Committee for Health
OFFICIAL REPORT
(Hansard)
Transformation of Health and Social Care:
Mrs Michelle O'Neill MLA (Minister of Health)
27 October 2016
NORTHERN IRELAND ASSEMBLY
Committee for Health
Transformation of Health and Social Care:
Mrs Michelle O'Neill MLA (Minister of Health)
27 October 2016
Members present for all or part of the proceedings:
Ms Paula Bradley (Chairperson)
Mr Gary Middleton (Deputy Chairperson)
Ms Paula Bradshaw
Mr Robbie Butler
Mr Gerry Carroll
Mr Trevor Clarke
Mr Mark Durkan
Mr Ian Milne
Ms Catherine Seeley
Mr Pat Sheehan
Witnesses:
Mrs O'Neill
Mr Richard Pengelly
Minister of Health
Department of Health
The Chairperson (Ms P Bradley): I formally welcome you to the Committee. I know we are all under
time pressures, so, Minister, I will hand over to you to make your presentation.
Mrs O'Neill (The Minister of Health): Thank you very much, Chair. I thank the Committee for the
opportunity to discuss the outworking of the Bengoa report and the statement I made to the Assembly
on Tuesday that set out the ambition for transforming health and social care over the next 10 years
and, alongside that, the concrete actions we will take to achieve that as set out in 'Health and
Wellbeing 2026: Delivering Together'.
Obviously, the Health Committee has an important scrutiny role to play as we begin to implement the
actions. My officials and I will fully engage with the Committee as we embark on this major
transformation programme for Health and Social Care (HSC). However, difficult decisions are ahead,
and, when we encounter them, I hope the Committee will consider the issues in the overall context of
the significant benefits to be achieved from the overall strategic approach.
The clear benefits to be realised are to secure improvements in health and well-being outcomes for
our people delivered by a sustainable health and social care system working effectively on a stable
financial footing. I have said many times that I feel absolutely privileged to be the Minister of Health. I
am very proud of the health and social care service and the dedication and hard work of all those who
work in it. I know the Committee shares the sentiments behind those words. We know, however, that
the health and social care system is under mounting pressure, with growing demand resulting in
delays in accessing services and unacceptable waiting times for treatment. In my first week as
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Minister, I made a statement to the House where I acknowledged what the challenges were, but, more
importantly, I pledged my commitment to transform Health and Social Care. I promised in July that I
would reflect on the expert panel's report and use that work to inform my vision for the long-term future
of health and social care here.
I believe we have a unique opportunity to make lasting and meaningful change. We can change
services that will improve the health outcomes of all the people of the North. We have a strong health
and social care system with many talented people working in it, but it is under considerable pressure
and change is absolutely needed. If we are to support everyone to live a long, healthy and active life,
we need to change the focus of our service and how and where we access those services.
The expert panel has clearly said that something very different has to happen at delivery of care level.
The evidence base is available to support the transformation, and it has been laid out in the expert
panel's report, as well as the reports that preceded it, including 'Transforming Your Care' and the
report by Sir Liam Donaldson. The root causes of the problems in waiting times, for example, are
representative of the wider challenges to the provision of world-class health and social care. They are
over-reliance on acute services rather than early intervention, meeting increasing demand, financial
constraints and a slowness to bring about radical change and reform. The Committee will be aware —
The Chairperson (Ms P Bradley): Can I just stop you one moment? Someone's mobile phone is on.
It will affect Hansard, and I think the public will be very interested in what the Minister has to say. Can
I just ask members and those in the Public Gallery to check their phones are either on flight mode or
switched off?
Mrs O'Neill: Thank you, Chair. The Committee will be aware that the HSC faces significant
challenges. To address that, we need a better model to deliver services and support the workforce in
providing the best care to patients. The current model was designed to deliver healthcare and social
services for the population of the mid 20th century; today, our society is getting older. People live
longer, which is a good thing, but often they have long-term health conditions. We are having fewer
children. We need to ensure that our system can meet the needs of today's population and that of the
future. The differences in health and well-being between the most and least deprived areas are still
very stark and are completely unacceptable. Comparable figures on birth rate, life expectancy,
alcohol-related deaths and admissions, suicide deaths and self-harm all indicate an increased need
for more extensive HSC intervention in our most deprived areas. The number of staff on the front line
increases year-on-year to try to meet increasing demand, but that is not the answer. It is simply not
possible to keep growing the workforce to prop up an outdated system. HSC staff work increasingly
hard to continue to deliver safe, high-quality services, but the way we are configured puts additional
pressure on them day and daily. The quality of our service and the experience of those providing and
receiving it is not as it should be.
The case for change is universally accepted, and I do not think I need to take up the Committee's time
by rehearsing all that here. 'Transforming Your Care', the Donaldson report and the expert panel's
report all provide helpful analysis of the challenges and opportunities facing Health and Social Care. It
is my intention to move beyond those reports and start the process of implementing transformational
change. As I said in the Chamber on Tuesday, 'Delivering Together' is now the only road map for the
future. I have spent a lot of time listening to HSC staff and users, and I am sure you have too. Many
of them emphatically tell me that they are up for the change. They are ready for change, and, in fact
they demand change. We have a unique opportunity, and we have to grasp it.
'Health and Wellbeing 2026: Delivering Together' is fully supported by my Executive colleagues.
There is total agreement across the Executive that it is the programme of transformation that needs to
be done. For the first time, we have the opportunity to implement a two-mandate vision to transform
health and social care, fully aligned with the new outcomes-based approach in the Programme for
Government. This approach places the onus on all of us to work together across the Departments to
deliver the best socio-economic outcomes for the people of the North.
Political leadership will obviously be vital to support the HSC as it moves forward with this
transformation to deliver better outcomes. Back in February, the five main political parties engaged
with the expert panel on the need to change and the principles that underpin it. There is a clear need
to continue this political fair wind and to deliver the changes required to deliver a world-class service. I
believe in a universal health service based on need and free at the point of delivery. My overriding
ambition is for all of us to lead long, healthy and active lives. 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
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with dignity, respect and compassion. I want to see a health and social care system that is efficient
and sustainable and where best practice is the norm and investment is made in areas that will
positively impact on service users.
My vision for Health and Social Care will require whole-system transformation across primary,
secondary and community care and a radical change to the way we access services. We will work
across sectors to build capacity in communities, allowing them to develop the skills and the knowledge
needed and the assets required to tackle effectively the underlying determinants of health and wellbeing. We want to give every child and young person the best start in life and support those who are
more vulnerable in our society, those who live in deprivation, our older population and those with
learning disabilities and mental health issues. The Committee may be aware of the excellent work of
the early intervention transformation programme and the family support hubs. I will build on that
success to support families, children and young people through intervening early when problems start
to emerge. For most people, when they need help, their first port of call is their GP. The future model
of primary care will see multidisciplinary teams embedded around general practice. 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 well-being. Given the importance of building multidisciplinary primary care teams and
recognising the pressure our general practice is under, I will increase the number of GP training
places to a 111 per year, with 12 additional places next year and a further 14 beyond that. This is only
one element of a range of actions I am putting in place to support our GPs and build capacity in
primary care. Before the end of the year, I will set out my full response to the recommendations of the
recent GP-led working group, which reported to me earlier in the year.
I also want to explore new roles and new ways of doing things based on evidence from here and
elsewhere. Significant potential is offered by roles such as advanced nurse practitioners and
physician associates. We need to consider how we can maximise their skills. The practice-based
pharmacist scheme is already under way. I expect close to 300 pharmacists to be employed in those
important roles by 2021 and investment of over £14 million per year. We are clear that we want to
deliver more care closer to people's homes, rather than in hospitals, where it is appropriate and safe to
do so. New models and services continue to develop and emerge, such as acute care at home. I
want to ensure those are implemented right across our health and social care system.
The further development of ambulatory assessment and treatment centres will allow patients to be
assessed, diagnosed and, if required, receive a treatment or procedure all in one day. I recently
visited similar facilities in the Royal Victoria Hospital and the Mater Hospital. It was amazing to see
the positive impact those services have not just for patients but for staff in trying to manage their busy
schedules. Elective care centres will be established for less complex planned treatment. Those
centres will be a resource for the region, and the way they operate will be designed around patients.
However, as I said in the House on Tuesday, elective care centres are not the solution to the
unacceptable delays currently faced by patients but are part of a holistic approach to patient-centred
care for the future.
The future model cannot succeed if it inherits the current unacceptable waiting lists. Immediate and
sustained action is therefore required to bring them under control. Tackling waiting lists will certainly
require some short-term investment. That is likely to take the form of increased in-house activity and
some use of the independent sector. I should be clear that those are short-term measures to bring
down waiting times and allow people to be treated and receive the care they need. Ultimately, I want
to get to the point where we have capacity in the HSC to deliver the services patients need, but my
overriding concern is ensuring that patients receive their treatment in a timely manner. I will therefore
bring forward a plan by January that will clearly set out how, over the next five years, we will address
waiting lists.
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. The expert panel has developed criteria that will help to assess the
sustainability and future of how those services are provided. I will move to consult on those criteria
without delay. They will then inform a programme of reviews to look at the configuration of our
services.
We also need to explore where all-island services can bring mutual benefit for patients, North and
South. We have already commenced a programme of work with counterparts in Dublin to explore allisland services, including transplantation, provision for rare diseases and mental health perinatal
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services. A further example is something I feel strongly about, and it is how we can better support
young people across this island with dual diagnosis of mental health issues and addictions. By
implementing new models of care and increasing our regional and all-island networks for specialist
services, we will not only deliver better outcomes for patients but alleviate pressures on vital acute
services, including reducing hospital admission rates, speeding up hospital discharge and reducing
the length of stays for patients who do not need to go into hospital.
In addition to those changes, I want to reduce bureaucracy and have a more streamlined and effective
mechanism for planning health and social care services. A new partnership approach with an
emphasis on collaboration, integration and improvement will be developed. Local providers and
communities will work in partnership, including the health and social care trusts, independent
practitioners, such as GPs, and voluntary providers to plan integrated and continuous local care for
the populations they serve. As I said on Tuesday, in the context of the decision to close the Health
and Social Care Board, I know the staff there are obviously anxious about their future, so it is a priority
for me to engage with those board staff in the coming weeks. I want to ensure that all stakeholders
have their say in how services are designed and implemented so that we can co-produce lasting
change that benefits us all.
We all have a stake in our health and social care system. Therefore, we all have a responsibility to
work together to ensure it is sustainable for the future. The principle of co-production will underpin
how we operate in the future. Very importantly, it signals a collaborative approach between the people
who provide services and the people who depend on them. Care should be planned around the
individual and the unique needs of that person. That must be based on real and meaningful
partnership.
In the design and delivery of health and social care, quality and safety will always be a fundamental
priority. Like many healthcare systems, there has been a gradual increase in improvement capability
across our health and social care service. The establishment of an improvement institute will help to
bring existing experience and knowledge together to work in a different, new way for much greater
impact. Evidence shows that we need to align quality improvement, regulation and the voice of those
who use our services much better if we are to achieve lasting change that focuses on what matters to
patients and staff. The establishment of the improvement institute affords us the opportunity to do
that.
As I said, I am committed to investing in the workforce of the HSC. The workforce is our greatest
asset, and I want to see a culture where staff feel empowered and where collaboration and
partnership working defines the way things are done. The expert panel has reaffirmed the importance
of effective planning and investment as a key priority to be addressed as an enabler for HSC reform. I
am, therefore, committed to developing by early 2017 and implementing thereafter an overarching
workforce strategy. I want all those who work in Health and Social Care to feel able to effect change
and improvement in care, which means developing leadership at all levels and ensuring that more
professionals will be directly engaged in the management and leadership of our services. Resources
will be invested to develop staff and leaders with the skills and behaviours that will be crucial as we
move forward.
I am also determined to realise the potential that modern information technology provides. Making
better use of technology and data is essential if we are to move to a model focused on service users.
I want to ensure the right information is available to the right professionals or, indeed, the services
users themselves when they need it and in the way they need it. I want to ensure that the multiple
handling of information ceases, by consolidating our patient records and enabling greater access to
citizens and freeing up health professionals' time to care.
This week, I am signalling a significant and radical programme of change. I have set out my plan of
action for the next 12 months, which will inform future years. Change cannot happen without
investment. We need to continue to deliver existing HSC services to those who need it whilst
developing and implementing new models and services. For the first time ever, the Executive have
collectively endorsed a programme of action and the plan for going forward. In doing so, they also
recognise that there is a cost. The Executive realise that additional funding is required not only for
transformation but to tackle our long waiting lists. It is my belief that we have a real and unique
opportunity. We face into a time of change, but it is change that must happen. 'Delivering Together'
sets out a direction of travel, and I hope all our society can embrace and support it in the challenging
but potentially rewarding times ahead. If we are serious about improving the health of the population
and supporting people to lead a long, healthy and active life, we have to deliver change. Staff in the
HSC and the users of our services are up for it, and I will provide the political leadership needed to
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drive change. I look forward to working with the Committee to take forward that change. I think that,
together, we can deliver the health and well-being outcomes people deserve.
I am sorry, Chair, if that was a bit of a lengthy introduction, but I think it is important, given the
significance of the work we are embarking on. I wanted to make sure I covered everything. I am
happy to take questions, and I am happy to engage with the Committee on an ongoing basis on how
we drive the change and to work collaboratively with it in the future.
The Chairperson (Ms P Bradley): Thank you, Minister, and thank you for coming today. You will
understand that, since you put your report out, there has been a certain amount of criticism and even
cynicism. I have probably been slightly cynical as well at stages, because I was here in the last
mandate when we had TYC, and, albeit that we did some very positive work through TYC, a lot of it
was stilted by the finances around it. I do not want the entire session to be about finance — it is so
much more than that, — but there are specific questions that I and other members will want to ask
about that.
You indicated something in the Assembly on Tuesday about securing funds, and we know it will take
significant funding to fund this. I know you had discussed how it would be part of your budget
discussions, and I know that we cannot put specific figures on things because there is such a lot of
work to do. There is a lot of work ahead, and I know that figure will fluctuate also. I think it would give
us some comfort as a Committee and to the people watching this if you could give any indication of
any preliminary work that has already been done with your Executive colleagues to secure funding
early to start implementing the changes you want to see.
Mrs O'Neill: Thanks, Chair. You can be forgiven for being cynical. There has been a bit of report
fatigue; I certainly picked that up when I came into office. We have had many good reports all pointing
to the same challenges, which we all can agree are evidenced: an ageing population, the financial
constraints and people living longer with more complex conditions. What I feel is different this time is
that, for the first time, the Executive have endorsed the plan for going forward, and, in endorsing the
plan, they have recognised that we cannot do it without additional funding. There is not an endless
pot of money, obviously, so the challenge to continue to deliver first-class health and social care whilst
trying to tackle waiting lists and transform the system.
Professor Bengoa helpfully pointed out in his report that, by 2026, the Health Department would need
90% of the block grant. That is the case for change. We cannot keep limping on, managing crisis
after crisis. We have to be serious about transformation. The only way we can do that is if we
resource the transformation programme. I am excited about the way forward. I am also really excited
about the focus we will bring to real collaboration. I could have set out other actions in the report and
taken decisions without working with consultants, nurses, doctors and all our staff who work across
the HSC, but that would not be co-production, co-design or meaningful collaboration.
What we have done is set out actions for the next 12 months that will inform the year after and the
year after that. I think that — I used a number of examples in the House on Tuesday — there is so
much innovation out there among healthcare staff, who are just going ahead and doing fantastic
projects that are improving outcomes for patients. We just need to do more of that. We do not even
need to reinvent the wheel here; there are a lot of practical things already happening. If it works well
somewhere, why do we not apply it across the board? Quite often, a lot of these things happen in
pockets, but we need to scale them up. If they work, let us do more of it.
I think this is different. The feedback I have been getting in the last number of days has been broadly
positive. I think people are up for change. Staff are absolutely telling me they are up for change, and
they want to be supported to do what they do best. That is what, I think, will characterise this as
different. This afternoon, I am going to Craigavon hospital, where I will engage with staff, hear their
feedback and talk to them about how we can work collaboratively in the future. I am excited about this
journey. We have no choice but to go on this journey. Year-on-year, I think we will see improvements
in the health service, and the staff will be supported to do what they do well.
The Chairperson (Ms P Bradley): Thank you. I know that your Executive colleagues are on board
with this, and that is positive. That is real positivity: seeing the report and its roll-out as different from
the other reports that have gone before. Will you ask that a specific part of the budget be for
transformation? When we look at the health budget, we know that it can all get sucked into acute care
and all the things we are trying to move away from to sustain primary care. Can we take it, then, from
what you are saying that part of the budget will be used specifically to look at transformation?
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Mrs O'Neill: Yes, you absolutely can. I just want to say, Chair, that I regularly engage with the
Finance Minister and Executive colleagues. I will not be found wanting when it comes to asking for
the funds we need to resource the transformation programme. You are right: if I were given £1 billion
tomorrow, I could prop up a system that does not work. That is not the right choice, however; the right
choice is to lead transformation that will bring us on a journey to a sustainable health service for the
future.
Discussions are ongoing. The Budget process in the Executive will happen over the next weeks and
months, and, as part of that discussion, I will strongly argue the case for additional funding. As I said,
the Executive already recognise that we need additional funding. Any additional funding I receive for
transformation should go to transformation; it should not be used to prop up an outdated system.
The Chairperson (Ms P Bradley): I agree. I want to ask the Minister one more question about the
way forward. You talked about a transformation board: that is an excellent idea. We need some kind
of board to lead and champion it and take it forward. Can you elaborate on that and give us any idea
of how the transformation board will be made up, what professions might be on it and when it will
come into action?
Mrs O'Neill: I hope to make an announcement on that in the next number of weeks. We are still
working our way through just who should be on it and working out the detail of it. It is one thing to
have a plan, but you need to drive it. I will drive it from a political leadership point of view, but within
the system, we need to make sure that we have clinician voices in the oversight. I had a meeting
yesterday with officials, and we are talking our way through that. I am happy to give the information to
the Committee as soon as I have it, but we are working our way through the detail of how it would
look. It is important we have that oversight.
The Chairperson (Ms P Bradley): Thank you Minister. Members will note that I shortened my
questions; usually I speak for an awful lot longer. I ask Members to do exactly the same. I ask them
to ask one or even two questions and keep them focused to the Minister. Professor Bengoa will kindly
be here after the Minister leaves, so we can question him then. Please also keep speeches to a
minimum. I have a list: Gary, Mark, Paula, Catherine, Ian, Robbie, Gerry, Trevor and Pat. That is
your order. I also ask the Minister to keep her answers brief, as we do not have a lot of time.
Mr Middleton: Thanks Chair, and I will try to keep my questions short. In Professor Bengoa's report
he stated that it is:
"either planned change or change prompted by crisis."
I very much welcome the Minister's vision, which she outlined. As a constituency MLA, which the
Minister is as well, I know that we often hear of people who are sitting on waiting lists for long times.
They bring forward those concerns. Minister, what comfort does the report give to those sitting on
waiting lists, whom we hear about on a daily basis?
Mrs O'Neill: There are two things in that. What I said clearly is that, as we embark on transformation,
if we do not build public confidence in tackling waiting lists, it will be difficult to get people to buy in to
what we are trying to do. There are short-term measures we need to take on waiting lists. Waiting
lists are a symptom of an outdated system and a system that does not work. In the short term, we
need to invest in bringing those waiting lists down. I have said that we need to push the system to do
everything it can and make sure it is up to full capacity. In the short term, we may need to use the
independent sector. That is not somewhere I want to be, but it is somewhere I will go to ensure that
patients get seen in as quick a manner as possible. It is a combination of those things in the short
term.
In the longer-term, it is about the real transformation. As I said, in January I will bring forward a
detailed report on how we will bring down waiting lists over the next five years. We have to get to the
point where we tackle the waiting lists. It is totally unacceptable for me as a Minister to say that some
people are waiting the length of time they are. I will do absolutely everything I can to bring down
waiting lists. That is the comfort and the message I send out very clearly to the public. Everything
that it is within my power and capability to do to bring down waiting lists, I will do. I will publish the
plan and come back and talk to the Committee in January about how we will do that and fund it.
Mr Middleton: Thanks, Minister. This is a slightly different line of thought, but, in your report, you
mention building capacity in communities and intervention, and we all recognise the serious health
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inequalities that exist in this country. You mentioned that it will take time to realign and grow the
community development resource. When do you envisage you will start assessing the services that
are already there? You said you are going to invest to meet any gaps, including the programme of
training. Can you elaborate more on how that will work?
Mrs O'Neill: Very much at the core of what we are trying to do in transformation is collaboration and
proper working with service users and staff. It also involves working with the community and voluntary
sector and the community in general and on strengthening the patient voice. That work starts from
now. We will go out and engage. Family support hubs are a brilliant example of how the community
and voluntary sector and the statutory services all come together. That is something that is proven to
work, so we need to build the community capacity to do more of that. That is really where we will go
with that. If we really want people to be involved in designing services, we have to build the capacity
out there.
You are absolutely right: health inequalities are so stark. It is just not acceptable in this day and age
that your outcomes are determined by your socio-economic status. The example I used the other day
was that, if you live in Belfast city centre, you will live nine years fewer than someone who lives at the
top of the Malone Road. That is just unacceptable. The only way to tackle that is by working
collaboratively across government. It is not just about the role of the Health Department; it is the role
of every Department. The new Programme for Government style will allow us to work collaboratively
and to home in on tackling early intervention and prevention. We know that we need to tackle these
things if we are to deliver better health for people in the future.
Mr Durkan: I thank the Minister for coming today. Welcome back, Professor Bengoa. I concur with
the Minister. The onus is on all of us to work together, but not just across the Executive; it is going to
be across the Assembly. We will help and support tough decisions being made, provided we are
convinced that they are the right decisions. That is when we will look to and listen to what the experts
say. Just to echo some of the sentiments expressed by the Chair, it is important that we get detail at
the earliest opportunity on what the transformation fund will look like, including how much will be in it
and an assurance that it is ring-fenced.
Now for my question. I welcome the commitment you gave in the Chamber around your vision for the
health service, moving away completely from reliance on the private sector. Was that just in regard to
dealing with waiting lists and elective surgery, which does rely on the private sector, certainly in the
short term — we have to do everything we can to help those on waiting lists — or does that vision
apply across the board? I think in particular of care for the elderly, which has not been mentioned a
lot. TYC came a cropper when trusts moved to close care homes across the North. How does the
Minister envisage the future of our residential and nursing care homes?
Mrs O'Neill: You first point was in relation to the fund. I am happy to come back to the Committee on
that. We will go through the process with Executive colleagues, and then I will be happy to come to
the Committee and discuss the transformation fund when we have the allocation.
I will just say two things in relation to the elderly population. First, domiciliary care is very important. I
will receive a report next month on a review of domiciliary care services. I cannot say it enough: the
workforce is predominantly female and is the lowest-paid in the health service. They do excellent
work caring for people and helping them to stay in their homes for longer; they go way above the call
of duty every day. I am very committed to making sure that we support that workforce in relation to
terms and conditions, because a sizeable number of domiciliary care workers work for the
independent sector. I would like to see a lot more employed directly by the health service. That is one
way of ensuring that they have proper terms and conditions and pay entitlements. I will carefully
consider the review of domiciliary care and make decisions on the future of that workforce.
There will also be a review of adult social care that will go out to consultation next March. Again, that
will help to inform the direction of travel in how we care for the elderly population. We have an ageing
population. That is one of the biggest challenges for the health service: people living longer and with
more complex conditions. Using the independent sector is not where I want to be. I believe in a
health service that is free at the point of delivery and based on need. We should do absolutely
everything we can to provide as much of our health service in-house as possible, but, as I have said
consistently, I cannot leave people on waiting lists and sitting out until we get to the point where our
health and social care trusts can deliver first-class health and social care. In the meantime, I will use
the independent sector, but it is only for the short term.
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Mr Durkan: I certainly share your ideology in that respect and fully recognise the value and
advantages associated with domiciliary care; however, this is somewhere where I might end up
differing from what experts are saying or have said. Of course, people want care at home, but the
reality — it will be a growing reality — is that not everyone will be able to receive adequate care at
home.
My next and final question is on the role the Minister envisages for allied health professionals (AHPs)
in rolling out or implementing her vision. They are a huge group and, again, will play a vital role if we
are to pursue the model espoused in the report and in the Minister's statement. They are the third
biggest group of health professionals, and it is my understanding — I could be wrong; I have been
known to misunderstand things in the past — that you, Minister, have not yet met any representative
body of AHPs. Will you commit to doing so in the near future to give them those assurances?
Mrs O'Neill: There are many people who want to meet me, and I am trying to get round everybody as
quickly as I can. There is no deliberate attempt to not meet anybody. I will certainly meet AHP
representatives, and I have engaged with some of them over the last five months. To put it simply,
they are a vital cog in the wheel when it comes to multidisciplinary teams and how we will invest in
primary care. Quite often, AHPs can provide services at primary care level that obviously mean that
people do not need to be referred to hospitals. Quite often, they can provide a lot of that work. In
future, AHPs will have a key role to play in the multidisciplinary teams that I am talking about. I want
them to know that I value what they do and that they will be a key part of the multidisciplinary teams in
future. As I said this week, as we develop the teams, we will have a named health visitor, a social
worker and a district nurse. Obviously, however, AHPs, physiotherapists and speech and language
therapists all have a key role in communities, so they will be a key part of all of that in future.
The Chairperson (Ms P Bradley): I just want a very quick supplementary, and a yes or no answer will
suffice. We know that there have been over 7,000 self-referrals to the physio pilot scheme in the
South Eastern Trust, and that has been extremely successful. Do you see that as part of the
transformation as well?
Mrs O'Neill: Yes. I know that you asked for a yes or no answer, but the board is looking at a review of
the pilot, so I think we can say, "Yes".
The Chairperson (Ms P Bradley): I remind members and the Minister that seven members have yet
to speak, so let us keep things brief and move on.
Ms Bradshaw: Thank you, Minister. My first question is very simple. You talked about short-term
investment to get waiting lists down. Did you make a bid for extra resources in the October monitoring
round and, if so, were you turned down?
Mrs O'Neill: No, I was not turned down. There is no longer a formal bidding process. October
monitoring has absolutely changed, so what there is now is an ongoing dialogue with the Finance
Minister and Executive colleagues, and I have had that discussion with him on many occasions. I was
successful in achieving capital funding from October monitoring for defibrillators for ambulances, for
example. Monitoring rounds now are part of an ongoing dialogue, and in the monitoring round the
Finance Minister will confirm what he has previously agreed, which was to fund highly specialised
technology to support anybody who is living with certain kinds of muscular dystrophy.
I am not disappointed with the October monitoring; it is what it is. That is not the way to address the
longer-term issues in the health service, but in our manifesto commitments the Executive parties —
my party and the DUP — set out clearly that we were going to invest an extra £1 billion over the
mandate for health. So far this year, from June monitoring and previous baseline allocations, we have
received additional funding of £200 million, and that is where we can make a real difference. October
monitoring is not going to solve the problems that we have.
Ms Bradshaw: OK, thank you. My second question is about rare conditions and chronic illnesses
such as myalgic encephalopathy (ME), post-polio syndrome and Huntington's disease, to name but a
few, which do not really have care pathways, treatments and services in place at the minute. How are
you going to factor in those and many other conditions that, at the moment, are crying out for
resources?
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Mrs O'Neill: I do not have specifics in relation to those conditions, so I will probably respond to you in
more detail in writing. Suffice it to say that we need to have care pathways so that anybody who is
diagnosed with whatever condition knows exactly how they will be supported. That is really what we
are talking about here in relation to designing services with service users and staff. If people have a
clear pathway, then they have a bit of security in knowing exactly how they will be supported. We
should get to the point where we have those clear pathways that are designed with patients, because
your lived experience will obviously help inform how the service delivers and supports you. I am very
committed to that, and we have seen really good examples of how that has worked in the past,
particularly in relation to mental health and recovery colleges and those support hubs. We have seen
really good examples of how, if you actually listen to staff and patients, you can deliver better care
pathways. That is what I will be committed to doing in relation to all the conditions that you set out.
Ms Bradshaw: Thank you. I will pass over now.
The Chairperson (Ms P Bradley): Thank you, Paula. I know that there was so much that you wanted
to say as well.
Ms Seeley: I thank the Minister for being here today. I want to note that there is an atmosphere out
there of positivity. Right across the sector, the report has been well received. There is confidence out
there, and that was reflected in the GP move to not go private and remain in our health system. There
is a lot of positivity.
I want to ask you about winter pressures as we approach the winter. Waiting lists are already
attracting a bit of media and public attention because of fear. As you know, admissions to hospital
increase as we approach the winter. I just want to know what you have done and what measures are
in place so that winter pressures do not send us into crisis.
Mrs O'Neill: There are a number of things, such as asking trusts to be prepared. They are aware of
the challenges that they will face over the next few months. They are putting their plans together to
tackle the winter pressure. Just yesterday, I asked the chief executives of all the trusts, the board and
the PHA to come to a meeting next Thursday, so that I can be assured, as the Minister, that they are
doing absolutely everything that they can to be ready to deal with the pressures that will inevitably fall
on the health service. Also, we were allocated additional funding in the June monitoring process, so I
used £13 million of that to help the trusts prepare for winter pressures, so that should help to deal with
some of the issues. We need to make sure that our trusts are resilient and able to cope with the
demand that they know will inevitably happen over the winter months. I will certainly assure myself
next week, when I meet the chief execs of all the trusts, the board and the PHA, that we are doing
everything we can.
Mr Milne: I welcome the Minister and Professor Bengoa along this morning. This is a very positive
report, and there is a responsibility on all of us to look on it in a way that works with the new proposals
to make a real success of it, because, if we do not transform our health service, the consequences
that have been stated are dire. Prior to publication of the report, you engaged with 70,000 care staff,
and there has been a lot of positive feedback from across the sector following publication and a clear
indication from staff and service users that they are up for change. When will you resume the
promised engagement with them?
Mrs O'Neill: I chose to write to every member of the health service on Tuesday, so, whilst I was on my
feet in the House, everybody received an email from me. That is really important, because staff need
to feel ownership of the change process. They are the backbone of the health service, and they are
going over and above the call of duty every day to help people. They deserve the courtesy and
respect of me engaging with them and actually listening. I want to be characterised as a Minister who
listens and engages. As I said, I am going to Craigavon this afternoon just to talk to staff about their
initial feedback and how they feel they can get involved in the transformation journey. If we are
serious about transforming services, we have to listen to staff. I will engage day and daily, alongside
all of the other engagements that I do anyway as a Minister. I am actually going to do a roadshowtype approach. I will go into hospital canteens, waiting rooms, wherever I can go that staff will engage
with me, because, if staff have ownership of the change process, if they feel they are being listened to
and have a voice and are being taken seriously, that is good for everybody. It is good for staff morale,
and it is good for patients because they will get better outcomes if we work collaboratively.
The Chairperson (Ms P Bradley): OK. We have just over 10 minutes, so let's get through it.
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Mr Butler: Thank you, Minister. I am enjoying your enthusiasm and your energy for this. I will ask
you two questions, and you can answer them both, rather than me going for a break, if that is OK? On
page 16 of 'Health and Wellbeing 2026', you give recognition to mental health professionals in the
voluntary and community sector. Given your recent commitment to champion mental health and
develop innovative solutions, will you now give further consideration to appointing a mental health
champion for Northern Ireland?
Mrs O'Neill: Are those your two questions?
Mr Butler: That is just one question, OK? I will just give you a second to take that. The second one
is, given the vacancy around funding and costs, can you provide a commitment that emergency frontline and arm's-length bodies, such as the Northern Ireland Fire and Rescue Service and the Northern
Ireland Ambulance Service, will not see further reductions in their budgets — in essence, robbing
Peter to pay Paul — if you cannot secure additional funding for those changes and, indeed, even if
you do and you are pressured from other places?
Mrs O'Neill: I am a mental health champion, and I will prioritise the issue. I have said that since I
have taken office. Tackling health inequalities, mental health, all-island collaboration, transforming the
health service: those are just a few of my priorities. I have a hefty workload in the time ahead, but I
am absolutely up for it.
Mr Butler: The question was whether you would commit —
Mrs O'Neill: I am coming to that. In relation to mental health, we need to do a number of things,
particularly in relation to parity of esteem for mental health. It is so important that we achieve that, and
I will certainly work towards it. In relation to appointing a mental health champion, I have said that I
will give it consideration, and I will do so as part of the overarching review that we will receive in the
Bamford evaluation report. That will help me set out my stall on what we will do on mental health in
the next number of years. I will consider the appointment of a champion in relation to that. It is about
what purpose it will serve and whether it further enhances what we do on mental health. I need to be
convinced of that because, obviously, given the cost of resourcing something like that, it would need to
make a difference. Needless to say, I am a mental health champion and will continue to be so, but let
me review the work that is being done in relation to the Bamford evaluation.
We are consulting on the Protect Life suicide prevention strategy. Again, I will engage personally in
that issue because it is something that I am passionate about. This will cost money, but I am
committed to securing additional funding from the Executive for the transformation piece. If we do not
transform the health service, we are just propping up an outdated system that does not work. It is not
a good use of funding, in my opinion, to throw good money after bad. We should use every penny that
we have to effect change and make a difference. I will be talking to the Committee about the budget
that I hope to secure for next year. That is work that the Executive are currently involved in, and they
will make an announcement on it in the next month or so.
Mr Butler: Sorry, can I just clarify something?
The Chairperson (Ms P Bradley): Very quickly.
Mr Butler: So it is not your intention to see any reduction in the budgets of arm's-length bodies and
other services that you are responsible for.
Mrs O'Neill: I do not think that I could ever say that, to be honest. We do not have an endless pot of
money. We have limited financial resources, and we have to make sure that I spend every penny to
the best effect, so that it delivers outcomes and makes a difference to people's lives. I have tough
decisions to take in financial planning, but it is a waste of energy if we have this brilliant programme of
work that we are going to embark on and do not finance it, so that it falls down. That is where things
have fallen down in the past. I am committed to financing it.
Mr Carroll: Thanks, Minister. I want to ask about something you mentioned on Tuesday. You said on
Tuesday that you did not want to focus on cuts: today, I ask whether you can give an indication of
where the axe will fall. That is a big question that people are wondering about and considering. My
other question is that you said on Tuesday that people would be willing to travel for specialised care or
particular methods of treatment. Has it been factored into this report and assessment that not
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everybody will be able to travel? Not everybody has a car or access to transport. Obviously, transport
needs to be improved generally. Has that been factored into the assessment of the rationalisation
process?
Mrs O'Neill: It absolutely is. I am from a rural area, so I know exactly the challenges that there are,
particularly in relation to public transport and other things at times. I think that people will travel
because they will get better health outcomes, so I think they are up for that. However, how they travel
will obviously be factored into it. Let us be innovative. Say for example — I will talk myself into
something here — there is a brilliant service available in Enniskillen and everybody from the North
travels to Enniskillen for it. Let us be innovative about how they get there. Can the trust provide
transport to help people to get there? Let us look at other ways of doing things, because not
everybody has access to a car. Access to the health service should be universal; there should be no
barriers. In relation to travel, we can work those things out and be innovative about it.
In your first question, you talked about cuts. If you are asking whether I face financial challenges as
Health Minister, absolutely I do. As I said in answer to the previous question, I have tough decisions
to take, but I am up for taking them. I do not believe in throwing good money after bad. I do not
believe in propping up something that does not work. I will take decisions based on the budget that I
am able to achieve from the Executive. The Executive have put their weight behind this. The
Executive have said that they will support it. In order to support it, you have to fund it.
The Chairperson (Ms P Bradley): We have five minutes left, and two more members.
Mr Clarke: It is a nice time to come in, Chair.
On the back of your last comment, there has been a lot of nice talk today, Minister. We talk about
positivity, but not very many people are being real here. The reality is that, according to Professor
Bengoa's report, 90% of the budget will be used if we do not change. There is evidence in that report
that what we are doing does not work, and that means cuts and changing services. You have been
very nice in how you have presented this, but I would like to see some tough words now, because we
need to see where those cuts will come and start to implement them so that we can see the change.
Money will not change everything here. You will not get any more money than what the block grant
brings. I would like to see the process sped up and see where the cuts are coming so that people can
get behind it.
You just gave an example — I live further from Enniskillen than you do — but, if I needed specialist
treatment in Enniskillen, I would be happy to go there rather than trying to protect a small hospital that
might be five miles from me. It is more an observation than anything else, but I am listening to this
and, to tell you the truth, I was getting depressed hearing about people in their own wee silos and their
own wee areas. I look forward to seeing you taking the challenge on and starting the process
because, unless you tackle the big issues, all this wee stuff is just by the by. It is more of an
observation, Chairperson, than a question.
Mrs O'Neill: It is a fair enough point. The stark reality is 90% of the block grant. You cannot say that
enough. That shows you why there is a case for change. That is why we need to do things differently.
Mr Clarke: We are doing things wrong.
Mrs O'Neill: I know that he will speak to you shortly, but Professor Bengoa said that this is not even a
financial discussion; it is about delivering better health outcomes. People need to feel confident that,
when you make changes, you are doing it for the right reasons. The right reasons are people living
longer and people living a full and active life. That is the conversation that we need to have. The
point is well made.
Mr Sheehan: Thanks, Minister. Apologies for being late. I had to do a school run. I can never figure
out why it is called a "run" because, when you want kids to hurry, the last thing they will do is run.
In any event, you talk a lot in your report about "co-production": can you explain to us what coproduction is and how its outworkings will look?
Mrs O'Neill: We all sometimes get caught up in language, and "co-production" probably does not
mean a lot to the public if you just say it on its own. Practically, what it means is that we will design
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services with patients and staff. There are good examples where it has worked, particularly in mental
health. It means that you have lived experience. For example, you are living with a condition and you
know the challenges for you as an individual and you know what the service needs to do to support
you. If we have that real conversation with staff and patients and then redesign services on that basis,
it will work for everybody. It will work for the service but also for the patient. The core of this work and
the transformation will be that collaborative working. It is about working in partnership across
government, with the community and voluntary sector and with patients and staff. It is about getting
everybody round the table to talk about what is best, what delivers better outcomes and how we can
support people more. I am really committed to doing that, and that will be a significant change in how
the health service does things. That will lead to real difference and to the public feeling ownership of
the health service.
The Chairperson (Ms P Bradley): Thank you, Minister. I think we have actually done record time; we
have one minute left. I am sure that I speak on behalf of all the members when I say that I wish we
could have had you here for a substantially longer time, because there are many more questions that I
and other members want to ask. You have said that you will be back in January to discuss the plans
for waiting lists and how that will be addressed, and I know that you will come back on the
transformation plan. I know that we will have a six-monthly update, so the Committee will be in
constant contact with you. We look forward to that. Thank you for your time today.
Mrs O'Neill: Thank you, Chair. I am happy to engage with the Committee as and when required.
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