue to do more and make sure that it has first-class services for people who present and need its services.”
“Yes. The increase in the number of patients that the Ulster Hospital has seen over the last number of years is significant. It is maybe the largest increase in any trust area. That shows the pressure that the hospital is under. That, combined with an ageing population and people presenting with more complex needs, leads to all the challenges that it has. <BR /> <BR />There are considerable workforce issues across all trust areas, which is why we need a properly targeted workforce plan to attract more junior doctors and the right staff to work in the right areas at the right time. There have been some advancements around advanced nurse practitioners, but how can we use other professionals to complement the whole team? The board and the trust are working on that in relation to the Ulster Hospital.”
“Whilst there are lessons to be learned in the RQIA report — the trust will set out its plan for how it will do that — I am confident that it has been working continuously since that inspection to improve where it could in advance of the report being published.”
“The trust was not sitting back and waiting for the report to be published today; it has already been very active in doing whatever it can to deal with the issues highlighted in the inspection. <BR /> <BR />I was lucky enough to have the opportunity to go to the Ulster Hospital last week and shadow an ED nurse. To me, those people are absolutely amazing. They are under such pressure and work day and daily to support patients. Their enthusiasm, even though they have all those challenges, was brilliant to see, as was their commitment and dedication. They were telling stories about how, when they were under pressure in wintertime, staff gave up their own time to come in and help out, which is a testament to our healthcare staff.”
“The RQIA report that has been published is the result of an inspection that was carried out in the Ulster Hospital during a four-day period back in February this year. The report of that inspection has been published today, and the trust now has an obligation to submit a formal quality improvement plan to RQIA to set out how it is going address the recommendations that have been made and the timescales for completion of any actions. It is important to note that, whilst there are a number of recommendations that must be addressed by the trust, inspectors did not find any issues that required escalation to the trust or the Department. That is important. It is also important to say that, since the inspection was held in February of this year, improvements have already been implemented in a number of areas.”
“That is why the vision for the future of health and social care services that I set out in 'Health and Wellbeing 2026: Delivering Together' places patients at the centre of service delivery and seeks to reform community and hospital services so that they are organised to provide care when and where it is needed.”
“<BR /> <BR />The HSCB and PHA regional unscheduled care team has developed a number of work streams to support improvements in patient flow and has been working with the South Eastern Trust to put in place structures and systems to ensure that discharges occur as soon as medical advice allows to maximise the efficient use of hospital beds and deliver the best use of resources to patients. <BR /> <BR />The pressures on the health and social care system that contribute to delays in discharging patients from hospitals are further evidence of the need to transform the way we deliver our services.”