To ask the Minister of Health for his assessment of winter pressures in the Northern Health and Social Care Trust.

My Department’s winter preparedness planning commenced in March 2024, which was two months earlier than the previous year.

Trusts worked with the Regional Control Centre in the months ahead to develop plans specific to each area. Trusts submitted their Unscheduled Care Preparedness plans to SPPG in September 2024.

A significant programme of work has been undertaken to reduce the potential risk of harm for patients who experience long waiting times in the emergency department.

The Northern Trust opened a Surgical Assessment Unit (SAU) in February 2024 followed by an Acute Ambulatory Unit (AAU) for medical conditions in April 2024, to supplement the existing Frailty Direct Assessment Unit (DAU) at Causeway Hospital. These services are aimed at easing pressure on the Emergency Department (ED) by facilitating direct referral from GPs and the ambulance service. From October 2024, the DAUs in Causeway and Antrim also provide access to advice from Trust clinicians which can help maintain patients in their own home, or attend more appropriate services the same day/week. The Trust updated their DoS (Directory of Services) in October 2024 to include Causeway AAU and shared information with primary care to increase direct referrals. This aims to increase the number of patients accessing alternative pathways to ED in an effort to reduce ED pressures and decrease ambulance handover delays.

The Trust commenced a ‘Frailty in-reach to ED’ service in Antrim in October 2024. The Trust is also increasing care home capacity, working with the independent sector, to develop an enhanced model of care for people with greater needs, such as dementia. The Trust have also engaged with the Northern Ireland Ambulance Service (NIAS) and General Practitioners to increase support to care homes and prevent unnecessary admissions.

The Trust continues to phase in the ‘Safer Patient Flow Bundle’ initiative across hospital wards and a frailty in-reach service in Antrim and Causeway EDs aimed at reducing non-elective length of stay. The Trust will also extend the REACH (Responsive Support, Education and Anticipatory Care with Care Homes team) initiative into winter, so that care home residents with recurrent readmissions to ED due to falls will be provided with a holistic assessment by the REACH team including a comprehensive falls assessment, a medication review and onward referral as required. This aims to reduce Emergency Department attendance and reduce hospitals admissions.

From an operational perspective the Regional Control Centre sought assurances in November that Trusts had adequate plans in place to manage any pressures over the Christmas and New Year Period. Actions taken in advance of the holiday period were to maintain capacity for front door, inpatient ward, key services (diagnostics) and discharge & community provision.

With regard to demand on services, ED attendances and hospital admissions have been lower in 2024/25 than they had been in 2023/24. The reduction is not significant, but it did not increase in terms of actual numbers.

The main pressure on services has come from an early and significant increase in flu and other respiratory illnesses in advance of and over the Christmas holiday period. These illnesses hit the elderly population and those with co-morbidities hardest and patients over the age of 75 years are likely to remain in hospital for seven days or more with flu.

A snapshot taken on 6 January 2025 showed that there were 288 patients in hospital beds with flu, placing considerable extra demand on services

Whilst the Trust had plans in place to ensure that staffing levels were at normal levels over the Christmas period, staff numbers were also hit with these illnesses making it difficult for the Trust to run services at planned levels, which added to their difficulty in managing the pressure.

In the period after Christmas, the Trust were challenged on both sites with lower than required discharges, resulting in poor flow in the hospitals.

The lack of flow in the hospitals, with admissions exceeding discharges in that period, combined with high numbers of flu and respiratory conditions and impact on staffing levels created more pressure than normal over the holiday period.

This pressure was experienced on all hospital sites in Northern Ireland which limited options for mutual aid which is normally applied when individual hospital sites come under increased and sustained pressure.

The pressure was not unique to Northern Ireland, with similar pressures being seen across all parts of the United Kingdom.