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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“But the kind of inaccurate, overblown criticism contained in the text of this motion does nothing to deliver improvements for patients or for staff. Instead, it creates fear and worry in the minds of those people at home who fear that the services they need will not be there for them when they need them or that their loved ones will not receive the level of care that they need. Blanket condemnations of public services and public servants is nothing more than Project Fear politics, and I believe they have no place in any discussion of the health and social care services that our people deserve. <BR /> <BR />Improvements have been made. Cancer services have been reorganised in recent years so that professionals with an expertise in treating the most common cancers can be brought together.”
“<BR /> <BR />I understand the worry and concern that long waiting times can cause for patients and families. Performance has not been strong enough in many, many areas, but I am committed to dealing with the problem, because that is what you do in government. <BR /> <BR />I will set out my vision for health and social care next week, and it is going to include specific actions to deliver improvements in this area. I hope that, at that stage, the Members of the House will be as up for discussing all those issues with me and that they will be up for tackling the vital tasks in the time ahead. <BR /> <BR />It is absolutely right to hold Health and Social Care to account for the level of services it provides. That is why my Department sets targets for cancer services that are so challenging, because they can drive improved performance.”
“That is wrong. The 6·7% figure is for urgent referrals for suspected breast cancer cases. There is a very important distinction, so let me be very clear: that statement is wrong. It would be highly irresponsible, if not outright scaremongering, to send out a message that all people given urgent referrals have cancer. Thankfully, that is not the case. We need to be very, very clear, and I am not for one minute trying to diminish poor performance. I have said before and I will say it again that any underperformance needs to be tackled. In this instance, it is important that we also correct the false impression that is being irresponsibly created by the Members who tabled the motion. Allowing politically motivated misinformation to spread is bad for the health service and demoralising for patients and staff.”
“I am determined to work with colleagues who want to be constructive. I am determined to work with stakeholders to make sure that we do more to deliver the improvement that we need. <BR /> <BR />It seems unbelievable that the Opposition would put forward a motion that is factually incorrect., but they have, and it falls to me today to correct a number of issues that were highlighted in the debate. The motion:”
“The Opposition have had two hours now to debate things, so let me get into what I want to say in response to all the comments made throughout the day. I am sure that I will answer everything that you have set out in your contribution. <BR /> <BR />Are things perfect? No, they are not. I have never stood once in the House and said that things are perfect. There is a recognition right across the piece that we need to tackle waiting lists and deliver better outcomes for people. That is the job of government. I consistently say that there are areas in which we can improve, but unlike the Members who tabled the motion, who ducked the responsibility of choosing to take tough decisions and make things better, I am not going to be found wanting in trying to fix the problems that we have in our health and social care system.”
“Let me start by saying up front that I am proud of the service that all those men and women provide day and daily to the people with cancer here and all the other people who need health and social care. I am proud of the dedication and hard work of the highly trained doctors, nurses and other medical professionals who provide such a high level of care to all our people. I am proud of the quality of the full range of health and social care services that we provide, not just for cancer but across the board.”
“I am very grateful once again to have the opportunity to set the record straight about a number of things that have been said throughout today's debate on the provision of cancer services. I thank all those people who shared their personal cancer journey and stories. It is not easy to get up in the House and do that. <BR /> <BR />I raised a point of order at the start of the debate, a LeasCheann Comhairle, because I believe that the motion is wrong. Not only is the spirit in which it is presented wrong but the facts noted in the motion itself are wrong. The Opposition, through the motion, seems intent on talking down our health service and the all the men and women who work really, really hard to provide that service.”
“Yes. I have committed to chairing the next meeting next month on the back of my announcement on Professor Bengoa's report.”
“I chaired the inaugural meeting of the strategic health partnership forum last Wednesday, and it was attended by my Department's senior management team, trusts' chief executives and nine staff-side representatives. The meeting was a first step and was very positive in contributing to the strategic direction of health policy. I look forward to working in the forum as we develop and shape policies for the future that deliver a first-class health service. The first meeting was a positive one, at which we discussed and agreed terms of reference. I look forward to working with the forum in the years ahead.”
“The Department increased the number of student places for the 2016-17 academic year by over 100, and I am committed to maintaining that level as a minimum in 2017-18. I am also considering options for even further increases as I develop my Department's budget for the coming year.”
“Yes, I can say, for one, that I am very proud of our local nursing and midwifery staff, and I think that it is entirely right that we continue to support student nurses through their preregistration training. Therefore, I am very happy to confirm that I have no intention of going down the route that is being followed in England. Bursary support for student nurses and midwives will continue.”
“Yes, I can. The payroll team in the Business Services Organisation has provided assurances that the majority of staff will receive their uplift and arrears in their November pay. The pay will be awarded and backdated to 1 April this year. A number of people who require manual uplifts will receive their payments in December or January, but the vast majority will be paid in their November pay.”
“Yes, I will. We have started that work, and I intend to feed into that in the time ahead. We provided the pay review body with a mandate for the 2017-18 pay review round in respect of all staff paid under Agenda for Change and all doctors and dentists in August. I will shortly issue evidence to support and inform the body's recommendations.”
“I am quite sure that I will make my way there at some stage. I have had many invitations. I have a very large inbox of invitations. I want to get out and I want to be a Minister who engages. I believe in listening to people on the front line and to staff, patients and carers. I am quite sure that I will be able to take the Member up on that offer at some stage in the future.”
“I answered a question earlier on the trust's current plans and said that it did not have any major plans to change. In going forward, during the whole transformation and in making sure that we reconfigure services that deliver better outcomes for individuals, we need to be clinician-led. The decisions about where we should provide services should be done in conjunction with patients and carers but should be clinician-led, because, if a doctor tells me that I will get a better outcome if I go to, for example, Craigavon for stroke services or to the Belfast City Hospital for another service, that is what we should be guided by. In going forward, we will make sure that decisions are taken based on better outcomes for individuals so that we have a better and healthier population.”
“I think that all our hospitals can do more and could be become specialists in various fields. That is one of the things that we need to do better in the time ahead. We cannot continue to provide everything in every hospital, but we could make every hospital a specialist in something and, where possible, make every hospital able to provide first-class outcomes, whether it be for stroke services or urology. No matter what it is, if you can get better outcomes, I think that people will be prepared to travel that wee bit further to get them. I do not have the detail of the individual plans for the Belfast Trust for the future, but, again, I am very happy to give that to the Member in writing.”
“I do not have particular information in relation to that, so I will have to provide it to the Member in writing, but I think that we need to focus on unscheduled care. That will help people from being distracted. If they are on a waiting list and are due to go in tomorrow morning and something happens and other people need to be seen first, that interrupts the surgery. So, it is important that we look towards how we can deliver scheduled care more efficiently and make sure that we take the pressure off acute services and A&Es.”
“Yes. I am always happy to discuss proposals, but we need people to come at it from a collective, creative point of view. We do not have an unlimited pot of money to do all the things that we want to do, so it is important that we tailor our resources towards the things that are most effective and which we can prove deliver better outcomes. I am always very happy to work in conjunction with councils and other partners to make sure that we collectively knock our heads together and do things better.”
“I have not visited the crisis intervention centre yet, but we all need to do more on suicide prevention. It is about a holistic approach. It is not just about the Department of Health's approach; it is about education and whether people have a job or access to a home. It is about all those things. <BR /> <BR />I am consulting on the new Protect Life 2 strategy, which is bringing all the partners together. That will be key for setting out our new direction of travel, what has been working well and what we can do more of. I encourage anybody who has not responded to that consultation yet to do so. Let us improve what we do for suicide prevention in a holistic, collective way.”
“I think that I have already answered that. I have said that we have not been found wanting in investing in GP surgeries. GPs are under pressure for the reasons that I have just highlighted, so we have to work with them. We now have the working group, which has reported and identified a number of issues, particularly in relation to increasing the number of GP training places. <BR /> <BR />My whole focus will be on investment in primary care. It is not just about the GPs; it is about the whole picture in primary care.”
“Many reports over the years have told us that we have to invest in primary care if we are to improve the picture. It is not just about GPs: it is about multidisciplinary teams; it is about the allied health professionals; it is about the community health visitor; and it is about the district nurse. It is about all those people working in partnership to make sure that we have first-class primary care.”
“Indeed, I can, and I have done so on many occasions in the House. The issues that we face in GP services include the ageing profile of GPs. A number of GPs are retiring, so we have to look at workforce issues and how we can address that picture. One of the things that I am considering is the GP workforce action plan, which has come forward to me. I am actively considering that and looking at how we can support GPs. <BR /> <BR />We have not been found wanting in supporting GPs. Over the last year — 2016-17 — we have seen significant investment of £1·6 million per annum to commission an additional 20 GP places. We are in the process of a five-year investment to bring pharmacy into GP practices, and we will put close to 300 pharmacists into GP practices. So, for me, it is about investing in primary care.”
“That is an operational issue for the trust. It is not something I have looked at before, but I am happy to provide information to the Member in writing on the trust's intention to look at it.”
“As I said in answer to a previous question, I allocated £13 million for winter pressures, which will deal with a range of things not only in the acute setting but with other things we can do in the community to help people to prevent needing to use acute services. I do not have the breakdown of figures for the South Eastern Trust, but it received its allocation of the £13 million to help it adjust to deal with what is an annual problem in all our health and social care settings.”
“The Member will know that the approach of the Programme for Government is outcomes focused. It talks about building better lives for individuals, so that could mean an awful lot of things to an awful lot of people. For me, I want to work to a point where anybody struggling to conceive gets the best support from the health service, and I will certainly work towards that. <BR /> <BR />As I said, my biggest challenge in IVF and being able to provide that support is financial. There are so many things I want to do as Health Minister, and so many things I wish I could change tomorrow. If you find yourself in that scenario, you are asking for support. Not everybody can afford to pay for additional cycles, so the optimum three cycles are what I want to work towards.”
“It is disappointing that the health service at this stage is not able to provide the optimum three cycles. That is obviously something I want to work towards. I have said that publicly and was saying it when I was on the Health Committee many years ago. We have only one cycle in place now, which is not the optimum number; NICE guidelines clearly state that the optimum number is three. I will certainly want to work towards that. Obviously, one of our biggest challenges in the health service is funding and being able to resource all the things you want to, but it is my intention to work towards being able to provide the optimum three cycles.”
“Yes, I am content. If the Member wants to drop me an email, we can arrange something.”
“I believe we do have strong policies in place, and I will clarify that for the Member when I leave after Question Time. If we did not, I would certainly rectify that situation.”
“I reassure people who may have sick loved ones or may be unwell themselves that the level of care they will receive from doctors and nurses here is second to none. My Department is working with colleagues in the Health and Social Care Board and the trusts to do everything possible to improve performance. The arrangements that have been put in place for other trusts to help with Southern Trust's breast cancer referrals have already had a positive impact. Provisional information shows that performance management has greatly improved to 78% in the Southern Trust in September, and I believe it is up to 100% today. <BR /> <BR />The trusts continue to work with the board to seek to resolve issues, and a workshop is scheduled for 26 October to identify options for delivering a sustainable, high-quality breast cancer service.”
“One received their first treatment at day 63, just outside the 62-day target. The final patient was a more complex case, and treatment did not commence until day 81.”
“The question is very timely. As Members will be aware, we are in the process of debating the issue of cancer services this afternoon. The performance figures for breast cancer in the Southern Trust for June are entirely unacceptable, but it is important to understand the full picture of what lies behind those statistics. <BR /> <BR />Of the 209 patients who waited longer than 14 days for a breast cancer referral in the month of June in the Southern Trust, 12 subsequently had a confirmed diagnosis of breast cancer; 94·3% did not have a cancer diagnosis. All of the 12 patients with a confirmed diagnosis have commenced treatment. Ten patients received their first definitive cancer treatment within 62 days, which means that the initial delay in diagnosis had no negative impact on their receiving treatment within a reasonable amount of time.”
“We are continually looking for more foster carers to come forward. We have about 2,200 children in care who need our support, and we need more people to come forward. We are actively involved in working with other Departments and key stakeholders to make sure that we raise awareness about how rewarding and fulfilling foster caring is and to ensure that we provide more support, particularly in relation to kinship; we are doing a lot of awareness work around that also. We have to continue to do more to make sure that more people come forward who want to adopt. Anybody I have encountered who fosters or adopts finds it very rewarding, albeit very challenging. That is why they need the support that we talked about earlier. It is so important that more people come forward and provide a loving home for children who find themselves in care.”
“I will always be guided by equality principles. I can assure the Member that, when I go out to consult, that will be very evident in the consultation paper that goes forward. There has been a lot of talk about this, and there have been a lot of court cases. It is about time we moved on and put it on a statutory footing.”
“It is extremely important that we support adoptive parents. That was one of the issues that was discussed when I met Adoption NI recently. One of the things that the Bill is looking at is defining adoption support services to mean that we provide counselling, advice and information for adoptive parents. It is also about other services that are prescribed by regulations in relation to adoption. The Bill will give us an opportunity to strengthen the supports for adoptive parents, and it places a statutory duty on adoption authorities to make sure that arrangements are put in place for the provision of support services that are specified in regulations. The Bill is timely, and it will support parents who adopt children and need all the support that we can give them.”
“<BR /> <BR />I also intend to consult on the duty of the Health and Social Care Board to provide information about adoption support services; to introduce a right for the descendents of adopted people to access records and intermediary services; to place arrangements for duly approved placements — that is, individuals or couples approved to foster or adopt — on a statutory basis; to amend the Children Order 1995 to strengthen arrangements in respect of private foster carers; and to seek views on the introduction of contact/no contact orders to ensure that the authorities are clear that their duty is to safeguard and promote the welfare of looked-after children when making contact arrangements.”
“Professor Alexis Jay undertook a review of the Safeguarding Board in April of last year. The review report was submitted to the Department, and I accepted all the report's findings in August this year. One of that report's key recommendations was that, in the longer term, the creation of a statutory child protection partnership should be considered as a replacement for the Safeguarding Board, with wider safeguarding sitting within an overarching Children and Young People's Strategic Partnership (CYPSP). I intend to consult on whether to include additional provisions in the Adoption and Children Bill to establish a statutory child protection partnership and place the CYPSP on a statutory basis.”
“In the main, the Bill is based on policy proposals consulted on in 2006. However, it also contains new provisions not previously consulted on but which I consider will deliver improved outcomes for children and young people, both in relation to adoption and children's social care. As part of the consultation on the Bill, I will also seek views on a number of further proposed changes to adoption, safeguarding and children's legislation. <BR /> <BR />I firmly believe that it is extremely important that an Adoption and Children Bill is introduced as soon as possible. The Bill is long overdue. I therefore intend to seek Executive agreement to consult on the draft Bill, with the intention of introducing it in the Assembly as soon as possible in the current mandate.”
“An Adoption and Children Bill has been drafted. It is principally intended to modernise the legal framework for adoption in the North and place children's welfare at the centre of the adoption decision-making processes. The current law on adoption is the Adoption Order 1987. It is based on English legislation drafted in the early 1970s and therefore reflects practice that is effectively 40 years old. The Bill will deliver a framework for adoption that is more consistent with the principles and provisions of the Children Order 1995 and international human rights requirements. <BR /> <BR />The substance of the Bill relates to adoption, although I propose to also make changes to the Children Order. The Bill will be substantive. The current draft contains approximately 140 clauses and five schedules.”
“Other measures at Causeway include improved discharge processes and increased pharmacy support. <BR /> <BR />Measures outside the hospital setting include expanding the trust's nursing home inreach service, improving access to starting new domiciliary care packages at the weekend, managing the community rehabilitation bed-based services and working with care homes to ensure that there is capacity for short stays as well as long-term placements over the winter period.”
“As we enter the winter period, there are the annual pressures that all our hospitals will face. I have allocated £13 million from the June monitoring round for unscheduled care and winter pressures. That funding will be invested in a number of areas to improve patient flow in unscheduled care, including winter pressures, capacity expansion on acute sites and staffing in emergency departments. <BR /> <BR />The Northern Trust share of the funding is £1·697 million, and some of it will be used to increase capacity for short-stay, fast turnaround for appropriate patients who come to the emergency departments in the Antrim and Causeway hospitals. That includes the development of a direct assessment unit in the Causeway Hospital to enhance assessment capacity and to improve emergency department flow.”
“There is no doubt about the current services at the Causeway Hospital. It is the trust's view that its acute hospitals at Causeway and Antrim are developed to support each other and work collaboratively to provide a strong, sustainable model for acute services. Those two hospitals also network with other acute services, especially in Belfast and in the west. The two hospitals need to be right-sized and properly resourced to meet the demand now and in the future to support the events that you refer to. The trust has never shied away from saying that it sees it as a valuable and integral part of its health and social care provision.”
“People are living longer, with more complex conditions, and the reason they do is that our health service is good and is delivering, day and daily, services that support people. Members of the House would do well to recognise that more and more. Moving forward, I have set it out that we will clearly have to reconfigure how we deliver health and social care. That does not mean that we have to have every service in every hospital; it means that we deliver first-class outcomes that we can stand over and people are content with. That is the transformation piece that I will be announcing and discussing in the House next week.”
“I have said that, and I said it in a recent debate. I will rehearse it again: the Northern Trust has said that it has no plans to move away from the model currently in place. To say that we can never change anything, that we can never reconfigure services or that we can never do better is a bit of an ostrich mentality — stick your head in the sand and say, "Let's keep doing things over and over hoping for better outcomes". That is not what we can continue to do in health and social care. <BR /> <BR />I have clearly set out that, on 25 October, I will set out how we are going to transform health and social care across the board. What is most important is that we deliver better outcomes for health and social care and make sure that people live longer.”
“I suggest that the Member could do better to listen. What I clearly said was that the Northern Trust has no current plans to move away from the model currently in place.”
“Decisions about the provision of services at Causeway Hospital are a matter for the Northern Health and Social Care Trust in the first instance. As I said in the recent Adjournment debate on health service provision in North Antrim, the Northern Trust has no plans to move away from the model currently in place, in which acute hospital services for its area are delivered from the Causeway Hospital and Antrim Area Hospital. The reconfiguration of services is an important and complex matter that goes beyond individual trusts and hospitals. I have given careful consideration to the implications of the expert panel’s report and will publish it and my response on 25 October 2016.”
“It is something that I am certainly considering. There is quite a lobby and campaign for it. Obviously, we have limited resources, and we have to make sure that we target them at those most in need, but, yes, I am considering it. I am actively looking at the issue.”
“It is so important that women know what services there are, particularly if they find themselves in a recurrent miscarriage situation. They need to know that they are going to be supported and how they can get that help.”
“All trusts have pathways in place for women who have had previous early losses or a history of a previous ectopic pregnancy, with women referred to a maternity or gynaecology team or a dedicated clinic, as required, on assessment of individual needs. As part of the implementation of the strategy for maternity care, 2012-18, actions are being taken to standardise services for women who experience recurrent miscarriage by clarifying and standardising referral criteria and pathways and developing guidance for GPs on appropriate referral. <BR /> <BR />That work is under way, and the board and the Public Health Agency, as I have said, have engaged with the Patient and Client Council in relation to issues raised by service users.”
“Women obviously attend when they need to through various routes, perhaps through GP referral or by going straight to A&E. It is important that all clinicians have the guidance in place that allows them to support women who find themselves with a miscarriage. We need consistency across all the trusts, and the guidance helps us to achieve that. We should have 24/7 access and support for women who find themselves dealing with a miscarriage. We are listening to patients and considering the work that was done with the Patient and Client Council. The fact that the guidelines are in place shows that we are listening and that there is an improving picture.”
“That is certainly going to be my mantra for going forward: we have to listen to the voice of patients, carers and families and make sure that we design supports and services for people who need them.”