Debate contribution: Winter Preparedness Plan

Debate contribution by Mr Mike Nesbitt on 10 November 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

10 November 2025

Type

Debate contribution (made as a minister)

Business

Opposition Business

Heading

Winter Preparedness Plan

Assembly identifier

Official Report component 5225431

Read the official Assembly record

Text

I will start in reverse order, by addressing the amendment, which I find very welcome. The Minister of Finance promised me up to £100 million towards pay, but the amendment is much more definitive than that: it talks about "£100 million". Therefore, the proposer's powers of persuasion with Mr O'Dowd are admirable compared with mine. I thank her for it. In next year's pay awards, I have made it clear to the unions and the professional bodies that, as soon as I am aware of what my budget is for 2026-27, the first thing that I will do is make what I call a "down payment", which will be a percentage. This is a pay award, not a pay rise. This year, it is 3·6% and 4%, and that is not a pay rise with inflation where it is. They are pay awards. However, as a sign of good faith, I will put some money up front and into workers' pay packets so that, for once, instead of having to wait months for what they are entitled to, they will get something up front. It will be before the two pay bodies make their recommendations. When they do that, if those awards are higher than the percentage that I have given at the start of the financial year, I will make up the difference. If — this is very unlikely — the two pay bodies are so stingy that we have awarded more than they recommend, the workforce will get to keep the additional. However, as I say, that is extremely unlikely, and so do the unions and the professional bodies. That is the plan. I cannot tell you what the percentage will be because I do not know yet what my budget will be for next year. Mrs Dodds wonders about the implications for service delivery, and so do I. However, until I know what my budget is and make a decision on that percentage, we cannot deal with what the service delivery issues will be. As to the winter preparedness plan, many Members have made a lot of the fact that I said in January that, for this winter, we would start with a blank sheet and get all the stakeholders in the room. That is exactly what we did, and that is the genesis of the plan. Everybody knows that there were four workshops, which were oversubscribed. I would imagine that, if I were to go through the list of everyone who attended the four workshops, I would be talking about well in excess of 100 people who are all health and social care professionals. If anybody wants me to get them back together so that you can say, "What you have come up with is really disappointing", just say so. I will not say that to them. That is up to you. I do not know why anybody thinks that it was going to be so radical that this winter was going to be fine —

— because the big issue, which has been identified by several Members, is with the flow not at the front door but at the back door. It is a lack of community capacity. If anybody thinks that you can click your fingers and, in one financial year, sort out the fact that we do not have enough people delivering care packages at home and we do not have enough care beds in the community, they are delusional. This is a step in the right direction. What concerns me at the moment is not the plan but the fact that this year's flu is coming early. We know that the flu comes every year from the southern hemisphere. We are seeing an unusually early start to the flu season. Surveillance data shows that it is increasing among children and rising across other age groups, and here we are on only 10 November. The NHS in England is talking about millions of vaccinations this week alone. The latest dashboard for us, which covers the week up to 2 November, has shown a doubling in community-acquired emergency hospitalisations because of flu. In the week to 2 November, it was 52 people, and that is exactly double the number in the week before. The vaccine uptake could be a lot better. In people over 65, it is over 50%, but, among 18- to 64-year-olds, it is only 21%. Here is another figure that was the same last year, in that it was troubling: of all trust-employed health and social care workers, it was 15·8%. We may be dashing towards additional winter pressures due to the flu this year.

I will go through some of the points in the plan. One is tackling ambulance handover delays through a new approach to collaborative working. There is the vaccination programme, and I again encourage all MLAs to encourage their constituents to get a vaccination, if they can. We have initiatives with Community Pharmacy, such as the Living Well and "Stay well this winter" campaigns. There are Pharmacy First services across community pharmacies, including the sore throat service, which has proved popular and effective. There is additional assistance for GP practices. Improving mental health and learning disability bed pressures will reduce the demand on emergency departments and ensure that the right care is available in the right place. We will support social care delivery in the community, improve system flow from hospitals and avoid ED attendance and admission for end-of-life care for those whose preference is to be at home. That is a big issue. We know that people who are terminally ill want to pass away at home, and we are concerned about some people sending sick people to emergency departments, where there is no bed for them, when they had a bed in a care home. We need to think about that. There were seven outputs from those four big conversations: the identification and risk stratification of frailty in the over-65s; supporting people to be well and cared for at home; avoiding admission for end-of-life care, which I mentioned; the provision of appropriate or sensible care — some clinicians are risk-averse, so someone might get an X-ray, a CT scan and an MRI scan when doing so is not necessarily in the best interests of the patient or the hospital flow; a frail, elderly pathway for ED attendees; clinical advance care planning; and a fractured neck of femur pathway improvement group. Those were the seven categories. I want to make another point or two, but I will give way to the Member.

I am glad that the Member has engaged with the sector. The four workshops were oversubscribed because people wanted to engage with the Department. We have engaged with the sector in great detail. The final point to which I will refer was, I think, brought up by Mrs Dodds. The Northern Trust does not have the Hospital at Home service but is starting the process to put that in place. Mrs Dodds said, "But, there are only 10 beds", and that that is great for those patients who end up being one of the 10 who get those Hospital at Home service domestic beds. That is fair enough, I suppose, but it is a start. What I question is this: how can you say, "You can only afford to do 10 beds", then say, in the same breath, "Ah, but the Department of Health gets over 50% of the entire Executive Budget"? Hospital at Home costs money. It is an initiative and a development. It is new. You cannot magic it out of the ether without money. The idea that the Department gets over 50% of the Executive's Budget is a bit of a red herring. Remember, we got the Executive and the Assembly back up and running at the beginning of last year by persuading Treasury that the block grant should be based not on a crude headcount but on assessed, objective need. When we are looking at the Health budget, why do we go back to that crude count and say, "You have got just over 50%"? Why do we not sit down collectively and decide on the assessed objective need to deliver world-class health and social care? My answer is that I do not want to take a greater and greater percentage of the Budget; I want to shift left into a neighbourhood delivery model that concentrates on prevention and early intervention. That is what we will do over the course of 2026. In the meantime, however, we will deal as best as we can with the winter pressures, which are additional to the 365 pressures that our health and social care workforce have to deal with every day.

1,458 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 13:45 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

Disagree with this assessment?

Classifications can be challenged. A person reads every challenge, and any change is recorded publicly above with its reason.

Challenge this classification