Health and Wellbeing 2026: Delivering Together

Ministerial Statements – in the Northern Ireland Assembly at 10:30 am on 25th October 2016.

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Photo of Michelle O'Neill Michelle O'Neill Sinn Féin 10:30 am, 25th October 2016

I apologise for the lateness of the statement. We had an Executive meeting this morning, and I endeavoured to get the statement into the pigeonholes. I believe that we did so at 10.00 am.

Mr Speaker, having received Executive endorsement this morning, I am grateful for the opportunity to make a statement setting out my ambition for a world-class health and social care system, Health and Wellbeing 2026: Delivering Together.

As I have said before, and I want to put on record again, I am proud and privileged to be the Minister of Health. I am proud of our health and social care service. I am proud of the dedication, the commitment and all the hard work of all those working right across our health and social care system. I am proud of the quality of the full range of health and social care services people here receive from staff whose key focus is to improve our health and well-being. I have witnessed at first hand the amazing work of Health and Social Care (HSC) and the positive impact it has on people’s lives. The depth of the dedication, commitment and compassion of all those who work right across our health and social care system continues to astound me.

However, the system itself is at breaking point. This is not news. Every person in the North and everyone working in our health and social care system understands this to be the case. Put simply, the system has not changed quickly enough to meet the demands and the needs of the population. While not always accurate, reports of long waiting lists and failed targets feature regularly in the media. This is why, in my first week as Minister, I made a statement to the House acknowledging the challenges but, more importantly, pledging my commitment to transform health and social care. I promised I would reflect on the expert panel’s report and put my vision for health and social care before you, and today I am doing so.

I thank Professor Bengoa and the expert panel and commend them for their work. I received the report, 'Systems, not Structures' in the summer and since then have spent time carefully considering the report, its implications and the next steps. Professor Bengoa has told us that we need whole system transformation if we are to meet the needs of the population. The expert panel’s report, alongside the Sir Liam Donaldson and Transforming Your Care reports, has been instrumental in developing Health and Wellbeing 2026: Delivering Together. To be clear, Delivering Together is now the only road map for reform.

As I have said, the case for change is universally accepted. When I addressed the Assembly in June, I spoke about the prevailing challenges that exist. By 2039, the population, aged 85 and over, will have increased by 157% compared with the position in 2014. Living longer is of course great news for us all, but, as we get older, we are more likely to live with one or more long-term conditions. In addition, our health and social care needs change, and we quite rightly have higher expectations. Our health and social care system needs to change if it is to meet the needs and the expectations of a growing population.

Health and well-being is shaped by many factors but above all by our social and economic environment. To our shame, the inequalities between health and social well-being outcomes across our society are stark. Where you live should not determine how long you live. A simple illustration of this is that people who live in Belfast city centre will live up to nine years less than those living at the top of the Malone Road. We should all be deeply concerned by that.

Across the North, the proportion of babies born with a low birth weight in the least deprived areas is lower than that in deprived. Children born in deprived areas are more likely to experience childhood obesity and to be in care. It is an outrage that, in 2016, your life experience may be predetermined by your social and economic circumstances. This must change, and that change must start now.

Like Ministers before me, I continue to increase investment in front-line services and in service developments and improvements, and this has gone some way to alleviating the pressures the system faces and the consequences for those requiring health and social care services. However, this is not enough. Our current delivery models are having an increasingly negative impact on the quality and the experience of care, and they are constraining the ability of the system to transform itself to meet 21st century health and social care needs. There are excellent examples of innovative practice, but these are often in pockets and not widespread.

The reality is that the current model is unsustainable. If we continue to provide services in the same way, using the same current models of care, demand projections show that ten years from now the HSC will need 90% of the entire Executive Budget — that is 90% of the entire Executive Budget.

Since coming into post, I have spent much time listening to HSC staff and to users. Not only are they ready for change, they want change and they are demanding change. They are not alone. The political summit hosted by the expert panel secured a mandate for change and the principles that underpin it. We have a "fresh start", supported by the Executive — it is not down to one Minister or one Department. There is total agreement across the Executive that this needs to be done.

Health and Wellbeing 2026: Delivering Together provides a road map for radical transformation in the way we receive health and social care services. This is not a quick fix. Given the size and scale of the challenge, I fully expect that the transformation process will take two mandates to properly plan, implement and embed, but we must start now.

In line with the Programme for Government and the Executive's population health framework, 'Making Life Better', my overriding ambition is for all of us to lead long, healthy and active lives. Health is a human right, and I believe in a universal health service, based on need, free at the point of delivery. I want to see a future in which people are provided with the information, education and support to enable them to keep well in the first place.

When care is needed, it should be safe and of high quality. Those who use services should be treated with dignity, respect and compassion. Staff are the system's greatest asset, and they must be empowered and supported to allow them to do what they do best. Put simply, I want to see a health and social care system that is efficient and sustainable, where best practice is the norm and where investment is made in areas that will positively impact on service users rather than prop up a failing structure.

My vision for health and social care is ambitious. It will require whole-system transformation across primary, secondary and community care, and a radical change to the way in which we access services. We will work across sectors to build capacity in communities. That will allow them to develop the skills and knowledge needed and the assets required to tackle effectively the underlying determinants of health and well-being. Tapping into their ideas and energy, we will build on and support the real strengths that they have. We will support the development of thriving and inclusive communities. Through building community capacity, developing social capital and investing in health-visiting and school nursing, we can ensure that every child and young person has the best start in life and is supported to fulfil his or her potential.

We will support those who are more vulnerable in our society, those living in deprivation, our older population and those with learning disabilities and mental health issues. We will help them to live the life that they want, maximising independence and maximising choice.

The early intervention transformation programme (EITP) is a good example of joined-up government, with the Department of Justice, the Department of Education and Department for Communities all working together to find ways of intervening earlier in their lives to improve outcomes for all our children. We will build on that success, including building the capacity of staff to work more effectively in delivering early intervention approaches.

We will also strengthen the work of the existing network of family support hubs available right across the North, which show how community, voluntary and statutory organisations can work together to help families doing their best as they face the challenges of bringing up children.

Improving the life chances of children and young people is a priority for me, particularly of those children for whom the state has taken on parental responsibility, or "looked-after children" as they are known. Those children experience much worse health, social, educational and employment outcomes than children generally have. That is not acceptable to me. I will expand the range of placement options and support available to them to support their mental and emotional well-being, educational attainment and overall health outcomes. We must and will become better parents for those children.

When people need care and support, very often, their first port of call is their GP. Primary care is the bedrock of our health and social care system, but it is still largely based on GPs working independently, with limited input from other skilled professionals, such as district nurses and social workers. There are many examples of how we have improved that integration, but we must go further. People do not live their life in silos, so we should not provide services in them. I will invest in our primary care services. I will put in place multidisciplinary teams embedded around general practice that will maximise the benefits that can flow from our integrated system of health and social care. Their focus will increasingly be on keeping people well in the first place and the proactive management of long-term conditions. They will be equipped to identify and respond to problems earlier, whether they relate to health or social needs.

The teams will include people from a range of disciplines, including GPs, pharmacists, district nurses, health visitors and social workers. I am also keen to explore new roles that are having positive impacts elsewhere, such as advanced nurse practitioners and physician associates. We need to be open to new ways of doing things, looking to approaches elsewhere, such as the model used in the Netherlands, where district nurses lead the assessment, planning and coordination of care in self-managed teams. I believe that the best of that approach and other approaches can be adapted and even improved on in our integrated health and social care system.

I recognise the challenges in recruiting and retaining GPs, and, given the importance of building multidisciplinary primary care teams, I will increase the number of GP training places to 111 a year, with 12 additional places next year and 14 beyond that the year after. Building on the increase in training numbers made earlier this year represents an increase of more than 70% in GP training places within a three-year period.

Alongside increasing the number of GP training places, we must make sure that general practice is a key part of the medical undergraduate curriculum. To that end, funding provided for undergraduate training will be redirected to support Queen's University in increasing the percentage of the undergraduate medical curriculum spent in general practice. I can also announce that 25 GPs have been accepted onto a GP retainer scheme, which was launched earlier this year. This has meant that GPs who may otherwise have been lost to general practice are attached to practices, are working in the out-of-hours service and have access to a supportive continuous professional development programme and mentoring.

I have initially commissioned five training places for an advanced nurse practitioner programme in primary care to start in February 2017 in addition to eight for emergency departments. I plan to at least double those numbers from September 2017 and then incrementally grow this cadre of staff for an increasing number of specialties over the next five years. By further extending the role of the nurse, I want to ensure that I still have sufficient nurses to continue to do the jobs they already do so well. Therefore, I am increasing the number of training places for new nurses by a further 100 from September 2017 to ensure that we will not be as reliant as we currently are on the international recruitment of nurses to fill vacancies in the years to come.

The role of physician associates (PAs) is one that I am keen to build on. I provided funding to support placements in primary and secondary care for an annual cohort of 20 PA students on the new postgraduate course being commenced in the University of Ulster in January 2017. I will also continue to invest in the practice-based pharmacist scheme, with close to 300 pharmacists expected to be employed across the North by 2020-21, taking the pressure off GPs, improving the use of medicines and supporting patients. The askmyGP online and phone triage system, which is allowing GP practices to see patients the same day and when they need to be seen, will be rolled out to a further 30 practices. These investments reflect some of the recommendations of the GP-led care working group, which reported earlier this year. I intend to provide a full response to the recommendations of the working group before the end of the year.

We must also make use of our valuable community pharmacies much more. They have an important role to play, particularly in supporting people to keep well in the first place and to use their medicines appropriately and safely. I want to develop a new framework for how we work with Community Pharmacy to fully realise pharmacists' potential.

There has been a long-standing ambition to shift more health and social care from hospitals to settings closer to people’s homes. I believe that this is the right thing to do, and I want to ensure that we realise that ambition. New models and services continue to develop and emerge such as acute care at home. For example, in the Belfast Trust and the South Eastern Trust areas, 460 frail elderly people have received enhanced or acute care at home services, avoiding 4,102 days in hospital. I want to ensure that patient-centred initiatives like this are implemented right across our health and social care system.

Ambulatory assessment and treatment centres are a further example of innovative patient-focused initiatives that I plan to develop further. These centres will provide a one-stop shop, allowing patients to be assessed and diagnosed and, if required, to receive a treatment or procedure all on the one day. In the Belfast Trust, in the past six months, over 9,000 patients have been treated in ambulatory care instead of waiting in the emergency department, and 81% of them were discharged home without needing to be admitted. Over 4,000 have received treatment on a planned basis through this approach without needing a stay in hospital. In the South Eastern Trust area, over 1,000 patients have benefited from this approach in the last six months. This and similar models in other trusts provide for a better experience for patients and a more effective use of our inpatient beds, and we need to build on the new services and expand their use.

Given the changes that I have set out for the rest of the system, it follows that the nature and focus of our acute hospitals will change. As well as enhancing the support received in primary care, we need to reform and reconfigure our hospital services. The expert panel has provided us with a road map to do so, and I plan to consult on the criteria recommended by it next month. Once agreed, this will form the basis of a programme of service reviews, seeking to ensure that our services are configured and built around what people need.

This is not a standing start. We have recently conducted clinically led reviews in pathology and imaging, and I intend to move to public consultation on these two important areas. In the future, the role of our hospitals will fundamentally change to focus on addressing the needs of patients requiring complex planned surgery or emergency care in an inpatient setting. There is strong evidence that concentrating specialist procedures and services in a small number of sites produces significantly better outcomes. Adopting this approach will mean that not every service will be available in every existing hospital, but, where those services exist, each and every one of us will benefit from more timely, safer and better outcomes.

Over the last few years, we have seen the development of very successful regional networks for a number of specialist services. These provide services to our whole population rather than to a small locality. We have seen that developed increasingly on an all-island basis, as in the case of the congenital heart disease network. I have already commenced a programme of work with counterparts in the Department of Health in the South to identify areas of mutual benefit and develop more cross-border and all-island services. I am keen to explore the potential benefits of this approach, particularly around delivering better perinatal services and support for new mothers, as well as considering ways that we can help young people who are struggling with mental health and addiction problems.

Evidence also shows that delivering planned and emergency care using the same facilities and resources can have an adverse impact on activity and, therefore, lead to an increase in waiting times. Far too often, scheduled appointments and surgeries may be cancelled when vital resources are diverted to deal with unscheduled care. Moving forward, elective care centres will be developed to carry out less complex planned treatments. These centres will make better use of the resources that we have through organising them differently. This may mean that a patient may travel further for their treatment, but there is strong evidence that elective care centres, such as those used in Scotland, can reduce waiting times and provide a better experience for staff and patients. I cannot tell you where these centres will be or how many we will have. The answers to these questions will be for the clinicians and professional managers in the HSC system to develop based on the evidence of what people need and working in partnership with service users and patient groups.

However, elective care centres are not the sole solution to the unacceptable delays currently facing patients. Rather, they are part of a long-term process moving towards a more sustainable model. This future model cannot succeed if it inherits the unacceptable waiting lists that blight our system. Urgent and sustained action is required to bring these under control. In light of the recommendations set out in the expert panel’s report, I intend to bring forward a strategy to reduce waiting lists.

I have set out the changes that I believe are appropriate for the delivery of services, but how we plan and manage these services is just as important. We need to reduce bureaucracy to make the decision-making process more streamlined and, importantly, to plan and manage services in a way that promotes collaboration, integration and improvement in service delivery. In the context of the decision to close the Health and Social Care Board, I know from speaking to staff that they are anxious about their future. They have already been involved in the design process, and that will continue. This is a priority for me and, now that the direction of travel has been fixed for the delivery of services, I will move very quickly on this matter. I will engage with the board staff as a matter of priority.

I believe that the approach that we take to transformation is as important as the transformation itself. From the outset, I was clear that this vision could be achieved only through partnership working and co-production. It is no coincidence that the document that I am publishing today is called 'Delivering Together'. It sets out in clear terms how I will bring forward transformation. We all have a stake in our health and social care system. It belongs to us all and, therefore, we all have a responsibility to work together to ensure that it is sustainable for the future. We must all work in partnership to design and deliver the changes.

The principle of co-production will underpin how we operate in the future, whether that be at a system level, designing how our services and hospitals should be configured, or at a service level, designing how care pathways and individual care should be delivered differently. However, very importantly, it also signals a collaborative approach between the people who provide services and those who depend on them. Care should be planned around the individual and the unique needs of that person, and this must be based on real and meaningful partnership. Our mental health recovery colleges are an excellent example of the benefits that can be realised through co-production, recognising and using the expertise that people with mental health difficulties have. We will now harness the energies of people who use all our services.

I want to align quality improvement and regulation far more closely to the voice of those who use our services and those who deliver them. We will replace a culture of targets and blame with one that focuses on outcomes and improvements. Outcomes should be shaped by what matters to people, not just by what is wrong with them. Improvements will be led by staff on the front line, not distant officials. This is already happening. Committed staff, working with the people they serve, are taking forward initiatives to improve outcomes, shorten waiting times and reduce bureaucracy.

Quality improvement initiatives, such as the integrated respiratory service in the west, are happening every day, designed and led by the staff on the ground. The community respiratory team provides patients with joined-up specialist support focused on self-management, and coordinated care. This is a much more streamlined and responsive service for patient, GPs and hospital services and benefits all.

Another example is the rapid assessment, interface and discharge team in the northern area, which is known as RAID. That innovative project is based on international best practice and recognises the links between good mental health and good physical health. Instead of the traditional approach to mental health referrals for people who go into emergency departments or are admitted to hospital, that team operates seven days a week, 24 hours a day to respond quickly to need. It also acts as a link to community mental health services, promoting recovery and well-being and ensuring continuous care and better outcomes.

Those are strong local examples, but they raise the question of why those services are not available to all the people of the North. I want to develop a system that will learn from such approaches and see them adopted across the system. As a first step towards that, I have asked that a group is convened of professionals and people who use services to establish an improvement institute. That will not be a new building or a new layer in our system, but it will help to bring existing experience and knowledge together to work in a different new way for a much greater impact. That will be supported by a new approach to learning and team working. Rather than concentrating power at the top, I want all those working in health and social care to feel able to effect change and improvement in care. We must support and equip teams to do what they do best — namely, provide excellent care — and not micromanage them and load them down with unnecessary bureaucracy. That means having greater collective clinical and professional leadership throughout the HSC, supported by skilled and able managers.

Too often, I have heard that the current culture in the HSC is characterised by competition and silos, and that must change. I want to see a culture where staff feel empowered and where collaboration and partnership working define the way things are done. The positive results of that way of working are clear to all. In one of our trusts, a head and neck cancer specialist nurse introduced a follow-up telephone aftercare service by working in partnership with patients, which resulted in a patient-led follow-up service that enables fast-track referrals to follow-up clinics. There are many more examples across the system, but that type of working needs to become the new norm. For that to happen, our staff need to be equipped with the tools that will allow them to lead change. That is why I have asked my officials to develop a system-wide HSC leadership strategy by next summer.

I am determined to realise the potential that modern information technology provides. The pace of technological change is rapid, and that is no different in health and social care. I want to ensure that the right information is available to the right professionals or, indeed, service users themselves when they need it and in the way they need it. We have too many systems; people often have to tell their stories or provide the same information over and over again. At best, that is frustrating, and, at worst, it is unsafe. I want to ensure that the double and triple handling of information ceases by consolidating our patient records, enabling greater access to citizens and freeing up health professionals' time to care.

That is a major undertaking. Even starting now, it will be a decade before we see real change right across our HSC system. However, progress is being made. Every day, more health and social care information and resources are added to NI Direct, and I expect to have a patient portal in place for dementia patients next year. We plan to roll out online access to health and social care records over the next five years, where service users and patients want it. As users of the service, information about us belongs to us, and having access to that information will help us to make informed choices about our lives.

This morning, I have set out what I believe to be a very ambitious vision for the future of HSC. What I am proposing is not a quick fix but a significant and radical programme of change. That is why I have been upfront about the time frame. However, I want to be really clear that the size of the task and the length of the journey will not dictate the pace of change. I have witnessed the pressure that staff are under every day. I know that 10 years is too long for them to see a difference, which is why I have set out my priority actions for the next 12 months: change starts today.

I am committed to taking a personal role in this process and will bring progress reports to the Assembly every six months. In short: I am up for this.

Change cannot happen, of course, without investment. We need to continue to deliver the existing HSC services to those who need them whilst developing and implementing change, so a period of double running will be necessary. Once I begin the process of co-production, I will be clearer about the financial requirement. What I can say today is that additional investment is needed.

I acknowledge that the cost of transformation may be significant, but standing still is not an option. There will be consequences if we do not deliver planned and managed change in our health and social care system. Even with the best efforts of all the staff, waiting lists will continue to grow, expertise will continue to be diluted and the best possible outcomes for our citizens will not be realised.

I believe that we have been given a fresh start. We are facing into a time of change, but it is change that must happen. Delivering Together sets out a direction of travel that I hope all our society can embrace and support in the challenging but potentially rewarding times ahead.

As Minister of Health, I will provide the leadership needed to drive change. I have no doubt that those working in the front-line service will not be found wanting in leading the transformation of the health and social care system. Today I hope that colleagues from all political persuasions will show the political leadership and courage needed to support the system in transforming itself. Together we can deliver the health and well-being outcomes that all our people deserve.

I commend the statement to the Assembly.

Photo of Robin Newton Robin Newton Speaker 11:00 am, 25th October 2016

Before I call a Member to ask the first question, I inform the House that a very large number of Members have indicated their desire to do so. In order that I can get in as many Members as possible, I ask that those who get the opportunity to ask a question ensure that it is short, sharp, focused and relevant to the statement made by the Minister.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I thank the Minister for her statement and for the eventual publication of the two reports. She talked about "a period of double running" and said that she will be clear about the finance when that begins. Does she recognise that Transforming Your Care (TYC) failed because of the lack of budget? What assurances can she provide to the public, patients and health professionals that this report will not fail? Was the Minister surprised by the apparently limited detail in the 'Systems, not Structures' report?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I start by commending the expert panel for the work that it did. The report that it produced was very clear and pointed out the stark challenges in our system. It was a very detailed and meaningful piece of work that engaged staff right across the health and social care system. I very much welcome the report. It has informed me of the direction of travel that we need to take.

I believe that, in going forward, we have no choice but to transform our health and social care system. If we are all invested in making sure that we have better outcomes for the population, we should all play our part and get on board for the transformation journey that we need to take. The Executive have endorsed a plan of action for going forward and realise that transformation costs money. They want to deliver better outcomes for our population. The clear direction of travel set out today shows that we will make a meaningful difference. We have to transform the system and support the staff who do an excellent job every day and are under pressure.

We have set out today a very clear programme for the implementation of change to make things better and deliver better outcomes. We should be focused on making sure that we deliver the best possible outcomes for all of the population. We have a real opportunity to make a meaningful difference and to be world leaders in what we provide through our health and social care system. We are already the envy of many areas that look towards our integrated system. Let us build on what is good, transform the system and put our health service on a sustainable footing. I believe that the rewards will be seen in the years to come, when we can stand over a first-class health and social care system in which staff, patients and carers are involved in the planning, production and design of the services that we provide.

Photo of Paula Bradley Paula Bradley DUP

I thank the Minister for her statement outlining her vision for Health and Social Care. Your vision is very ambitious, Minister, but I believe that, with consensus in the House, it is achievable. The statement mentions that tough decisions need to be made and refers to the Bengoa criteria. Will the Minister tell the House what process she intends to put in place to involve communities, front-line staff and political representatives in order to make that a reality? Will she also advise what preliminary work has been done to cost the proposals set out in her statement?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for her positive contribution. I look forward to working with you as the Chair of the Health Committee. We have a shared interest in delivering better outcomes for our population. This is a real opportunity, and I know that you will be happy to work with me to make sure that we deliver a first-class service.

We should not start the conversation about money. Obviously, it is very important and we need it to transform the system. However, the principle behind all this is transforming services to deliver better health outcomes for the population. I am deeply committed to universal healthcare that is free at the point of delivery for the whole population. For the first time ever, the Executive have collectively endorsed a programme of action and the plan for going forward. In doing so, they recognise that there is a cost. We will enter the Budget process in the weeks and months ahead and will, I hope, secure the transformation funding that we require.

The Member asked how we will work and build confidence in the system.

That is about meaningful engagement and listening to staff and patients. It is about making sure that the decisions that we take are clinician-led. If those decisions are clinician-led, people will know that they are about better health outcomes for them. It is about having a frank and honest conversation with individuals about the plan and about where we need to go. We want them to help us deliver the services. People are up for that; the staff and patients whom I am engaging with are up for that. I am, personally, going to embark on a process of engagement, and I will go anywhere that health service staff want to talk to me about getting involved in the conversation. I want to make sure that we collectively go on this journey, but I also believe that it is about genuine ownership — giving staff and patients ownership of the direction that we are going to take.

Photo of Catherine Seeley Catherine Seeley Sinn Féin

I thank the Minister for her statement and welcome the work that has gone on behind the scenes to get us to today. She has made it clear in the past that mental health is a priority of hers. Will she set out her plans in relation to mental health and how we can achieve parity of esteem for it?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for her question. I have said in the House on many occasions since taking up office that mental health will be one of my key priorities. When it comes to reshaping services, co-production and looking at how we are going to deliver services in future, mental health is one of those areas, through recovery colleges, where we can see how co-production works. I want to do more of that. We have to work towards the point where we have parity of esteem for mental health, which, to me, means recognising the true impact of mental illness on society. It is about a focus on recovery and greater involvement of experts and the experience of the service user and those who are living with mental illness. It is about investing in service developments where resources allow. It is about exploring the potential for all-island developments. As I said in my statement, there are a number of areas where we could work more collaboratively, particularly in perinatal mental health and in relation to young people who find themselves with a dual diagnosis.

There is so much that we have still to do. I am going to receive the review of the Bamford report action plan in the next month, and that is going to help me inform the direction of travel. I want to set out very clearly a plan of action for the next number of years, which will set out how we are going to achieve parity of esteem for mental health. It is so important that we help people to remain well and that we promote positive mental health messages. I want to prioritise this, and, as I said, over the next number of months, I will produce a plan for taking that forward.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I very much thank the Minister for her statement and welcome the publication of this report, which contains some extremely sensible and necessary proposals. However, the lack of specifics in the report and in the statement on the transformation or rationalisation of our hospital estate means that a spectre of doubt will loom over services in several areas. When will she be in a position to put more meat on the bones of this statement and let us know what this means for where?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

We did not just arrive at this scenario overnight. The health service did not get to the state it is in overnight. This has been a process that happened over many years, and it is for a number of reasons, including an ageing population, growing expectation and demand, financial challenges, the Tories cutting the block grant and all the implications of all of that. I could list the challenges, which are well rehearsed and, I think, universally accepted. We have to get better about how we deliver our services.

What I set out this morning is a true reflection of the length of time that it is going to take to properly transform the system. There is no quick fix, so we need to have a sustained plan of action, which is what I have clearly set out. We cannot just sit back and wait for 10 years to go by and see what happens. We have to be part of everyday actions that are making a difference. I have clearly set out my plan of action for the next 12 months, which is very much focused on co-production and co-design. If I am serious about co-production and delivering services in conjunction with patients, carers and staff, I should not run too far ahead of the ball. That would not lead to meaningful collaboration or engagement. What I have set out, clearly, is a plan of action for the next 12 months, which is going to inform the year after, the year after and the year after. I think that what we will see is incremental change.

I would suggest to the Member that we should not allow any seed of doubt to be sown out there. This is a positive development. We all want to see better health outcomes for all of the population, and the best way to do that is to work together. I have said that I will come back to the House every six months throughout this journey to update Members on where we are and on how far we have got in our progress. I think that this is different from anything that has come before. We have an Executive that have put their full weight behind this direction of travel. We have an Executive that realise that we need additional funding to transform and that want to tackle waiting lists. I have said that I am going to bring forward a plan in January that will set out very clearly, over the next five years, how we are going to bring those waiting lists down.

That is the plan of action to deal with the backlog, but if we do not transform the system, the waiting list picture is not going to get any better and staff are going to come under even more pressure. I suggest to all Members that this is a positive day. This is a fresh start for health, and we should go out and tell the public that we are committed to delivering this transformation.

I, as the Health Minister, will not be found wanting in the leadership that I will show in driving forward meaningful transformation, because I am committed to tackling health inequalities and delivering first-class health outcomes for all the population.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Minister. The reports are very good and very much reflect what we, as Health Committee members, have been hearing over the past few months. The increase in GP places each year to 111 is very much to be welcomed. As you know, however, the British Medical Association and the Royal College of General Practitioners have a lot of urgent and pressing matters that need to be attended to, not just about more places. I am talking specifically about more finances. How do you plan in the shorter term to address finance issues?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

We all recognise that GPs are under pressure. The focus that I placed today on primary care will really help improve that picture and really help support GPs. The fact that, within the next number of months, all GP surgeries will have a named health visitor, district nurse and social worker shows in itself the commitment to multidisciplinary teams, which the BMA and GPs are asking for. The other thing is around working with Community Pharmacy. Our community pharmacists can do so much more, and they are crying out to do so much more, so I want to work with them. I will develop a framework over the next number of months with them. Whenever we come to agreeing a new contract, we can work more collaboratively with Community Pharmacy.

As a combination of building community capacity, all those things will make a real difference to primary care. When it comes to making difficult decisions in the future about where services are based, we have to invest in primary care. People have to feel that it is different in primary care. The initiatives that we have set out today are going to do that.

The GP-led working group has set out a number of asks, some of which we have addressed today. However, I will respond to the full report by the end of the year, and we will look at other areas in which we can work together.

GPs are the bedrock of primary care, so this is a good opportunity for us not just to give a nod to primary care but to make a real, meaningful difference. I think that the implementation of some of the initiatives that I have set out will make a real difference.

Photo of Gary Middleton Gary Middleton DUP

I thank the Minister for outlining the report. The expert panel report states that action must be taken to address elective care waiting times. The Minister stated that she intends to bring forward a strategy to try to address and reduce waiting times. Can the Minister outline what content she foresees being in the strategy?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for his question. I consistently say, and I say it again here today, that waiting times are unacceptable. They are unacceptable to me and, I think, to all of us. We share that.

I understand absolutely that, if you are waiting to be seen as an individual — a parent, a daughter or a son — it is so stressful and worrying if you cannot get to see someone as quickly as possible, so we need to do two things. We need to address the backlog, and that is what the plan will very much be about. Alongside that, we need to develop and transform our system so that we do not get to that point.

These are new ways of working. We are trying to operate a 20th-century health and social care system trying to deliver 21st-century care, and those two things do not marry. If we do not transform the system, our waiting lists are not going to get any better.

I have already done a large body of work on waiting lists and am bringing forward a plan. We are going to need additional funding to be able to do that. To build public confidence that what we are doing is the right thing, we need to address waiting lists alongside the transformation piece. Transformation is the longer-term solution. In the meantime, we have to bring forward a plan, which I am going to do by January, that will clearly set out how, over the next five years, we will try to bring down the waiting lists.

Photo of Ian Milne Ian Milne Sinn Féin

Buíochas fosta leis an Aire as an ráiteas seo inniu. I thank the Minister for her statement this morning. Our community pharmacies are providing vital services every day. Can the Minister explain how she plans to utilise them better to help deliver the vision and changes that she has set out today?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for his question. I 100% agree that community pharmacies play a vital role in our health and social care system. Recently, when I was out visiting one of the community pharmacies, I saw at first hand how they contribute, which included doing things that you would not believe that a pharmacy does.

Quite often, they can be the first port of call for a lot of people, particularly in deprived areas, where people may be more likely to go to their community pharmacist than to their GP. They are crying out about wanting to do more. I want to work with them to do more. Our community pharmacies dispense over 40 million prescription items every year and have unequalled access to people in local communities. That gives them the opportunity to promote well-being through the best use of medicines and delivering important support about healthy lifestyles. When we look towards winter, pharmacy in the community has a critical role in supporting people to stay well and to make informed choices about HSC services.

I want to maximise the potential of Community Pharmacy: they are up for it, I am up for it, and we can make a real, positive difference. This is all bringing it back to the focus on primary care. It is about the GP. It is about the district nurses. It is about the allied health professionals. It is about the social worker. It is about the community pharmacists. It is about the community itself. It is about that partnership and collaborative working. If we successfully get to that point, we will see real, meaningful differences, particularly in tackling health inequalities and in making sure that we are reaching people at a very early stage. Early intervention and prevention are absolutely key when it comes to the health service.

Photo of George Robinson George Robinson DUP 11:15 am, 25th October 2016

I thank the Minister for her statement. Can she outline the timescale for the additional GP retraining to impact on the front-line of out of hours care in areas such as the western out of hours? In towns such as Limavady, there have been occasions when there is no GP service between 8.30 one evening and 8.30 the next morning.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I have outlined a number of areas where we will work with GPs, and one is recruiting and increasing the number of GP training places, but it is also about looking at the role that associate physicians can play. We need to explore new ways of working, and I have announced some moves on that. I also think of advanced practitioner nurses. A lot more people can support the GP in that setting. We need to move to the point where we truly have these multidisciplinary teams in place. GPs are under pressure, particularly in rural areas. We have seen some particular challenges in relation to that. I am committed to increasing the numbers of GP places by, I think, 12 next year and 14 the year after. We have also seen, in the last year, an investment package of up to £5·1 million in 2015-16 and a further £7 million this year. We are continuing to work with GPs. We have increased the number of GP places, but I will respond in due course to the recommendations of the GP-led care working group in the context of the Budget process.

Photo of Robbie Butler Robbie Butler UUP

I thank the Minister for her answers so far and, indeed, for the report. The Minister thought it important enough to mention extending the role of nurses and midwives, and recommendation 3 talks about innovative approaches. I hope that she will agree that that is not an innovative approach. It is doing more for less. With that extension in role that she talks about, will she also recognise that an additional responsibility payment may be required for those people, and will she commit to recognising that our nurses, midwives and care staff are appreciated and treated fairly?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

When I talked about innovative approaches, I meant supporting the staff to do what they do well. I pointed out a number of examples of when staff have gone ahead and developed innovative practices, and I think that we need to scale those up. If something works, let us do it across the board. Quite often, a lot of the innovative projects and initiatives that staff have taken are done in pockets, but we should replicate it across the whole of the North if it works.

As I have clearly set out, I will make a workforce strategy plan. We do not have a workforce strategy plan right across Health and Social Care, and so, if we are to transform the system, we also need to look at what our workforce challenges are. I have set out that I will take forward that programme of work. For me, that will allow us to make sure that we have the right staff who are trained in the right way and in the specialisms that we need. I think that it is innovative to look towards more areas such as advanced practitioner nurses and physician associates and see how they can support the staff to do the excellent work that they do. Try not to be too critical. I think that this is a good day for health. We should embrace it and take it on board.

Photo of Linda Dillon Linda Dillon Sinn Féin

I thank the Minister for her answers. Can she outline how her vision, set out in Delivering Together, will help address the health inequalities that exist?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

This is one of the things that Professor Bengoa picks up in his report, and I went on to highlight it. The health inequalities that we face are stark. I do not think that we should ever be comfortable with that picture. However, I believe that the only way to tackle health inequalities is through collaborative working. The new Programme for Government approach allows us to do that.

It is not right that where you live determines your outcomes in life, but we know that that is the case. We know that deprivation is linked to health outcomes, job choices, employment and housing. We need to tackle them all. The vision that I have set out in Delivering Together is focused on keeping people well in the first place and on providing the education, information and support that they need to make informed choices, regardless of where they live. By building capacity in our multidisciplinary teams in primary care and ensuring that there is a named health visitor, district nurse and social worker for every GP practice, they will be better equipped to respond earlier and work with people to address the lifestyle choices that impact on their health and well-being.

What I have outlined is investment in, and development of, community resources. We will work with our partners and all the community to develop the strengths and assets to tackle the determinants of health and well-being. We have to tackle the root causes of health inequalities head on. We can no longer tolerate the correlation between deprivation and health outcomes. We can truly judge our system when we have improved that picture. I think that the direction of travel that we are going to take will lead to that improvement.

Photo of Gordon Dunne Gordon Dunne DUP

I too thank the Minister for her long-awaited report on what is a very important issue. How does the Minister see improvements to patient flow in our hospital system, given that bed-blocking has been critical and has had a serious knock-on effect throughout the system as many patients await community care packages?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Some innovative practices have improved patient flow. Our emergency departments are full, particularly in winter, and patient flow is very difficult. Often, older people cannot be discharged from hospital because there is no domiciliary care package in place, and there are particular challenges in relation to the workforce there.

In December, I will receive the report on the review of domiciliary care. I passionately believe in domiciliary care. These people, mostly women, are the lowest paid in our health service. Quite often, the trusts contract the work out to independent providers. Care workers do not get any mileage allowance and, if they work in a rural area, there could be 20 miles between one person's house and another's. That takes what are already low wages down even further. I am committed to supporting these people and helping them with their professional development. I look forward to the report, but I am passionate about making sure we do more to support domiciliary care workers, because support the system. They keep people at home longer and patients can be discharged from hospital more quickly.

Alongside this, in March, we will consult on the review of adult social care. That will also allow us to improve on how we deliver services and will make sure that we have settings to care for people that are appropriate and adaptable, because not everybody fits into the one approach. That is the conversation we will have about this matter.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I thank the Minister for the report. The statement suggests that there may need to be some changes to, or indeed closure of, emergency departments. Often, rural communities are impacted most by these changes, yet I note that there is no reference in the statement or the report — in what I have skimmed of it — to the Ambulance Service and the vital role that it plays in delivering front-line care to people in their moment of need. Will the Minister comment on whether the Ambulance Service will receive additional resources as part of this programme?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The Ambulance Service plays a key role in health and social care and has been very progressive in the new initiatives that it has brought forward to ensure, in particular, that an ambulance crew does not sit for a long time at a hospital waiting to drop a patient off into the care of a clinician. We need to do more of that.

Some of the challenges we have in the Ambulance Service are in relation to the workforce. We will look at every element of the health and social care system, including ambulance staff, to make sure that we have proper workforce planning and meet the needs of the service. I am committed to working with the Ambulance Service. The report does not talk about the Ambulance Service, but it is an integral part of the HSC system and we need to work with all elements of the system.

You talked about closures. We need to frame the conversation on the best outcome for individuals and on what delivers the best possible health outcome for individuals. The report that Professor Bengoa and the expert panel took forward very rightly focused on delivering better systems, not structures. I could have spent the next five years focusing on structures, but the outcomes would not have changed. If we get the system right, the structures will change in time. If we invest in primary care, we can make a real difference to what people get in their community. Let us remember that the traditional model of going to hospital is not a 21st century one; there is a recognition out there that we need to do things differently. People want to stay at home, and we should support them there as long as possible.

Only those who are acutely ill or are in for emergency reasons should be in hospital. If we can work towards that, people can see a real difference to the support that we provide in communities. Acute care at home is a really fine example of how that works. All the staff and clinicians go into people's homes and support them to stay in their own bed at night. That can make a big difference to someone who is not well. For me, it is about doing more of that. Structures will change in time. Let us invest in primary care. That is certainly my vision for what I want to do.

Photo of Alex Maskey Alex Maskey Sinn Féin

I thank the Minister for her important statement. Where does she think there is any further potential to deliver specialised services on an all-island basis?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

There are definitely areas where we can build on that. Some of the collaboration that already exists, particularly in children's cardiac services and radiotherapy for cancer patients, shows that we have been able to develop really innovative services for the population on the island. That benefits not only patients but staff because they are allowed to specialise in the areas that they wish. There are so many more opportunities — for example, transplantation of organs and rare diseases. We have also developed a programme of work with the Department of Health in the South to identify other areas of mutual benefit. I set out in a statement areas where I think that we could collaborate more — for example, mental health and perinatal mental health in particular. There is no service on this island to support women with mental illness in pregnancy. I would certainly be very proud if we were able to deliver such a service, and I think that we could do it collaboratively across the island. That would allow us to develop it a lot more quickly than perhaps we could do individually. Recently, I have had conversations on dual diagnosis and young people and adolescents with mental health and addiction problems, and I think that, again, we do not have any service right across the island. If we include transplantation, those are just three areas where there is scope. A scoping study is ongoing, which I look forward to receiving. I want to take forward measures that allow us to develop a first-class service for the population.

Photo of Stephen Farry Stephen Farry Alliance

I thank the Minister for her statement. She has welcomed the report and commended Professor Bengoa and his colleagues for their work, but she has not taken the opportunity to systematically go through the recommendations in her statement or documentation and give her response. It is traditional for Ministers, when they receive reports, to give their view of the report as a whole. For the avoidance of any doubt, will the Minister clarify whether she fully accepts the report that has been presented by Professor Bengoa in its entirety and, if not, what aspects she does not accept?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I assure the Member that I do; I believe that I said that at the outset. I said that I endorsed the recommendations that the expert panel had put forward. I said that very clearly in, I think, the opening paragraph. Let me say it again in case you missed it: I endorse the expert panel's report, and I have set out my plan of action on how I will take those things forward.

Photo of Danny Kennedy Danny Kennedy Deputy Speaker

I refer the Minister to action point 12 on page 26 of the report, under the heading "Transformation":

"Establish and seek members for a transformation oversight structure with membership drawn from within and outwith the HSC."

That target is to be met by or during November 2016. Will the Minister outline what the size of the structure would be; how many members it would have; who would appoint those members — practitioners, academics or politicians; and how it would avoid duplication with those with existing responsibility?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

It is clear that we have to drive change. I will provide the political leadership for change, but we need clinician-led oversight of service reconfiguration. November is next week. Over the next couple of weeks, I intend to set out what that panel will look like. Suffice it to say that it needs to be clinician-led. It also needs to include people from inside and outside the health and social care system. I am working up the detail of that and will make an announcement in the coming weeks. We can have a lovely direction of travel, but it is important to drive the implementation. I will drive it politically, but I am asking for clinicians.

I remember that, when I first came into office and was speaking at an event somewhere, my message to the health service was this: help me to help you. That is the message that I will leave as your answer: it is about how I can help the health service to do more and support it to deliver the first-class service that it is committed to delivering. I think that the direction of travel that we have set out here is the correct one. Hopefully, it will command universal acceptance. We need to recognise that, for the first time ever, the Executive have endorsed a plan, and they are committed to tackling waiting lists and delivering better outcomes for the population. To me, that is how we should be measured because, in government, you take tough decisions and deliver better outcomes for the whole population.

Photo of Richie McPhillips Richie McPhillips Social Democratic and Labour Party 11:30 am, 25th October 2016

I thank the Minister for her statement. I welcome it and the acknowledgement that the health service is at breaking point.

The Minister noted the need for change in the configuration of acute services. At this stage, does she have any information on where regional services will be provided, especially those in the Western Trust?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

You cannot help being parochial. The expert panel has set out the criteria that it believes should be considered when it comes to service reviews. It also set it out very clearly that we cannot keep delivering every service in every hospital, so we need to specialise. That is good not only for patients and patient outcomes but for the staff who get to build their skills and knowledge. When it comes to the direction of travel, today is not about closures or hospitals; it is about changing the picture and about better health outcomes. What does that mean? Does it mean that you travel a little further to get a first-class service? If, for example, after a stroke, people have to travel 20 minutes extra, but their outcomes are better — they will live longer, their mobility will not be as reduced and their speech will be better — I think that they will be prepared to do that. This morning, I listened to Janice Smyth from the Royal College of Nursing clearly say that people will travel if they get a first-class service. People need to understand why you make changes, so I want to communicate with staff, patients, carers and families to make sure that we are all part of designing the services and that people understand the care pathways and why they have to travel to services. Let us not focus today on closures; let us focus on building a first-class health and social care system.

The criteria for service reviews will go out to consultation over the next number of weeks, and I look forward to receiving Members' views. When the criteria are agreed, let us get on with the service reviews and making sure that we design a first-class health and social care system.

Photo of Mike Nesbitt Mike Nesbitt UUP

I welcome the Minister's commitment to parity between mental health and physical health, but I also challenge her: parity will have real meaning only if she addresses the imbalance in funding and resource, so will she commit to that over the 10-year period?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Maybe the Member misunderstands what parity of esteem is. It does not mean giving the same resource to physical health and mental health —

Photo of Mike Nesbitt Mike Nesbitt UUP

I did not say that.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The Royal College of Psychiatrists clearly said that in its report when asking for parity of esteem to be established. When I talk about parity of esteem, I am talking about moving towards true recognition, attention of resource and the Department's attention to the mental health issue. When we focus more on recovery and promoting good, positive mental health messages; when we invest in service developments; when we do more for perinatal health; and when we review the Bamford action plan — I have set out a plan for the next five years — you will be able to see how we will deliver parity of esteem. I am very committed to doing that, and I think that all Members share that aspiration. For far too long, mental health has not had the attention that it deserves. It blights all our communities, and people who find that they are vulnerable because of mental health issues need to be supported.

Photo of Gerry Mullan Gerry Mullan Social Democratic and Labour Party

This is a follow-up to Mr Middleton's question about elective care. As far as the lack of care centres is concerned, does the Minister intend to increase capacity here, especially through new capital build projects in the public sector, rather than having a total reliance on the private sector?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Elective care centres are within the HSC estate, so they will be developed in line with need. As I said in my statement, we do not yet know the number or where they will be placed, but the service reviews will allow us to do that. Elective care centres will really help us to deal with waiting lists by allowing people who have been scheduled for minor surgery to be seen without interruption to the service. That, in itself, will bring down waiting lists in the longer term. We will consult on the criteria, and, next year, we will move towards deciding where the elective care centres should go, and I think that they will make a real, meaningful difference to patient outcomes.

Photo of Stewart Dickson Stewart Dickson Alliance

Thank you, Minister, for your statement. Recommendation 6 requires additional funding for the transformation and transition. Have you secured that money from your Executive colleagues?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Yes. The Executive have endorsed the direction of travel and have endorsed the plan. In endorsing it, they have also recognised that transition is going to take additional funding. They also endorsed the fact that, in order to bring down waiting lists, it will need additional funding in the short term. So, for a time, we are going to have dual running. We have to keep the health service delivering every day alongside the transformation piece, but we cannot be distracted from transformation because, if we do not do it, the system will be in crisis in years to come.

Photo of Kellie Armstrong Kellie Armstrong Alliance

Thank you very much, Minister, for your statement. Recommendation 7 refers to the creation of a transformation board. Will the Minister confirm that — outwith what happened with Transforming Your Care, where there was no implementation plan — the implementation plan that is mentioned in part 5 on the actions will be followed and monitored regularly with published outcomes?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I am absolutely committed to moving to outcomes-based analysis; that is where we need to be. We will not do that overnight, but it is certainly what we are working towards. I will update the House every six months on the plan because that shows that we are serious about transformation and driving it forward. It is also about saying to Members that I want to work with them and deliver better health outcomes for all of the population. There is no danger of this falling down if there is genuine effort to implement it. I will not be found wanting in my political leadership. Also, the oversight structure that we have put in place, which is clinician-led, will make a real, meaningful difference and is something that has not happened before.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

Will the Minister give a guarantee that this report will not lead to the further encroachment by the private sector into our NHS?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Obviously, I am working towards a position where we do not need to use the independent sector. In the meantime — it will take a number of years to get to that point — there are people on waiting lists and we cannot just leave them there. We are going to have to do a combination of things in the short term. We are going to have to make sure that we are at full capacity within the health service, but also, in the short term, we are going to have to use the independent sector. I cannot let patients suffer whilst we get to a transformed health and social care system. I believe that, in the short term, we are going to need the independent sector. Certainly, for me, the longer-term goal is universal healthcare, free at the point of delivery for all people who need health and social care services. We should not have to rely on provision outside of the health service to deliver all those services that are much-needed.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

So, here we go again. Another fresh start in health. The recycling of a great plethora of fine words from an Executive that, since 2011, have reduced beds in our hospitals by 10% and then are surprised by the chaos that results. How can the Minister come to the House with grand proposals that she has not costed? What is the costing of what the Minister is proposing? Surely any proposal, to be credible, needs to be costed before it is embraced.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

It must be exhausting being so negative all of the time.


I have clearly said that I have set out a direction of travel. I have also said that the Executive have endorsed that direction of travel, in the recognition that we need additional funding. We are about to go through the Budget process, and I would like to see, at the other side of that Budget process, that we will also have a funding allocation that allows us to transform the system. It is very clear that what we have here is a real road map for change and transformation; one that will deliver incremental change, year-on-year, that will see staff and patients supported and that will lead to an open and honest conversation about where we are going.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I have costed everything that I am talking about. With the Minister of Finance and my Executive colleagues, I am working through the due process of the Budget decisions. That will all become very clear to you, so do not be too worried. You will see it all in due course.

Photo of Eamonn McCann Eamonn McCann People Before Profit Alliance

In light of the Minister's assurance that, in future, more attention will be paid to the perspectives and opinions of front-line staff than those of a manager sitting in an office with a spreadsheet — I paraphrase, of course — what steps will she take to ensure that we have no repetition of the grotesque situation that arose in the Western Trust area when £8 million earmarked for learning disability services was not spent on learning disability services? No explanation, of an adequate or clear nature, has been produced for this shortfall. We deserve to know this, and we do not know it. Will the Minister take steps at least to ensure that there is no repetition of this happening?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

On the Western Trust issue, I have met the families and the carers, and I continue to do so. I have given them all reassurances that we will get to the bottom of it. What we seriously need to be about — this is the core tenet of what I am talking about — is co-production and co-delivery meaning that. It means proper collaboration. It means people understanding that, if you make service changes, patients need to understand why you are doing so. They need to know that it is about trying to provide a better service for them. They need to understand that and be given every piece of information. I am committed to that. In building capacity in communities, co-production, co-delivery and co-design are going to be instrumental in helping us deliver a first-class health and social care system. Openness, honesty and transparency are key. The trusts are up for that, and the Department is up for that. Together we can, as I say, deliver first-class health and social care outcomes for all the population. That should be the only aspiration that we all work to for the health service.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I thank the Minister for the report. 'Health and Wellbeing 2026' refers to ambulatory assessment and treatment centres. Are those similar to the community care and treatment centres that are planned for such places as Newry? Will an ambulatory assessment and treatment centre include facilities such as a minor injuries unit?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

No, ambulatory care centres are a different set-up altogether. They allow people whom a GP thinks need to be seen by a consultant to go into a centre. For example, I visited one centre last week in the Royal, and there is also one in the Mater. One of the things that they do is, if you are referred to one, you can have your blood tests and X-rays, see the consultant and be assessed and watched throughout the course of a day. The stats show that quite often, as I said, you can then be sent home and do not have to be admitted to hospital. That is the ideal, for nobody wants to be in hospital unless it is absolutely necessary. If we can scale up the number of those ambulatory centres — the form that they take may be different, depending on where they are placed — that will make a real, meaningful difference to individuals. Again, it will prevent hospital admissions, which is what we should all be working towards. People to not want to be in hospital. I look forward to the development of these ambulatory centres. I think that they will make a real, positive difference to bed blockages and waiting lists.

Photo of Michelle Gildernew Michelle Gildernew Sinn Féin

I also welcome the Minister's statement and the publication of the report. There is a lot in there that I welcome, especially on mental health, children and looked-after children.

The Minister is aware that there is a lot of pressure in the system on nurses, social workers and other front-line staff. I very much welcome the increase in GP places, Minister. You are aware of the increasing pressure on GP practices in rural areas, particularly in Fermanagh. In reference to an earlier question, do not forget that, when people are travelling further for services, the road goes both ways. Hopefully people will be travelling west for some services rather than us travelling east all the time. Do you see the increase in the number of GP training places having a very positive influence on the delivery of the report, given that most people's point of contact is their GP?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Absolutely. This is about trying to address the challenges for GP services, but it is very much about, as I said, building up that team. The multidisciplinary approach is going to make a real difference, I believe. The fact that GPs have a team around them that can interact and that can rely on one another will make a significant difference to primary care. Staff are working even harder and are under a lot of pressure, so we have to get this right. We have to do it. Social workers are telling me about the pressures that they are under. I constantly hear about social workers going home and having to sit up until 2.00 am writing up reports. That is not sustainable for anybody's working pattern. I want to do more to work with all those teams to make sure that they support one another. Furthermore, we have a real opportunity to make sure that primary care is embedded, multidisciplinary and action-based. This is really going to change the picture.

On rural services, I absolutely agree with the point about designing services. Although people are always happy to travel if they are getting a better outcome, we do not want to starve them. It does not mean that everything has to be centralised in Belfast, for example. It can be the case that services are spread across the North. I am not going to give examples, because people will seize on them, but there are really good, innovative things being done in each trust. Each trust has a crucial role to play in determining where we develop services and where they are safe, because at the core of all of this has to be patient quality and patient safety.

Photo of Alex Attwood Alex Attwood Social Democratic and Labour Party 11:45 am, 25th October 2016

I welcome the statement and acknowledge that it is challenging work. I think that everybody recognises that the Minister is applying herself to this challenging work and there should be no doubt about that assertion. If it is the case that, in years 2 to 5 of this mandate, there will be increased health budget allocations in the existing structures and double running as the reforms are rolled out, have the Executive agreed this morning, and has the Minister of Finance confirmed to you, that double running will be permitted during this mandate and that, from year 2 to year 5, can you give a broad indication of the increased budget allocation that will be required to facilitate double running?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The Executive have recognised that we will need a period of double running, but they also appreciate that it will not be forever; it will be until we transform the system and put Health on a sustainable footing. We do not have a choice, because if we do not do it, the system will be in crisis and the entire block grant could be sucked up by Health. What would we do then for every other service and Department — for Education and roads and everything else that is important to people's lives?

We do not have a choice. The Executive have clearly committed to the plan and, in doing so, have clearly also committed to the transformation fund. We will see the allocation of funding as part of the Budget process in the next few weeks and months, and I am sure that we will discuss it in the Chamber. We do not have a choice. I cannot say that enough: we do not have a choice. We have to transform Health and Social Care, otherwise the system will break at some stage in the future. In recognition of that, the Executive are fully behind the strategy and the two-mandate plan. We have never had a two-mandate plan before, so that is really significant in itself. It sends out a very strong political leadership message that the Executive are committed to delivering this transformation programme alongside tackling all of the immediate issues that we have.

Photo of Roy Beggs Roy Beggs UUP

The Minister talked about investment in primary care. My constituents from Larne, Carrick and Newtownabbey have most of their care provided from Antrim and Belfast, so I welcome that there will be a greater focus on primary care. There needs to be investment in order that our GP practices can be improved and services provided. What investment will follow in capital and resource budgeting to enable more services to be provided locally from our GPs and other allied professionals?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I have already answered that in relation to the number of places that we have announced for GPs, nurses, named social workers, health visitors and district nurses and the roll-out of askmyGP to 30 more practices. All those things come with a cost, but I have decided that I can do them within the budget I have set out and that I am planning with the Executive. This is about real, meaningful change; it is about investment in the front line; it is about investment in primary care. For us to be successful in this transformation programme, we have to do that.

Photo of Nichola Mallon Nichola Mallon Social Democratic and Labour Party

The Minister will not be surprised by the content of my question, which relates to the devastating, ongoing problem of mental health and addiction among our young people, not least in my own constituency of North Belfast. I wholeheartedly welcome the Minister's commitment to exploring specialist treatment, on a regional and all-island basis, for our young people who are struggling with mental health and addiction problems. Could the Minister shape her thinking on that matter further? Does it involve the provision of a specialist treatment centre or a unit for dual diagnosis, particularly for those at the most acute end of the problem?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I am committed to developing services with the Minister in the South. We have embarked on identifying areas where we can collaborate, but the issues of perinatal mental health and dual diagnosis stand out as areas where we can do something, because we do not have a service on this island. We are actively looking at what is available in the Twenty-six Counties, and we will then develop the conversation further.

We need to do more to support those young people, and there is a lot of debate about what that might look like. We need to have that conversation. I have met with you and Carál Ní Chuilín and Gerry Kelly about how we can do more, particularly given the challenges and recent deaths in North Belfast. I am committed to tackling mental health issues, and I am very committed to making sure that we support our young who find themselves in such a vulnerable situation and making sure that the health service responds to their needs.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

I thank the Minister for her statement and wish her well. My question is in relation to — you will not be surprised as you have given me a namecheck — mental health. It is really in relation to dual diagnosis and the partnership with our health and social care staff as well as our partners and stakeholders in the community sector. I am aware that the Protect Life 2 strategy is out for consultation, and perhaps the Minister would like to wait until then, and Bamford, but can she give us some assurance that our partners in the community and voluntary sector will not become invisible when reforming our health and social care practices?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I thank the Member for her question, and I can absolutely give that assurance. The community and voluntary sector does amazing work and is very engaged in all our communities. It is absolutely part of the picture in supporting all those people who find themselves with mental ill health. Going forward, obviously, I am consulting on the Protect Life 2 strategy, the suicide prevention strategy, and I intend to engage personally on that issue as I believe we can continue to improve what is good out there and learn lessons where we need to do so. I want to work with the community and voluntary sector.

Recently, and you are aware of and attended it, the Future Search event in Belfast looked at bringing together all the partners across the community, voluntary and statutory sectors and looked at how, collaboratively, we can do more to deal with suicide in our society. I am very much committed to that collaboration, that partnership working, and I am very much somebody who wants to listen to those who are engaging with people with mental ill health, day and daily, in their communities at 12.00 midnight. I know the commitment of some of the community and voluntary sector individuals, and I really want to work with them in the time ahead.

Photo of Robin Newton Robin Newton Speaker

Members, that concludes questions on the Minister's statement.