Michelle O'Neill
Mid Ulster · Sinn Féin · Northern Ireland
“We are shocked and deeply saddened for both the victim of the horrific incident in north Belfast and the people who have been impacted on by the disorder that we have witnessed since. There is absolutely no justification for racism, violence or intimidation.”
“It is the latest chapter in a political psychodrama. It has been playing out in Westminster for forever and a day but particularly over the past 10 years. Tomorrow is the 10th anniversary of Brexit, which inflicted so much damage to the wider economy. We are now on the verge of having a seventh British Prime Minister in 10 years.”
“We cannot look at things in isolation. Whether it is the refugee integration strategy, the framework or the legislation, all those things need to move together and at pace.”
“I agree with the Member about the ugly language that was used to describe some people in our community. Like the Member, I have met many people from the black and ethnic minority community in recent times. I do that on an ongoing basis, but I did so recently given what happened over the last number of weeks.”
“There is not just one answer to it, as the Member knows. We need to come at it from every angle. That could be a policing response initially, for which additional funding was secured. I agree that this is the third year in a row in which we have had that type of racist behaviour on our streets. Likewise, I would describe it as a pogrom.”
“Building on that progress, the Executive Office is contributing £3·3 million towards the Derry on the North Atlantic Museum, which is due to open in 2027 and will further enhance Ebrington’s role as a heritage and tourism destination. <BR /> <BR />Ebrington is also continuing to develop as a vibrant events space.”
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“I thank the Member for her comments, and I absolutely agree that we need to support women who find themselves in that scenario. We must absolutely take on board the guidance and suggestions that have been made by the Patient and Client Council, and we are actively doing that. All trusts provide services and support, probably in varying degrees, according to what trust area you are in, for women who have miscarried. It is important that we have consistency and that people know what support is there and how they can access it. <BR /> <BR />A lot of good work has been done. Our midwives and obstetrics and gynaecology staff have all been given written information to guide them as to how to support those women. It is important that we continue to build on that and listen to the patient's voice.”
“<BR /> <BR />In line with NICE guidance, trusts have been asked to ensure that, for problems in early pregnancy, a system is put in place to enable women referred to an early pregnancy assessment service (EPAS) to attend within 24 hours if the clinical situation warrants that. Those arrangements are now in place in two trusts, and the PHA will be reviewing progress with all trusts in December this year.”
“Ensuring that the right services are in place for treating and supporting women and their families during what can be a very distressing time is of great importance to me. I am pleased to be able to say that, following work by the Public Health Agency (PHA) with trusts and patient groups to consider issues of variation across early pregnancy services, a commissioning intention and a referral pathway were developed and issued in June this year. The commissioning intention asks the trusts to ensure that they have appropriate arrangements in place to facilitate rapid access to care for women with problems at any stage of pregnancy.”
“<BR /> <BR />We also have a lot of good work being done on the positive mental health and well-being message. Last week, for World Mental Health Day, we were able to launch the anti-stigma campaign. Stigma and people being afraid to talk about mental health and to ask for support are still key factors. The sayings were, "It's OK not to be OK" and "It's OK to ask for help". That is important for mental health. I have clearly prioritised that as being an area in which I want to work towards parity of esteem, but it is important that people understand what parity of esteem means for mental health.”
“It is not about legal barriers but about proper access to services. Parity of esteem can sometimes be taken to mean applying the same amount of money to physical health and mental health, but that is clearly not what the report states and that is not my intention. My intention is to improve the picture and invest in all the service developments that I have included. One of the things that is going to inform that process is the review of the Bamford evaluation, which will give us the evidence to move forward. <BR /> <BR />I have highlighted mental health as being one of the areas that I want to prioritise. We can do more. We have excellent services out there: a brilliant community and voluntary sector and so many partners that want to work together to deliver better outcomes for all those people who find themselves mentally ill.”
“I have already highlighted how I intend to take that investment forward.”
“We have an improving picture. In the past decade, the annual allocation to mental health services has increased from £200 million to over £250 million. On the basis of last year's commissioning plan, the figure was confirmed as being approximately £250 million, which represents just over 5·5% of the departmental expenditure limit of £4·7 billion. <BR /> <BR />The Participation and the Practice of Rights (PPR) campaign said recently that only 8·5% of the overall health budget was allocated to mental health for 2015-16, despite evidence suggesting that the mental health amount equates to about 25% of total cases. That is broadly accurate, and, despite increases in the annual allocation to mental health services from £200 million a decade ago to £250 million now, it is clear that more investment is needed.”
“That will include work with other Departments on comprehensive early years support. <BR /> <BR />Regional acute inpatient services at Beechcroft are frequently under pressure. An independent review in 2014 concluded that the current 33-bed model is appropriate but that, crucially, that is dependent on the further strengthening of crisis resolution and home treatment services. <BR /> <BR />In addition, and in line with the independent review's recommendation, a managed care network of acute child and adolescent mental health services is being established. That will bring acute services into one managed system, ensuring greater consistency across the region and streamlined access to Beechcroft.”
“Child and adolescent mental health services are delivered under a stepped care model, and the Health and Social Care Board leads a reform process under the auspices of the stepped care model implementation review. Much progress has been made, but more needs to be done, particularly in relation to investment in community and specialist services, workforce planning and recruitment. CAMHS investment now exceeds £20 million annually, and I am considering reform and investment options across a range of mental health services, including child and adolescent mental health services.”
“The board is leading on that area of work. <BR /> <BR />Finally, I plan to closely work with Ministers in the South to explore the potential for developing some of these services on an all-island basis. I think that that will make it more feasible to allow us to develop some of the services in a more timely manner.”
“<BR /> <BR />The fourth principle that I wish to adhere to is service development where resources allow. The Bamford evaluation, which is going to report to me imminently, will outline the needs and gaps in services. Emerging findings include a need for more emphasis on carers’ provision and crisis support. My officials are developing options on the physical monitoring of people with mental illness; a regional perinatal service; child and adolescent mental health services (CAMHS) and improved early intervention; eating disorder services; psychological therapies; mental trauma; personality disorders; provision in the justice system; safe places for people suffering from dual diagnoses; and implementation of the Mental Capacity Act. The fifth principle is structural reform and performance management.”
“I intend that my plans, based on six principles, will contribute to improvements in line with an outcomes-focused Programme for Government. <BR /> <BR />First, I am committed to moving forward towards parity of esteem. Secondly, I want to develop and sustain a recovery culture. Thirdly, involvement by people with lived experience in the design, delivery and evaluation of services is essential. Mental health is leading the way in developing co-production: collaboration between people who provide care and people with lived experience. That has resulted in the development of networks and the employment of people with lived experience as recovery consultants. Just last week, I launched another recovery hub in the Southern Trust, which was a really good example of that co-production and co-design.”
“With your permission again, a Phríomh-LeasCheann Comhairle, I will answer questions 2 and 14 together. <BR /> <BR />'Building on progress' is an important contribution to my work to champion mental health, which is one of my top priorities. I was pleased to meet a delegation from the Royal College of Psychiatrists recently to discuss it in detail. The report acknowledges that there have been improvements in provision in recent years, and the commission found many good services. It highlights issues in relation to funding, treatment access, community and specialist services, structures and data. It makes eight recommendations for improvement, including the key point that mental health must be given equal priority with physical health. The findings are largely consistent with my vision for mental health.”
“I am happy to say to the Member that I will not be found wanting in trying to bring the issue to the fore as quickly as we can. It has been in the ether for far too long, and we need to resolve it.”
“As legislators, we have a duty to legislate, and we have to do that on the basis of the evidence that we have before us. The Justice Minister and I have had the report for only a week, and we said that we would look at it collectively. We have nothing to hide. The report has been done by professionals, and it is work that has also been informed by the previous piece of work — the consultation that you were involved with as Justice Minister. We have taken into account all of those factors, and we have taken into account as wide a range of views as possible. It is very important that, when we move forward and take decisions that are in the best interests of women, we do so on the basis of the evidence that we have before us.”
“Yes, I think that it is so important that we look at how we as a health service provide, and, obviously, we are where people turn to for help and support. Where those women turn to for help and support, they need to have adequate and appropriate supports in place. I am glad to be part of this work. I am glad that the Justice Minister and I have been able to progress it as soon as we took office. Now that we have the report, we will work our way through the recommendations, and we will bring forward what we need to in terms of legislative change on the basis of the report. It has been a very collaborative piece of work, and I thank the Member for his continued interest. I look forward to updating the House on the way forward as soon as we can.”
“It is unfortunate that the Opposition are again trying to use a really sensitive, complicated and emotive issue for anyone who finds themselves in that scenario. I have the best will and intention towards the women who need our support, and, with that best will, I will bring a paper to the Executive, as I have just said. I will consider the recommendations of the professionals and of all those who found themselves in this scenario and gave information to the working group. It has been good work, and I look forward to bringing the proposal to the Executive and making sure that we have in place fit-for-purpose structures and supports that will allow women who find themselves and their families with a diagnosis of fatal foetal abnormality to receive first-class support.”
“I am happy to discuss the report's recommendations with the Member and other Members in due course. I received the report only last week — I think that it was last Tuesday evening — so the Justice Minster and I want to give it consideration. That is normal practice. We will then, on the basis of the recommendations, bring it to the Executive for discussion and, hopefully, chart a way forward for how we will support women who need our support. I look forward to being able to progress the report as quickly as possible. I was keen to make sure that we completed the work of the working group and were able to move forward to provide the assurance that people are asking us for.”
“— or through the Public Health Agency, as that cannot have been easy for them.”
“Women willing to engage and share their experience, whatever that had been, were afforded the opportunity to communicate their experiences to the group, whether personally, in writing or through the Public Health Agency (PHA), which has undertaken work with women and families who have been directly impacted. <BR /> <BR />The Chief Medical Officer and the Chief Nursing Officer also met women and took account of the views of women who had engaged with the PHA through their work. Some women continued their pregnancy to term; some did not. I am grateful to the women, their partners and their families who took the time to relay their experiences either directly to the Chief Medical Officer —”
“<BR /> <BR />The focus of the working group's outreach work was to capture the broadest possible spectrum of views of women, the partners and families impacted by a diagnosis of fatal foetal abnormality and the health professionals providing their care, including representatives of the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Midwives and the Royal College of Psychiatrists. In considering the trauma that can be suffered by women and their families where a diagnosis of fatal foetal abnormality has been made, the group was guided by the wishes of women, their partners and their families regarding any engagement.”
“The report of the working group on fatal foetal abnormality was developed in line with the terms of reference for the group: to consider issues relating to cases of fatal foetal abnormality, including matters addressed in the previous consultation by the Department of Justice; and to provide a report to the Justice Minister and me with recommendations, including on potential legislative change for termination of pregnancy as necessary.”
“With your permission, I would like to answer questions 1,11 and 13 together. I can confirm that the Justice Minister and I received the working group's report on 11 October and are actively considering its proposals. You will understand that the Justice Minister and I will want to take some time to consider and reflect on the recommendations. When both the Justice Minister and I are content, the report will be submitted to the Executive for their consideration and then their approval. It is not intended to publish the report or its recommendations until the Executive have concluded their deliberations.”
“The reasons for that are due to previously highlighted staffing issues, including the untimely and tragic passing of a senior doctor in the Southern Trust. The motion also quotes 392,000 as the total number of people on waiting lists. Again, that is little more than a back-of-the-envelope calculation, adding up all waiting list figures for outpatients, inpatients and diagnostics. That misrepresents published statistics. For those reasons, I ask the Members opposite to reflect on the inaccuracies that I have highlighted and ask them not to move their motion on the basis of the fact that it is highly inaccurate.”
“On a point of order. It is on the debate that we are about to begin. I believe that there are factual inaccuracies in the motion that has been tabled for discussion, namely the fact that it refers to 6·7% of breast cancer patients missing the 14-day target. That is wholly misleading. The true picture is that the 6·7% is for urgent referrals for suspected breast cancer and not for people who have been diagnosed with breast cancer. That is not to mention the inaccuracy of stating that our services are in crisis. Four of the five health and social care trusts have extremely strong performances against breast cancer targets. The Southern Trust has a strong track record in meeting the 14-day target and has had a well-publicised dip in performance in recent months.”
“I take that on board. I did meet the group when it was here in Stormont. I had an opportunity to talk to them, and one of the things that they raised with me was that awareness needed to be raised, because the disease travels through families, so it is important that we do that. It is like everything in health and social care: early intervention and prevention are key.”
“I do not have details with me in relation to Huntington's disease, but I am very happy to provide to the Member in writing what strategy we have around that disease. I think it falls into the category of rare diseases. We are working closely with the rare disease group to be able to make sure that we have a proper strategy in place. I think it kicks in by 2020, but I will give the Member more details on Huntington's disease in writing.”
“The annual flu programme began on 3 October. It runs from October until the end of March. The vast majority of vaccinations should be completed by early December in advance of when the flu season normally reaches its peak.”
“In the North, the annual seasonal flu vaccination programme is delivered through GP practices and school health teams. The vaccine is offered free to those considered to be at most risk of developing serious complications if they are infected with an influenza virus, ie anyone over 65 years old, anyone under 65 with certain medical conditions and all pregnant women. In addition, all preschool children aged two or older can now receive the vaccine via their GPs. The vaccine is also offered to all primary-school children via the school health service. The annual flu vaccination programme is well established and achieves really good rates of uptake.”
“Recently — I think it was last year — the number of places went up from 65 to 85. There is a recommendation from the GP-led working group that we should look towards raising that number even further, so I am certainly giving consideration to that to make sure that we have the proper workforce and staffing levels to make sure that we have first-class GP services. I will continue to work with the Royal College of General Practitioners and the BMA to address the challenges that are identified by GPs.”
“I fully appreciate the challenges in GP-led services, and I am committed to developing a plan that will ensure long-term sustainability for GP services. There are particular challenges in rural areas. You have pointed to Fermanagh as an example, and that has been an extremely difficult issue. I assure the Member that the board and the trust are working hard to make sure that we have GP services on the ground delivering for patients. I have met local representatives from the Royal College of GPs and the BMA GP committee to listen to their concerns, and I am considering the findings of the GP-led working group, which has made a number of recommendations on identifying future funding priorities for health and social care services here. I am certainly committed to making sure we address the issues and the challenges for GP surgeries.”
“Absolutely. I can without reservation say that that is the case. This is a priority. This is an issue that has been left in the ether for too long. No matter what their choice is, we need to support these women. The working group was established as soon as I came into office; I made sure that it set about its task. As I said, I will receive that report in the next number of days, and I intend to bring it to the Executive for full consideration.”
“I will obviously continue to discuss the issue with the Justice Minister. We have to be guided by the working group we put in place to do a job and bring back recommendations on how we need to do things differently. I suppose it will be for the Executive to decide how we take it forward, but I will bring the report that the working group produces over the next days to the Executive in its entirety. If there is a recommendation for legislative change, I will certainly be up for making that legislative change.”
“I am grateful for the work of the working group, and I look forward to bringing forward how we will implement the changes that the group will recommend.”
“Obviously, clear guidance has been published and is with all trusts. Any woman or any family who find themselves in the scenario of having a diagnosis of fatal foetal abnormality is in a desperate situation. It requires the health service to be responsive by being supportive of that individual, no matter what their choice is for the future. The work of the working group has been vital in how we go forward and change things. Women who find themselves in this scenario need every possible support we can offer. It is a really difficult scenario, so it is important we make sure that the systems, processes and practices within the health and social care trusts are fit for purpose and are responsive to the needs of those individuals.”
“The Minister of Justice and I agreed the membership and terms of reference of the fatal foetal abnormality working group on 5 July. That group has been working over the summer and the last number of months to consider the care and support provided to women and their families when a fatal foetal abnormality diagnosis has been given. That includes consideration of legislative changes. The group has met on several occasions, and I expect to receive its report in the coming days. Along with the Minister of Justice, I will then bring it to the Executive.”
“I do not have a particular time frame, but I believe that I will get the report over the next number of weeks. I will then make decisions on the way forward. It is important that we have and provide clear information for people who may need specialist drugs, whether for cancer or anything else. The work has been really useful. I think that I will take receipt of that over the next number of weeks. I am then happy to provide the House with information on how we take it forward.”
“I do not have details on that specific drug. I will always be led by clinical guidance and professionals. I am happy to take a look at it, but I do not have information with me on that drug.”
“I have already said publicly that I intend to publish the document, and I will do so on 25 October, so you can get your reading ready for that day. I have told the Committee for Health that that is what I will do. Nothing will be held back. I will publish the report by Professor Bengoa and the panel, but, more importantly, alongside that I will publish how I intend to take things forward, transform health and social care, deliver better outcomes and bring down waiting lists. I think that that is the piece of work that we all want. I look forward to engaging with everybody on that because, at this time, we have an opportunity to show political leadership and work with clinicians to ensure that we have clear patient pathways and a better system that delivers 21st-century care for all those who need health and social care services.”
“We have to address it, and I have said that doing that is a priority for me.”
“I share the Member's concern about waiting times. Since I took up office, I have said that some of the waiting times are totally unacceptable. We need to transform how we deliver health and social care so that people are not sitting on waiting lists. I have inherited what I think is an outdated system that is trying to deliver 21st-century health and social care. We have to transform how we deliver care in order to bring down waiting lists. I am certainly committed to that. I have told the House that I intend to announce my way forward on how we will transform health and social care, and I will do that over the next number of weeks. The situation with waiting lists, whether they be for breast cancer referrals, which we discussed last week, or autism assessments — no matter what it is — cannot continue the way it is.”
“Yes. As I said, I very much value the work of Community Pharmacy. We are currently in the process of agreeing new contractual arrangements with it, and that will form part of discussions for the contract. Pharmacies want to do so much more, and I want to work with them to allow that. They deliver really high patient outcomes and maximise front-line engagement with individuals who come in to ask for advice. There is an appetite in Community Pharmacy to do more, and I want to work with it to make sure that we support it in delivering more.”
“I tried to set that out in my initial answer on the factors that the board takes into account when deciding whether someone can relocate. It has to be about serving the population. Community Pharmacy is an excellent resource, which can do, and wants to do, so much more to support people. I read somewhere that, particularly in deprived areas, people are more likely to seek the advice of their pharmacist than that of their GP. We need to use that resource more, and I want to work with Community Pharmacy. The board takes all the factors that I outlined into account when deciding whether a relocation is allowed to go ahead.”
“<BR /> <BR />My Department's vision for Community Pharmacy's contribution to the reform of the health and social care system is set out in a number of strategic documents currently being implemented, including 'Transforming Your Care', 'Making It Better Through Pharmacy in the Community' and the medicines optimisation quality framework. Optimising the benefits of medicine is an important enabler of reform, and the skilled Community Pharmacy workforce are applying their clinical skills to help achieve better outcomes for patients and promote healthy lifestyles. Community pharmacies also support reform by helping to reduce demand on GP and other acute services through provision of advice and treatment of common complaints without the need for a doctor's appointment.”
“Community pharmacies have a strong role to play in supporting the reform of the health and social care system. They help people to get well and to stay well. They dispense approximately 40 million prescription items a year, provide advice and information about medicines and a healthy lifestyle, offer services to improve the safe and effective use of medicines, and support self-care and prevention. There are currently 533 community pharmacies, employing highly qualified pharmacists supported by dedicated healthcare teams. Community pharmacies are therefore an important resource in local communities, and it is estimated that approximately 9% of the population visit a community pharmacy daily.”
“OK. I will take on board what the Member says. The issue has not been highlighted to me as one of concern, but I will ask officials to look into it.”
“<BR />A minor relocation is one in which there will be no significant change in the population served and in which other circumstances are such that there will be no appreciable effect on the pharmaceutical services provided by the applicant or by any other community pharmacy in the neighbourhood. If the board decides that a relocation is not minor, the application is treated as if it were a new application to join the pharmaceutical list.”
“The change of premises must be within the neighbourhood of the premises currently occupied, and the same services must be provided to essentially the same population. If the board agrees that the relocation is minor and is satisfied that the pharmaceutical services that are provided from the existing premises will be provided from the new premises and that there will be no interruption in the provision of those services except as allowed by the board, it must grant the application. In reaching its decision, the board must take account of the views of Community Pharmacy NI.”
“There are no current plans to review the regulations relating to applications by community pharmacies to relocate their premises. The Health and Social Care Board is required to make arrangements for the provision of community pharmacy services, which includes dispensing drugs that are prescribed by prescribers. It does that by contracting out those services to independent retail pharmacies, and a community pharmacy contractor can only dispense health service prescriptions if they are included in the pharmaceutical list that is maintained by the board. <BR /> <BR />If a community pharmacy contractor wishes to relocate within the neighbourhood in which they already provide services and to provide the same pharmaceutical services without interruption, they can make an application to the Health and Social Care Board.”
“Yes; I have no reason to believe otherwise. As I said earlier, we have some fantastic and amazing healthcare workers engaging with people on the front line and trying to prevent homelessness and who are worried about the patients they deal with. They do an excellent job, and I have no reason to doubt that my Department is in any way found wanting in working cross-departmentally, with other agencies and with the community and voluntary sector. If the Member has any particular issues that she wants to raise, I would be very happy to receive that information.”