Debate contribution: Waiting Lists: Effect on Winter Preparedness

Debate contribution by Mr Mike Nesbitt on 20 January 2026.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

20 January 2026

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Waiting Lists: Effect on Winter Preparedness

Assembly identifier

Official Report component 5348627

Read the official Assembly record

Text

Mr Deputy Speaker, thank you very much. I am very pleased to be engaged in a debate on this issue, because it is fundamental to try to deliver better outcomes for patients, service users and staff, and, indeed, to talk about the reset — the so-called shift left. To start positively, I am pleased that all Members who contributed appeared to be agreeing with me and my analysis, which I came to after last year's additional winter pressures, that the problem is in community capacity. It is not in ED capacity; it is in community capacity. It is about the flow, and I am determined to address that flow by improving community capacity. Mr McGrath said that he does not agree that it is going to take five years. I think that Mr McGuigan may have been in the same position. I will certainly take that back to the professionals who told me that it would take at least five years, and I will challenge them once again to justify their time frame. I read a report of Mr McGrath's in, I believe, 'Down News'. It was a terrible misrepresentation of the position, but be that as it may. Let me briefly set out what we have observed over the recent period. Flu rates peaked early this season and then began to fall across all age groups leading into the Christmas period. That had an impact on our ability to work in ED. Despite that, there were reductions in the number of patients in ED awaiting admission and the number waiting over 12 hours once admitted in the run-up to Christmas and immediately after that. Ambulance arrivals exceeded the forecast between 24 and 30 December. Handover delays over two hours fell significantly from 23 to 27 December, but then they did rise again at month's end. All trusts worked to increase discharges in advance of Christmas Day to maximise bed capacity. On Christmas Eve alone, trusts achieved 646 discharges versus 357 admissions — tangible evidence that targeted operational actions can enhance flow when they are properly planned and coordinated. Those facts matter not just because they demonstrate effort and impact but because they highlight the interplay of demand, capacity and flow. Additional winter pressures are symptoms of whole-system dynamics. I noticed some Members talking about winter pressures. As of last year's experience, I am of the opinion that the pressures on EDs are 365 days a year. Therefore, it would be more appropriate to talk of "additional" winter pressures. Attendances at EDs are influenced by urgent care alternatives, community pathways, primary care access and public health behaviours. Admissions depend on clinical decisions and alternatives such as same-day emergency care. On that basis, I point out that we have repurposed £10 million to try to deal with those pressures. That money has gone to enhancing Hospital at Home and providing more short-stay inpatient beds and more frailty assessments. In the "big discussion" that led to the plan, I really focused on frailty and care for the elderly. I believe that, given our growing and increasingly elderly population, if we can crack how we deliver care for the elderly, we will be a long way towards the reform that I would like to see. The £10 million was also spent on increasing ambulatory pathways, not least in cardiology and respiratory services, and early reviews. The ambulance handovers reflect ED congestion, inpatient bed availability and the speed with which patients move through acute care. Recognising that, we adopted the whole-system approach. The big discussion workshops, led by our Chief Nursing Officer and Chief Medical Officer, brought together stakeholders from across Health and Social Care (HSC) to examine pressures and co-design practical responses. On the big discussion workshops, I note that Mr Donnelly attributes to me a degree of cynicism. It seems to me that he was implying that it was almost a political move. I simply say to him that, if he is going to accuse the Chief Nursing Officer and the Chief Medical Officer of allowing me to manipulate them for political purposes, I would like advance notice of that meeting, because I could sell tickets for it. Our overarching plan stresses practical prevention measures such as the vaccination programmes. Community pharmacies are stepping forward through Pharmacy First, and we have public campaigns such as Living Well and "Stay well this winter". I know that Members said that vaccination rates amongst HSC staff are not particularly brilliant, and I do not disagree with that, but they are a lot better than they were last year. That improvement needs to be acknowledged, along with the fact that we are far from there yet. General practice has scaled capacity through additional sessions and support for residents in care homes, including through medical care plans. Hospitals retain the capability to open additional beds. The regional coordination centre supports the trusts and the Ambulance Service to manage the pressures. I have visited it, and, if the Committee has not done so, I certainly commend a visit to Knockbracken. I know that Members want to see faster progress on ambulance handovers, the reduction in waiting times at EDs, the removal of corridor care and effective hospital discharge, and so do I. That is why the trusts have been asked to focus investment and effort where they yield the greatest demonstrable impact: redirection to alternative pathways, hospital flow and handover improvements at EDs. We are already seeing improvements in some of the metrics compared with last year. We have seen a reduction in the number of 12-hour delays. In the Belfast Trust, there has been a 12·5% reduction in the year to date. The Northern Trust achieved an 8·5% reduction in December, and the Western Trust achieved an 8% reduction in December. In the Belfast Trust, there were over 800 fewer delays over two hours, and the Western Trust continues to have the best ambulance handover performance. We must hold those gains and recognise and applaud them, while, of course, building on them throughout the rest of the year. That brings me to winter 2026. As I stand here today reflecting on the current position, I reiterate that planning for winter is a year-round process. However, publication of my intentions and expectations ahead of winter 2026-27 will be made available by the summer. I will set out priorities and expectations, focusing on distinguishing between what is unique about the pressures in winter compared with those year-round. It is important that we understand what we can and cannot predict and plan for ahead of winter. That will be followed by the publication of the trusts' winter delivery plans, which I want to see by the end of September. The trusts' plans will provide the detailed actions that will be taken to provide operational resilience throughout the anticipated extreme operating context of the winter months. I sense that we need to do more to communicate how those plans work and the interplay between them. I sense that some think that the Department's plan is it, full stop and end of story. There is a lack of understanding — that is on us — about the fact that the trusts publish the operational plans. I believe that the Department's plan should be a framework from which the operational plans flow.

If I have time, I will, but I have a lot to get through. Members raised a lot of issues, and I want to return to them, not least those raised by Mr Gaston. Winter weather can bring about an increase in falls, and that is why we are looking at frailty. No single lever will remove a winter peak or erase a queue at an ED, but what we can do, and are doing, is shape demand intelligently by directing patients to the right care at the right time; strengthening community and primary care in line with the shift-left agenda; reducing avoidable attendances and admissions; improving internal hospital flow; and accelerating safe, timely discharges. That is the work of stabilising the system while we pursue longer-term reforms. I acknowledge the fact that the Committee Chair and Deputy Chair attended an ED on a Sunday evening. It is the same ED that I have attended in the past number of weeks — Antrim Area Hospital's emergency department — but I attended it in the morning. There were two patients in the reception area, and, on the far side, most of the cubicles were empty. There was no pressure whatsoever that morning. That morning was 25 December. We all know that we cannot replicate that on 25 January, but it says something to me about the demand side of the equation. We have not mentioned the demand side once in the debate. It has all been about the capacity. If we focus only on capacity, we will always have to come to the conclusion that capacity will never meet demand, even with a budget of £8·4 billion. Therefore, in 2026, the Department of Health will try to put a focus on managing demand, because it seems that that can be done. It certainly needs to be tried. There will be a focus on helping people to stay well and preventing the need for hospital admission. Our ongoing vaccination programmes remain the best possible protection from infectious diseases, despite what some Members believe. Workforce vaccination recognises that protecting staff means that you protect patients and sustain services, so I welcome the commitment to the vaccination programme, which was evidenced in the higher uptake in 2025-26. The total number of HSC-employed staff who received the flu vaccine in the current programme is 21,698 from a total eligible cohort of 75,028 people, representing an uptake of 28·92%, which is lower than I would wish. That is the target to improve next year. It will also be important to reach parts of the workforce that, historically, have had a lower uptake, so we will listen to staff, address their questions and try to remove logistical barriers. We will continue to work with the Public Health Agency to implement improvements for 2026-27. To address increased admissions and longer stays, we will centre efforts on managing flow and discharge into the community and on helping people to stay at home, where possible, while receiving the treatment that they need. It is crucial that people are treated in the right place at the right time. We have learned from previous years that targeted discharge campaigns can create capacity, but they have to be sustained and connected to downstream community and care home services. We also learned that real-time data on attendances, admissions, discharges and handovers enables action when coupled with clear escalation protocols and empowered local leadership. I will also briefly address the role of the public. We have asked people, and will continue to ask them, to get vaccinated when eligible; use urgent care alternatives where appropriate; attend scheduled appointments or provide timely notice if they cannot do so; and cooperate with discharge processes. I know that those are not small requests, but they are asks that recognise a shared responsibility to keep services available for those who need them most. I ask Members to be careful and thoughtful with their language. Mr Robinson said that EDs were "totally gridlocked".

The dictionary definition and common understanding of the word "gridlock" are that nothing is moving. That is not the case in our emergency departments, although things move far too slowly. That is an incredibly important distinction for somebody who may, as we speak, be thinking of attending an ED. If there were gridlock, there would certainly be no point in doing that, but that is not the case.

Mr Gaston was critical of a reply from the Department to an Assembly question for written answer (AQW). It is a two-page reply. I reviewed it over the break and can say that it does not lack detail. Regarding what he said about category 2 responses, the Ambulance Service — he knows this, because he has had the response — has agreed with staff-side representatives a formal escalation process for defined, time-sensitive category 2 incidents and specific time-critical inter-hospital transfers. Such incidents may be responded to during periods of lawful action short of strike and in the final hour of shift, where direct conveyance to a point of care is appropriate. Mr Gaston also complained about the Department's lack of speed in responding to questions for written answer. So far this month, the Executive Office and the Department of Justice have responded to 49 AQWs: the lowest of any Department. In the same period, the Department of Health has responded to 251 AQWs. In fact, as we approach the second anniversary of the restoration of the Assembly, the Department of Health has answered over 8,000 AQWs. We have no additional staff or resource, compared with the Executive Office or the Department of Justice, to respond to five times the number of queries.

2,162 words. Text as published by the Northern Ireland Assembly.

Assessment

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Assessed 21 October 2026 at 14:15 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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