Antrim and Causeway hospitals prepare for winter surge as Northern Trust reveals plans to ease pressure on services
Wednesday 28 October 2026
Patients across Ballymena and the wider Northern Trust area could receive more treatment at home and avoid unnecessary hospital admissions this winter, as health authorities prepare for another challenging period for emergency departments, hospital beds and community services.
New winter surge plans published across Northern Ireland set out measures to improve patient care, reduce ambulance handover delays and help medically fit patients leave hospital sooner, freeing up beds for those who need them.
For Antrim Area Hospital and Causeway Hospital, the Northern Health and Social Care Trust has detailed arrangements for same-day emergency treatment, hospital discharge and community-based care, alongside efforts to protect planned operations during periods of increased demand.
However, the Trust's detailed preparations also reveal longstanding pressures within mental health inpatient services, where additional beds have been routinely required for approximately two years.
Health Minister appeals for public support
Health Minister Robbie Butler has urged the public to work alongside health and social care services as the six Health and Social Care Trusts and Public Health Agency publish their winter surge plans for 2026/27.
The plans are intended to help services manage seasonal illness, increased demand for emergency treatment and the additional pressures that winter places on patients, families and healthcare workers.
Mr Butler said:
“The HSC system faces pressure 365 days a year, but we know that winter is a particularly challenging time for our staff and services. The Trust plans aim to ensure that our system has the appropriate measures in place to deal with this additional demand. My focus is to ensure that services remain safe, resilient and responsive, while protecting both patients and staff.”
The Department of Health is also establishing a Surge Oversight Programme Board to strengthen monitoring, information sharing and coordination across the health and social care system.
Antrim and Causeway emergency care arrangements
One of the Northern Trust's main priorities is ensuring patients can be assessed and treated without an overnight hospital admission where this is clinically appropriate.
Same Day Emergency Care services have been expanded at both Antrim Area Hospital and Causeway Hospital, allowing suitable patients referred through emergency departments, GPs or the Northern Ireland Ambulance Service to receive assessment and treatment before returning home.
The Trust's detailed operational plan confirms different service schedules at the two hospitals:
• Antrim Area Hospital: Same Day Emergency Care operates Monday to Saturday.
• Causeway Hospital: Same Day Emergency Care operates Monday to Friday.
Both hospitals also have specialist services to assess frail patients, with an emphasis on identifying those who can be safely supported without a prolonged hospital stay.
A planned Reset Week at each acute hospital will test admission, assessment and discharge arrangements ahead of winter pressures.
The Trust is also focusing on earlier involvement from senior clinical decision-makers, helping patients receive appropriate treatment plans without unnecessary delays.
Getting patients home and freeing hospital beds
Improving hospital discharge is another central part of the Northern Trust's winter response.
Delays in arranging home care or residential placements can leave medically fit patients occupying hospital beds while others wait for admission through emergency departments.
The Trust intends to strengthen discharge arrangements through integrated teams, earlier planning and improved coordination with home-care providers and care homes.
Its discharge lounge arrangements currently differ between the two main acute hospitals:
• Antrim Area Hospital: The discharge lounge operates seven days a week.
• Causeway Hospital: The discharge lounge operates Monday to Friday and has been relocated to an area capable of accommodating patients in beds, increasing the range of patients it can support.
Early Review Teams now operate across the entire Northern Trust area, with an initial review of home-care arrangements expected within two weeks.
The Trust's detailed plan also identifies a seven whole-time-equivalent Early Review Team workforce and reports that reviews have released approximately 70 hours of home-care capacity per week each month since January 2026.
These reviews are intended to ensure patients receive an appropriate level of support after discharge while making available care hours more effectively.
A new multidisciplinary care home support team is also expected to be established from November 2026, bringing together nursing, physiotherapy, occupational therapy, pharmacy, dietetics, dementia support, speech and language therapy and medical expertise.
The aim is to support care home residents earlier, avoid preventable hospital admissions and help patients return safely to appropriate care settings.
Hospital at Home service shows growing demand
A developing Hospital at Home service is among the Northern Trust's measures to reduce pressure on hospital beds.
Introduced in November 2025, the consultant-led service initially operates in East Antrim, providing suitable patients with short-term acute treatment in their own homes or care homes.
It is particularly focused on older and frailer patients who might otherwise require admission to hospital.
The service brings together medical, nursing, physiotherapy and pharmacy expertise, with referrals available through several routes, including GPs, ambulance services, emergency departments and community healthcare teams.
Figures published in the Trust's detailed winter response show:
• 198 referrals received since the service began in November 2025, up to the reporting point in the plan.
• 126 referrals accepted for assessment and intervention.
• 26 referrals recorded in July 2026.
• 50 referrals recorded in August 2026, an increase of approximately 92% on July.
• Eight to ten patients expected to be supported at any one time when the commissioned caseload is fully delivered during winter.
The Trust reports that accepted referrals have helped avoid emergency department attendance and subsequent acute hospital admission, although the figures do not establish how many patients would otherwise definitely have required admission.
Referrals are considered five days a week, with nursing cover available seven days a week until 10.45pm.
The Trust intends to establish the service more fully in East Antrim before considering expansion across its wider area. No confirmed timetable for that expansion has been published.
Mental health beds under pressure for two years
While the winter plans outline measures to improve patient care, the Northern Trust's detailed operational response also identifies significant existing pressures within mental health inpatient services.
The Trust states that services are operating above their commissioned capacity, with additional contingency beds routinely used and, at times, demand exceeding those arrangements.
Its published response states:
“Mental Health inpatient services are currently operating above commissioned capacity, with contingency beds routinely utilised and, at times, exceeding planned contingency arrangements.”
The document further acknowledges:
“This level of surge demand has been sustained for approximately two years and has become a recurrent operational pressure rather than a short-term response measure.”
This indicates that the additional demand is not simply a seasonal winter issue but an established pressure affecting services throughout the year.
The Trust warns that continued reliance on additional beds requires corresponding investment in staffing and resources to maintain safe care. Without recurrent funding, it identifies risks to service sustainability and workforce resilience.
Progress on proposed rehabilitation and acute inpatient facilities, including the Birch Hill Mental Health Hospital project, also remains dependent on capital funding.
The Trust says its existing estate does not provide suitable alternative accommodation meeting modern mental health safety and therapeutic standards without significant investment.
Ambulance handovers and emergency response
Reducing the time ambulance crews spend waiting to hand over patients at hospital remains another priority.
The Northern Trust plans to continue working with the Northern Ireland Ambulance Service to improve handovers and ensure crews can return to responding to emergencies.
Its detailed response refers to a regional 45-minute ambulance handover backstop, alongside targets for managing suitable emergency calls without unnecessary hospital conveyance.
These include:
• Hear & Treat: A regional target of 10% of emergency calls managed through clinical advice without dispatching an ambulance.
• See & Treat: A regional target of 15.5% of emergency calls managed through assessment and treatment without taking the patient to hospital.
• Ambulance handovers: A 45-minute regional backstop target for transferring patients into hospital care.
These are operational targets rather than confirmed current performance levels. The Trust's published response does not provide sufficient figures to establish how consistently Antrim Area Hospital or Causeway Hospital is meeting the handover standard.
The Trust says improvements have already been made through its Release to Rescue arrangements, which are intended to reduce delays in returning ambulance crews to emergency duties.
Emergency doctors warn of ‘impossible situation’ ahead of winter
Last week a stark warning was issued from the Royal College of Emergency Medicine (RCEM), which has called for urgent action by the Northern Ireland Executive to prevent further deterioration in emergency care.
Department of Health figures published on 22 October show that more than one in five patients attending Northern Ireland emergency departments between July and September 2026 waited over 12 hours before being discharged, admitted or transferred. A decade earlier, fewer than 1% of patients experienced waits of that length.
Only 32.3% of patients were seen within four hours during the quarter, according to RCEM, representing the worst performance for that period of the year on record.
Dr Michael Perry, RCEM Northern Ireland Vice President, warned:
“The pressure Emergency Departments in Northern Ireland are currently under is absolutely brutal – and it's only going to get worse as we go into winter.”
He added:
“Instead of a respite, ED staff have been firefighting all year. For thousands of patients, this has meant waits of more than 12 hours. The unluckiest among them are subjected to corridor care, long waits on trolleys waiting for a bed – and some are even coming to harm.”
Describing the impact on patients and healthcare workers, Dr Perry said: “Our patients are suffering and our staff are working themselves ragged to provide safe care in an impossible situation.”
RCEM is urging the Executive to tackle delayed hospital discharges to free up inpatient beds, extend the opening hours of services needed to discharge patients and maintain safeguards around ambulance handovers.
The College has also called for the Release to Rescue policy, which governs the transfer of patients from ambulances into emergency departments, not to have its existing two-hour timeframe reduced to 45 minutes over winter.
The warning highlights the scale of the challenge facing Antrim Area Hospital, Causeway Hospital and other emergency departments. While the Northern Trust's winter plan outlines measures to improve patient flow and reduce unnecessary admissions, emergency doctors are warning that existing pressures must be addressed before seasonal demand increases further.
More support in local communities
Beyond hospital services, the Northern Trust plans to develop four Integrated Neighbourhood Teams across its area.
These teams will bring together primary care, community health services, social care and voluntary organisations to identify vulnerable residents and coordinate support.
Their initial focus will be older people at risk of hospital admission, with assessments and individual support plans intended to prevent deterioration and help residents remain independent.
The Trust is also continuing work on virtual monitoring, community nursing and direct assessment services that can provide suitable patients with specialist support outside hospital.
Vaccination programmes will remain an important part of winter preparations, including flu and respiratory syncytial virus (RSV) vaccinations for eligible groups.
The Northern Trust's detailed response also identifies 88 peer vaccinators across six clinical divisions, supporting efforts to improve staff vaccination uptake.
Protecting planned operations during winter
The Northern Trust says it intends to protect planned treatment and operations as much as possible while responding to increased emergency demand.
This includes prioritising urgent and red-flag cases when hospitals experience exceptional pressure.
The Trust's plans also refer to the continued development of surgical ambulatory care, with services operating seven days a week at Antrim and five days a week at Causeway.
A business case is being developed for an Elective Overnight Stay Centre at Causeway Hospital, although the published plan does not establish that the project has secured approval or funding.
For patients awaiting planned procedures, the effectiveness of winter measures will be particularly important because emergency demand and delays in freeing hospital beds can affect the capacity available for scheduled treatment.
Minister urges patients and families to play their part
Alongside the operational measures, Health Minister Robbie Butler has appealed for public cooperation to help services manage increased demand.
He said:
“We must all work together to protect our Health Service this winter. You can do small, simple steps, such as getting your vaccination if eligible, engaging proactively with hospital discharge processes if you or a family member are well enough to leave hospital and taking steps to stay well.”
The Minister also encouraged people to seek appropriate healthcare advice before conditions deteriorate and to use community services where suitable.
“Where you do need healthcare, I would encourage you to seek support early and from the most appropriate place to meet your need. This may not require a hospital setting, but be available within your own community, from GPs and community pharmacists.”
The Northern Trust is similarly encouraging residents to use appropriate services, including community pharmacies, GPs, minor injuries services and emergency departments according to their healthcare needs.
Emergency departments remain the appropriate place for serious illness or injury, while life-threatening emergencies require an immediate emergency response.
Mr Butler also appealed for understanding towards healthcare workers.
“I would also appeal to the public to please be patient and respectful with our staff as they deal with the increased demand and strive to treat the sickest quickest.”
Where to read the winter plans
The Northern Trust has published both a public-facing winter plan and a more detailed operational response explaining the measures being developed across its services.
Northern Trust Winter Plan 2026/27:
Northern Trust detailed winter surge response:
Other regional plans are available online:
• Belfast Trust: https://belfasttrust.hscni.net/wpfd_file/bhsct-detailed-winter-surge-plan-2026-27/
• South Eastern Trust: https://setrust.hscni.net/wp-content/uploads/2026/09/SEHSCT-Winter-Surge-Plan_public-document_18.09.26-FINAL.pdf
• Southern Trust: https://southerntrust.hscni.net/wpfd_file/shsct-winter-plan-2026-27
• Western Trust: https://westerntrust.hscni.net/winter-plan-2026-27/
• Northern Ireland Ambulance Service: https://nias.hscni.net/nias-launches-winter-plan-for-2026-27/
• Public Health Agency: https://www.publichealth.hscni.net/publications/draft-pha-winter-surge-plan-202627
• Department of Health Strategic Planning and Performance Group: https://online.hscni.net/winter-surge-planning-2026-27/
For patients and families across the Northern Trust area, the coming months will test whether expanded community treatment, faster hospital discharge and improved emergency care arrangements can make a measurable difference.
The plans set out what services intend to do, but they do not guarantee shorter waits or additional hospital capacity. With longstanding pressures already evident in parts of the system, the key measure of success will be whether patients can access safe, timely treatment when winter demand is at its highest.
