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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“This is one of the things that Professor Bengoa picks up in his report, and I went on to highlight it. The health inequalities that we face are stark. I do not think that we should ever be comfortable with that picture. However, I believe that the only way to tackle health inequalities is through collaborative working. The new Programme for Government approach allows us to do that. <BR /> <BR />It is not right that where you live determines your outcomes in life, but we know that that is the case. We know that deprivation is linked to health outcomes, job choices, employment and housing. We need to tackle them all.”
“For me, that will allow us to make sure that we have the right staff who are trained in the right way and in the specialisms that we need. I think that it is innovative to look towards more areas such as advanced practitioner nurses and physician associates and see how they can support the staff to do the excellent work that they do. Try not to be too critical. I think that this is a good day for health. We should embrace it and take it on board.”
“When I talked about innovative approaches, I meant supporting the staff to do what they do well. I pointed out a number of examples of when staff have gone ahead and developed innovative practices, and I think that we need to scale those up. If something works, let us do it across the board. Quite often, a lot of the innovative projects and initiatives that staff have taken are done in pockets, but we should replicate it across the whole of the North if it works. <BR /> <BR />As I have clearly set out, I will make a workforce strategy plan. We do not have a workforce strategy plan right across Health and Social Care, and so, if we are to transform the system, we also need to look at what our workforce challenges are. I have set out that I will take forward that programme of work.”
“We are continuing to work with GPs. We have increased the number of GP places, but I will respond in due course to the recommendations of the GP-led care working group in the context of the Budget process.”
“I have outlined a number of areas where we will work with GPs, and one is recruiting and increasing the number of GP training places, but it is also about looking at the role that associate physicians can play. We need to explore new ways of working, and I have announced some moves on that. I also think of advanced practitioner nurses. A lot more people can support the GP in that setting. We need to move to the point where we truly have these multidisciplinary teams in place. GPs are under pressure, particularly in rural areas. We have seen some particular challenges in relation to that. I am committed to increasing the numbers of GP places by, I think, 12 next year and 14 the year after. We have also seen, in the last year, an investment package of up to £5·1 million in 2015-16 and a further £7 million this year.”
“I want to maximise the potential of Community Pharmacy: they are up for it, I am up for it, and we can make a real, positive difference. This is all bringing it back to the focus on primary care. It is about the GP. It is about the district nurses. It is about the allied health professionals. It is about the social worker. It is about the community pharmacists. It is about the community itself. It is about that partnership and collaborative working. If we successfully get to that point, we will see real, meaningful differences, particularly in tackling health inequalities and in making sure that we are reaching people at a very early stage. Early intervention and prevention are absolutely key when it comes to the health service.”
“Quite often, they can be the first port of call for a lot of people, particularly in deprived areas, where people may be more likely to go to their community pharmacist than to their GP. They are crying out about wanting to do more. I want to work with them to do more. Our community pharmacies dispense over 40 million prescription items every year and have unequalled access to people in local communities. That gives them the opportunity to promote well-being through the best use of medicines and delivering important support about healthy lifestyles. When we look towards winter, pharmacy in the community has a critical role in supporting people to stay well and to make informed choices about HSC services.”
“I thank the Member for his question. I 100% agree that community pharmacies play a vital role in our health and social care system. Recently, when I was out visiting one of the community pharmacies, I saw at first hand how they contribute, which included doing things that you would not believe that a pharmacy does.”
“If we do not transform the system, our waiting lists are not going to get any better. <BR /> <BR />I have already done a large body of work on waiting lists and am bringing forward a plan. We are going to need additional funding to be able to do that. To build public confidence that what we are doing is the right thing, we need to address waiting lists alongside the transformation piece. Transformation is the longer-term solution. In the meantime, we have to bring forward a plan, which I am going to do by January, that will clearly set out how, over the next five years, we will try to bring down the waiting lists.”
“I thank the Member for his question. I consistently say, and I say it again here today, that waiting times are unacceptable. They are unacceptable to me and, I think, to all of us. We share that. <BR /> <BR />I understand absolutely that, if you are waiting to be seen as an individual — a parent, a daughter or a son — it is so stressful and worrying if you cannot get to see someone as quickly as possible, so we need to do two things. We need to address the backlog, and that is what the plan will very much be about. Alongside that, we need to develop and transform our system so that we do not get to that point. <BR /> <BR />These are new ways of working. We are trying to operate a 20th-century health and social care system trying to deliver 21st-century care, and those two things do not marry.”
“I think that the implementation of some of the initiatives that I have set out will make a real difference.”
“<BR /> <BR />As a combination of building community capacity, all those things will make a real difference to primary care. When it comes to making difficult decisions in the future about where services are based, we have to invest in primary care. People have to feel that it is different in primary care. The initiatives that we have set out today are going to do that. <BR /> <BR />The GP-led working group has set out a number of asks, some of which we have addressed today. However, I will respond to the full report by the end of the year, and we will look at other areas in which we can work together. <BR /> <BR />GPs are the bedrock of primary care, so this is a good opportunity for us not just to give a nod to primary care but to make a real, meaningful difference.”
“We all recognise that GPs are under pressure. The focus that I placed today on primary care will really help improve that picture and really help support GPs. The fact that, within the next number of months, all GP surgeries will have a named health visitor, district nurse and social worker shows in itself the commitment to multidisciplinary teams, which the BMA and GPs are asking for. The other thing is around working with Community Pharmacy. Our community pharmacists can do so much more, and they are crying out to do so much more, so I want to work with them. I will develop a framework over the next number of months with them. Whenever we come to agreeing a new contract, we can work more collaboratively with Community Pharmacy.”
“That is the plan of action to deal with the backlog, but if we do not transform the system, the waiting list picture is not going to get any better and staff are going to come under even more pressure. I suggest to all Members that this is a positive day. This is a fresh start for health, and we should go out and tell the public that we are committed to delivering this transformation. <BR /> <BR />I, as the Health Minister, will not be found wanting in the leadership that I will show in driving forward meaningful transformation, because I am committed to tackling health inequalities and delivering first-class health outcomes for all the population.”
“We all want to see better health outcomes for all of the population, and the best way to do that is to work together. I have said that I will come back to the House every six months throughout this journey to update Members on where we are and on how far we have got in our progress. I think that this is different from anything that has come before. We have an Executive that have put their full weight behind this direction of travel. We have an Executive that realise that we need additional funding to transform and that want to tackle waiting lists. I have said that I am going to bring forward a plan in January that will set out very clearly, over the next five years, how we are going to bring those waiting lists down.”
“We have to be part of everyday actions that are making a difference. I have clearly set out my plan of action for the next 12 months, which is very much focused on co-production and co-design. If I am serious about co-production and delivering services in conjunction with patients, carers and staff, I should not run too far ahead of the ball. That would not lead to meaningful collaboration or engagement. What I have set out, clearly, is a plan of action for the next 12 months, which is going to inform the year after, the year after and the year after. I think that what we will see is incremental change. <BR /> <BR />I would suggest to the Member that we should not allow any seed of doubt to be sown out there. This is a positive development.”
“We did not just arrive at this scenario overnight. The health service did not get to the state it is in overnight. This has been a process that happened over many years, and it is for a number of reasons, including an ageing population, growing expectation and demand, financial challenges, the Tories cutting the block grant and all the implications of all of that. I could list the challenges, which are well rehearsed and, I think, universally accepted. We have to get better about how we deliver our services. <BR /> <BR />What I set out this morning is a true reflection of the length of time that it is going to take to properly transform the system. There is no quick fix, so we need to have a sustained plan of action, which is what I have clearly set out. We cannot just sit back and wait for 10 years to go by and see what happens.”
“As I said in my statement, there are a number of areas where we could work more collaboratively, particularly in perinatal mental health and in relation to young people who find themselves with a dual diagnosis. <BR /> <BR />There is so much that we have still to do. I am going to receive the review of the Bamford report action plan in the next month, and that is going to help me inform the direction of travel. I want to set out very clearly a plan of action for the next number of years, which will set out how we are going to achieve parity of esteem for mental health. It is so important that we help people to remain well and that we promote positive mental health messages. I want to prioritise this, and, as I said, over the next number of months, I will produce a plan for taking that forward.”
“I thank the Member for her question. I have said in the House on many occasions since taking up office that mental health will be one of my key priorities. When it comes to reshaping services, co-production and looking at how we are going to deliver services in future, mental health is one of those areas, through recovery colleges, where we can see how co-production works. I want to do more of that. We have to work towards the point where we have parity of esteem for mental health, which, to me, means recognising the true impact of mental illness on society. It is about a focus on recovery and greater involvement of experts and the experience of the service user and those who are living with mental illness. It is about investing in service developments where resources allow. It is about exploring the potential for all-island developments.”
“I want to make sure that we collectively go on this journey, but I also believe that it is about genuine ownership — giving staff and patients ownership of the direction that we are going to take.”
“That is about meaningful engagement and listening to staff and patients. It is about making sure that the decisions that we take are clinician-led. If those decisions are clinician-led, people will know that they are about better health outcomes for them. It is about having a frank and honest conversation with individuals about the plan and about where we need to go. We want them to help us deliver the services. People are up for that; the staff and patients whom I am engaging with are up for that. I am, personally, going to embark on a process of engagement, and I will go anywhere that health service staff want to talk to me about getting involved in the conversation.”
“In doing so, they recognise that there is a cost. We will enter the Budget process in the weeks and months ahead and will, I hope, secure the transformation funding that we require. <BR /> <BR />The Member asked how we will work and build confidence in the system.”
“I thank the Member for her positive contribution. I look forward to working with you as the Chair of the Health Committee. We have a shared interest in delivering better outcomes for our population. This is a real opportunity, and I know that you will be happy to work with me to make sure that we deliver a first-class service. <BR /> <BR />We should not start the conversation about money. Obviously, it is very important and we need it to transform the system. However, the principle behind all this is transforming services to deliver better health outcomes for the population. I am deeply committed to universal healthcare that is free at the point of delivery for the whole population. For the first time ever, the Executive have collectively endorsed a programme of action and the plan for going forward.”
“I believe that the rewards will be seen in the years to come, when we can stand over a first-class health and social care system in which staff, patients and carers are involved in the planning, production and design of the services that we provide.”
“The clear direction of travel set out today shows that we will make a meaningful difference. We have to transform the system and support the staff who do an excellent job every day and are under pressure. <BR /> <BR />We have set out today a very clear programme for the implementation of change to make things better and deliver better outcomes. We should be focused on making sure that we deliver the best possible outcomes for all of the population. We have a real opportunity to make a meaningful difference and to be world leaders in what we provide through our health and social care system. We are already the envy of many areas that look towards our integrated system. Let us build on what is good, transform the system and put our health service on a sustainable footing.”
“I start by commending the expert panel for the work that it did. The report that it produced was very clear and pointed out the stark challenges in our system. It was a very detailed and meaningful piece of work that engaged staff right across the health and social care system. I very much welcome the report. It has informed me of the direction of travel that we need to take. <BR /> <BR />I believe that, in going forward, we have no choice but to transform our health and social care system. If we are all invested in making sure that we have better outcomes for the population, we should all play our part and get on board for the transformation journey that we need to take. The Executive have endorsed a plan of action for going forward and realise that transformation costs money. They want to deliver better outcomes for our population.”
“As Minister of Health, I will provide the leadership needed to drive change. I have no doubt that those working in the front-line service will not be found wanting in leading the transformation of the health and social care system. Today I hope that colleagues from all political persuasions will show the political leadership and courage needed to support the system in transforming itself. Together we can deliver the health and well-being outcomes that all our people deserve. <BR /> <BR />I commend the statement to the Assembly.”
“We are facing into a time of change, but it is change that must happen. Delivering Together sets out a direction of travel that I hope all our society can embrace and support in the challenging but potentially rewarding times ahead.”
“We need to continue to deliver the existing HSC services to those who need them whilst developing and implementing change, so a period of double running will be necessary. Once I begin the process of co-production, I will be clearer about the financial requirement. What I can say today is that additional investment is needed. <BR /> <BR />I acknowledge that the cost of transformation may be significant, but standing still is not an option. There will be consequences if we do not deliver planned and managed change in our health and social care system. Even with the best efforts of all the staff, waiting lists will continue to grow, expertise will continue to be diluted and the best possible outcomes for our citizens will not be realised. <BR /> <BR />I believe that we have been given a fresh start.”
“<BR /> <BR />This morning, I have set out what I believe to be a very ambitious vision for the future of HSC. What I am proposing is not a quick fix but a significant and radical programme of change. That is why I have been upfront about the time frame. However, I want to be really clear that the size of the task and the length of the journey will not dictate the pace of change. I have witnessed the pressure that staff are under every day. I know that 10 years is too long for them to see a difference, which is why I have set out my priority actions for the next 12 months: change starts today. <BR /> <BR />I am committed to taking a personal role in this process and will bring progress reports to the Assembly every six months. In short: I am up for this. <BR /> <BR />Change cannot happen, of course, without investment.”
“I want to ensure that the double and triple handling of information ceases by consolidating our patient records, enabling greater access to citizens and freeing up health professionals' time to care. <BR /> <BR />That is a major undertaking. Even starting now, it will be a decade before we see real change right across our HSC system. However, progress is being made. Every day, more health and social care information and resources are added to NI Direct, and I expect to have a patient portal in place for dementia patients next year. We plan to roll out online access to health and social care records over the next five years, where service users and patients want it. As users of the service, information about us belongs to us, and having access to that information will help us to make informed choices about our lives.”
“For that to happen, our staff need to be equipped with the tools that will allow them to lead change. That is why I have asked my officials to develop a system-wide HSC leadership strategy by next summer. <BR /> <BR />I am determined to realise the potential that modern information technology provides. The pace of technological change is rapid, and that is no different in health and social care. I want to ensure that the right information is available to the right professionals or, indeed, service users themselves when they need it and in the way they need it. We have too many systems; people often have to tell their stories or provide the same information over and over again. At best, that is frustrating, and, at worst, it is unsafe.”
“That means having greater collective clinical and professional leadership throughout the HSC, supported by skilled and able managers. <BR /> <BR />Too often, I have heard that the current culture in the HSC is characterised by competition and silos, and that must change. I want to see a culture where staff feel empowered and where collaboration and partnership working define the way things are done. The positive results of that way of working are clear to all. In one of our trusts, a head and neck cancer specialist nurse introduced a follow-up telephone aftercare service by working in partnership with patients, which resulted in a patient-led follow-up service that enables fast-track referrals to follow-up clinics. There are many more examples across the system, but that type of working needs to become the new norm.”
“I want to develop a system that will learn from such approaches and see them adopted across the system. As a first step towards that, I have asked that a group is convened of professionals and people who use services to establish an improvement institute. That will not be a new building or a new layer in our system, but it will help to bring existing experience and knowledge together to work in a different new way for a much greater impact. That will be supported by a new approach to learning and team working. Rather than concentrating power at the top, I want all those working in health and social care to feel able to effect change and improvement in care. We must support and equip teams to do what they do best — namely, provide excellent care — and not micromanage them and load them down with unnecessary bureaucracy.”
“Another example is the rapid assessment, interface and discharge team in the northern area, which is known as RAID. That innovative project is based on international best practice and recognises the links between good mental health and good physical health. Instead of the traditional approach to mental health referrals for people who go into emergency departments or are admitted to hospital, that team operates seven days a week, 24 hours a day to respond quickly to need. It also acts as a link to community mental health services, promoting recovery and well-being and ensuring continuous care and better outcomes. <BR /> <BR />Those are strong local examples, but they raise the question of why those services are not available to all the people of the North.”
“The community respiratory team provides patients with joined-up specialist support focused on self-management, and coordinated care. This is a much more streamlined and responsive service for patient, GPs and hospital services and benefits all.”
“We will now harness the energies of people who use all our services. <BR /> <BR />I want to align quality improvement and regulation far more closely to the voice of those who use our services and those who deliver them. We will replace a culture of targets and blame with one that focuses on outcomes and improvements. Outcomes should be shaped by what matters to people, not just by what is wrong with them. Improvements will be led by staff on the front line, not distant officials. This is already happening. Committed staff, working with the people they serve, are taking forward initiatives to improve outcomes, shorten waiting times and reduce bureaucracy. <BR /> <BR />Quality improvement initiatives, such as the integrated respiratory service in the west, are happening every day, designed and led by the staff on the ground.”
“We must all work in partnership to design and deliver the changes. <BR /> <BR />The principle of co-production will underpin how we operate in the future, whether that be at a system level, designing how our services and hospitals should be configured, or at a service level, designing how care pathways and individual care should be delivered differently. However, very importantly, it also signals a collaborative approach between the people who provide services and those who depend on them. Care should be planned around the individual and the unique needs of that person, and this must be based on real and meaningful partnership. Our mental health recovery colleges are an excellent example of the benefits that can be realised through co-production, recognising and using the expertise that people with mental health difficulties have.”
“This is a priority for me and, now that the direction of travel has been fixed for the delivery of services, I will move very quickly on this matter. I will engage with the board staff as a matter of priority. <BR /> <BR />I believe that the approach that we take to transformation is as important as the transformation itself. From the outset, I was clear that this vision could be achieved only through partnership working and co-production. It is no coincidence that the document that I am publishing today is called 'Delivering Together'. It sets out in clear terms how I will bring forward transformation. We all have a stake in our health and social care system. It belongs to us all and, therefore, we all have a responsibility to work together to ensure that it is sustainable for the future.”
“Urgent and sustained action is required to bring these under control. In light of the recommendations set out in the expert panel’s report, I intend to bring forward a strategy to reduce waiting lists. <BR /> <BR />I have set out the changes that I believe are appropriate for the delivery of services, but how we plan and manage these services is just as important. We need to reduce bureaucracy to make the decision-making process more streamlined and, importantly, to plan and manage services in a way that promotes collaboration, integration and improvement in service delivery. In the context of the decision to close the Health and Social Care Board, I know from speaking to staff that they are anxious about their future. They have already been involved in the design process, and that will continue.”
“This may mean that a patient may travel further for their treatment, but there is strong evidence that elective care centres, such as those used in Scotland, can reduce waiting times and provide a better experience for staff and patients. I cannot tell you where these centres will be or how many we will have. The answers to these questions will be for the clinicians and professional managers in the HSC system to develop based on the evidence of what people need and working in partnership with service users and patient groups. <BR /> <BR />However, elective care centres are not the sole solution to the unacceptable delays currently facing patients. Rather, they are part of a long-term process moving towards a more sustainable model. This future model cannot succeed if it inherits the unacceptable waiting lists that blight our system.”
“I am keen to explore the potential benefits of this approach, particularly around delivering better perinatal services and support for new mothers, as well as considering ways that we can help young people who are struggling with mental health and addiction problems. <BR /> <BR />Evidence also shows that delivering planned and emergency care using the same facilities and resources can have an adverse impact on activity and, therefore, lead to an increase in waiting times. Far too often, scheduled appointments and surgeries may be cancelled when vital resources are diverted to deal with unscheduled care. Moving forward, elective care centres will be developed to carry out less complex planned treatments. These centres will make better use of the resources that we have through organising them differently.”
“Adopting this approach will mean that not every service will be available in every existing hospital, but, where those services exist, each and every one of us will benefit from more timely, safer and better outcomes. <BR /> <BR />Over the last few years, we have seen the development of very successful regional networks for a number of specialist services. These provide services to our whole population rather than to a small locality. We have seen that developed increasingly on an all-island basis, as in the case of the congenital heart disease network. I have already commenced a programme of work with counterparts in the Department of Health in the South to identify areas of mutual benefit and develop more cross-border and all-island services.”
“Once agreed, this will form the basis of a programme of service reviews, seeking to ensure that our services are configured and built around what people need. <BR /> <BR />This is not a standing start. We have recently conducted clinically led reviews in pathology and imaging, and I intend to move to public consultation on these two important areas. In the future, the role of our hospitals will fundamentally change to focus on addressing the needs of patients requiring complex planned surgery or emergency care in an inpatient setting. There is strong evidence that concentrating specialist procedures and services in a small number of sites produces significantly better outcomes.”
“Over 4,000 have received treatment on a planned basis through this approach without needing a stay in hospital. In the South Eastern Trust area, over 1,000 patients have benefited from this approach in the last six months. This and similar models in other trusts provide for a better experience for patients and a more effective use of our inpatient beds, and we need to build on the new services and expand their use. <BR /> <BR />Given the changes that I have set out for the rest of the system, it follows that the nature and focus of our acute hospitals will change. As well as enhancing the support received in primary care, we need to reform and reconfigure our hospital services. The expert panel has provided us with a road map to do so, and I plan to consult on the criteria recommended by it next month.”
“For example, in the Belfast Trust and the South Eastern Trust areas, 460 frail elderly people have received enhanced or acute care at home services, avoiding 4,102 days in hospital. I want to ensure that patient-centred initiatives like this are implemented right across our health and social care system. <BR /> <BR />Ambulatory assessment and treatment centres are a further example of innovative patient-focused initiatives that I plan to develop further. These centres will provide a one-stop shop, allowing patients to be assessed and diagnosed and, if required, to receive a treatment or procedure all on the one day. In the Belfast Trust, in the past six months, over 9,000 patients have been treated in ambulatory care instead of waiting in the emergency department, and 81% of them were discharged home without needing to be admitted.”
“I intend to provide a full response to the recommendations of the working group before the end of the year. <BR /> <BR />We must also make use of our valuable community pharmacies much more. They have an important role to play, particularly in supporting people to keep well in the first place and to use their medicines appropriately and safely. I want to develop a new framework for how we work with Community Pharmacy to fully realise pharmacists' potential. <BR /> <BR />There has been a long-standing ambition to shift more health and social care from hospitals to settings closer to people’s homes. I believe that this is the right thing to do, and I want to ensure that we realise that ambition. New models and services continue to develop and emerge such as acute care at home.”
“<BR /> <BR />The role of physician associates (PAs) is one that I am keen to build on. I provided funding to support placements in primary and secondary care for an annual cohort of 20 PA students on the new postgraduate course being commenced in the University of Ulster in January 2017. I will also continue to invest in the practice-based pharmacist scheme, with close to 300 pharmacists expected to be employed across the North by 2020-21, taking the pressure off GPs, improving the use of medicines and supporting patients. The askmyGP online and phone triage system, which is allowing GP practices to see patients the same day and when they need to be seen, will be rolled out to a further 30 practices. These investments reflect some of the recommendations of the GP-led care working group, which reported earlier this year.”
“<BR /> <BR />I have initially commissioned five training places for an advanced nurse practitioner programme in primary care to start in February 2017 in addition to eight for emergency departments. I plan to at least double those numbers from September 2017 and then incrementally grow this cadre of staff for an increasing number of specialties over the next five years. By further extending the role of the nurse, I want to ensure that I still have sufficient nurses to continue to do the jobs they already do so well. Therefore, I am increasing the number of training places for new nurses by a further 100 from September 2017 to ensure that we will not be as reliant as we currently are on the international recruitment of nurses to fill vacancies in the years to come.”
“Alongside increasing the number of GP training places, we must make sure that general practice is a key part of the medical undergraduate curriculum. To that end, funding provided for undergraduate training will be redirected to support Queen's University in increasing the percentage of the undergraduate medical curriculum spent in general practice. I can also announce that 25 GPs have been accepted onto a GP retainer scheme, which was launched earlier this year. This has meant that GPs who may otherwise have been lost to general practice are attached to practices, are working in the out-of-hours service and have access to a supportive continuous professional development programme and mentoring.”