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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“From the start, like other Members, I want to recognise that I believe that the issue has been badly handled. Families and carers deserve answers, and that will certainly be my job as I look at the information in front of me. All Members have spoken passionately about the real face of the issue and the challenges for those who care for a loved one with a learning disability. It is important that we discuss the issue, and it is right and proper that it has given rise to a great deal of concern across all the political parties, families and communities in the Western Trust area. <BR /> <BR />Before I address the points made during the debate, I want to assure all the families that I share their concerns and that my priority is to ensure that their voices continue to be heard and listened to, as the trust seeks to resolve the issue.”
“I want to work with them to improve the picture and the services that we provide for people who have mental health problems. We can do an awful lot more. Collectively we have a great opportunity for the transformation of the health and social care system, and the fact that we now have a Programme for Government that is very outcomes-focused means that we can make things better for those who have mental illness.”
“I am open to considering the benefits of the appointment of an independent mental health champion who would defend the rights and interests of people with mental health problems and educate, raise awareness and reduce the stigma associated with mental illness. There is a need, however, to explore all the options for fulfilling the role, taking into consideration the existing good practice across the HSC. All of that, as I said, will be considered in line with the Bamford evaluation report. I will receive a draft of that over the summer. Thereafter, my priorities for the future development of mental health services will be to address the gaps in service with the full involvement of mental health service users and carers. <BR /> <BR />I thank Members for the tone of the debate.”
“For me, it was a practical example of how to do things differently. A lot of the charity and voluntary groups had never worked together before, but they really came together. I know that the Member who moved the motion was at the same event. It was clear that there was a willingness in the sector to work together and be more collaborative in how we support people. We need to look at all of those things. I certainly do not have a closed mind to the idea of a champion, but we need to give the proposal a bit more attention and to factor in the fact that we will have the evaluation of the review. <BR /> <BR />I have made it clear during my tenure that one of my main priorities will be to champion mental health. In that sense, I am honoured to be the Executive's mental health champion.”
“The Health and Social Care Board is also developing options for a co-production mental health infrastructure that will consider the active involvement of people with lived experience of mental ill health in the delivery, development and design of mental health services. Proposals are at an early stage and will require detailed development and costing. <BR /> <BR />An alternative to a champion appointed by the Minister might be that relevant mental health voluntary and community organisations would come together to appoint a champion who would then be truly independent and authoritative. Last week, I had the privilege of addressing the final conference of the Together for You project, which was an excellent example of the voluntary and community sector working in partnership.”
“Could, for example, a champion appointed by me be truly independent and be seen to be independent? What selection criteria would I use, and would those criteria need the endorsement of the voluntary and community sector? How would I ensure that proper governance and accountability arrangements were in place? <BR /> <BR />Options for the development of a formalised approach for the involvement of mental health service users and carers in the improvement and development of mental health policy and services will be considered in our Bamford evaluation report. The appointment of a mental health champion is certainly one of a number of options to be considered, alongside, for example, the possible further development of mental health service user forums, which appear to work very effectively in a number of trusts.”
“Doing that will allow us to tackle seriously all the issues that Members have referred to in the debate. <BR /> <BR />I turn now to the call for me to appoint a mental health champion. The proposal for the appointment of a champion is a popular suggestion in the mental health sector generally. It has been mooted by a number of third-sector mental health organisations. In principle, a mental health champion is a positive suggestion. They could be an authoritative and independent voice for people with mental health issues and for reform. They could lobby the Executive and, where necessary, criticise the system. They could advocate for mental health and be a public face and a media spokesperson. <BR /> <BR />A number of potential issues with the proposal that I appoint a mental health champion need to be carefully considered.”
“As an Executive, we face the challenge of deciding how we spend a limited budget. The forthcoming comprehensive spending review presents an opportunity to identify and prioritise bids for the investment required in mental health. In doing so, I do not underestimate the challenges that exist right across Health and Social Care. <BR /> <BR />Over the last four or five weeks, I have made comments in the House about the transformation of the health and social care system and how we deliver services. We have a real opportunity to transform how we deliver services that will allow us to focus on, place additional priority on and invest more in addressing health inequalities. All these things are linked to poor outcomes, particularly in mental health. I hope to achieve political consensus on how we transform the health service.”
“The evaluation will also form the basis for confirming the priorities for mental health service development in this Assembly mandate. Possibilities already identified include the establishment of a comprehensive mental trauma service, the further development of eating disorder services and the need for specialist perinatal mental health services — all those issues were, I know, referred to by Members during the debate. Officials are also looking at more overarching concepts, such as funding, oversight and delivery structures, as well as parity of esteem with physical health, which is one of our key challenges. <BR /> <BR />While our mental health services have come a long way since Bamford, it is clear that we have much more to do. I am committed to their further reform, which will require funding.”
“The emerging themes include the need to further embed and promote psychological therapies and the concept of recovery; to provide more practical support to carers; to improve access to services in times of mental health crisis; to improve the experience of patients admitted to acute mental health facilities; and to increase the involvement of the voluntary and community sector.”
“<BR /> <BR />As for future mental health priorities, the Bamford review set in motion some of the most significant changes that have ever been seen in mental health services here. Those changes have transformed how we deliver care for people with a mental illness and have significantly improved the achievable outcomes. An evaluation of Bamford actions is well under way, and I am expecting a draft report over the summer. While I expect the evaluation will demonstrate that good progress is being made in the reform of mental health and learning disability services, it will also provide us with a more sophisticated understanding of the needs and the gaps.”
“<BR /> <BR />There has been a major programme of resettling people who were long-term patients in psychiatric hospitals into community-based settings, with the aim of affording them a better quality of life and integration into the community. In 2007, there were 472 long-stay patients in psychiatric hospitals here. Of those 472 patients, 18 long-stay patients now remain in mental health hospitals, with plans to resettle 10 this year. <BR /> <BR />Specialist community-based eating disorder services have been established in all trusts, and practitioners are building their expertise in that complex area. An exercise is ongoing to scope the need for a specialist eating disorder unit here, and I am expecting a final report by the end of this year.”
“We also now have a 33-bed children and adolescent mental health inpatient unit at Beechcroft, which opened in 2010. In July 2012, the Department published a stepped care service model for child and adolescent mental health services. That promotes a more consistent, person-centred approach to mental health service delivery for children and young people. Improvements include an increased focus on early intervention, better multidisciplinary working and collaboration with the community and voluntary, education and youth justice sectors. The HSC Board and trusts have worked hard to implement the service model across the North. Primary mental health teams are now established in all trusts, as well as crisis response and home treatment teams. Investment in CAMHS has increased from £ 9·5 million in 2007 to around £20 million now.”
“<BR /> <BR />There have been big steps forward in the development of psychological therapy services, with investment now exceeding £10 million a year. A range of services is now provided, including psychology, psychotherapy, cognitive behavioural therapy and trauma therapy. The HSC Board estimates that between 75,000 and 80,000 sessions are provided annually. The HSC Board is into the third year of a five-year plan to establish primary care talking therapy hubs across each trust area. The hubs focus on providing a range of psychological therapies for people experiencing common mental health problems. They are developed around general practice and will improve access to earlier support and care. <BR /> <BR />In accordance with the Bamford review, children’s mental health services are mainly delivered through community-based teams.”
“It commits the HSC to deliver care that is more personalised and improves the experience of people with mental health problems by adopting a more evidence-based and recovery-oriented approach. In line with Bamford, mental health services have moved towards a recovery-based ethos. The principle of recovery is based on people with mental illness regaining control of their life and learning to manage their health so that they can have hope for the future and participate in their community. Staff have been trained in recovery-based practice, and recovery colleges have been established in each trust. Peer support workers are also now employed in each trust. As part of the Bamford evaluation, we have heard some very positive stories from people who are now in recovery and are getting on with their life, but we need to see much more of that.”
“<BR /> <BR />Since Bamford reported in 2008, investment in mental health services has increased by nearly £50 million a year to around £250 million a year. The balance of funding has shifted. At the time of the Bamford review, we were spending 60% of the mental health budget on hospital services and 40% on community services. His vision was to reverse those figures, and now we spend nearly 60% on community services. We can see some major key developments in mental health services, but, as I said, I believe that we have to transform the health service to allow us to put more weight and focus on the services that we deliver for people who find themselves feeling mentally ill. <BR /> <BR />We have seen improvements, including a regional mental health care pathway, You in Mind, which was launched in October 2014.”
“That will be a significant policy driver for improvements in mental health services during the life of this Assembly. <BR /> <BR />Members referred to Bamford and the modernisation of health services. There is a recognition that, in the past 10 years, there has been significant reform and modernisation of mental health services here, propelled by the Bamford review. The vision was that people with a mental illness should be treated in the community, close to their family and friends, unless there is a clinical reason for not doing so. Accordingly, the focus of mental health service development in the last number of years has been on early intervention, home treatment services and the development of psychological therapy services.”
“It is vital from not only a health perspective but an economic perspective that people with mental health problems can access the right treatment at the right time. There is significant evidence of the effectiveness of psychological therapies on creating the right conditions for people to resume or regain employment. The HSC Board found that, for every £1 invested in psychological therapy services, there is a saving of £1·75 to the public sector. It is clear that we need to continue to carry out investment in that area. <BR /> <BR />Mental health also has implications for policy on housing, education and criminal justice. It is the ultimate cross-cutting issue. I am, therefore, very pleased that improving mental health features very prominently throughout the draft Programme for Government framework, which is out for consultation.”
“It found that it costs the local economy an estimated £3·5 billion per annum. That figure includes direct and indirect healthcare costs, and indirect costs such as the loss of output because of the inability to work and the need for the payment of benefits etc. The research also found that around 45% of people who claim illness-related, out-of-work benefits do so because of mental ill health. That is the biggest single group of claimants. Conversely, the report estimates that, within two years of recovery following successful treatment for mental ill health, the employment rate for those with moderate or severe mental health problems is increased by 11·4% and 4·3% for those with mild mental health problems.”
“All those things lead to very difficult and challenging times for individuals. We all know only too well about how much suicide continues to tear families apart. <BR /> <BR />Mental illness can affect anyone in any circumstance. It is estimated that one in four adults in the North will suffer from a mental health problem at some stage in their life. The Public Health Agency's Making Life Better strategy, which was published in 2014, established that the North has a 25% higher overall prevalence of mental illness when compared with England. <BR /> <BR />In terms of the economic cost of mental illness, people with mental health problems are at a greater risk of unemployment, job insecurity, absenteeism and lower salaries. The HSC Board carried out some research in 2014 to try to quantify the cost of mental illness here.”
“I welcome the opportunity to participate in today's debate. It addresses one of my priorities. Like others have done, I welcome the tone of the debate. I think that we all understand the challenges and recognise the real face of this. I think that we all understand that we need to chart a way forward where we address the imbalance in how we focus in the Department on mental health and make sure that we address the fact that it needs to be given more attention. We have come a long way, but we certainly have a further way to go. <BR /> <BR />Many Members referred to the fact that there is no shortage of evidence about the prevalence of mental illness right across the North. We have the challenges of the intergenerational legacy of the conflict, which Members picked up on; the ageing population; deprivation; unemployment; and stress at work.”
“Yes, I absolutely agree. When we come to review the strategy, we want to make sure that we get it right, listen to everybody and look at what has been good and what has worked. We also need to look at the challenges in rural areas compared with urban areas, because sometimes they can be very different. We need a proper review of all that as we move forward. Yes, I think there is underinvestment, and I think we need to shift the balance of the investment that has occurred to date. I have a very difficult financial picture in front of me. That said, this is an area where I want to prioritise some work.”
“Again, as I said earlier, mental health is a priority for me, and I seriously want to work with groups on the ground providing services, particularly in the community and voluntary sector, which I very much value for working with people who find themselves in crisis or want to ask for help and some support. I certainly want to prioritise that area of work. I want to review what services we provide and how they are provided. Lifeline has recently been reviewed, so we are going to be moving forward with that. I want to make sure that we deliver on the Bamford vision. I think that there is so much that we can do. If the Department can be a wee bit more creative in working with the community and voluntary sector, we can be more effective on the ground.”
“That being said, I want to work with the nursing profession to make sure that we do absolutely everything we can to maximise the numbers in the service and make sure that those nurses feel supported, because obviously we value the work they do, day and daily, in supporting patients.”
“I do agree with you. The Department and the trusts are working particularly with new nurses who are training. In an earlier answer, I referred to the fact that about 20% of nurses decide to leave once they have qualified. It is about trying to talk to those nurses to say that there are opportunities and make sure that they are aware that there are opportunities here. <BR /> <BR />I think that nursing staff deserve to get fair pay for the job they do. I think that we have massive challenges here, not least because of continual Tory Government cuts to the block grant.”
“That shows that we are moving in the right direction, but we certainly have further to go. <BR /> <BR />The Department invests heavily in training new nurses every year, with the provision of university fee and bursary support. We also continue to work with the nurses on education and continuing with education. The other area that we have been looking at is the return-to-nursing programme, and we recently committed additional funding to commission an increase of 100 nurses. That will also allow us to take get more nurses back into practice. So, while I think that there are major challenges, we are moving in the right direction, but we certainly have a further way to go.”
“Obviously, nurses are key to service delivery. They are the backbone of the health service. I want to work with the Royal College of Nurses to make sure that there is better workforce planning. A lot of work has been done in that area. A number of additional nurses — I think it is 100 — are coming in to start their training this year. I think that that is significant, but we need to continually keep that under review. I do not believe that 100 nurses will fill the gap that has already been identified there, so I want to work with nurses and the royal college to make sure that we bring forward the correct number of nurses in the future. There have been significant improvements in nursing numbers over the last number of years. There are an additional 186 nurses in our trusts compared with the number this time last year.”
“The estimated cost of providing that service is about £1·9 million. Perinatal mental health is an issue that I can remember championing in the previous mandate from 2011, when I was on the Health Committee. It is certainly another area where I think we can do some good work. I want to explore that further with the Minister in the South to see whether there is any way that we can work together to deliver it quicker.”
“That provides the regional guidance for all health and social care professionals who come into contact with pregnant women to ensure that their mental health problems are identified as early as possible and that we make sure that we have the appropriate support services in place.”
“Yes. There has been some work done on it to date. There are plans for a perinatal mental health and a mental trauma service. Also, I omitted to say in my original answer that there will be study into eating disorder services, which will report in December. The lack of provision of a dedicated specialist and bespoke perinatal mental health service is a significant gap here. I want to be able to move forward with that. There are potential opportunities for us to do that on an all-island basis. That is something that I want to pick up with Simon Harris TD over the next number of weeks. <BR /> <BR />The 'Integrated Perinatal Mental Healthcare Pathway', which was published in December 2012, is being updated.”
“That shows that there is a lot more early intervention, crisis response, home treatment and the use of evidence-based psychological therapies. <BR /> <BR />There are gaps in service provision and funding, and I want to use all the information that I have to best identify how we move forward. I want to work with clinicians and people who are providing the service, as well as the community and voluntary sector. When it comes to taking positions on the new comprehensive spending review, I want to make sure that we properly invest in mental health and help the most vulnerable.”
“Since becoming Minister, I have made it clear that mental health is one area that I will prioritise. We all recognise that mental health problems are a significant societal challenge that need to be addressed. I intend to address some of the historical underinvestment, but, equally, I accept that the health and social care budget in general is under extreme financial pressure, as are the Executive as a whole. <BR /> <BR />In my assessment so far in relation to mental health services, we invest annually about £250 million. That is an increase of £50 million a year compared with the position a decade ago. Also, it is significant to note that nearly 60% of mental health funding is spent on community services compared with 40% a decade ago.”
“We all recognise the value of the community and voluntary sector's work. It alleviates a lot of pressure in the health service, and, without it, the service would be stretched a lot more. So, yes, I value the work that it does, and I want to work with it and move forward on how we can work together, how we can be more innovative about how we work with people and how we can be more creative in changing and structuring how we deliver services to those in need.”
“It is important that we tackle the issue and support people who want to get help. I am sure that the Member is aware of Northlands in Derry and the issue of funding. I am going to take up an opportunity to visit it and talk about the service that it provides, which, I am aware, is a first-class service that people value very much. It is important that we invest in addiction services and support people who are at a time in their life when they are most vulnerable. I do not have figures in relation to the current investment in addiction services, but I am very happy to provide that to the Member in the future.”
“No, there are not. I have just answered the question. I told you my position in relation to fatal foetal abnormality and being able to support those women who are in a crisis situation. I have been given the work that has been done to date — the terms of reference that have been drawn up — and I intend to sign off on them when I have had a conversation with the Justice Minister over the next number of weeks.”
“Absolutely. We have to tackle the root causes of why people get sick in the first place. We have to try and get a breakdown of the correlation between people who live in deprived areas and their health outcomes; for example, tooth decay, cancer diagnoses and all those things. For me, as Health Minister, this is something that needs to be a priority. We have to get to the point where we tackle those issues head on, where we invest in prevention and have a very strong public health message. Very positive work is happening and has been happening for quite some time. We have a strategy for illness prevention and health promotion. I want to see that through. However, I think we can do much more. In order to get us to that point, we have to really reinvigorate, and look at structural issues in, the health service.”
“Not as yet; I suppose that we are four weeks into the new mandate. Certainly, it will be a focus for me. It is important that we tackle health inequalities, which is why we need to transform the healthcare system to allow us to do that. Unfortunately, at the moment, no Minister has been able to tackle and actually invest properly in order to deal with health inequalities because there simply was not the funding to do so. All the money is, I suppose, being sucked into dealing with the acute sector. Unless we shift that focus, we will not get to the point where we can tackle health inequalities. I have identified it as a priority. I know that the Executive will want to have a discussion on the way forward and how we do that. I am very keen to explore that with them.”
“We will discuss the issue and will be able to move forward.”
“I can assure the Member that he has not unearthed any new secret: it is my party position that we think that there should be legislation that allows women to be supported in relation to fatal foetal abnormality. The legislation that needs to come forward will come from the Department of Justice. I want to work with the Justice Minister. I also want to engage with women who have been impacted. This afternoon, I will meet Sarah Ewart. Obviously, everyone knows Sarah's story. I want to engage with her because she is someone who has actually gone through the experience of having a child with fatal foetal abnormality. It is important that we take decisions that are based on evidence and that we take the right decisions. I do not think that it is any shock that I will speak to the Justice Minister over coming weeks. We have a meeting scheduled.”
“As current Health Minister, I want to meet families who have been impacted by fatal foetal abnormality and then decide how we move forward as quickly as possible to bring clarity to the issue of fatal foetal abnormality in the health service.”
“Well, I will not answer for the Attorney General: you can take your issue up with him. I can say that the Executive did, as you rightly said, set out that there needed to be a working group on fatal foetal abnormality. Simon Hamilton raised the issue with the Executive when he was Health Minister. I can confirm that the terms of reference for the group were proposed and drafted and that the membership of the group was discussed with the former Justice Minister. I can confirm that the terms of reference were not formally signed off, so, consequently, the group has not met. However, I am looking at the issue and giving the matter careful consideration. I will meet the Justice Minister over the next number of weeks. I intend to discuss how we take the issue forward.”
“I want to assure the Member that I will ensure that the plan to rectify what has been identified as a problem will be fully communicated to parents and carers. I assure you that the board will also work with the trust to quantify the money that we are talking about: £8 million has been mooted, but I do not know whether that is an accurate figure at this stage. We are still working with the trust to identify that, but I can assure you that we will ensure that we will work with the families and those people with a learning disability who have been affected by the underinvestment that has clearly been there over the last number of years.”
“However, I assure the Member and local families and carers that action is now being taken to address that, starting with the development of a long-term plan by the Western Trust to quantify and address any spending gap. The trust will be fully supported in its work by the Health and Social Care Board and my Department. Families and carers will be fully engaged too. <BR /> <BR />It is also my intention to monitor closely the trust’s progress in the coming weeks and months on the issue. In doing so, I will pay particular attention to what families and carers are saying, which, to date, has raised some questions about the trust’s handling of the issue. In the light of that, I am seeking an explanation from senior trust officials of their actions leading up to and including the statement that was made on 10 May.”
“It is important that I start by acknowledging the concerns of the families and carers in the Western Trust who have been affected by the issues with adult learning disabilities services in their area. I want it to be clear that I fully understand their concerns and support their efforts to seek the assurances that they are entitled to from the trust that their loved ones are being provided with appropriate and effective services. That is why, in my first few days of office, I sought an urgent and detailed briefing from my officials on the issue. <BR /> <BR />On the basis of that briefing, it is now clear to me that there is a historical issue with funding for adult learning disability services in the Western Trust.”
“There is massive pressure on the system, and, even though we have been able to increase the number of nurses coming into the system this year, we need to do a lot more about training more nurses and offering more opportunities. We are working with difficult budgets, but we need to be creative in how we do that and how we can get more nurses into the system.”
“The trusts will also make conditional job offers to third-year preregistration nursing students, pending successful completion of their degree programme and registration with the Nursing and Midwifery Council. <BR /> <BR />Alongside that, my Department commissioned the development of a career pathway for nurses and midwives to identify opportunities for local nurses. It was launched by the Chief Nursing Officer in November 2015. We continue to focus on making HSC an employer of choice for those wishing to pursue a nursing career. I am keen to engage with nursing staff. Next week, I will meet representatives of the Royal College of Nursing, and I am keen to talk to them about what else we can do to make sure that we retain newly qualified nurses and train more nurses.”
“The loss of newly trained nurses in particular is one of the biggest challenges that we have in workforce planning. The Department established a regional nurse recruitment group in January this year to address proactively nursing workforce challenges. To date, the group has agreed the streamlining of all regional recruitment processes for band 5 nursing vacancies across the trusts to make it easier for nurses to navigate the recruitment process. That also includes the advertising of nursing vacancies and regular interviews, the promotion and use of social media to engage with students and to communicate job opportunities and a joint approach by my Department and the trusts to engaging with university students in years 1, 2 and 3 to promote the local job opportunities that are available to them.”
“With a fair wind and with good political will in the Chamber, we can, once and for all, put report fatigue to bed. We have had so many reports, but now, with Professor Bengoa's report and the restructuring of the board — all the things combined — we have a massive opportunity to transform the health service. That will mean that we provide more services in-house, which is ultimately my objective. I have not engaged with the independent sector to date, but I am sure that I will in the time ahead. My priority is to make sure that we have a first-class health service and that all those services, by and large, are provided in-house.”
“First and foremost with the waiting lists, it has to be about patient safety. That is why there has been an over-reliance on the independent sector to get people seen. I clearly identified that as a short- to medium-term issue. I look forward to working with the Chair of the Health Committee and Committee members on how we transform the service to allow us more money to invest in primary services. In the longer term, we want to provide those services in-house. The only way we will be able to do that is if we seriously transform how we deliver services. <BR /> <BR />In my first number of weeks as Minister, I have been out meeting staff and engaging with the trusts and people right across the sector, and there is a willingness to change how we do things.”
“Eighty thousand patients benefited through the delivery of 54,000 additional outpatient assessments, 17,500 additional inpatient day case treatments and diagnostic assessments. In 2015-16, the balance of the funding was utilised for a range of pressures, particularly for domiciliary care and GP out-of-hours services, which have impacts on waiting lists and people being referred if they do not get primary care in the community. <BR /> <BR />In addressing the pressures, the £40 million allowed us to bring down the number of people on waiting lists and to put the Department on a firmer financial footing for 2016-17, avoiding the need to reduce any elective care services this year. It was an investment well worth making.”