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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“Yes, absolutely. That is going to be key. All the trusts employ so many domiciliary care workers in-house who are paid directly by the trust. They will also buy in so much domiciliary care service from the independent sector. That is not a good enough position. I want to see trusts employing more people in-house. Domiciliary care workers are the lowest-paid workers in the health service. Quite often, those who work for the independent sector will not get travel costs. They are expected to go onto every rural and country road to go and see people who need their support, but they are expected to do that without any mileage payment. That is not acceptable.”
“Yes. I have said that I am going to use the piece of work done by the expert panel as a foundation to drive forward the transformation. We have to look at everything. The focus has always been on the acute end of things and the acute services. We have to tackle the root causes of why people get sick. We have to be real about investment in primary care, and domiciliary care workers are obviously part of primary care. There are particular challenges around trying to recruit people to work in domiciliary care in rural areas. Hospital backlogs are created because people cannot be discharged from hospital because there is no care package in place. These are the things that we seriously need to address. The expert panel's work and my response to it, and my vision of transformation, will address how we are going to deal with social care.”
“The Finance Minister could give me millions upon millions of pounds tomorrow, but I would not be prepared to invest that money to keep doing things the way we have been. <BR /> <BR />We need proper transformation, and we need real transformation. That will be my priority as Minister of Health. We have to deliver better outcomes, and the only way we will do that is through such real and meaningful transformation. As I said, I look forward to all the parties in the House supporting me in that transformation and taking the difficult decisions that need to be made. That is the only way we will deliver better outcomes and the only way we can deliver to time frames that make sure that people do not wait ridiculous lengths of time for treatment and assessment. That will be a priority. I have set out many times how I intend to do that.”
“Yes, I am. I am aware of many such people, even in my constituency. People turn that way because they cannot get access as quickly as they would like. That is why we have to transform how we deliver health and social care. Whilst there has been plenty of talk about it in the past, and report after report has pointed to the challenges in the health and social care system, we need real action and we need to deliver transformation. That is what I am committed to doing. I have set out my stall on how we need to deliver in the short term and the medium term, but the longer-term picture is about changing how we deliver services. We have to be real about delivering better outcomes for people, and the only way we will do that is to stop doing things the way we are doing them and to stop getting caught up in the black hole that is health.”
“The present situation cannot continue, as all parties recognised when they signed up to the principles in Professor Bengoa's report when he set out on his work with the expert panel. <BR /> <BR />If you look at all the factors that led to why we are in this situation, you will see that waiting lists are absolutely, 100%, totally unacceptable. We need to rectify that problem. I will certainly do that, and I have set out on a number of occasions to the House how I intend to do it in the short term, the medium term and the longer term.”
“There are a number of factors. We have an ageing population; people are living longer with more complex needs so need more supports. Individuals and patients' expectations have risen, and rightly so, and the demand for services is greater. If you refer to the question on autism and look at the numbers referred for assessment, you will see the rising demand for our health service. <BR /> <BR />The numbers also very clearly point to the reason why we need to transform Health and Social Care. We cannot keep doing things the same way and expect a different outcome. The only way we will be able to seriously address the issues and make the necessary investments is by reforming how we do things.”
“<BR /> <BR />I am considering the expert panel's report, which makes very clear the need for change. I look forward to setting out my vision for Health and Social Care over the next number of weeks. That will include elective care waiting times. The health service here will continue to do its utmost within the resources it has available to ensure that the clinical needs of patients are met, patient safety is maintained and patients do not wait any longer than they have to.”
“To be able to deliver sustainable improvements in waiting times, we must take action that addresses the root causes of the problem. Short-term measures to address immediate pressures will, on their own, not be enough. Unfortunately, there is no quick fix. The position that I inherited in May was one of continuing deterioration in waiting times. It is just one of many challenges facing the health service here, and the need for change is very clear. As I said before, I will need time and new investment to deliver the radical change necessary to deliver sustained, long-term improvement. As I also said before, my policy will be to adopt a balanced approach to taking further short-term action when funding is available, combined with longer-term change.”
“The latest provisional figures for outpatients waiting longer than 52 weeks for their first consultant-led appointment show that, at 31 July 2016, the most recent figures available to me, there were 19,849 patients waiting in the Belfast Health and Social Care Trust, 1,698 patients in the Northern Trust, 4,689 patients in the South Eastern Trust, 3,278 patients in the Southern Trust and 4,104 patients in the Western Trust. <BR /> <BR />I wish to reiterate that tackling excessive waiting times is high on my agenda for delivering improvements in the health service. I want to assure patients and their families again that long waiting times are completely unacceptable to me and I that understand the worry and stress that people feel when they are waiting to hear when they will be seen.”
“Yes, absolutely. We will take all that into consideration. It is important that we support that. There has been a lot of media focus and attention on kinship recently, and it is so important. The family support network is key, so it will all be considered.”
“Absolutely; that is what the strategy will be about. There will, obviously, be a cost factor associated with the strategy, but as I said, when I engaged with the group of children in care, they clearly set out the changes that they feel need to happen. I agree with them, but I have also committed to them that we will put proper legislation in place that will allow all those things to happen speedily. There should not be any delays in processes and in making sure that people are placed in proper homes and given every support possible. The facts speak for themselves when it comes to educational attainment, health outcomes, potential mental health problems and all those things that we know are relevant to children in care. It is so important that we support these young people on their life journey.”
“Yes, I intend to bring forward an Adoption and Children Bill. I have said publicly that I intend to bring a Bill to the Executive and put it out for consultation to make sure that we have the most efficient and robust possible legislation in place to support children who find themselves in that situation. The Bill will strengthen support mechanisms for those who are involved in adoption. I am keen to get Executive endorsement for that, and I will do that over the coming weeks.”
“Yes, I am very happy to do that. As I told the group of children that I met, they may be small in number but they are a high priority for the Executive and we want to deliver better outcomes for them, whether in health or in education or just in their feeling comfortable in their home environment. It is important that we talk to them. They clearly articulated to me what they feel needs to happen with services and how we support them. I am keen to continue that engagement, and, as I said, I have asked trusts to consider some sort of formal mechanism whereby they can engage with children in care in their areas. I am also going to try to provide an opportunity in the Assembly for MLAs to engage with children who find themselves in care.”
“I look forward to working with the Executive and the Assembly to support families in the North to stay together and to ensure that, when we make decisions to take children into care, we provide a system of care that nurtures them, acts in their best interests at all times and secures the best possible outcomes for them.”
“For example, I have invested £500,000 to extend the Going the Extra Mile scheme to more young people in foster care to enable them to remain with their supported family until they reach the age of 21. I have also invested an additional £2 million in fostering services in response to service pressures and a further £150,000 to enhance therapeutic support for looked-after children, particularly those who have suffered or been exposed to trauma. <BR /> <BR />I thank the Member for his interest in the issue of looked-after children and recommend that other Members show a similar interest.”
“Some of that will be done directly through me. I have already met a group of looked-after children in my time in office, and I am committed to ongoing engagement. I am also committed to providing Members with the opportunity to engage directly with looked-after children, and I am considering how that can be done to best effect. In their role as corporate parents, I have asked all five trusts to consider establishing formal engagement mechanisms to facilitate direct engagement with looked-after children in their area. <BR /> <BR />I accept that a looked-after children strategy may require some additional investment, either to test new ways of working or to extend existing supports available to looked-after children. I have already made a number of new investments.”
“To deliver on the Programme for Government commitment, and in the context of the Executive's wider children's strategy, my Department is developing a strategy that is specific to looked-after children. The LAC strategy will be reinforced by a family support strategy, also being developed by my Department. Both strategies are being developed on a co-design basis, and we intend to consult on a draft LAC strategy and supporting action plan early next year. Where legislation is required to deliver any of our strategic aims for looked-after children, that will be done by way of an Adoption and Children Bill. I have already made public my intention to bring forward a Bill in the current mandate. <BR /> <BR />I want to ensure that looked-after children are given the opportunity to shape the strategy.”
“I want a care system in which fewer children need to become looked after, in which quicker decisions are made about where they will live permanently and in which there are improved outcomes for each and every child in every area of their life, including physical, mental and emotional health and well-being and educational attainment. I also want to ensure that everything possible is done to secure their successful transition into adult life. <BR /> <BR />It is a commitment that I cannot deliver alone. I will need the help of the wider Executive, which, as is reflected in the draft Programme for Government, have also agreed to improve support for looked-after children.”
“The term "looked-after children" (LAC) refers to a diverse group that varies in age, the reason for being looked after, the age of first entry into the care system and the duration in care. Although some looked-after children and young people can go on to enjoy success, as a group, outcomes, including health and education outcomes, tend to fall significantly below those of the general population. <BR /> <BR />In my term as Health Minister, I am determined to give those children and young people the priority that they deserve, in keeping with my duties as their corporate parent.”
“<BR /> <BR />There was and is good progress being made with the £2 million that was invested, but we have not got there yet — far from it, when you look at that waiting list. The Belfast Trust's share of the £2 million was £418,940, which paid for a range of things, including staff overtime, but that is not a sustainable approach. We have to recruit. We have to make sure that we have ongoing recruitment and a proper workforce that can deliver the assessments that need to happen. I will continue to monitor the progress being made, but we seriously have a way to go. When I met Autism NI the other day, I committed to working more with the community and voluntary sector on the work that it does.”
“As I said earlier, the prevalence of autism in the school-age population is continuing to increase. If you compare the figures that I talked about and look at this year alone, you will see that there has been a 17% increase in the number of referrals for assessment. That is testimony to the work being done to raise awareness, with the result that people are more alert to the fact that autism exists and that they are entitled to get a referral for assessment. When you look at it, you can see that that in itself creates a demand for services. It is so important that we continue to review the strategy, make sure that we are fit for purpose and meet the need that is there.”
“What I believe we need to do is to keep the strategy continually under review. It is important that it be cross-departmental in nature and has an action plan. In partnership with stakeholders and people out there who are involved with families and carers day and daily, we need to plug the gaps that are there. The way in which that can be done is by informing ourselves of the views of people with autism and those of their families, their carers and the community and voluntary groups that work with the sector.”
“I thank the Member for her question. As I said, there is a strategy in place that creates a statutory obligation to prepare, review and monitor the implementation of a cross-departmental strategy. That came about as a result of the Autism Act 2011. There are a number of themes right across the strategy, all of which are very relevant. We can all point to really good examples of things that have happened as a result of the strategy. We have more autism training for front-line staff, education professionals and youth workers. We have one-stop shops developed by the Northern Trust and Belfast Trust for adults to obtain employment and careers advice. Adjustments have been made to the theory and practical driving tests. We can point to a number of things as good examples.”
“We had the additional investment of £2 million right across all the trusts to try to deal with the backlogs that are there. <BR /> <BR />I would never stand here and say that it is acceptable that someone should have to wait that length of time. All I can say to that parent is that I will work night and day — I have done for the four months since I came into post — to make sure that I transform health and social care to deliver better outcomes for that child and every other child who needs health and social care.”
“It is unacceptable that she has to wait that long. It is totally unacceptable that anybody has to wait that length of time, particularly for children to be referred for assessment in the first place, so that we can put a proper package in place to support them. I would not stand here for one minute — never, ever — and defend that type of waiting list, whether for autism services or any other supports for people who need health and social care. That is why we have to transform health and social care. We cannot keep doing things the way we are doing them. That is why we need to move forward with the transformation piece. I look forward to engaging with all the parties in the House about how we seriously engage on how we will transform the delivery of health and social care services.”
“Look at the prevalence of autism over the last number of years: it has risen from 1·2% of the school-age population right up to 2·3% this year. That shows that there is obviously a growing demand. That is testimony to the great work that has been done on raising awareness. Families know that they can be referred, and they are seeking referral for assessment. That is really important. <BR /> <BR />The fact that we have a rise in the demand for autism services and supports means that we need to be continually tailoring the supports that are on offer. We have the autism strategy and plan in place, and they obviously need to be continually reviewed to make sure that we have services that are fit for purpose and meet the needs, in as timely a manner as possible, of all the children who need to be referred for assessment.”
“I thank the Member for that question. I totally agree with her. We can see that the situation in the Belfast Trust is obviously worse when it is compared with other trusts; there are particular issues there. I have set out how the trust itself intends to deliver. We need to move to the point where we are looking at a more regional service and a regional model approach. That would provide consistency across the board, not just for autism but for other disabilities. That will be key. I will keep a close eye on investment in the Belfast Trust and how it is trying to address the problems. <BR /> <BR />The fact that we have so many more people coming forward for referral shows that there is a lot of awareness now about autism.”
“Further, a recruitment process is currently under way to fill six new posts that, when complete, will substantially improve waiting list management in the Belfast Trust. However, sustained improvements will require substantial reform. Therefore, in parallel to the actions that I have just set out, the HSC Board is also in the process of agreeing with the trusts a new regional model for autism services to improve both the diagnostic process and access to early intervention in line with current best practice and along with NICE guidelines. That new model will optimise the scope for the integration of child development, emotional and mental health services, as well as working more closely with the education sector, to ensure that the provision of coordinated and appropriate support for children with autism is in place.”
“All referrals to trusts for an autism assessment are prioritised on the basis of clinical need, not educational status. However, I am fully aware of the current waiting list position in the Belfast Trust and can assure the member that action is being taken to tackle the issue utilising the £2 million additional investment made available to all trusts from 1 April 2016. To be clear, I am committing to getting those waiting lists down and ensuring that children and young people are assessed as quickly as possible. In the immediate term, additional capacity for assessments has been secured from additional hours and overtime clinics. In addition, arrangements are being developed for the assessment of children in the Belfast Trust to be undertaken by other trusts.”
“We have to improve things for people with a learning disability, and the only way we can do that is proper communication. It is also about delivering and designing services and supports that actually meet the needs of people with learning disabilities, and I am very committed to making sure that in transforming and going forward we co-design all the services that are delivered for all those out there who need to avail themselves of health and social care.”
“The Member is probably aware that I have already met families, and I will continue to engage with families. It is a fact — I have met families and will continue to. I have received representations from many of the elected representatives in West Tyrone, you included, and I am happy to keep engaging to make sure that we put out the facts. I do not think that it is helpful to scaremonger. I think that there is a recognition right across the board that there is a problem — a problem that needs to be addressed. I will not be found wanting in my role in addressing that. I will not be found wanting in my role of holding the trust to account and making sure that it properly engages with families. Even when we quantify the figure, in going forward we have to make services better.”
“We certainly have a way to go in building up trust, but I am committed to making sure that I play my role as Minister to make sure that happens.”
“<BR /> <BR />We need to get to the bottom of the figure so people can quantify the amount of money and how long this underspend has been going on. We will get there. The board is actively working its way through that, but it is a difficult process. I am assured that we will get there. I will not stand behind; I will be very forthright in publishing that figure and making sure that families are aware of the figure. I will also be very sure to make strong guarantees about the investment of an additional £3 million that has been put in place to improve the picture. I do not want to wait until we have the final figure; I do not want to wait until that work is done. I want to make sure that we are already actively working on the ground and making changes. That is happening.”
“I thank the Member for his tone and his question. As I said to him in the Adjournment debate that he brought to the House, in my first couple of days in office, when the issue was brought to my attention, I very clearly involved myself with the issue. I have continued to push the trust around what it is doing, particularly around engagement with families, because that is key. There is such a big breakdown in trust here over many years that needs to be addressed. I want to make sure that I hold the trust to account in terms of what it is doing. In the last number of weeks, after speaking to families, I have again instructed it to look at how it engages with families. I do not think that it has gone far enough. Families are telling me that, so I want to address that.”
“I have set out how the trust has been instructed to engage better, and I have written again to the chief executive in the last number of weeks because, in my experience and in my conversations with families, they do not feel that it has gone far enough. I am OK to take that on board and to engage with the trust to make sure that that happens. We need full transparency, trust to be built up again and proper supports on the ground. That is more important to families than trying to score petty political points off other Ministers.”
“— for all those people right across the Western Trust area, and I have set out how I have done and will do that. The amount of underspend, which goes back for many years, needs to be property quantified. I have always said that. I said it in June. Work is going on in the board to make sure that that happens. <BR /> <BR />It is important that we do not throw more flame on the fire by trying to make headlines around figures. If it is £8 million, let us get to the bottom of it and address what has happened in the past. That is the work that I have been involved in. I have very clearly set out my stall by supporting the families in the Western Trust area.”
“OK. I think that I did answer the question. Perhaps the Member was not listening. I very clearly set out what is happening across the trust. I very clearly set out that I took this up in my early days in office as a priority issue that I was concerned about. I very clearly set out how I have instructed the trust to engage better with families and carers. That is key for moving forward. There has been a breakdown of trust in the area, and that is totally unacceptable from the families and carers' point of view. <BR /> <BR />As we move forward, families are more interested in our finding a resolution to the issue than standing up and trying to do a bit of circus antics in the Chamber. It is far more important that I deliver better services —”
“I am committed to working with the trust and others to ensure that the right services are in place, and I will continue to pay close attention to the progress that the trust is making.”
“While I think that we can all agree that all this progression is welcome, we cannot be complacent, and I have made clear my expectation that more needs to be done. A continuing commitment is required right across the system to ensure that we are delivering the right services for people with a learning disability and their families. Therefore, the trust will continue to develop a plan for further investments, working closely with the families and local representatives. <BR /> <BR />As I made clear during the Adjournment debate in June, and as these recent investments now demonstrate, I will not be found wanting in my support for people with a learning disability and their families.”
“In the immediate term, some £3 million is being invested to secure additional professional and support staff to enhance the community infrastructure in the Western Trust area and to address the priority needs of those transitioning into adult services by, among other things, increasing the day opportunities and day centre support. <BR /> <BR />In addition, I understand that the trust intends to develop an awareness programme and education sessions for families to continue to engage with MLAs and others as it progresses this crucial work. <BR /> <BR />I have also been assured that the trust will review how it communicates progress to all families affected, and this is something that I will continue to monitor very closely.”
“Since I first became aware of the issue, I have been closely monitoring the actions of the Western Trust, in particular its engagement with families and carers. Indeed, I wrote recently to the chief executive of the trust to make clear the seriousness with which I take the concerns that have been expressed to me by families and carers and to underline the need to restore confidence by resolving the issue in a robust and transparent way. <BR /> <BR />While work to determine the extent of any underspend is ongoing, it is clear to all of us that urgent action is necessary in the shorter term. As part of this, the Western Trust has taken a number of steps to begin to address the issue, which include the development, in partnership with families, of a phased investment plan in adult learning disability services.”
“People still do not seem to be getting the answers that they need. Obviously, the trust is not communicating properly with people. I look forward to taking that forward, and I assure the House and those who are impacted that I will not be found wanting in my support for people with a learning disability.”
“I have a very short time. I take the opportunity to thank those working across the five trusts for the high-quality care they provide, because, whilst we have identified a problem and something that needs to be seriously addressed — I recognise that — it is important that we acknowledge that there are excellent healthcare staff who work hard, day and daily, to support people who need services and support. I wanted to put that on record. <BR /> <BR />The clear message that I want to send to the families and carers is that I take this issue seriously, I am listening to your concerns, I will engage with you in person and I will give due consideration to the report from the trust. Having listened to all the comments around the Chamber today, I think that people still do not understand the problem.”
“<BR /> <BR />In conclusion, I think that many will agree that, whilst it is absolutely right that the Chamber gives a voice to people with real issues that need to be addressed, like the Western Trust issue that we have just debated, I should put it on the record that we must not forget to recognise the good work that goes on in the health and social care system and acknowledge the staff who work tirelessly to make sure that there are proper opportunities and support for people who are more vulnerable, particularly those with learning disabilities.”
“It is the people behind the headlines, the people with learning disabilities and their families whom we need to reassure and support going forward. That is why, as I said last week in the Chamber, I have sought an explanation from the trust of its handling of the issue to date. I am considering the trust's response. It is also why I will meet some of the families later this week. At that meeting, I look forward to hearing at first hand their views and concerns, which will, obviously, help to inform any future action I may take in relation to the issue.”
“<BR /> <BR />I have been in post for four weeks. I want to transform the health and social care system, and I want to get to a point where we adequately address the needs of people with learning disabilities and those who are more vulnerable in society. I want to see a changing picture in which we have real investment to provide real opportunities for people who have learning disabilities and provide real support for those who have caring responsibilities. That is when we will be truly judged on delivery. I want to get us to that point, and I look forward to engaging with Members on how we get there. <BR /> <BR />Going back to the issue that we are dealing with today, I hope that it is clear from my remarks that I take the issue very seriously.”
“That is a testimony to the people that they are. <BR /> <BR />A lot of questions have been asked today around responsibilities and who does what. Whilst, ultimately, spending decisions at a local level are for trusts to make, I will closely monitor the trust’s progress to ensure that it is focused on delivering solutions that take account of what families and carers say. <BR /> <BR />It will come as no surprise to the Assembly when I say that there are obvious and real budgetary constraints facing the health and social care system. They are such that it is incumbent on all parts of the system to ensure that the resources that we have are prioritised to meet the needs of our communities. That, no doubt, will be a key factor in the work that the trust is doing now, together with the board, to resolve this issue.”
“I was disappointed to hear some of the evidence suggesting that the trust has still not learned its lesson and is still not engaging properly with families. I will make sure that I take that on board and relay it to the trust to make sure that there is proper and real engagement. <BR /> <BR />Going forward, the plan will set out how the trust intends to address the gap. That is, obviously, something that families want to know about and be involved in. Again, that aspect of the plan must be fully communicated to the families, who, I am aware, have raised concerns about the implications of redressing any imbalance for other programmes of care. This is a group of people who feel they have been wronged by the trust, but they are concerned about the implications for other people who may need health and social care services.”
“I want to be very clear to the families who may be listening to the debate, and I do not want to cause any more angst for people who are already extremely concerned and angered by what they have seen unfolding over a number of years. I absolutely understand why families are anxious to know the actual figures involved. That is why my focus is on ensuring that they are fully engaged in the development of the plan going forward. The Western Trust is now working urgently, with the support of the HSC Board, to robustly and accurately quantify the spending gap that has occurred. The provision of that information and clarity is important, so that we know the scale of the problem that we are dealing with. <BR /> <BR />I have also listened to Members refer to the need for real engagement with families and carers.”
“As I said in the Chamber last week in response, I think, to Ross Hussey at Question Time, it was the level of concern expressed by family members in my first week in office that prompted me to seek an urgent briefing from my officials. That confirmed that the problem concerning the funding of adult learning disability services in the Western Trust was historical, and Members have referred to that today. <BR /> <BR />I am aware that a figure of £8 million has been discussed and quoted widely in recent weeks as being the amount of underspend that the trust needs to address. Members have referred to other figures today, and it is important to state that we do not have the figure in the information that we have. I have heard some people saying that the issue may go back over 20 years, so we could be looking at an even larger figure.”