Flu, flow and frontlines: Inside NI’s winter health strategy as service anticipates seasonal surge

As Northern Ireland prepares for another challenging winter, the Department of Health has published its 2025–26 Winter Preparedness Plan, setting out a comprehensive strategy to protect vital health and social care services and support staff across the system.

The plan, described as “an overarching framework for regional and local action,” identifies ten priority areas designed to maintain patient safety, improve hospital flow, and strengthen workforce resilience through the most demanding months of the year.

“The overarching aim is to maintain patient safety and service continuity during periods of increased demand,” the Department stated.

Ten priorities to protect health services

The strategy takes a system-wide approach, with ten key pillars of action:

• Urgent and Emergency Care Flow: Improved ambulance handover protocols and the expansion of Same Day Emergency Care (SDEC) and Acute Care at Home services.

• Hospital Discharge and Community Capacity: Enhanced early discharge planning and greater intermediate care capacity to reduce delayed transfers and free up hospital beds.

• Primary and Community Care: Strengthening GP access and pharmacy-led schemes to divert demand from emergency departments.

• Mental Health and Crisis Response: Expanded crisis resolution teams and 24/7 helplines to meet rising demand for psychological support.

• Workforce Resilience: Flexible rostering, temporary staffing pools and wellbeing initiatives to retain and support healthcare workers.

• Vaccination and Infection Control: Rollout of flu and COVID-19 vaccination campaigns and reinforced infection prevention measures.

• Elective Care Protection: Dedicated elective hubs ring-fenced to prevent cancellations, with support from the independent sector where needed.

• Children’s Services: Paediatric surge plans to manage spikes in respiratory illnesses, coordinated with schools and public health teams.

• Data, Surveillance and Communication: Real-time dashboards and public messaging campaigns to guide service access and monitor pressures.

• Regional Coordination and Escalation: Unified responses through escalation protocols when operational thresholds are breached.

“The plan is not a substitute for localised surge planning but provides a framework for coordination and escalation,” the Department added.

Implementation and immediate actions

Health and Social Care Trusts are expected to finalise their local winter plans by early November, with surge modelling and workforce reviews already underway.

Vaccination programmes for healthcare staff and vulnerable groups are being prioritised, while public information campaigns will be launched in the coming weeks.

Integrated Winter Surge Planning Teams will oversee implementation, supported by daily operational meetings and weekly regional reviews to ensure swift action where pressures intensify.

“The health and social care system will face significant challenges this winter. This plan sets out how we will respond collectively,” the Department concluded.

“Work together to help protect vital services” – Minister Mike Nesbitt

Northern Ireland Health Minister Mike Nesbitt

Launching the plan, Health Minister Mike Nesbitt emphasised the shared responsibility of the public and the health system to safeguard services over the winter months.

“While the HSC system is under 365-day pressure, it is undoubtedly magnified in the winter months. To help mitigate this, and deliver the best possible care to those who need it, we again are asking the HSC system and the public to work together to help protect vital services,” said Minister Nesbitt.

He explained that the 2025–26 plan builds on lessons learned from previous winters and the outcomes of the Department’s “Big Discussion” workshops, which brought together leaders from across the Health and Social Care (HSC) system to develop a “whole systems approach to improve patient and staff experiences.”

The plan focuses on five overarching themes — prevention, the role of pharmacy and General Practice, hospital care, local planning and preparations, and whole-system flow improvement for the elderly and frail.

Key measures for the 2025–26 winter

Among the plan’s core measures are:

• Tackling ambulance handover delays, with new collaboration between Trusts and the Ambulance Service to reduce maximum waits from four hours to one hour.

• Extensive vaccination programmes for influenza, COVID-19, RSV and shingles, with dual flu and COVID-19 jabs offered at the same appointment for convenience.

• Community Pharmacy initiatives, including the ‘Living Well’ and ‘Stay Well This Winter’ campaigns and the ‘Pharmacy First’ service, providing assessments and treatments for minor ailments such as sore throats without GP appointments.

• Support for GP practices, including 10,000 medical care plans for patients in nursing and residential care homes and over 98,000 additional sessions to manage winter demand.

• Paediatric measures, enhancing capacity, repatriating patients from Belfast to regional units, and extending NISTAR (Northern Ireland Specialist Transport and Retrieval) hours for neonatal and paediatric transfers.

• Mental health and learning disability improvements, reducing emergency department pressures and ensuring the right care is provided in the right place.

• Strengthening social care delivery, improving hospital discharge processes and system flow for the elderly and those living with frailty.

• Enhanced end-of-life care, helping patients who wish to remain at home avoid unnecessary hospital admissions.

Minister’s call for public cooperation

Minister Nesbitt acknowledged that the system faces “significant pressure before winter sets in” and stressed the importance of collective action.

“We must be clear that while the steps taken will go some way to mitigating the anticipated pressures, they cannot be eradicated altogether,” he said.

“Our Health and Social Care system is already under significant pressure before winter sets in, not least because of the very challenging financial situation. In order to successfully navigate the upcoming winter period, it remains vitally important that we all play our part, to make sure that HSC services are ready and available for those who need them most.”

He encouraged the public to get vaccinated, follow health advice, and support hospital discharge efforts when patients are well enough to return home.

“Please be patient and respectful with our staff as they deal with the increased demand and strive to treat the sickest quickest,” Minister Nesbitt added.