Debate contribution: Winter Preparedness Plan 2025-26

Debate contribution by Mr Mike Nesbitt on 20 October 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

20 October 2025

Type

Debate contribution (made as a minister)

Business

Questions for Urgent Oral Answer

Heading

Winter Preparedness Plan 2025-26

Assembly identifier

Official Report component 5188781

Read the official Assembly record

Text

I published the overarching winter preparedness plan on Thursday 16 October. It had been my intention to publish it at the Northern Ireland Confederation for Health and Social Care (NICON) conference on the Wednesday, but I took a decision to delay by one day, because I wanted to allow for further consideration of the publication of the individual trust plans, trusts being the operational leads on emergency departments (EDs) and hospital flow. The plan published last week includes a series of measures to help mitigate the additional pressures experienced across Health and Social Care (HSC) in the winter months. I stress the additionality, because those pressures are now experienced 365. The measures include tackling ambulance handover delays through a new approach to collaborative working between the trusts and the Northern Ireland Ambulance Service (NIAS); vaccination programmes against diseases such as influenza, COVID-19, shingles and respiratory syncytial virus (RSV); Community Pharmacy initiatives such as the Living Well and "Stay well this winter" campaigns; the provision of Pharmacy First services across community pharmacies, including the sore throat service, which offers advice, clinical assessment and treatment of sore throats without the patient having to wait for an appointment with a GP; additional assistance for GP practices, with the provision of 10,000 medical care plans for patients in nursing and residential care homes and over 8,000 additional sessions to help manage winter pressures; improving mental health and learning disability bed pressures to reduce demand on EDs by ensuring that the right care is available in the right place; supporting social care delivery in the community and improving system flow from hospitals; and avoiding ED attendance and admission for end-of-life care for those who have a preference to be at home. I reiterate that the publication of the plan was not the starting point. Planning for this winter started many months ago. In many areas, the actions in the plan have already been implemented. I point to some of the recent progress made on ambulance turnaround times as an illustration of that. To navigate the upcoming winter period successfully, it is vital that we all play our part in making sure that HSC services are ready and available for those who need them the most.

The point is that, back in January, as the Member may recall, in reacting to last winter's additional pressures, I said that I wanted all the stakeholders in the room with a blank page. I asked the Chief Nursing Officer and the Chief Medical Officer to lead a series of events. It was not just a one-off; it was a series of four big discussion meetings about the whole system flow. Each meeting was oversubscribed, so I am confident that every section of Health and Social Care was consulted about the plan.

The Member will be aware that we follow advice on vaccinations from the Joint Committee on Vaccination and Immunisation (JCVI), and we stick with its advice. It has changed a bit on the availability of the COVID-19 vaccination in particular. I am disappointed that I have not been able to action the real living wage as yet, but that is a function of the £600 million pressure on the Health Department's budget. On pay, the Member will be aware that the Executive are releasing £100 million, which is approximately 50% of what I need to fulfil the two pay recommendations for Agenda for Change staff and for doctors and dentists. I need to find £100 million. I have asked officials to urgently work up options, and I hope to meet the Royal College of Nursing, the trade unions and the other professional bodies perhaps as early as tomorrow but, certainly, as soon as possible. I intend to say to them, "This is the situation. Here are one, two or three options". I want to do the one that suits them the best, because I want to demonstrate to them how much I value their presence. As I often say, you need buildings, beds, equipment and medicine, but, unless you have the workforce with you, all the rest is as nothing.

I accept that the flow through a hospital is determined largely by the lack of community capacity in domiciliary care packages and care home beds. I absolutely accept that and have never questioned it. You cannot magic up that level of resource in a single month or year. It therefore remains a problem, but I assure the Member that it remains a focus for me. The four workshops that I talked about — the big discussions — were very focused on practical steps that could be taken this winter, into 2026, and in preparation for winter 2027. The Member rightly identified things that are missing, but it would be wrong to put them in the plan and raise expectations that they can be dealt with within the existing workforce and resources.

I say two things in response to the Member. All trusts review domiciliary care packages frequently to ensure maximum efficiency. Sometimes, somebody who has a domiciliary or home care package needs it to be enhanced because their condition has deteriorated, but, at other times, it is possible to claw back and redistribute some hours. That is the first thing. Secondly, as the Member will be aware, the Northern Health and Social Care Trust has not, to date, had a Hospital at Home service. A total of £845,000 is being made available to the trust to establish such a service, which will help.

I agree with the Member. Where a vaccine is available, I encourage everybody to avail themselves of it. I have looked at some of the uptake percentages. Overall, they have dropped year-on-year over the past three years, and they are particularly low amongst the workforce. I have asked for a piece of work to try to understand the reasons for that. It would be easy to say that it is about vaccination hesitancy, and, if I had to make an informed guess, I would have put that at number one, but I suspect that, when we have bottomed it out, that will not turn out to be the case. However, if it is about accessibility, for example, care homes get vaccination offers at their front door, so, for staff, particularly those who are on duty on the day, it could hardly be easier. There are some fundamental issues that I do not yet understand about low uptake, particularly among the HSC workforce.

The Member is quite right: we need to learn year-on-year. The lessons have been trapped in the seven actions that have been identified. Action plan 1 is:

"Identification and risk stratification of frailty in over 65s".

Number 2 is:

"Keeping people well at home - enhanced care in care homes".

That is probably about boxing smarter rather than introducing additionality. Number 3:

"Avoiding admission for end-of-life care"

will be informed by the Committee's report on palliative care. Number 4 is:

"Provision of appropriate (sensible) care",

which is about learning from past experience. Number 5 is:

"Frail elderly falls".

We need a pathway for that, because it is particularly important — I have just been upstairs, hearing about osteoporosis — to reduce deconditioning, but we also want to avoid unnecessary conveyance following falls. Action plan 6 is on advance care planning, and number 7 is a specific one:

"Fractured neck of femur improvement group".

Those actions are all things that we have learnt and that came out of the four seminars that made up the big discussion.

I agree with the Member. I went out and met some social workers — I think that it was in Altnagelvin — who made the point to me that the regime and the criteria for direct payments are overcomplicated. That is one of the many areas in which we have overcomplicated the delivery of health and social care. I have asked for a review to see whether we can do it more effectively and in a more patient- and service-user-centred way. Some of the examples that I was given involved unfavourable comparisons with how things are managed in the Republic of Ireland. If there are lessons to be learned from the South, they will be learned.

Funding of £2·5 million has been made available to support GP practices to increase their capacity to meet the anticipated increase in demand this winter. We anticipate the delivery of around 10,000 medical care plans for patients in nursing and residential care homes, and over 8,000 additional sessions to help manage winter pressures in general practice. We have also engaged on the development of the Northern Ireland local enhanced service to manage winter pressures for 2025-26. The £2·5 million is, I understand, fresh additional money.

Obviously, ambulance handover times have to be a key focus because the ambulance handover is, basically, the start of the flow through the hospital setting. We have to get the whole thing working in tandem. The trusts and NIAS had a visit to a hospital in London to learn from its approach to releasing ambulances more quickly and, because of that, were asked to adopt a similar model. To support that, £12 million has been allocated to trusts to implement targeted interventions by the end of the month, and this is the twentieth of the month. Our immediate goal is to eliminate ambulance delays of over two hours by 1 December. All trusts signed up to that goal at the workshops, and once that milestone is achieved we will move towards a much more ambitious 15-minute handover target. It is a system-wide challenge, and I have tasked my Department with leading the coordinated action that is required to deliver those improvements. That will have a profound effect on outcomes and on patient satisfaction because the longer that they wait in ED, the more frustrated that they get and, indeed, the more likely it is that a less-than-ideal outcome will be delivered.

I have visited the emergency department at Altnagelvin, and I recognise absolutely the need for a new-build ED in Derry. It is the oldest of the type-1 EDs, and it looks it. However, some of the performance statistics that I looked at this morning suggest that its performance is not the worst of all the type-1 EDs. That is a testament to the staff and the workforce who operate that ED because they are operating in far-from-ideal circumstances. On an assurance that the plan will deliver, all I can say to the Member is this: we had four workshops at which we brought in representatives from every nook and cranny of the health and social care system. I am not about to say that they do not know what they were talking about, or that they do not know how to do things better. That is the foundation of the plan.

I am not making such a claim. I expect that the additional winter pressures will result in people's waiting for far too long in emergency departments to be seen. I do not think that we will eradicate the idea of corridor care this winter. I do not think that we will do away with the fact that, if you were to walk into an emergency department, you would meet people who have been in a chair of some description for 12 hours, 24 hours or, maybe, even longer. The Member can certainly say that it is only 10 beds and is only the introduction of Hospital at Home, but I welcome it, because it is a start. It is something that we are going to build on. I have seen Hospital at Home in operation and have spoken to patients who get it. They much prefer it to spending time in an acute bed or elsewhere in an acute hospital. It works financially as well; it is cost efficient. It is a good thing. I accept that it is maybe just the start of something, but at least it is a start.

I am very sorry to hear that. It is probably not a unique experience in our type 1 emergency departments. I simply say this to the Member: if we were to go across the water, we would see the same. When I was in Washington in March, I visited MedStar Georgetown University Hospital. I believe that it was built in 1947, but an extension has just been added, at a cost of over $800 million. The emergency department is comparatively massive, but every corridor had trolleys with patients on them. We are not outliers; we are struggling, just as many health services are struggling. I am doing whatever I can to try to get to a position in which no patient walks out because they have had enough of waiting.

I very much regret the experience of Mrs O'Neill. I cannot say anything that will satisfy the Member.

The answer is that it will not happen. If they are not paid what they are due, I expect them to continue to ballot for industrial action. I expect them to take strike action. As I have told the House before, the Royal College of Nursing has made it clear that, this time, there will be no derogations. The Chief Nursing Officer has told me, effectively, that she is not sure how we could possibly manage that. That is why, as we sit here, I have officials working on a small number of options to restore pay parity. It is my ambition that health and social care workers will get their payment and that the only disadvantage that they will face this year will be a delay in that payment.

I am sorry to say to the Member that nurses and other hospital staff are well accustomed to looking after more patients than they are supposed to look after. It has happened previously: it happened last winter, and it does not just happen in the wintertime. They manage. I am very grateful to them for managing, but I wish that it was different.

2,339 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 13:33 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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