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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“As you said, £40 million was secured in the November monitoring round. That was an attempt to address the short-term measures that are dealing with waiting lists. There was some success in that over 80,000 patients benefited as a result of the additional waiting list activity carried out in the latter part of the year. At the end of March, as a result of the £40 million, those waiting for their first outpatient appointment came down by 25%, and those waiting for admission for treatment came down by 16%. Those are significant outcomes in moving in the right direction, but we have a lot further to travel. <BR /> <BR />Of the £40 million, £21·5 million was utilised on waiting list activity, and a further £3·4 million that we were able to allocate brought waiting list activity spend to about £25 million.”
“I am certainly committed to doing that in the time ahead. Whilst we deal with the short-term issues of getting patients seen and achieving their appointments, we have to tackle the longer-term issues seriously, and I am committed to doing so. We have an opportune time now: Professor Bengoa's report is coming out in the next short while, and that will allow me to clearly set out a vision on how we move forward and get the political buy-in to deliver on that vision.”
“We all realise the impact on patients who are waiting to be seen. If you are unsure about what is wrong and are waiting to be seen by someone, there is worry and stress that has an impact on your health. It is important that we deal with the issue. We have to get waiting lists down and make sure we get to a position where we have a sustainable healthcare system. There is too much focus on acute services. We need to transform the health service to allow us to invest in primary care and take a preventative approach whereby we work more with our GPs, our allied health professionals and the people in the community. <BR /> <BR />If we are to move that way, the whole focus of the health service needs massive structural reform. I want to get to that position and for the Assembly to work with me to get to it.”
“My policy will be to adopt a balanced approach to taking further short-term action combined with longer-term change to address waiting times. It will take time and significant investment to bring waiting lists back to an acceptable level whilst, simultaneously, increasing capacity to meet increasing demand. I will continue to engage with my Executive colleagues to secure the additional investment that is necessary to transform the delivery of services.”
“Last year, over 8,600 new and review appointment slots at Craigavon Area Hospital were lost because patients did not attend their appointment. I know that many patients have a genuine reason for not being able to attend their appointment, but every missed appointment is a lost opportunity for someone else to be seen. Again, I urge the public to let hospitals know, where possible, if they are unable to attend so that their slot can be reallocated. <BR /> <BR />As I indicated in my statement to the Assembly last week, the root causes of the problems in waiting times are representative of the wider challenges to the provision of world-class health and social care: an over-reliance on acute services rather than early intervention in meeting increasing demand, the financial constraints and slowness to bring about radical change and reform.”
“The latest provisional figures for Craigavon Area Hospital show that at 31 May 2016, the most recent date for which figures are available, 1,623 patients were waiting longer than 52 weeks for a first consultant-led outpatient appointment. I have made it clear that patients waiting for that length of time to be seen by a consultant is totally unacceptable to me. Reducing the length of time that patients have to wait for elective assessments, surgeries and treatments is a key priority for me; it is one of a number of key priorities. <BR /> <BR />As I highlighted in my response to the first question for oral answer, lost capacity through missed appointments could have a significant impact on waiting times.”
“Whilst we can only speculate on the outcome of Thursday's referendum, I believe that the challenges in the health and social care system will be there after Thursday. They are there before Thursday, and they will be there after Thursday. I do not believe that leaving the European Union will be the panacea to solve all the ills in the health service. That is certainly not my understanding or my assessment of the evidence that I have in front of me.”
“The Member will be very aware of my party's position on Brexit. We have the same position on the implications that there will be for the North. If you look at research and development in the health service, you see that we have been able to draw down research money with Scotland and the South, which was quite significant. That is one example, I suppose, of the implications. I have listened carefully to the "Leave" campaign, which has very much majored on the health service and said that, if we pull out of Europe, we will have a lot more money to put into the health service. I do not see that being the case. It is a false argument and a scare tactic in relation to the implications in moving forward.”
“That was the right decision to take at that time. When the information is in front of me on my desk, I will listen to all the evidence, and I will make sure that I take a very informed decision going forward.”
“I can give that assurance. I worked closely with the people of Rathlin when I was Minister of Agriculture and Rural Development. Legislation that I brought forward in the last mandate means that all Departments have a responsibility to protect the needs of rural dwellers, and people on Rathlin are, obviously, more isolated than most. It is important that we are mindful of the islanders and the services that they require and make sure that they have access to first-class healthcare. <BR /> <BR />In relation to not meeting you with your delegation, I am inundated with requests to meet. However, I can say that I want to make sure that I consider all the information that is before me. The previous Minister obviously halted the process in relation to the day centres because of the changes in the private sector.”
“As I develop my vision for the health service — he wants to deliver a 10-year vision — let us set out a plan where we can work collaboratively and provide first-class services to people across the island. This is a small island with a small population, and there are natural areas where we can work more collaboratively.”
“That is the work that we are involved in at the moment. When the feasibility study was done in 2009 — it is pretty much out of date now — heart surgery, for example, was identified as an issue. We have reached 2016 before we have been able to deliver that service. In my initial conversations with Minister Harris, I want to use that as a baseline or a starting point, but I want to look at what we do better. I am happy to provide you with a list, outside Question Time, of what we assess that we can deliver that the South maybe does not have. That is part of the core work that we will take forward together. I do not want it to be a stretched-out process; it is work that can be done pretty quickly.”
“I do not have any detailed briefing on that, but I am happy to respond to the Member. We are looking at all areas where we can work more collaboratively. Providing a first-class service means you need to have a certain number of patients to treat. When it comes to all these areas, there is a lot more scope for cooperation across the island. The Minister in the Twenty-six Counties has indicated his willingness to allow us to move forward and scope that out. There was a feasibility study in 2009 that highlighted key areas where we could work together, but we need to build on that and update it. I want to bring forward that work and explore where we can work best for the patients who need the service and how we can do that collectively.”
“I absolutely agree on turning it into a reality, and I intend to do so over the next, I hope, short period of time. Obviously, we are reviewing the business case, and I hope that we are coming towards the end of that process. In the immediate future, we will be in a position to make an announcement, move forward and provide this vital service. There has been a very strong campaign for it, rightly so because it is needed on the island. We can provide a first-class service to all the children who are affected by heart problems as a result of congenital heart failure because we will work collectively. I hope to make an announcement on that in the coming weeks.”
“<BR /> <BR />Other areas include anti-smoking campaigns and a smoke-free HSC. On mental health and promoting positive mental health messages and on suicide prevention there is excellent work ongoing by the Institute of Public Health in Ireland. We have had the work that has been done on a self-harm registry. We have been working with the GAA, for example, through the Public Health Agency and the National Office for Suicide Prevention in the Twenty-six Counties. There are really positive initiatives on promoting good public health messages, and I want to build on that in the time ahead. I am delighted that after a recent conversation with Simon Harris, the Minister in the South, he agreed to work more cooperatively on how we can explore all the areas of mutual benefit.”
“As far as examples of public health are concerned — I have pointed to a few — the two Departments work closely on alcohol and drug misuse to ensure that we share information and best practice, and we have taken forward joint initiatives when appropriate. Recent joint initiatives include jointly commissioned research on the potential impact of minimum unit pricing for alcohol, a joint report on reducing alcohol misuse through addressing accessibility and availability, a joint resource on hidden harm and information-sharing on new psychoactive substances and learning from the legislation that has been enacted in the South. There is also a lot of work happening on obesity. We have an all-island obesity action forum, which is chaired by Safefood and continues to meet and share information and best practice.”
“I intend to get out and about to meet the people delivering the service on the ground right across the North, so I am happy to take the Member up on that invite at some stage over the next number of months.”
“<BR /> <BR />Further priorities for my Department will include exploring opportunities for further collaboration in specialities such as organ transplantation, the treatment of rare diseases, the response to major trauma, alcohol and substance misuse and mental health, particularly the prevention of suicide and self-harm. At the heart of that collaboration is my commitment to put the interests of patients first and foremost by delivering safe, high-quality health services and better outcomes for all.”
“We can work together particularly in relation to public health awareness initiatives. <BR /> <BR />I intend to build on examples of that collaboration, including the Altnagelvin radiotherapy unit, which will open later this year. It will make world-class cancer treatment accessible to patients living in the north-west of Ireland. It will add to the successful 24/7 primary PCI service at Altnagelvin Hospital, which was expanded in May of this year to make life-saving treatment available to patients from County Donegal. Good progress has also been made on the establishment of the all-island congenital heart disease network. I am confident that we will take the next major steps forward in achieving the network's vision of a world-class all-island service with our colleagues very soon.”
“I commend the work that has been done to date between the health services, and I want to take those efforts to the next level. We face the same health issues, challenges and opportunities right across the island, as was highlighted by the 2009 North/South feasibility study: demographic change, health inequalities, mental health, obesity and substance abuse. Working together to address those would make sense on a number of levels. It would utilise the total population size to secure the sustainability of vulnerable services, where collaboration would realise real benefits for patients. It would deliver better outcomes for patients, North and South. It would achieve the more effective use of resources and investment in new healthcare initiatives, where we could share learning and best practice between our health services.”
“A key priority for me will be the further development of all-island networks to tap into the benefits that collaboration on health and social care services will bring to every part of the island. I have spoken with my counterpart in the South, Simon Harris, to explore how our health services can further collaborate on improving people's health. My vision of a transformed health service in the context of the upcoming Bengoa report and the announcement by the Minister in the South of a 10-year plan is an opportune time to strengthen and progress all-Ireland health. <BR /> <BR />There is already positive collaboration with the South through, for example, EU-funded initiatives, as well as cancer and cardiac services in the north-west.”
“As I said, we have to come at that by communicating with patients and asking them to work with us. If we are asking them to work with the service in relation to how they cancel appointments, we have to be upfront about the disappointing number of appointments cancelled because clinicians or other staff are not available. As I said, I have set a target for this year to reduce by 20% the number of hospital-cancelled consultant-led outpatient appointments. It is important that we send out the message very clearly that we want patients to help the service to be more effective. We can do that with strong communication and by making sure that the service does not cancel appointments unnecessarily.”
“It is important that we communicate well with patients. It is important that people are seen in a timely manner in relation to their medical needs. That is why we have the targets in place. We need to keep striving to reduce the waiting list targets. I have said in the House over the last number of weeks that the current situation is not sustainable and is not acceptable to me. We need to drive forward with improvements, which is about working with the board and the trusts and looking at the elective care plan; the Member will know that I have asked the trusts to bring that forward. I am keen to make sure that we drive down the waiting times for all the people who need urgent medical attention.”
“I look to the board and the trusts to continue to focus on the issue to make sure that we secure improvements in performance. The board will continue to work with the trusts to ensure that best practice, including the application of good waiting list management, is consistently applied to minimise the number of hospital cancellations. Consultants, for example, are asked to give at least six weeks' notice of planned leave or study leave, and the board meets the trusts regularly to monitor elective care performance, including the delivery of agreed volumes of core activity. The rate of cancellation of outpatient appointments is one of the factors considered when assessing the delivery of core activity.”
“I do not have that figure, but I can make a general reference to the fact that appointments can be cancelled by hospitals for a range of reasons — for example, if consultants or other staff are not available — and appointments will be rescheduled or a patient treated elsewhere. Suffice to say, I regret any cancellations that inconvenience patients and mean that they have to wait longer. At times, that might be necessary, but I want it minimised as much as possible. <BR /> <BR />As I said, I have set a target for 2016-17 to reduce by 20% the number of hospital-cancelled consultant-led outpatient appointments. I acknowledge that performance is not where it should be and needs to be better. We need to get better at how we deliver the service.”
“It is. We need to come at this two ways. We need to address the issue of why patients cancel appointments, but we also have to be serious about hospitals cancelling appointments for whatever reason. Appointments can be cancelled by hospitals for a range of reasons, but I have set a target for 2016-17 that we must reduce by at least 20% the number of hospital-cancelled, consultant-led outpatient appointments. It is only fair that, when we ask people to respond better, we also ask the service to respond better and make sure that the maximum number of people can be seen in an appropriately timely manner.”
“Provisional data for 2015-16 indicates that there were 52,303 new and review attendances at Causeway Hospital. Some 3,779 patients, of whom 995 were new appointments and 2,784 were review appointments, did not attend their appointment, which represents a did not attend (DNA) rate of 6·7%. This is lower than the average regional DNA rate of 8·3% in 2015-16. The Northern Health and Social Care Trust has the lowest rate of patient non-attendance of all the trusts: 6·5% in 2015-16 against the average of, as I said, 8·3%. Measures taken by the trust include using a text reminder service, which has reduced the did not attend rates for hospital appointments, and reminders are sent out three days prior to an appointment date with a telephone number to call if the patient is unable to attend.”
“<BR /> <BR />Again, I go back to the point that, on its own, that investment is not enough. The money will allow us to get treatment to those people as early as we can, but it is not enough. This is not simply a money issue. I am asking the Assembly to support me in transforming the health service and to be constructive. As I said, I listened to the contributions to the debate, and, although they were by and large constructive, sometimes a bit of political point-scoring slipped in. I ask Members to rise above that to help me to help people and to transform the health service, because that is certainly the job I am committed to in the time ahead.”
“As I pointed out in my statement yesterday, tackling excessive waiting times is obviously high on my agenda for improvements. The additional £30 million that was committed by my predecessor was obviously an important step in allowing us to reach the 80,000 people whom I referred to. It will support up to 25,000 additional assessments and some 12,000 additional treatments across a wide range of specialities, including orthopaedics, gastroenterology, neurology and ENT. Importantly, it will see a £10 million investment in diagnostic services, building capacity to support up to 50,000 additional tests to help meet increasing demands, as well as supporting seven-day services. Trusts have also been asked to put in place arrangements to continue to undertake additional in-house activity during the first quarter of 2016-17.”
“The reality is that we do not have the capacity in the health service at this time to deliver for people in the manner in which we wish to. I want to get to the point where we are not using the private healthcare sector, because I believe that is money that we could invest in increasing capacity in the health service. Whenever we look towards having a health service that is free at the point of delivery and free for all, we need to seriously address the root causes of why people get sick. Only when we get to that stage will we truly have a health service that is on a sustainable footing. <BR /> <BR />I will give way to Jo-Anne Dobson very quickly.”
“I fully understand why the motion has been brought to the House. It is for the same reason as I chose to make a statement yesterday: the current situation with waiting lists is not acceptable to me. Waiting lists are still far too long, but it is clear that the recent investments directed towards waiting lists are making a difference. It will take time and significant non-recurrent and recurrent investment to bring waiting lists back to an acceptable level whilst trying to increase capacity to meet demand.”
“<BR /> <BR />Looking to the future, I will continue to hold trusts to account and work with the Health and Social Care Board. You will remember from yesterday that I pointed out the fact that the board has been tasked with creating the five-year plan for elective care. I intend to make sure that I take full control of that and take the lead in holding trusts to account on the work that they are doing, making sure that they are doing everything possible for elective care.”
“The recent investment means that, for those waiting for their first outpatient appointment, the greatest reduction has been in those waiting for more than 52 weeks, which is down by just under 25% since December. Those waiting for more than 18 weeks is down by 18% and those waiting over nine weeks is down by just under 18%. That is to be commended, but there is a lot more to do and a long way to go. <BR /> <BR />Looking to the future, I think that the investment is not enough. The issue is not just with money. Money will help us to be able to get some people seen immediately, but it is not just the issue in the longer term. I want to invest in transforming the health service. I want to invest in health inequalities. I want to work with other Departments to be able to head off the issues before they become acute.”
“I very much look forward to continuing to work with staff to chart our way forward. Whilst I have a vision and I want to get political leadership and have other parties signed up to that vision, we need to have our healthcare workers and staff signed up to that vision and believing in it because they are providing the service. That will be my job of work over the time ahead. <BR /> <BR />Members referred to the fact that this is not a blip. It is certainly not a blip: we can see that. I referred to the fact that June monitoring is not the solution, but it is the solution in the short term, and 80,000 patients have benefited as a result of that. Over the next number of weeks, I will be in discussions in relation to June monitoring and making further bids to allow me to do that.”
“I said that I would give way to Jo-Anne Dobson first. I will let you in towards the end. <BR /> <BR />We all have to rise to the challenge and make the changes that are necessary to ensure that we get a health service that continues to deliver for those in greatest need. The message is very simple: we cannot stand still. We must evolve to survive. <BR /> <BR />Like others, I recognise the hard work, professionalism and skill of those staff in the health and social care sector. I said that I would engage with front-line staff from day one, and I am glad to have been out on the ground meeting staff. They are the people who are best placed to tell us about the challenges that they encounter every day as they go about trying to look after people and give the best possible care.”
“We have seen where all-island working in the past has been able to deliver for healthcare services, particularly in relation to children's services in Dublin and Belfast. We need to build a lot more on that, find efficiencies where we can and work together to make sure that we provide a first-class health service for all the people on this island.”
“There must be a firmer grip on the strategic direction of healthcare delivery in the North to ensure the best possible healthcare for all our patients. <BR /> <BR />As I said yesterday, the work of Professor Bengoa is critical. I will speak to him when he comes next week, but he is also offering to speak to all the parties, and I know that other parties have taken that opportunity in the past and I encourage you to do so again. Hopefully, he will produce his final report towards the end of June, and I will be keen to come back to talk to the Assembly about how we move forward with that. <BR /> <BR />There are also areas for strong cooperation with my colleagues in the South. We will need to build a strong partnership.”
“If you let me just get through a bit and then I will let you come in towards the end. <BR /> <BR />As I said, the way that we deliver services has to be transformed, and I intend to focus my efforts on making that transformation. I listened today to some contributions from Members, and we are all guilty of looking after our own constituencies and talking about the services in our areas. It is not about buildings; it is about how we provide services to people. I would much prefer to offer people the best possible service that we can offer. That is where we need to focus our attention. <BR /> <BR />I want to focus my efforts on reshaping our health and social care sector to make sure that we are as effective as we can be.”
“That is about trying to deal with the massive and unacceptable lists. When I look to the future, I have to look at where we want to be and how I can chart my way forward. <BR /> <BR />I really look forward to Professor Bengoa's report because that will be key. I agree that there have been a number of reports. Let us now use Professor Bengoa as a step forward. I will use that to develop my vision. I will put that vision to this Assembly, and I hope that all parties can support that vision. I do not think that we are all speaking with a forked tongue here. I believe that people are genuinely interested in trying to work together and deal with the many challenges in the health service. <BR /> <BR />If anybody has ideas, I want you to come forward and talk to me. I am a Minister who is open to discussing those issues.”
“Catherine Seeley pointed out that I need to work more with other Departments, and I am certainly up for that. I think that there are many challenges in relation to poverty, isolation and all those other things that we need to tackle, and I want to tackle those constructively with other Departments. If we are able to tackle those things and stop people from needing and depending on the health service further down the line, only then are we actually going to make a difference. We are continually going to have this conversation around waiting lists and challenges in the health service, of which there are many. I am two weeks in post and I have identified many areas where we need to reform, make things better and reconfigure services. When I look to the future, I look at what we can do in the short term.”
“We have to deal with the immediate issue of actually getting patients seen. In order to do that, I will not apologise for bidding into the monitoring process to achieve additional funding. The fact that the Executive gave additional funding to the Department of Health towards the end of last year meant that 80,000 patients actually received treatment. That, for me, is something that we should not shy away from, and I will not apologise for bidding for additional funding — I have to deal with the here and now. <BR /> <BR />I have a vision for the health service that we shift the focus from acute care and move to the point where we invest heavily in preventative measures and in tackling the root causes of why people get sick in the first place.”
“That will require a much-needed focus on reducing health inequalities so that, no matter where you live, you will have the same chance of a long and healthy life. We have to promote healthy lifestyles further to avoid pressure on services. Furthermore, we need new developments, and medical technologies and drugs are also increasing in demand and raising costs, which means that we must use the limited resources that we have in a wise manner. <BR /> <BR />I welcome the tone of the debate so far, and Members are suggesting that they want to work with me constructively in order to tackle this major issue, and I hope that will be the case. I am open to listening to suggestions. I listened to some commentary today about the short-term issues and that it is not good enough to just throw money, in monitoring rounds, at the issue.”
“Go raibh maith agat, a Cheann Comhairle. First, I welcome the opportunity to respond to the motion and the comments that have been made so far. <BR /> <BR />Yesterday, I made a statement to the House, as my first piece of business, on the issue of waiting lists. This is a priority for me as Minister for Health and an issue that we need to tackle as quickly as possible. Excessive waiting times are totally unacceptable and, after listening to Members contributions today and in yesterday's debate, I think that everybody understands the reason why we are in the position that we are in and identifies with the fact that there has been an increase in demand for services. We need to address those challenges by investing a lot more in preventing illness and promoting healthy lifestyles.”
“For me, the use of the independent sector is a short-term measure to allow people to be treated and to receive the care that they need. Whenever independent sector provision is used in the health service, it is only because there has been a real body of work done around the capacity of the health service to deliver and on what the short-term capacity is. For me, the overriding concern is ensuring that patients receive their treatment in a timely manner. That, for me, is the key. Obviously, I want to get to the point where we have the capacity in the health service to deliver.”
“I will never abandon my principles, I can assure you of that. I can tell you that I want to see a position where we do not need to use the independent sector. I want to be in a position where we create a health service that is on a sustainable footing that can deliver first-class services, and I think that the only way that we can do that is if we transform the whole healthcare system and how we deliver it. That is why I have set out the vision about how I want to move forward, and, as I said earlier, we are going to continually come back to this conversation around capacity issues in the health service, waiting lists and all of those things if we do not seriously transform the healthcare sector. <BR /> <BR />That having been said, I will not allow patients to be very much in need.”
“That issue has not been brought to my attention, but if the Member wants to write to me or drop me an email, I will be happy to examine it further. As I said, it has not been on my desk yet, but I am happy to look at it.”
“I want to set out a vision where the endgame will be that we put more resources into preventative work to tackle health inequalities and the reasons why people get sick in the first place. The only way that we will get that is if we have real pace of change and real meaningful change that actually reconfigures how we deliver services. That is my priority in the time ahead, and that is the legacy that I want to leave in this Department.”
“I referred to Professor Bengoa's report. There have been a number of reports over the last number of years: the Maurice Hayes report at the start of 2001, the Donaldson review, and Transforming Your Care. So, we have had a number of steps forward and all those brought some positive change. One of the things that the Donaldson report recognised was that the pace of change was not quick enough, so that is what we need to move forward with. I want to take the body of work that Professor Bengoa has been involved with and seriously transform our health service. Otherwise, we will be having this debate and this conversation time and time again. If we do not get to the situation where we have the health service on a sustainable footing, we cannot invest in new technologies and new drugs, and we cannot help patients more.”
“As I said, there are particular challenges in rural areas.”
“I do not have any departmental assessment. I can certainly look into that, but I agree that it is a factor in my constituency role when dealing with patients and people who cannot be discharged from hospital because there is no care package. That is a real issue. It is particularly an issue in rural areas, where it is difficult to recruit carers. There is large scope for work to be done around why you cannot recruit carers. These people are usually the lowest paid. Quite often, if they work for the independent sector, they do not get mileage costs, so there is a big issue that I want to focus on and give attention to because we do want people to be cared for at home; we want that to be more and more the emerging picture. The only way to do that is if we have proper workforce planning and we work to make sure that we can recruit carers.”