Suzanne Pullins
Interim Chief Executive
As we reflect on the last year, we recognise the exceptionally challenging environment in which staff continue to deliver services for our
community, shaped by rising demand, workforce pressures and ongoing financial constraint.
Despite these pressures, however, colleagues have remained steadfast in their commitment to delivering safe, compassionate care for our population, and this Annual Report reflects both the scale of that commitment and the progress we have made, despite the many ongoing challenges.
We serve a growing and changing population of almost 480,000 people across the largest geographical Trust area in Northern Ireland.
We have both the largest older population and the largest child population in the region, a reality that continues to drive increasing demand across our acute services, community care, mental health and children’s services. Understanding and responding to these pressures, while maintaining compassion, quality and safety, remains at the heart of our work.
Over the coming years, our Trust will serve an increasingly ageing population, further intensifying demand on health and social care provision. Against this backdrop, our focus throughout 2025/26 has been on transformation, sustainability and improving outcomes and experience for patients, service users and their families.
Unscheduled and emergency care has remained under sustained pressure throughout the year, driven by high levels of attendance and increasing patient acuity, particularly among older and frail patients. While Emergency Departments are often seen as the focal point of system pressure, we know that congestion in acute hospitals reflects much wider challenges across the health and social care system.
In response, we have continued to invest in modern, patient-centred models of care designed to ensure people receive the right care, in the right place, at the right time. Our ambulatory and same-day emergency care services have been pivotal in achieving this. By providing rapid assessment and specialist pathways that avoid unnecessary hospital admission, these services have helped to reduce pressure on our Emergency Departments, improve patient flow and enhance experiences for our community. These approaches represent a fundamental shift in how urgent care is delivered and are a clear example of how innovation and clinical leadership can drive meaningful improvement.
Addressing delayed discharges has remained a major priority for the Trust. Limited availability of homecare packages and growing demand for dementia care continue to affect patient flow across acute and community settings. Through focused system leadership, restructuring of discharge teams and investment in additional dementia and residential capacity, we have begun to see early improvements. While challenges remain, this work has strengthened partnership working and reinforced the importance of whole-system solutions to complex problems.
As demand for homecare continues to rise, supporting people to live independently at home remains central to our strategy, and is very much aligned with the Department of Health’s Reset Plan and Neighbourhood Model of care. The Trust delivers or commissions over three million hours of homecare each year, and while significant pressures remain, it is encouraging that unmet need within our Trust area is now at its lowest level in six years.
A major programme of reform is underway to stabilise and enhance homecare provision, with early results showing reductions in waiting times and hospital delays. These improvements directly impact on quality of life for service users and carers and support the sustainability of our wider health and social care system.
Alongside urgent care, we have made encouraging progress in elective services. Recurrent investment in diagnostic capacity, including imaging and endoscopy, has contributed to improvements in waiting times across a range of specialties.
Our new MRI scanner at Causeway Hospital has significantly improved access to diagnostics for patients who no longer need to travel to Antrim Area Hospital with the necessary diagnostics now available on-site. This is also supporting ambulance capacity and patient flow across the system.
With the new MRI commissioned for up to 4,000 scans per year, we remain confident that Causeway Hospital has the potential to become an elective hub serving the entire North West region; and, as the hospital marks 25 years since first opening its doors in May 2001, we are making steady progress on delivering on our Vision for Causeway and realising our ambition for the hospital and local community.
Our outpatient modernisation programme continues to embed more efficient and flexible models of care, ensuring that patients are seen more quickly. The continued development of diagnostic services, including the Rapid Diagnostic Centre at Whiteabbey Hospital, demonstrates our commitment to early diagnosis and improved outcomes.
Service reform has been a major area of focus across Health and Social Care and for our own Trust, in particular. We are very proud of our Reform North programme and, over recent years, the Trust has led significant service reform, including changes to maternity services and proposals for the reconfiguration of general surgery within our Trust.
We are looking forward to the opening of our Alongside Midwifery-Led Unit at Antrim Area Hospital, on-track for completion by summer 2026.
Construction is also underway on another significant capital development project at Antrim. The new £3.5m Macmillan Information and Support Centre will provide enhanced support for people in our Trust area who are living with a cancer diagnosis, and their families.
While we are rightly proud of the significant progress we are making across a number of service areas, we cannot ignore the fact that some services remain under significant strain.
Severe workforce shortages in some specialty areas have resulted in very long waits for patients. Children’s services face rising demand and increasing complexity, with pressures on short breaks provision, placements for Looked After Children, and support for children with special educational needs. Mental Health services continue to experience high levels of demand, workforce challenges and infrastructure constraints, particularly within inpatient settings.
The condition of our inpatient mental health estate, and the delay in progressing the Birch Hill development, remains a significant concern. While we recognise the wider pressures on capital funding, the continued use of facilities that are no longer fit for purpose presents both clinical and operational risk. Addressing this remains an urgent priority, and we will continue to engage with partners to secure a long-term solution that supports modern, therapeutic models of care.
Financially, 2025/26 has been extremely challenging. Rising pay costs, demand-driven pressures and workforce-related expenditure continue to place significant strain on the Trust’s finances.
In the last year, we have been able to deliver savings of more than £33m thanks to the incredible efforts of colleagues and teams across our organisation. While this is a considerable achievement, we cannot stand still. As we enter a new financial year, it will be necessary to make further savings and initiatives are underway to reduce reliance on agency staffing, improve procurement and stabilise our workforce.
However, efficiencies alone will not address the scale of the challenge. Sustained investment and continued transformation will be essential to achieving long-term financial sustainability for Health and Social Care across the region.
Throughout all of this, one constant has been the extraordinary commitment of our staff.
Our workforce is our greatest asset, and I remain immensely proud of what it means to be part of Team North. Whether delivering care on our wards, supporting people in their own homes, working in our community teams or providing essential support services, our staff continue to go above and beyond for the people we serve.
We know that the pressures facing health and social care take a toll on our workforce.
Incidents of violence and aggression towards staff are wholly unacceptable, and we remain committed to doing everything possible to protect our people and ensure they feel safe and supported at work.
In September 2025, we became the first Trust in the region to trial the use of body-worn cameras by staff working in our Emergency Department and following the trial’s success, the Board of our Trust agreed the permanent use of body-worn cameras in our Emergency Departments in Antrim Area Hospital and Causeway Hospital.
Initiatives such as this, alongside enhanced staff support and leadership development, demonstrate our determination to create a positive working environment where staff feel valued and respected.
As we look ahead, I am confident that the Northern Trust can and will remain agile to the changing needs of our community, as we strive to continue improving outcomes and experiences for our patients and service users.
We have a clear strategic direction, strong clinical and professional leadership, and a workforce that is deeply committed to delivering for our community. The challenges we face are real and significant, but so too is our capacity to respond through innovation, partnership and resilience.
I would like to thank our staff, our partners, and the communities we serve for their continued support. Together, we will continue to build a Trust that delivers high-quality, compassionate and sustainable care, now and for the future.
Suzanne Pullins, Interim Chief Executive, 25 June 2026