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 do not think that it is just the responsibility of the health service; it requires a holistic response. It should obviously be cross-departmental. It relates to a home or a house and to people's mental health and physical well-being; it is right across the piece. If we were to legislate for that, it would obviously be cross-departmental, but I would certainly be open to looking at all that. We should do absolutely everything we can to prevent anyone from becoming homeless and should provide whatever supports we can. I am very open to working with Executive colleagues to make sure that we deliver the best possible outcomes.”
“Regionally, the Public Health Agency (PHA) has confirmed recurrent investment in the Drug and Alcohol Mental Health Service (DAMHS), and trusts are in the process of recruiting to those teams. <BR /> <BR />In addition, a range of alcohol and drug education, early intervention, treatment and support services was launched in July 2015 across all five health and social care trust areas. A number of those services are targeted specifically at children and young people and their families, and work is ongoing to improve awareness of the services. It will, of course, require time for those relatively new services to bed in properly and to allow for meaningful assessment of their effectiveness. In the meantime, the need of any additional support will continue to be monitored and kept under review.”
“There is substantial demand for addiction and mental health services for young people throughout the region, and services are under constant pressure. In Belfast, the demand for drug and alcohol mental health services has resulted in those services being provided by a very specialist team with a largely consultative role that only directly deals with very high-risk individuals. Step 3 child and adolescent mental health services (CAMHS) community services continue to see and treat young people who have a significant mental health issue as a result of their substance misuse, for example, psychotic presentation, or have co-morbid mental health and substance misuse issues.”
“Yes, I obviously concur with you about the work that staff do on the front line in engaging with people, trying to make a difference and trying to support them. It is my job to support those staff to enable them to do what they do well. We should be innovative, and I am always open to looking at new ideas and at good practice and rolling it out where it is proven to work. If there are any initiatives that work, we should replicate those across the North to ensure that we deliver the best support we possibly can for those who find themselves homeless.”
“Yes, I can make sure that that happens. It is not just a nod to the issue; it is about real and meaningful engagement. I will certainly make sure that the relevant officials attend, and I will also show leadership at the ministerial group, which is important in showing the significance of the issue and the priority that we give to it.”
“<BR /> <BR />The Department for Communities is leading on an interdepartmental action plan to address some of the problems that are specific to Belfast, and my Department, the Public Health Agency and the Belfast Trust are responsible for addressing two key actions, namely developing arrangements to ensure that people discharged from hospital who do not have access to accommodation are signposted effectively to existing services and assessing the services available in relation to alcohol and drug early intervention, harm reduction and treatment and support services —”
“Concerns were raised about a possible lack of communication between health services and homeless people; problems with access to mental health and addiction treatment; and a lack of arrangements with social services when homeless patients are discharged from emergency departments or inpatient care. Those concerns are being addressed.”
“In addition, I am a member of the inter-ministerial group on rough sleeping and homelessness, and Minister Givan will shortly convene a meeting of that group that I will attend. <BR /> <BR />Health and social care must be available on the basis of clinical need to everyone equally, including homeless people and rough sleepers, and care and treatment must be delivered in the appropriate primary, community and secondary settings when required. While services are available, it is accepted that there may be increased difficulties in homeless people and rough sleepers accessing those services, and that is a key area that the Department is considering in conjunction with the Public Health Agency. <BR /> <BR />We are all aware of the tragic deaths of five homeless people in Belfast last winter.”
“One of the objectives of the homelessness strategy is to improve services to vulnerable homeless households and individuals. This objective impacts on the health and social care service in a number of ways, particularly in relation to mental health, domestic and sexual violence and substance misuse. <BR /> <BR />Officials from my Department and the Public Health Agency participate in the homelessness strategy steering group and contribute to addressing policy and service delivery issues in partnership with the Department for Communities, the Housing Executive and the range of voluntary and community sector organisations that provide assistance and outreach to homeless people.”
“GPs are asking for this; they are asking for support to allow them to see people in a more timely fashion. GPs are distraught and distressed if they cannot see people on the day and if people are having to wait for a number of days to get appointments. This is about real transformation; it is about doing things differently and allowing GPs to free up their time. I do not think that we will get to a point where we cannot support GPs to do this. This will deliver better outcomes for people. In the scheme of things, the financial investment is not massive, but it makes a real difference. I do not think that there will be an issue with competition and who gets the service; it will be an issue of how quickly we can roll it out and how everybody embraces it.”
“The feedback has been so positive. As I said, 94% of people said that they were satisfied or very satisfied. The pilot is available to any GP practice that wants to avail itself of it. We have actually put some funding in place to support that. That funding allows GPs to adapt and bring in something that could be difficult to bed in at the start. I am very keen that we roll it out right across the piece if we can. GPs are very keen to do that. They want to see the people who need to be seen and they want to see them on the same day, if necessary. The askmyGP scheme has shown that it does work and that it allows GPs to free up their time to see people. I am very keen to roll it out across the board, and GPs are keen for that to happen, too.”
“It would really help with the workforce challenges that we have in that area.”
“There are obvious challenges in recruiting GPs, and rural GP practices are having particular challenges. The GP-led care working group has reported back to me, and I am very keen to take forward a number of that group's recommendations, particularly those looking at the recruitment and retention of GPs. There are particular challenges in the north-west. In answer to a previous question, I talked about the challenges in relation to dental services and recruiting dentists. However, it is the same right across the piece. Recruitment is difficult in the Western Trust area. Would a medical school in that area help? I think that it would, and I am very keen to progress that. I have had some discussions with the university about taking that forward. I am very keen that that happens.”
“As part of the GMS contract settlement for 2016-17, up to a further £7 million will be invested in general practice, including £2 million to meet the additional demand for GP services, £1·7 million to continue to roll out the practice-based pharmacists programme and £160,000 to develop online booking and repeat prescribing systems. These systems will be available to every GP practice that wishes to adopt them and will mean that people can access their GP surgery online at a time that is convenient for them.”
“This will mean that, where appropriate, patients can be given advice and assistance directly by a pharmacist, with GP time freed up for the patients who most need to see them. The first wave of pharmacists has been recruited. Over 35 whole-time equivalent posts have been filled, with staff starting to take up posts from mid September. The second wave of recruitment is under way, with wave 3 being planned. <BR /> <BR />In January, investment of £1·2 million per year was secured to increase the number of GP training places each year from 65 to 85.”
“In 2015-16, an investment package of up to £5·1 million was agreed for general medical services (GMS), including additional funding of £3·1 million to build capacity in GP out of hours services, up to £1·2 million to increase the skills mix in general practice and help meet the demand for blood tests and other diagnostic work, and up to £300,000 to recruit and retain GPs. Further non-recurrent funding was also provided last year to pilot a phone and online triage system, which we have just discussed. <BR /> <BR />In December last year, a five-year initiative was launched to place up to 300 pharmacists in GP practices by 2021, with an associated total investment rising up to £14 million per year.”
“The initial results from the pilot exercise are extremely positive. Patients using the askmyGP app have received a callback from their GP or other care professional in around 30 to 40 minutes and often much sooner. In cases where a patient needs to be seen, they are being seen on the same day. Across the GP pilot practices, 94% of patients using askmyGP were satisfied or very satisfied with the service. GPs have also been extremely positive about the impact of the new service on their ability to meet patient demand and the reduced pressure on their working day. Work has now commenced to extend the pilot to a further 30 GP practices.”
“AskmyGP is a telephone- and web-based patient triage system, and it is being piloted in four GP practices here, including Abbey and Aberfoyle. Patients contacting their GP practice for an appointment are asked to provide responses to a series of questions about their condition either over the telephone or online. The responses are then passed to the GP, who makes a decision about the most appropriate course of action to respond to that patient's needs. For some patients, that might mean referral to another healthcare professional for advice or treatment, ensuring that patients who do not need to be seen by a GP can be seen quickly.”
“The people of mid-Ulster deserve, want and crave confirmation that the project will go ahead, and I am certainly committed to delivering it in this mandate.”
“I can confirm that it will be an investment in mid-Ulster of £45 million. I am very aware, as the Member is, of the concerns over the years about the project and whether it was going to come to mid-Ulster at all. We have finalised the case, and I can say categorically, without any doubt, that the project will go ahead. We have appointed the design team, the works will be delivered, and we hope to have staff training and working there from the 2020-21 financial year. <BR /> <BR />It is a £45 million investment for mid-Ulster, and it is something I know the council has been lobbying very strongly on. As I said, I will talk to the council to give assurances that the project will go ahead.”
“With the design team in place since last month, it has been tasked with undertaking necessary design work to progress the approved works. We hope that early works will start in spring 2017, and the approval of the main works, through the approval of an outline business case, is planned for the first half of 2018. Main construction works are planned to commence in late 2018, and it is estimated they will take just over two years to complete, in 2020-21.”
“Training opportunities will include addressing fires in confined spaces and intense smoke, working with rapid water, as in flood rescues, and dealing with the outcome of road traffic accidents. <BR /> <BR />The local community in mid-Ulster will be fully engaged during the development of Desertcreat, and I have written to the chief executive of Mid Ulster council offering to meet him and all elected members regarding this important investment.”
“On 28 September, I announced the appointment of the design team for the early works at Desertcreat. That is a positive step forward in the development of a much-needed new Fire and Rescue Service training facility. Early works on the ground at Desertcreat are expected to commence in spring 2017. The total forecast capital investment is approximately £45 million, and the main design includes a fire station, teaching accommodation, a multipurpose training warehouse, a hothouse and swift-water and skidpan facilities at Desertcreat. The main capital works are expected to commence by late 2018. <BR /> <BR />The training centre, once completed and operational, will provide a facility in which our firefighters can learn the skills they need to keep the public and themselves safe.”
“It is one of those issues that are quite emotive and topical. Some people do not want to be forced to have fluoride in their water, and I think that is a legitimate and genuine concern. It is something we keep under review. Any decisions I take will be based on a clinical assessment of whether something is the right thing to do for people's outcomes. I will always be guided by that, and it is the same scenario for fluoride in water.”
“I am sure Michael will be glad to hear you are still singing his praises after he has left the House. I do not have the figures with me, but I am happy to respond to the Member in writing with the stats on the number of people who were successful in the recruitment.”
“I do not have any information about the Western Trust specifically; I am happy to provide that to the Member in writing. Obviously, there are challenges for the Western Trust, but there are challenges for many trusts with workforce issues and being able to recruit people. We have an over-reliance on locums, and that is not the place that we want to be. We need to transform Health and Social Care, and we need a real and meaningful workforce plan that allows us to recruit staff. It is difficult to recruit staff. Quite often, trusts go out to recruitment but cannot fill posts. We need to do more to change that picture. I do not have specific information about the Western Trust, but I will write to the Member.”
“<BR /> <BR />My Department has also provided funding for tooth decay prevention campaigns over the years — for example, since 2005, £100,000 has been provided to trusts to target children in deprived areas. It is important that we continue to do more of that preventative work. Looking to the future, I want to focus on prevention, not just for tooth decay but right across the piece. It is important that we prevent people from getting to the point at which they need to use hospital services. Prevention is one of my key priorities.”
“I absolutely agree with the Member that prevention is better than cure. We need to do more to prevent tooth decay from happening in the first place, because that would be the ideal scenario. We have a regional preschool prevention programme called "Happy Smiles" for children in nurseries. All trusts deliver programmes similar to the tooth-brushing challenge, which is delivered in the Belfast Trust from primary 4 onwards. Evidence is growing that, where prevention programmes are targeted on young children, a reduction of up to 30% in disease levels can be reached. I want our children to be the beneficiaries of all these successful prevention programmes.”
“<BR /> <BR />As with all specialities, trusts are continuing to work with the Health and Social Care Board to minimise dental waiting times within the resources available. Patients are treated on the basis of clinical urgency, with patients of equal clinical priority being seen in chronological order. The board is also working with trusts and referring practitioners to finalise the roll-out of referral guidelines that aim to reduce the number of unnecessary referrals for consultant-led dental treatment and thereby allow clinicians to focus on patients who require treatment.”
“My Department is working closely with the Health and Social Care Board (HSCB) in developing an elective care plan to arrest the decline in elective waiting times and deliver sustainable improvements in the medium to longer term across all specialities. As well as maximising the number of patients who can be treated in the community, the plan will ensure that existing funded capacity in the health service is fully maximised and targets new and recurrent investment to expand the health service's capacity to meet patient demand. However, it will require significant additional funding to deliver this. I will continue to engage with my Executive colleagues to secure the additional investment necessary to transform the delivery of services.”
“Gabh mo leithscéal. I brought the information into the public domain because that is where it should be. I am committed to making sure that we deliver better outcomes for all women who are referred for breast cancer assessment. I will not be found wanting in my priority of dealing with waiting lists and bringing them down, and I will not be found wanting in transforming health and social care. I hope that the Opposition table as many questions for urgent oral answer as possible so that we can talk about every issue, because I am committed to driving forward transformation, and I hope that they assist me with that.”
“Not after I published the results on Thursday. Mrs Dobson has, in the past, raised the issue of breast cancer referrals; I will certainly give her that. Not one Member, including Mark Durkan, the member of the Health Committee who tabled the question for urgent oral answer, has asked me to talk about this issue. I published the information because it is better to have it in the public domain.”
“I published the information six days ago. Let us be very clear: not one Member from the Opposition Benches has written to me, asked me a question, emailed me or called to my office — not one person.”
“On your first point about the Executive using the opportunity to talk about openness and transparency, it has taken others six days to bring a question for urgent oral answer to the House. I published this information last Thursday, and I would much —”
“I am certainly committed to ensuring that we have an overarching workforce plan, which will be key alongside service delivery, service reconfiguration and a change in how we do things. Key to the success of all that is being able to make sure that the workforce are brought along with you and that they are up for the challenges and the change that needs to happen.”
“In the meantime, we are working with the other trusts to make sure that they are able to provide additional clinics and to support people and have them assessed within the timescales, particularly the 14-day target. As I said, the figures now speak for themselves on being able to turn the picture around. <BR /> <BR />Workforce planning in general is a major issue right across health and social care. It is something that I certainly want to tackle in the time ahead. If we are to transform health and social care and have more investment in the community, we have to make sure that the workforce are fit for purpose and supported, and are doing the job that they do best. That job is to engage with, treat and help people.”
“I am always trying to find solutions. I am always trying to deliver better outcomes for people. We will do that by transforming how we deliver health and social care, so, regardless of what we are talking about, it is about delivering better outcomes. It is about early intervention and prevention. Some challenges, particularly in the Southern Trust, have been about workforce planning, but that is not specific to the Southern Trust. Right across the board, there is difficulty with the recruitment of radiologists and consultants. Despite the fact that the Southern Trust went out to recruitment, it was not able to be successful in recruiting anybody to those posts. It is out again to recruitment, and, hopefully, that will start to alleviate the situation in the trust.”
“It has faced down the challenges that it has had. Is it acceptable when it happens? No, it is not, but we have to keep driving change forward and making sure that people work together and deliver better outcomes.”
“It is really important that there is never a knee-jerk approach. As I said, I published these figures last Thursday, and it has taken until today, six days later, for the matter to come to the House as a question for urgent oral answer, which begs the question about someone's genuine approach to dealing with the issue. There is genuine concern out there about waiting lists and referrals, which I accept. I met Cancer Focus yesterday, and this is one of the issues that we discussed. There are genuine concerns that we need to address. Nobody should wait any longer than the ministerial targets that have been set out, and, if that continues to happen, that is where we have to take real and meaningful action. Those trusts are working hard. I think that the Southern Trust has turned the picture around.”
“The new-style Programme for Government will be a lot more fit for purpose to allow us to do that and to deliver many more better outcomes.”
“As I said, it is the most challenging thing for you as an individual if you are on a waiting list and are in pain, or if you have child who is ill. For whatever reason, you may be on a waiting list, and we have to get waiting lists down. I look forward to working with every Member to make sure that we get to that point. We need to invest in health and social care. We need to invest in people's outcomes. We need to tackle the root causes of why people get sick in the first place. The correlation between deprivation and outcomes, whether that be cancer, tooth decay or many other conditions, is so stark. We need to tackle it with and invest in early intervention and prevention, and we need cross-departmental working.”
“The problems we are talking about today in the Southern Trust are on breast cancer referrals, but I have consistently said that waiting lists across the piece, no matter what someone is being referred for, are not acceptable, are not tolerable and cannot continue. They have continued to grow year on year, and one of the main reasons they have continued to grow is because we have an outdated system that is trying to deliver 21st-century health and social care, and it is not happening. We need to reform the system to allow us to get better outcomes. I want to get to the point at which we can stand in the House and talk about real, positive service developments that make a real difference to people as opposed to talking continually about the negativity around waiting lists.”
“If it is happening to you, it is the most important thing in your life. We need to get to the point where we have appropriate referrals in a timely manner so that people are assessed and getting the help they need. That is the transformation and priority piece I am involving myself in.”
“I know you are new to the House, so I will be kind insofar as to say that that comes back to the bigger picture of waiting lists. We have to deal with the waiting lists issue, and the only way we will tackle that is by transforming health and social Care. Many bodies of work have been done over the last number of years. Things have gone well, other things have not gone so well and some things have not been implemented the way they should be. I have received a panel report that looks at the burning platform that is health and social care. I intend over the next number of weeks to set out my stall on how I am going to deliver better outcomes for every individual. That is what we should be about. Whether it is dental waiting lists, referrals for autism assessment or breast cancer referrals, it does not matter what it is.”
“<BR /> <BR />I keep saying this over and over again, but I cannot say it enough: if we do not change how we do things, we are not going to deliver better outcomes. That is certainly what I am committed to doing in the months and years ahead.”
“I will work in reverse. We are reviewing the service framework, and I hope to have that information in November, which will then allow us to decide and best inform how we take forward a potential cancer strategy, if we decide that is the best course of action. I do not have statistics with me on ovarian cancer, but I am very happy to provide them to the Member. It would be the same scenario if we were in the situation of people being referred and not being seen within the targets. As I say, I believe in these targets. They are very challenging for a reason. We should never reduce the targets. We should continue to keep the pressure on and make sure the service responds to the need. That is the challenge for me as a Health Minister.”
“<BR /> <BR />I encourage all women, particularly those over 70, to consider contacting their local breast screening unit to arrange an appointment every three years. Many women do not realise that the risk of breast cancer continues to increase with age. It is so important that we continue to raise awareness. Some good things are happening in our system, including the fact that, despite all the challenges we have, the five-year survival rate for breast cancer is better here than in England, Scotland and Wales. That does not mean we can rest on our laurels; it means that something is working and is good, so we need to do more of that and more of the same. I think the fact that so many more people are being referred into the system is because the awareness is starting to really kick in and people are starting to take it on board.”
“I thank the Member for his question. This is breast cancer awareness month, and it is important that we continue to raise awareness. The figures I referred to and the fact that over 10,000 more people have been referred show that the awareness campaigns are working. The Public Health Agency is urging all women to be breast aware and to think about attending screening when invited. I use this opportunity again today to encourage all women to do so and to consider attending. We all know that prevention and early intervention are key in saving lives from breast cancer. Regular breast screening reduces the risk of death from breast cancer. On average, one life will be saved from breast cancer for every 200 women screened.”
“These people are providing excellent services, and those are the targets that they are meeting. Do we fall down in some of the other categories? Yes, the health service does, and that is why we need to do more.”
“I said that in the Department's accompanying press release. <BR /> <BR />At the end of September, the Belfast Trust's 14-day performance was at 99%. There is 1% still to go there, and that is what we need to work towards. The Northern Trust was at 99%. The South Eastern Trust was at 100%. The Southern Trust, obviously, has had a problem, and it was at 78% at the end of September. However, I am told that, as of today, it is up to 95% based on its performance of the last week. The Western Trust is at 100%. This is testimony to the clinicians and the people who are working on the front line delivering first-class health services. I know for a fact from my engagement with those people that they are devastated whenever they hear knee-jerk reactions to the service that they are providing.”