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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“One of the things that I have been doing is making sure that the trusts start to work more in partnership together. There should be no competition between trusts; it should be about the best outcomes and how they can work with a neighbouring trust to deliver better outcomes for people. There has been a turnaround in the Southern Trust. It is important to say that, in this month alone, over 95% of urgent referrals in the Southern Trust have been seen within the 14-day target. <BR /> <BR />It is important that no Member of the Assembly has a knee-jerk reaction to media reports. I am not for one minute suggesting that the Member opposite has done that. The report was published last Thursday. I put it out there in the public domain last Thursday, and I made it very clear that the statistics are not good enough.”
“I published the report and the statistics, because I think that we need to keep putting in the public domain where the health service needs to do better. I published these statistics for that reason and will continue to do so. It is so important that we tackle waiting lists. I said from the very first day I took office that we need to tackle waiting lists, transform health and social care and give mental health parity of esteem alongside physical health. Those are the challenges that I have. I took my position in the Executive knowing that I have many challenges, but I am certainly up for delivering better outcomes. I look forward to all the parties in the House working with me to deliver the transformation that we need to deliver.”
“As I said, I do not think it is acceptable that we have the situation that we have. As chair of the all-party working group on cancer, the Member is very aware of the workforce challenges that there are, and which were a particular problem in the Southern Trust area. As I said, this all points to the reason why we need to transform health and social care. We have to deliver better outcomes. We have a responsibility as an Executive to deliver better outcomes, and I am certainly up for that challenge. In the next number of weeks, I will announce my direction of travel for what we need to do differently to deliver those better outcomes. <BR /> <BR />Just so that everyone is very clear, this is a report that I published last Thursday.”
“I listened with interest this morning to some of the commentators in the media. What Margaret Carr from Cancer Research said was so apt and so appropriate. She said that waiting lists are a symptom of a bad system — a system that is not working. That is what I have been consistently saying to the House, and what I am setting out in my transformation piece is how we are going to deliver better outcomes for people. That is the real test that we need to apply to ourselves in delivering better outcomes for all those people who need any element of our health and social care system.”
“I have raised that issue in the House before and discussed it on the back of a debate in the Chamber, where I said clearly that I would look towards developing a cancer strategy. I think that what we have seen over the last number of months, particularly in the Southern Trust area, has been shocking. I think that it is unacceptable that any woman has to wait any longer than is absolutely necessary. The targets are challenging, and they are challenging for a reason. That is to make sure that we deliver the very best outcomes that we possibly can for any woman who finds herself referred for breast cancer assessment. <BR /> <BR />We need to continue to do more. I think that this also points to the fact that we need to continue to deliver real, meaningful transformation.”
“Despite those challenges, it is positive that the five-year survival rates for breast cancer — the most common cancer in women — continue to be better than those in England, Scotland and Wales, and I am determined that that trend will continue.”
“<BR /> <BR />Increasing pressures on cancer services, due to an ageing population and increased referrals, inevitably create a pressure on our health services. For example, between 2014-15 and 2015-16, an additional 10,348 people were referred as red flag because of suspected cancer. Of those 10,348, over 3,000 were red-flag referrals for suspected breast cancer. That is why we need to reform the health and social care system. Longer term, we need to ensure that we have a sustainable breast service in place to ensure that patients are seen within the timescale set. A workshop is due to be held on 26 October with all trusts to identify longer-term solutions for providing a sustainable breast service across the North, given the staffing challenges in breast services right across the piece.”
“I am aware that the Southern Health and Social Care Trust is experiencing challenges in meeting the 14-day target for urgent referrals for suspected breast cancer. I regret any delays that are being experienced, and I wish to assure you that everything is being done to ensure that those referred are being seen as soon as possible. The provisional figures for September show a marked improvement in performance in the Southern Trust, with 77·6% of urgent referrals seen within the 14-day target. That is as a result of trusts working together to provide additional clinics. In addition, the trust has extended its working hours, and that has facilitated the operation of a fourth breast clinic.”
“<BR /> <BR />As Minister, I am committed to ensuring that Health and Social Care provides the best possible services for epilepsy patients within the resources available to my Department. I look forward to working in partnership with the all-party group and Epilepsy Action. I urge them to continue their important work representing the needs of patients and their families, and I will continue to work in partnership with them in the time ahead.”
“However, there is no doubt that improvements in medicine are at least partly driven by better understanding and better analysis of the evidence and information available. <BR /> <BR />Condition-specific databases can help to inform how services and treatment are structured and delivered and can provide a more detailed picture of what works and what needs to be improved. Technology and data can be great enablers of quality improvement, and it is important that we exploit them to drive innovation and a better service for patients. I have therefore asked my officials to look again at what information we hold and whether there may be merit in creating a distinct database for epilepsy.”
“The group will also consider future models of service delivery aligned to patient needs, succession planning for staff and, most important, ensure that there is sufficient capacity in teams to meet the demand on services and that people can access the treatment and information they need. <BR /> <BR />The motion also highlights concerns regarding the creation of a database to aid in the care of epilepsy sufferers. While an epilepsy database does not currently exist, I am assured that the HSC trusts maintain medical records for all patients and their care is documented accurately in those records. Details captured include an account of the advice and support offered, the investigations required and the treatment options.”
“<BR /> <BR />The specialist epilepsy nurses in each of the five health and social care trusts already play a key role as a contact point for patients and a valuable support for GPs and primary care teams in managing the care of these often vulnerable patients. I want to see that specialist service enhanced, and a regional group is working on the modernisation of neurological services, and that includes epilepsy. As part of that work, the Public Health Agency has established a regional neurology nursing group. One of the group's functions is to review the staffing complement for all neurological nurse specialist posts, including epilepsy provision, across the North.”
“<BR /> <BR />It is also important to be aware that epilepsy is not something that can be cured overnight; it is a long-term condition that many patients will have to deal with throughout their life. Medical treatment is, therefore, only part of dealing with epilepsy. As with other long-term conditions, it needs to be managed, and patients and their families play a pivotal role in that. <BR /> <BR />The contribution of the patient in making the diagnosis and in the management of the condition supported by clinical staff cannot be ignored. The key to that is ensuring that appropriately trained staff, working with patients and their representatives, design and deliver care and treatment pathways that are patient-led and tailored to people's lives and circumstances.”
“The incidence of epilepsy here is estimated to be around one in 100, and that is broadly similar to estimated incidence rates in Britain and in the South of Ireland. Epilepsy can start at any age, but it most often begins during childhood. It is often not possible to identify a specific reason why someone develops the condition, although some cases, particularly those that occur later in life, are associated with damage to the brain. <BR /> <BR />Epilepsy is most often diagnosed after patients have had more than one seizure; that is because many people have a one-off epileptic seizure during their lifetime. The most important information needed to make a diagnosis is a description of the seizures by the patient and by someone who witnessed the event.”
“<BR /> <BR />A diagnosis of epilepsy can have a tremendous impact on an individual and their family, and many Members referred to that during the debate. Apart from the physical impact on health, epilepsy can also have significant repercussions on an individual’s ability to work, provide for a dependent family, and their ability to live a normal life. <BR /> <BR />Epilepsy is not a single condition; there are over 40 types of epilepsy, consisting of at least 29 syndromes and a further 12 or so clinically distinct groups, defined by the specific cause or underlying cause. Estimates by the Health and Social Care Board indicate that there are between 7,000 and 9,500 people living with epilepsy. It is, of course, fundamentally important that they receive the care and support that they need to lead an active and normal life.”
“I thank the Member for proposing the motion, which provides us with the opportunity to consider the services provided to those living with epilepsy. I thank all those who made considered and valuable contributions throughout the debate. <BR /> <BR />Like others, I start by recognising the work of the all-party group on epilepsy, as it has shown a clear commitment to highlighting the needs of epilepsy patients. I would like to put on record my appreciation of the valuable contribution that Epilepsy Action makes in our bid to improve the lives of epilepsy sufferers. <BR /> <BR />I also want to pay tribute to the hard-working epilepsy nurses, consultants and all the Health and Social Care staff who play such a vital role in the delivery of epilepsy care in hospitals and in the local community.”
“That is what I look forward to debating time and time again, I am quite sure, with all Members. I encourage Members to contact me and talk to me about how they feel we should be transforming health and social care. We have a really good opportunity to get it right, and it is so important that we do so.”
“It is important that we provide clarity as soon as possible to give residents and the people who work in care homes the information that they need. <BR /> <BR />As I said, I welcome the debate, and I will pick up on any issues that Members feel I have not responded to. The one thing I would say is that transformation and reconfiguration will not be easy. It is going to require difficult decisions, and it is going to require us all to be really serious about delivering better outcomes for individuals. That is what it has to be about. It cannot be about being wedded to buildings. It has to be about how we, as an Executive, can deliver the best possible outcomes for individuals.”
“I wonder about the expectations around the Bengoa report. He is looking at the whole system. You will remember the principles that your party also signed up to. It is about reform and the fact that we have major systems challenges in health and social care. Professor Bengoa is not looking at every individual care home or hospital site, nor is he looking at what should be done in every GP practice. He will be looking at the holistic picture of health and social care and how we need to transform it. <BR /> <BR />Professor Bengoa is not involved in where we are going with residential care homes. A big body of work has already been done in relation to that. I am considering that report from the board alongside talking to my officials.”
“In the independent sector, they often do not get transport costs, which causes problems and takes their take-home pay even further down. We need to focus on those areas. <BR /> <BR />I will give way to the Member.”
“Let me just run through the issues. <BR /> <BR />You raised the issue of Rathlin. As far as I am aware, there is 24-hour, seven days a week nursing cover on Rathlin. If there are particular concerns about Rathlin, I encourage you to contact me after the debate has concluded, and I am happy to pick that up. <BR /> <BR />It is so important that we review how we support older people. In the immediate future, I intend to look at a review of social care services and how we support older people. It is not good enough that trusts do not have enough people in-house to provide domiciliary care packages. Trusts are also having real difficulties in recruiting people from the independent sector. During Question Time last week, I talked about some of those challenges. Domiciliary care workers are the lowest paid people in the health service.”
“<BR /> <BR />In relation to the Roddens and residential care homes in North Antrim — Members will be aware of this — following confirmation that Four Seasons Health Care was proposing to close seven of its care homes, my predecessor asked the Health and Social Care Board to halt the review and the current process examining the future role and functions of residential care homes as a precautionary measure. I have now received information from the board on the outcome of the review, and I am considering it along with advice from my officials. I have yet to make a final decision on the future of statutory residential care homes, but I will ensure that the right care services are available for patients. You can be assured that that will remain a priority for me.”
“In September 2015, the Department approved the strategic outline case for the expansion of renal services. The proposal is to establish a medical-led satellite unit in the Causeway Hospital, which will provide renal services for up to 50 patients. The estimated capital cost of the project is around £3 million. The Northern Trust is developing the associated outline business case, and, following submission for approval by the Department, the project will be considered alongside other capital projects in the HSC trust's capital priorities.”
“Ultimately, if we continue to do that, it is patients who will suffer. For me, that goes beyond trusts and hospitals: it is about the radical transformation of health and social care. We should be under no illusion whatsoever that it is absolutely necessary to safeguard our HSC for this and future generations. <BR /> <BR />I received the expert panel’s report earlier in the summer and am taking my time to consider fully all its recommendations and implications. As I said, I will publish, in the immediate future, not only the panel's report but my plans for reforming the HSC. <BR /> <BR />Members mentioned a number of issues. As I said, if I have not picked up on all of them, I will read Hansard and am happy to respond in writing. The renal unit was mentioned and where we are with that.”
“<BR /> <BR />Many Members referred to Professor Bengoa's work and the expert panel that set out to look at the current configuration of services regionally and to provide advice on a new delivery model for HSC services. In the immediate future, I intend to bring that work to the Executive, the Health Committee and the House. As part of that work, Professor Bengoa and his colleagues engaged with all the main parties represented here, all of which contributed today, and the case for change and agreeing a vision and set of principles that would underpin reform was set out and agreed. <BR /> <BR />For us in the Chamber, it is about all of us recognising the need to transform the way in which we deliver health and social care services right across the North. We cannot keep doing things in the same way and expecting different outcomes.”
“That model avoids hospitalisation and institutional care, and supports prompt discharge when acute intervention is needed. We should be clear that these are the services that patients need. <BR /> <BR />The trust has no plans to move away from the two acute hospital site model currently in place. Acute services are delivered from Causeway and Antrim. Those hospitals work collaboratively and network with other acute services, particularly in Belfast and the west. <BR /> <BR />Local hospitals will continue to play an important role in that network, but, at the same time, we must work to deliver services through a modern efficient network that is well placed to take advantage of the advances in medical science and patient care, which will no doubt continue to be made through the 21st century. Our people deserve no less than that.”
“It is a model that supports people to live independently, with home as a first choice, and outside the home being in accessible, locality-based facilities.”
“<BR /> <BR />The Northern Trust has certainly not been immune to the challenges facing the wider system, and it would be foolish to think that there are any simple solutions. However, the trust is already engaged and working with communities to develop and improve the services that it provides for patients. I welcome the positive commentary that some Members made about that ongoing piece of work. The trust used the turnaround and support team to provide a strong foundation for the five-year reform and modernisation programme, which is under way. <BR /> <BR />The model for services in the Causeway locality has a strong emphasis on integrated, locality-based community services delivered in partnership.”
“Despite the scale of the challenges that it faces, the trust is working hard and is focused on the task in hand, which is to deliver high-quality, safe and effective care in the most efficient manner possible. However, we need to accept and acknowledge the very real pressures facing health and social care services right across the North in general terms, although those are obviously also relevant to the Northern Trust. They include a rise in chronic conditions, driven by our ageing population and unhealthy lifestyle habits; an increased demand and over-reliance on hospital services; growing expectations of our population and fast-moving opportunities in technology and medical interventions; workforce challenges; and the ongoing financial challenges.”
“<BR /> <BR />It is important to set the context for what care the Northern Trust delivers on a day-to-day basis and the environment in which it operates. The Northern Trust area has a population of just under 440,000, which is the largest resident population in the North. In common with the rest of the North, the demand for health and social care in the trust area grows annually by approximately 6%. That includes demographic growth, resulting in a higher number of older people with complex health needs and co-morbidities and in increased referrals. <BR /> <BR />In 2015-16, the trust had 44,944 people admitted to hospital care and 46,752 day cases. Every year, the trust and partners in the independent sector provide millions of hours of domiciliary care.”
“We can all agree that we need to invest in people, in our workforce and in the future, and, over the next number of weeks, in response to the Bengoa piece, I will articulate the way in which we do that. I will pick up on some of the particular issues raised about care homes and the renal unit, as well as other points. <BR /> <BR />I will start, however, by recognising, like others did, the work of the trust and its staff for their service and commitment to the delivery of high-quality health services. Like Mr Storey, who secured today's debate, I pay tribute to the hard-working staff in the hospitals and those delivering health and social care services in the community for their service to the local community and their commitment to delivering high-quality health services.”
“I thank the Member for proposing the topic for the Adjournment debate. I have been very impressed by the considered and valuable contributions that everybody made throughout the discussion. I will attempt to address all the points raised, but, if I do not pick up on something, I will be very happy to write to Members to provide confirmation. <BR /> <BR />Everybody can agree on where we need to go with healthcare, particularly when it comes to the points raised about early intervention, prevention, tackling health inequalities and making sure that we have fit-for-purpose care packages in place. We need to look seriously at social care and at what we are doing on that end of health and social care.”
“I am quite sure that they can, but I will clarify that. I cannot see any reason why that would be a problem.”
“It is important not to just focus on the negatives. Whilst we have to address the challenges that are there, we should also sing really loud about what is excellent in health and social care services.”
“OK, yes, I am happy to take it away, give it some consideration and see if there is a way. I totally support everything that you said about what Action Cancer does. It is absolutely amazing and reaches so many women. If I can be part of supporting that work, it will help me to deliver better outcomes for patients. That is something that we all want to work together on. <BR /> <BR />Actually, breast cancer survival rates here are excellent. We are leading the way, and we can be very proud of that. Quite often when we talk about health and social care everybody focuses on the negatives. It is sometimes important for us to sing loud about the good things that happen. There are many good things. There are many staff on the ground who provide excellent services and deliver better outcomes for people.”
“<BR /> <BR />In the longer term, there is a need to have a sustainable breast service in place across the North to make sure that patients are seen within the timescales that have been set out — the recommended 14 days. That is vital. That is when we can say that what we are doing is excellent.”
“Absolutely; I think that it is invaluable. What it does is amazing. It gets out, is on the ground, is in communities and meets people, and I think that that is really important. <BR /> <BR />The performance on breast cancer in the Belfast Trust is improving. The latest stats from July indicate that 87% of patients were seen within 14 days, but we obviously want to meet the target, which is 100% of patients being seen within 14 days. It is an extremely worrying time for a woman who has been referred and needs to be assessed. There are a number of particular challenges in the Belfast Trust around radiologists and staff vacancies, and the trust is working on those to secure additional capacity to be able to deal with the cases that are referred.”
“I do not have any details in relation to that. There is nothing on my desk that suggests that there is anything in particular for me to be worried about. I suppose that I will look into it and respond to the Member in writing, but I do not have any detail with me on any particular challenges or problems.”
“We have to seriously transform how we deliver health and social care so that we do not have people who, quite frankly, sometimes present at A&E because they cannot get a GP appointment or have ongoing conditions and are on waiting lists to be seen.”
“Obviously, the Belfast Trust leads on providing adequate services. It comes back to the conversation that runs through every question that I have answered today. We have to transform how we do things if we are to make sure that we have better outcomes for people and make sure that people are not sitting in A&E for a very long time. We have a lot of work to do on awareness and why people present in A&E in the first place. Is it the most appropriate place for them to go? Should they be at the minor injuries unit? We need to look at all those things in the round. <BR /> <BR />Belfast A&Es are obviously extremely busy. The staff there do excellent work and are very much challenged day and daily.”
“It will also enable people to understand and take ownership of the process.”
“It is significant that we develop shared aims and a shared approach to how we bring forward transformation because transformation will mean change. It is so important that people understand why we are making changes and understand that it is not always about saving money but is genuinely about creating better outcomes for people. I think that the best way to do that is to make sure that there is wholesome engagement with the workforce at every level. I intend to host the first meeting of the health partnership forum, which will bring together all the leaders across the Department and all the leaders from the trade union representation. That will be a major piece of work that is vital for me, particularly in trying to bring forward the transformation and to enable people to understand that we are doing it for the best reasons.”
“It is so important, more so than ever before, that we continue to engage with trade unions, and it is so significantly important now given that we are about to embark on a process of transformation. I always say this genuinely and most people in the House will share the same sentiment: the best asset that we have in the health service is the workforce. It is so important that they are given ownership of the changes that we are trying to make and so important that they feel that they are listened to, because they are on the front line delivering services. <BR /> <BR />I recently established a new health partnership forum and I will personally chair the first meeting. This shows that I am really serious about engaging with trade union side.”
“Yes, since I have taken up the post of Health Minister, I have made it very clear that I want to listen to and hear the views from the grass roots. Where I can, I want to make changes that reflect those ideas. I have had a number of meetings with trade unions since coming into office and have further introductory meetings lined up over the coming months to ensure that I have an opportunity to hear from all the staff representative bodies.”
“I thank the Member for her comments and I will certainly take them on board. There appears to be growing demand for a comprehensive strategy, and, as I said, I have not ruled it out. Officials are currently engaged in a round of discussions with the community and voluntary sector and with the major charities that provide brilliant support and research. We are determining if any support could be provided from the community and voluntary sector if we decide that we need to progress a review here. I have not ruled it out and am certainly still open to the idea, but let us do a bit more homework on it.”
“Meeting the challenges posed by cancer is a priority for me and will continue to be one of the highest priorities. I think we have made great strides in tackling cancer and there has been significant progress in the past decade since the cancer centre in Belfast City Hospital opened. We need to continue to drive forward continual progress, and I and my Department are committed to working in partnership with others to provide the best cancer services that we can. The issue of a comprehensive cancer strategy has been raised with me and I am giving it some consideration. I attended an event that the Chair of the Committee hosted a few months ago, and I said that I would give it due consideration.”
“In those circumstances, the trust continues to use contingency measures, which may require consolidating resources in the out of hours bases where patient demand is greatest. Patient safety has to be first and foremost in all those circumstances, and the trust takes that into account. <BR /> <BR />The Southern Trust also recently took a number of actions to support the out of hours service; for example, the introduction of nurse practitioners, clinical pharmacists to support GPs in managing the service, ongoing recruitment campaigns for GPs, the provision of additional funding to boost capacity at busy times, and supporting flexible shift hours and bases to work from. A body of work is being done, but there have clearly been particular challenges in the Southern Trust.”
“The Southern Health and Social Care Trust has been facing significant challenges in the provision of the out of hours service. As with the other out of hours providers, there is a number of reasons for that, including difficulties in recruiting and retaining GPs to maintain the provision. The Southern Health and Social Care Trust provides GP out of hours services from five bases: Armagh, Craigavon, Dungannon, Newry and Kilkeel. This configuration is intended to ensure that the vast majority of residents in that trust area have access to an out of hours base should a face-to-face appointment be required. There have been occasions when the Southern Trust has had an insufficient number of GPs and other staff available to deliver out of hours services from all of those five bases.”
“GP services and out of hours services are under significant pressure. The Department and the Health and Social Care Board have been working with out of hours providers right across the North to try to address the challenges that are facing the service. In 2015-16, an additional £3·1 million was made available to help build capacity in GP out of hours services, with a further £1·1 million made available to help out of hours providers meet the increased demand for services over winter months and the Easter period. There are significant challenges that we need to continually review and work our way through.”
“If we want to provide better outcomes, support people closer to home and allow older people to stay in their homes and not have the need for residential care etc, we should be supporting the workforce to be there to do it all. That is certainly where I want to go. That is the direction of travel that I intend to take in making sure that we support domiciliary care workers, which, in turn, will obviously benefit the patient.”