Shaping a new role in health

Just a few months after switching ministerial portfolios from agriculture to health, Michelle O’Neill talks to agendaNi’s David Whelan about her plans for radical reform, championing mental health treatment and improving all-island collaboration for better health and social care.

Switching briefs from the focussed portfolio of agriculture to that of Stormont’s largest department, Michelle O’Neill said that the magnitude of her task became apparent very quickly. Describing it as an “honour” to be chosen by her party for the “very challenging” role of health, O’Neill aims to embrace the opportunity for serious reform.

As Minister for Agriculture, Environment and Rural Affairs, O’Neill was vocal about the negative impact a Brexit would have on the agri-food sector. Her concerns centred on the Single Farm Payment for farmers, EU funding within the agri-food sector and any future impact on exports. Fast forward a few months and a successful Leave campaign, O’Neill retains an input on the agriculture brief through Executive’s Brexit discussions but has adopted fresh concerns within her new department such as the impact on the health and social care workforce and EU funding for research and development. “I have my own concerns and my party have particular concerns in relation to Brexit,” she said. “I believe the impact is going to be negative. The majority of people here in the north voted to Remain and I think it’s our job as politicians to honour that vote and actually continue to argue the case with both the British government and also at a European level.”

While it may be difficult to get away from the overriding impact of Brexit on the Northern Ireland economy and the subsequent finance impact relative to all departments, O’Neill believes that the local political changes offer fresh opportunities. Speaking about working within a two-party Executive, with the inclusion of Independent Justice Minister Claire Sugden, following the choice of the SDLP and UUP to create an opposition, O’Neill said: “It’s an opportunity for joined up, collaborative working. The public want to see political agreement on the way forward and I think we’ve already seen the Executive working to make changes in its new format. I am very positive about the Executive relationship and the opposition will do what they do. However, I would encourage them to be constructive where they can. As a Minister I’m always in listening mode and I’m happy to engage with anyone who has a constructive input.”

 

Another positive opportunity, she said, is the new outcomes-based format of the Programme for Government, again pointing to the benefits of greater collaboration. “I believe it’s a good time to be a Health Minister,” she added. “The new format is recognition that tackling things such as health inequalities is not just the business of the health committee but the duty of all departments. It’s about improving outcomes for people as a whole and recognising that sometimes unemployment can link directly to mental health problems, as an example. Departments will no longer act in silos, which has been traditionally a pattern in the past.”

With such a wide-ranging brief, O’Neill said that it was important that she established and laid out her priorities right from the off. Those include tackling mental health inequality, the promotion of early intervention and prevention on the public health agenda and most notably the over-arching transformation and reform of health and social care. The publication of recent ED waiting time statistics (see page 92-93) highlights the need for change. The planned reform will be driven by a report compiled by an expert panel, led by Professor Rafael Bengoa, suggested by Sir Liam Donaldson in his 2015 report. O’Neill is expected to brief the Executive on the report and seek endorsement for reform in early August.

Speaking about the piece of work and how influential it will be on her final blueprint, she said: “There have been a number of reports done over the years which all pointed towards the challenges the health service would face in its current format. We are at the stage now where health is on a burning platform and we are at a critical point of the massive challenges it faces. The Professor Bengoa piece of work looks at models of care, delivering services differently and supporting the workforce to do the job that they do best. Alongside it we have the piece of work around the restructuring of health and social care, including the future of the board and the structures to deliver new models of care. I am considering all of that work and will seek Executive endorsement and direction in early autumn. However, I am aware that the magnitude of the challenges will make it difficult implement complete reform within one mandate. For me, this has to be about a five to 10 year plan and will be a two-mandate strategy to deliver change.”

“I believe that there is a realisation and a desire out there among clinicians, staff and patients to change how we do things and to ensure that we get better outcomes. This isn’t just about saving money or reducing staff, it’s about ensuring that people have better overall outcomes, which is the core reason behind our need to change.”

Gay blood ban

O’Neill has already shown an indication that she won’t delay on change. Within just eight days of taking up her new role, she moved to lift the ban on gay men donating blood in Northern Ireland, a subject which had previously been a long-running controversy. Former Health Minister Edwin Poots had fought a costly legal battle to keep the ban, which had been lifted in England, Scotland and Wales in 2011. However, announcing that a new “one-year deferral system” would come into effect from 1 September, meaning that gay and bisexual men can give blood one year after their last sexual contact with another man, O’Neill was praised by campaigners. O’Neill denied that her decision had been influenced by personal or party position. “Although it has been a party position for a long time (that the ban should be lifted), I take decisions as Minister of Health based on patient safety and that will always be my overriding concern,” she said. Last year the DUP’s Simon Hamilton appeared to soften on his party’s previous holders of the health portfolio by suggesting the ban could be lifted if a government advisory body ruled it was safe. O’Neill added: “I had the information and the decision was based on strong scientific evidence by the clinicians making the recommendations. I put a position to the Executive and they endorsed the position.”

Abortion

Another controversial piece of legislation in her in-tray on arrival to the post was that of abortion law reform in Northern Ireland. The reform is a joint piece of work between the Department of Health and the Department of Justice and will be guided by a special panel, set up by former Health Minister Simon Hamilton, to examine the means by which cases of fatal foetal abnormalities could be dealt with. O’Neill has also set autumn as a timeframe for Executive presentation. “I hope that in the autumn we will be in a position to make recommendations to the Executive based on the work of the working group that has been established,” she said. “Justice has already had a consultation and there has already been a lot of bodies of work done around the issuing of clinical guidance. My role is drawing all that work together and then making a recommendation to the Executive. Obviously I have a personal view in relation to legislating for fatal foetal abnormality but again, as Health Minister, I have to be guided by the evidence. It’s about moving forward on the issue of fatal foetal abnormality and establishing what we can do to support those people who find themselves in an extremely difficult situation, whether they decide to carry on their pregnancy or not.”

Standing in the way of some of the Minister’s ambitions will be a tightening budget. However, O’Neill is adamant that the focus must be on moving away, rather than towards, any versions of a private health care solution and that health care should remain free at the point of delivery. Speaking specifically about the waiting list crisis for emergency departments she said work is underway to develop a five-year strategy with the Health and Social Care Board on a longer-term vision for addressing the problem. “We can’t keep throwing money off into the independent sector to deal with the problem but I believe that we have to use the independent sector for now until such times when we are able to deal with it in house. My priority is working to make sure that we deliver health and social care free at the point of delivery for all those people that need it,” she said.

As the controller of the largest departmental budget by a significant margin, O’Neill also believes that having a party colleague (Máirtín Ó Muilleoir) controlling the Executive’s purse strings as Finance Minister, will not make her job any easier. “He is the Finance Minister for all departments. We have held a few meetings and he has expressed his support, particularly around the transformation piece, but essentially he will give all departments a fair hearing when it comes to budgets and spends.”

Mental health

As well as disappointing recent emergency department waiting times, recent statistics taken from the Health and Social Care Board by the BBC showed that one in every three patients with mental health issues are being forced to wait more than 13 weeks for treatment. As a champion of mental health, O’Neill recognises an imbalance in relation to a focus on physical and mental health. “I want to shift the balance and make sure that we can put mental health on an equal standing in terms of priority,” she said. “One of the things that we are going to be doing include announcing the refreshed Protect Life Strategy, creating a better engagement with the community and voluntary sector who provide excellent services day and daily to people who find themselves in crisis.

“I also think that we need to work collaboratively across the island. Suicide doesn’t know any boundaries or borders and I have identified potential all-island collaboration aiming to deliver first class services for all people on the Island of Ireland.” Recently, the Minister announced a £42 million investment, alongside her southern counterpart Simon Harris TD, in an all-island Congenital Heart Disease Service and she believes that there is further scope across wider health. “I believe there are real possibilities for natural collaboration and further links to be established. Minister Harris agrees with me and we have initiated a piece of work looking at a range of potential shared areas, which we hope to report on in November,” she added.

Looking to the future and O’Neill has already set her benchmarks for measuring the success of her time in office. “It’s not going to be easy but if we have delivered meaningful transformation and made substantial distance along the road of delivering better outcomes for patients then that is something I would be particularly proud of. Also, given that mental health is one of my priorities, if we’ve shifted the focus and put mental health on an equal footing with physical health as a priority, I will be very happy.”

 

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