The information below outlines the detailed plans that will support the Trust’s response during winter 2026/27. As this is an operational planning document developed in line with Department of Health guidance, it includes some healthcare terms, service names and acronyms commonly used across the health and social care system. While we have aimed to make the document as clear as possible, some technical language is necessary to meet planning, governance and reporting requirements.
Expectations for Winter Surge Planning
Contents:
- Prevention
- Inclusion
- Operational readiness
- Urgent and emergency care
- Improving patient flow through our hospitals
- Improving ambulance handover and response
- Discharge
- Alternative pathways
- Intermediate
- Elective care
- Workforce sustainability
- Digital and data
- Paediatrics
- Mental health
- Social care
- Data monitoring and escalation
- Governance and assurance
- Neighbourhood model of care
- Glossary
Prevention
Expectation
The vaccination programmes must be widely available using a combination of GPs, community pharmacies, school nursing teams and Trust-led vaccination clinics. Trusts must maximise their use of vaccinators and ensure every contact with eligible individuals is used to encourage, promote and carry out vaccinations.
Response
Local planning and coordination within school nursing has been completed for the annual childhood influenza vaccination delivery programme which begins in October 2026 until December 2026.
The Staff Vaccination Programme is working towards a coordinated blended approach with vaccine clinics to be delivered across multiple community and acute sites, supported by a peer vaccinator model with over 88 peer vaccinators. Flu vaccination will be offered to all staff attending the Occupational Health Service. Staff flu vaccination clinics will be available for staff events where appropriate.
The Trust will work with PHA, primary care, community pharmacy and independent sector care home providers to support delivery and promotion of vaccination for eligible care home residents and staff. Existing care home engagement routes, including provider communications and clinical support teams, will be used to promote uptake, identify barriers, and ensure residents, families and staff receive clear information on the benefits of vaccination ahead of winter. This will support prevention of outbreaks, reduce avoidable deterioration, and help maintain care home resilience during periods of increased winter pressure.
Expectation
In relation to the annual seasonal influenza vaccination programme for staff, Trusts must strive to improve on the prior year’s delivery, with an indicative target of 50% of relevant staff, including staff within Independent Sector (such as Home Care and Care Home providers and others as relevant) being provided with a vaccination. In delivering this Trusts should set out how this is to be achieved including easy access across Trust locations. To help achieve this Trusts must engage with those parts of the workforce with historically lower uptake of vaccination, to invite open and focused conversations to help understand staff concerns and address any barriers.
Response
The Staff Flu Vaccination Operational Group, which includes representatives from each division, meets monthly to ensure a coordinated approach to increasing staff uptake of the flu vaccine. The group reports to the Oversight Group and the Senior Executive Team.
The Autumn Vaccination Programme Oversight Group, chaired by the Director of Operations and the Director of HRODCC, provides strategic and operational oversight of the staff flu vaccination programme.
To support improved uptake and accessibility, in line with the 50% indicative target for 2026/27 for all Health Care Workers, the Peer Vaccinator model is being expanded, with 88 peer vaccinators currently in place across six clinical divisions.
Staff flu vaccine uptake will be reported regularly to the Trust Senior Management Team throughout the programme, with any issues escalated as required.
A meeting has been arranged with PHA to discuss in-year funding for the NHSCT staff and community autumn flu vaccination programmes.
Flu vaccination clinics have already been scheduled, providing extensive coverage across acute and coordinated community locations, including Trust staff clinics and Trust community clinics throughout Trust localities.
A communications plan has been developed, with high-profile pre-launch communications scheduled to begin on 14 September 2026.
Communications will provide clear, consistent messages to support staff flu vaccine uptake, including myth-busting information, practical guidance on how to access vaccination, and visible endorsement from staff and senior leaders across divisions. Messaging will promote the full range of access routes, including Trust clinics, peer vaccinators and community pharmacies, with posters and targeted communications used to reach staff who may not have regular access to Trust PCs.
Independent Sector partners will receive regular updates on Trust-based staff vaccination clinic arrangements, with access available for Independent Sector staff through both Trust staff clinics and public vaccination clinics.
Expectation
The PHA and Trusts must continue to:
- Deliver coordinated public messaging
- Promote self-care and use of services that are most appropriate to need
- Clearly signpost access routes to care
Response
- NHSCT Occupational Health Service and Corporate Communications hosted a regional cross-Trust photoshoot with PHA on 22 July 2026. It featured staff and peer vaccinators, and the resulting images will be used by each Trust to promote flu vaccination.
- Regional meetings are being held with PHA and Trust communications leads to ensure consistent messaging about the importance of flu vaccination and to address common myths.
- Regular communications will be issued to NHSCT staff and managers explaining how to access the vaccine. These will include short video clips and updates on Trust vaccination clinics, peer vaccinator locations and access through community pharmacies.
Inclusion health
Expectation
There are certain vulnerable groups, for example, the homeless who experience significant health inequalities, face barriers to accessing healthcare services, and may be disproportionately affected by cold weather, respiratory illness and service disruption during winter periods.
HSC organisations should ensure that winter surge plans include measures to mitigate the disproportionate impact of winter on vulnerable groups including improved access to preventative healthcare, support safe discharge pathways, and maintain close working with public and voluntary sector partners.
Response
The Trust Homeless Health Nurse and Specialist Health Visitor for Ethnic Minorities will continue to:
- Work alongside the trust immunisation team to encourage uptake of vaccinations, as per PHA guidance, to vulnerable populations living in shared accommodation such as hostels and hotels, covered by these services.
- Provide health and wellbeing support to 8 Homeless Hostels in NHSCT, available for contact by any client who is discharged from Hospital for ongoing support.
- Provide assertive in-reach services that support the principles of Right Person, Right Place, Right Time through holistic assessment, early identification of unmet health and social care needs. With timely referral and signposting to appropriate health, social care, community and voluntary sector services. Helping to prevent escalation, reduce avoidable hospital admissions, and improve outcomes for vulnerable individuals and families.
- Work in partnership with statutory, voluntary and community organisations to improve service coordination, and reduce repeat attendances at emergency departments.
Operational readiness
Expectation
Trusts must:
- Maintain safe staffed bed levels
- Define escalation triggers and action
- Implement a structured escalation framework
- Ensure critical care surge capacity
- Maintain equipment readiness
Response
- Work is ongoing with ward managers to ensure the implementation of strong rostering principles, along with a clear process for securing bank cover for rota gaps.
- The Trust has a clear escalation and full capacity plan in place, with actions to be taken at service level and across the unscheduled care pathway to maintain critical care and other capacity in times of heightened pressure.
- Our winter surge staffing plan will aim to support Emergency Departments with nursing and medical in-reach services to manage the anticipated increase in attendances.
- Other areas of focused support include respiratory and frailty to address key anticipated pressures during the winter period, alongside a detailed staffing resilience plan covering all unscheduled care services over the Christmas / New Year period.
Expectation
Each Trust must have a defined escalation model including:
- Clearly defined escalation levels
- Trigger thresholds based on real-time data
- Specific operational actions at each level
- Regional coordination where required
Response
The Trust has a well established escalation model based around our site coordination hubs on both acute sites. Escalation thresholds are determined by a real-time HEWS score alongside our ED Full Capacity assessment, and trigger agreed actions across hospital and community services. We work with regional partners via the RCC to ensure mutual support and assistance where possible and appropriate.
Urgent and emergency care
Expectation
Communications:
Trusts must implement local communications plans that:
- Promote alternatives to Emergency Departments
- Encourage attendance at scheduled appointments
- Improve and encourage access in primary and community care
- Support early patient and staff engagement in discharge planning
Response
- Building on learning and analytics from last year’s winter communications campaign, we will refine our approach to deliver more targeted messaging that supports our patients access to the right care, in the right place, at the right time.
- Communications will focus on promoting alternatives to ED, supported by short videos. We’ll also do proactive media, highlighting the level of missed appointments and importance of attending scheduled appointments. Focus this year will also look specifically at discharge with reference to SAFER model.
- Messaging will be coordinated across internal and external channels to encourage informed decision making, reduce pressure on acute services, and help maintain patient flow through winter period.
- Communications will be delivered through a multi-channel campaign, using media relations, social media platforms, website, engagement with stakeholders and political representatives, internally we will use traditional posters, intranet, emails and team briefings.
Improving patient flow through our hospitals
Trusts must increase utilisation of urgent care at the front door of their hospitals.
This includes:
Expectation
An increased proportion of patients seen, treated and discharged by Same Day Emergency Care (SDEC), in accordance with the Trust specific GIRFT recommendations.
Response
The Trust has well established SDEC models on both acute sites, with Antrim running Mon-Sat and Causeway Mon-Fri. Both sites have front door frailty and specialty input.
In line with NHSCT’s GIRFT recommendations the Trust will take forward the following key areas:
- Continued focus on ensuring senior decision makers early in the patient’s journey to ensure plans of care are in place
- A focused Reset Week on each acute site to ensure all admission, assessment and discharge processes are tested for resilience prior to winter
- Ensuring all ambulatory pathways are in place as planned and resilient, working closely with NIAS
- Focus on frailty ensuring the most vulnerable patients in our care are assessed by the correct specialty teams and with comprehensive geriatric assessments plans put in place to avoid hospital admission or reduce lengthy hospital stays
- Plan staffing levels around the predicted periods of peak activity.
Expectation
Increased urgent care offered via Trust Urgent Care Centres for lower acuity patients in lines with Summary Emergency Department Indicator Table (SEDIT) benchmarking.
Response
The Trust streams patients at the front door to Minor Injuries pathways where appropriate. We continue to use the CCG referral pathway from primary care.
Expectation
Improved information and pathways for ambulance services in the support for people with palliative and end of life care in the community ensuring KIS information is up to date, directories re: access to nursing and medical support is clear in and out of hours and all palliative care patients are on a palliative care register for each Trust area to reduce incidence of avoidable transfer to hospital.
Response
- The Trust is planning the establishment of a multi-disciplinary care home support team, who will provide assessment and input to care home residents across the NHSCT, inclusive but not limited to a single approach to falls prevention and management in the care home setting, as well as building on the work led by REACH around education/training and support to the care home staff team.
- Work is ongoing in terms of the proposed new model, the workforce and the steps needed to implement the model. The aim is to have the model in place for this winter.
- Service users known to District Nursing services who are Palliative Care and End of Life are identified on Encompass. Work is ongoing regionally to establish Palliative Care and End of Life registers for service users in Care Homes.
Expectation
Advanced Care Planning should be proactively promoted and reviewed to support timely decision-making, patient choice and avoidance of unnecessary hospital attendance or admission.
Response
The Department of Health has assumed leadership for the regional implementation of Advanced Care Planning. A centrally coordinated approach is being taken, encompassing governance, staffing training, ICT infrastructure, and public communications. The Trust is represented at the Regional Group and will support local readiness and implementation within the Trust. Regional engagement with Directors of Older People’s Services is planned to support implementation.
Improving ambulance handover and response times
The Northern Ireland Ambulance Service (NIAS), working with the 5 HSC Trusts, are to reduce avoidable ambulance despatches and conveyancing. HSC Trusts must minimise ambulance handover delays in order that community response times can be improved and to ensure patients access care in an appropriate setting. This includes:
Hear & Treat target of 10% of total emergency calls so that NIAS’s integrated clinical hub can provide advice to prevent an ambulance dispatch.
See & Treat target of 15.5% of total emergency calls thereby avoiding conveyance to emergency departments.
Expectation
Hospital Handover backstop of 45 minutes which will require full implementation of the Handover Protocol (including safety withdrawal), in order that ambulance crews can be released for community response.
Response
The Trust has made significant improvements in ambulance handover since the introduction of Release to Rescue, and will continue to focus on this area as a high priority in our unscheduled care reform programme.
Expectation
Consideration of alternative pathways of transport to ambulance services.
Response
The Trust continues to work with NIAS to encourage uptake of alternative conveyancing pathways including Same Day Emergency Care and Hospital at Home.
Discharge
Timely discharge is essential to maintaining patient flow and ensuring that acute beds are available for those who need them most, supporting safe, efficient care throughout periods of heightened winter pressure.
Expectation
Trusts must ensure that Clinical Leaders are supported in ensuring appropriate actions are embedded with regard to SENSIBLE care.
Response
The Trust is engaged in the SENSIBLE Care programme and is keen to progress engagement further, as discussed with CMO in a recent meeting with our senior team.
Expectation
Promotion of early ward rounds 7 days per week by senior decision makers to ensure timely discharge.
Response
The Trust has recently undertaken a review of senior decision making and improved the match between peaks of workload and availability of senior decision makers. Work has also focused on improved identification of patients requiring senior review at the weekend, to ensure that consultant ward rounds are maximised within available resource.
Expectation
Internal processes must be streamlined to ensure minimal delayed discharges of patients following their episode of care. Simple delayed discharges are to be no more than 4 hours by 30/06/26.
Response
The embedding of the SAFER patient flow model has improved early planning and identification of discharges across all medical wards. The site coordination model on both sites also supports a strong focus on simple discharge.
Expectation
Discharge Delays associated with Trust’s Internal Hospital Assessment Processes (IHAP) processes were to be eradicated by 01/04/26, as Trusts should ensure action commences at point of admission and is completed in line with estimated discharge date. If action is still required, this should be completed prior to the winter surge period.
Response
The development of an Integrated Discharge Team, with daily presence at Ward Board Rounds, has enabled earlier identification of new referrals and earlier commencement of the assessment process, with acceptance and screening taking place within an hour of referral.
We continue to work with patients and families to encourage engagement where possible while an acute intervention is ongoing and a recovery path may not be clearly defined.
Expectation
Discharge lounges, discharge to assess and early review teams must be maximised within existing resource.
Response
Antrim Discharge Lounge operates 7 days per week. Causeway is Mon-Fri but has relocated to an area that can accept beds, which has increased its ability to accommodate patients with a range of needs.
Our Discharge to assess pathway remains available through referral to the Recovery Service. The Early Review Teams (ERT) now cover the entirety of the Trust locality with a 2-week timeframe for first review. Opportunities to enhance ERT service capacity within available resource continue to be explored.
Expectation
Enhance working with the care home, care at home and voluntary sector to support timely discharge.
Response
- The Trust has a well-established Homes Reference Panel and will continue to engage with our IS Care Home partners to ensure effective working over the winter period. This will be supplemented by the development of a Care Home Support Team, the continued role of the Reach Team in education and training support to Care Homes, alongside the Integrated Discharge Team and the Trusted Assessors working in partnership with Care Homes to support safe and timely discharge.
- The Multidisciplinary Care Home Support Team is expected to be in place from November 2026. This model will bring together expertise from nursing, physiotherapy, occupational therapy, pharmacy, dietetics, dementia home support, speech and language therapy, and medical services to provide coordinated support to care homes.
- In relation to care at home, the Trust will continue to align winter discharge planning with the Strategic Reform of Home Care Services. This reform work is focused on developing a more sustainable and responsive model of home care through geographical zoning, improved brokerage arrangements, stronger provider accountability, and more effective use of commissioned capacity.
- During winter, these arrangements will support earlier identification of capacity pressures, prioritisation of packages that facilitate discharge or prevent admission, and improved continuity over weekends, bank holidays and peak pressure periods.
- Through the Neighbourhood model of care, the Trust will build on its relationships with the Community and Voluntary Sector to maintain people at home. Preventative models of care are also being piloted within the Causeway Locality in partnership with the Primary Care MDT and the Community & Voluntary sector.
Alternative pathways
Hospital at Home
Expectation
Maximise the provision of short-term acute care in patients’ homes and care homes
Response
Hospital at Home is operational across both care homes and patient’s own homes in East Antrim locality. Referrals are accepted for admission avoidance or early supported discharge from hospital for conditions suitable for management outside acute setting. The Hospital at Home operational group meets regularly to review opportunities to optimise service potential, including extension of referral pathways where appropriate.
Hospital at Home is a consultant-led service with other disciplines including physiotherapy, nursing and pharmacy directly employed in the team. There are numerous referral pathways open to this service from primary care, NIAS, other community services including district nursing and REACH, and acute pathways including ED and respiratory. Referrals are considered 5 days per week, with nursing cover available across 7 days up to 10:45pm.
Hospital at Home was introduced in November 2025, with intention to embed within the East Antrim locality initially and rollout more widely across the Trust at a future date. Caseload numbers have been increasing over the past weeks since expansion into patients’ own homes. Referrals to Hospital at Home have increased from 26 in July 2026 to 50 in August 2026. Of the 198 referrals received from inception of the service in November 2025 to date, 126 were accepted for assessment and intervention, thus avoiding conveyance to ED and a subsequent admission to an acute bed. We anticipate full delivery of the commissioned caseload of 8-10 patients across the winter period.
Expectation
Provide Home Based alternatives to prevent unnecessary admission or enable early discharge which should include OPAC services
Response
Hospital Diversion Nursing Teams support patients to remain in their own homes through facilitation of IV antibiotics, blood transfusions etc. OPAT services provide an important role in enabling early discharge from Acute settings to the care of Hospital Diversion Nursing Teams.
Hospital Diversion Nursing Teams operate across 7 days, including public/bank holidays until 10.45pm. Care planning will ensure adequate staffing available during periods of anticipated surge.
Intermediate Care
Expectation
Expand bed-based step-down capacity, within resources available
Response
The Trust has an ongoing focus on maximising the use of our funded core bed stock, both community hospital and statutory residential through a strong performance managed approach to Bed-based Intermediate Care to reduce LOS and maximise turnover.
In addition to this we will explore options to block book additional IS capacity to support hospital discharge, within available resource.
Expectation
Improve flow from acute settings
Response
The Trust is finalising the full implementation of an Integrated Discharge Team across Antrim and Causeway along with a number of enabling activities:
- Daily escalation meetings are held with Brokerage regarding packages of care.
- Response times from community hospitals and statutory residential homes have been reset to two hours.
- The Trust is engaging with independent sector providers to agree more timely responses across all seven days and to clarify the role of the Trusted Assessor.
Within available resources, staffing capacity across the Integrated Discharge Team, physiotherapy, occupational therapy and speech and language therapy will be enhanced over bank holidays and key weekend periods.
Expectation
Drive alternatives through maximising use of Digital Technology e.g. Virtual Wards; and
Explore how digital technology and remote monitoring/testing can support early patient discharge/ ED admission to protect in patient bed capacity.
Response
The Trust already manages a virtual OPAT ward from Antrim DAU, avoiding admission for this cohort of patients. We are engaged with the broader Virtual Ward pilot being led by Belfast Trust and are keen to see the outcome of this and how it can be rolled out across the region.
Expectation
Trusts should continue to adhere to strict clinical governance standards if a non- designated space is being offered for patient care, noting the Reset Plan and Operational Planning Guidance indicates the direction of travel to reduce the need for such temporary capacity, key priorities include:
- Risk assessments and infection prevention measures for any escalation area;
- Senior clinical oversight to ensure patient safety and dignity; and
- Continuous monitoring of patient flow and escalation triggers as part of Trust surge plans, through regular safety and capacity huddles.
Response
There is robust Infection Prevention and Control (IPC) oversight in place across all wards and undesignated beds on a daily basis. Individual patient risk assessments are undertaken to ensure appropriate placement decisions are made, taking account of clinical need, infection status, and patient safety considerations.
In addition, senior nursing oversight is maintained 24/7 through the Patient Flow Coordinators, who constantly monitor patient demand, capacity, and flow across the organisation. This is supported by adherence to agreed escalation triggers and processes, with regular collaborative reviews involving Site Coordinators and operational teams at scheduled meetings throughout the day.
These arrangements provide continuous oversight to support safe patient placement, maintain patient dignity, and mitigate risks associated with capacity pressure.
Elective care
Expectation
Trusts must build on existing initiatives to enhance and streamline capacity by maximising resources and protecting elective care from winter pressures through ring-fencing.
Response
Elective care activity will be protected as far as possible through active management of clinic and theatre capacity with weekly monitoring of theatre utilisation and monitoring of Red Flag and Urgent performance. Priority will be given to red flag elective cases at times of extreme pressure. Ambulatory pathways and day surgery will be maximised to protect inpatient elective capacity.
Expectation
Trusts should make day surgery the default for many procedures, further developing regional Day Procedure and Elective Overnight Stay Centres, and expanding the ambulatory care model.
Response
Surgical ambulatory care is available at Antrim Area Hospital seven days a week and at Causeway Hospital from Monday to Friday.
Day-case surgery will continue to be utilised wherever clinically appropriate to minimise inpatient bed requirements and protect elective activity.
The EOSC business case for Causeway is under development.
Workforce sustainability
Expectation
Trusts must:
- Maintain minimum safe staffing levels during and after the key bank holiday dates. This will require consideration of skill mix, management of leave and plans to manage unexpected or seasonal levels of absence;
- Ensure senior decision-makers are present across all shifts
- Manage leave to maintain service continuity over peak periods
- Optimise skill mix and cross-training
Response
The Trust will maintain a focus on workforce sustainability throughout the winter period, ensuring that staffing plans support safe care, service continuity and timely decision-making during periods of peak pressure. Services will review staffing levels, skill mix, leave arrangements and absence trends, with escalation processes in place to address emerging workforce risks. Senior decision-makers will be available to support operational decisions, and opportunities to optimise skill mix and cross-cover will be considered where safe and appropriate.
The Trust will monitor surveillance information provided through the PHA Incident Management Team, including information on influenza, RSV, COVID-19 activity, outbreaks, vaccination uptake and other emerging winter health risks. This information will be reviewed to inform escalation decisions, deployment of staffing resources, activation of surge plans and targeted communications activity.
Digital and data
The Trust must:
Expectation
Interrogate and understand patterns of service utilisation and uptake of vaccinations dynamically and respond promptly to insights therein
Response
The Trust regularly examines age profile of admissions, flow, LOS, uptake of ambulatory pathways, Ambulance conveyances, use of Phone First etc, which helps to inform our operational response and strategic reform programme.
Staff flu vaccination uptake is recorded directly via VMS PHA system and is updated daily. Weekly uptake for staff flu vaccinations is reported to Trust Senior Management Team by Occupational Health team on a weekly basis throughout the autumn programme. Uptake rates will help to inform clinic frequency and comms through the programme.
Expectation
Use data tools – including the SAPPHIRE intelligence dashboard – to target resources effectively to best manage the most vulnerable within our communities
Response
The Trust is working with PHA to develop and embed access to the SAPPHIRE dashboard, and will consider how best to use its analysis to inform service planning, particularly in the development of the Neighbourhood Model of Care.
Expectation
Use digital tools, in conjunction with service improvement methodology, to maximise the opportunity for care to be proactive, provided in the most suitable environment at the best time to those most in need.
Response
The Trust has a wide range of data sources and a well embedded programme of Quality Improvement helping to target, plan and reform service delivery across all our operational divisions.
Paediatrics
The detail of each Trust’s response should be clearly set out in the response to this guidance, including:
Expectation
Protocols for the repatriation of paediatric patients from busier units to units with more capacity; ensuring those patients who require tertiary level care can access this in a timely manner
Response
A senior nurse participates in the daily regional virtual paediatric nursing meeting to identify suitable paediatric patients for potential repatriation.
An NHSCT senior paediatric manager and clinician will attend the regional paediatric winter planning workshop on 4 September 2026.
Expectation
Ensure promotion of the uptake of all vaccination programmes for children and in particular encourage parents to ensure their children aged 2 years and over, take up the offer of influenza vaccination.
Response
Public health nursing staff actively promote uptake of all vaccination programmes including influenza vaccination at health and developmental review contacts.
The Trust holds follow up RSV vaccine clinics for any children within the target population not captured by Maternity and Neonatal services and the service works with NHSCT corporate communications dept to ensure vaccination messaging is well promoted on Trust social media platforms.
Expectation
Trusts should also encourage pregnant women to take up the offer of RSV and Pertussis vaccination, when invited to do so.
Response
Maternity services will liaise with the vaccination service to ensure vaccinators are available at antenatal clinics to improve uptake and support the administration of Pertussis, Flu and RSV vaccines to pregnant women at key points in pregnancy.
Maternity services will liaise with PHA to ensure key information around vaccination in pregnancy, including ‘myth busting’ is available and accessible to all women and staff.
The service will also consider communication with women via MyCare app to enable improved information sharing and staff will be asked to review and discuss vaccination status throughout the pregnancy pathway.
The service will provide regular updates and source training sessions for midwives, obstetric staff and maternity support workers on;
- Current vaccination recommendations.
- Addressing vaccine hesitancy.
- Common myths and misconceptions.
- Effective vaccine conversations with women and families.
Maternity Services will identify ‘Vaccination Champions’ within maternity teams to promote best practice and provide peer support. Regular reporting of vaccination uptake/ dashboard will be shared with the teams to ensure an upward trajectory is maintained.
Expectation
Include measures to increase uptake by all Paediatric staff of the offer of influenza vaccination including easy access to the vaccine.
Response
Local vaccination promotion materials will be displayed across all applicable clinical areas as well as visibility of senior staff uptake of vaccine.
The Trust will encourage and facilitate attendance at Occupational health/peer vaccinator drop-in clinics/own GP /pharmacy.
Mental health
Expectation
Trusts must identify short term bed capacity solutions
Response
Mental Health inpatient services are currently operating above commissioned capacity, with contingency beds routinely utilised and, at times, exceeding planned contingency arrangements. 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.
The continued use of additional beds requires associated workforce and resource investment to ensure safe, high-quality care can be maintained. Without recurrent funding to support this additional capacity, there remains an ongoing risk to service sustainability, workforce resilience and the ability to meet increasing demand across Mental Health services.
Expectation
Trusts must progress Rehab and Acute Inpatients facilities
Response
Progression of rehabilitation and acute inpatient facility developments remains dependent on the availability of capital funding for the proposed Birch Hill Mental Health Hospital project. Current estate infrastructure does not provide suitable alternative accommodation that meets modern mental health design standards, including ligature reduction requirements, therapeutic environments and safety expectations for service users and staff.
While opportunities to maximise the existing estate continue to be explored, any substantive redevelopment or repurposing of current facilities would require significant capital investment and resource allocation to achieve the required clinical, environmental and safety standards
Expectation
Trusts must agree escalation procedures for extended delays
Response
The Trust has established a range of escalation and flow management arrangements to support the timely management of delayed discharges, admissions and bed capacity pressures. Daily interface meetings are held across acute and community services to review patient flow, identify individuals requiring admission, consider potential discharges and explore opportunities for facilitated early discharge through Home Treatment Team support where clinically appropriate.
In addition, the Trust participates in daily regional escalation meetings and Critical Incident Management meetings which provide oversight of bed availability, demand and capacity pressures across the region.
Within Mental Health inpatient services, weekly Length of Stay and Bed Management meetings are held to review complex cases, monitor delayed discharges, identify barriers to progression and agree actions to optimise patient flow and maximise available bed capacity.
Expectation
Trusts must continue to work up more suitable alternative Places of Safety so demand on our Emergency Departments is reduced.
Response
Work is currently underway to review and evaluate alternative models implemented within Belfast Trust to determine whether similar approaches could be safely and effectively adapted within NHSCT. This review will consider clinical effectiveness, operational feasibility, estate requirements and workforce implications.
The establishment of a dedicated Place of Safety would require significant investment in infrastructure, staffing and ongoing operational resources to ensure compliance with safety, governance and quality standards.
Social care
Expectation
The Trusted Assessor model, now embedded across Trusts, must continue to be implemented to help improve the timeliness of assessments for older people moving from hospital into residential or nursing care.
Response
The Trusted Assessor role is now embedded and will be further enhanced through the development of a dedicated Care Home Placement role within the IDT model.
Networks have been established with all key IS Providers and we are establishing a daily live list of care home availability.
Expectation
Work must continue to develop and implement the Care Home Availability App by winter 2026 if possible as this will provide improved real-time visibility of residential and nursing home capacity, supporting earlier and more informed discharge planning ahead of winter.
Response
The Trust welcomes and will support the implementation of the Care Home Availability App by Winter 2026.
Expectation
Work must continue to develop a system that captures Care Home Demand. This will support better forecasting, matching of patient need to available provision, and earlier engagement with providers.
Response
The Trust will support the work of the Regional Care Home Provider Collaborative in benchmarking and identifying gaps and surpluses in provision of categories of care both locally and regionally and engaging the market to stimulate required growth.
A process will be established to oversee and manage the transitioning of residents identified as requiring a move between categories of care, to ensure all bed types are being effectively utilized and optimized.
Expectation
Work should continue to build on the demonstrable benefits of Early Review Teams.
Response
The current ERT is a small, focused team of 7 WTE staff which provides timely post-discharge and early package reviews to ensure care arrangements remain proportionate to presenting need, support reablement, and release capacity back into the wider home care system.
Since January 2026, ERT activity has released approximately 70 weekly home care hours each month, creating recurring capacity that can be redirected to new discharges, unmet need, and pressure points across community services. This represents a demonstrable and measurable contribution to improved flow, reduced delay, and better use of home care resource.
Building on this model through winter will strengthen the Trust’s ability to maintain discharge momentum, respond flexibly to increased demand, and ensure that care packages are reviewed at the earliest appropriate point rather than becoming embedded at a higher level than required.
Further investment would enable the team to increase review capacity, provide greater resilience during peak pressure periods, and maximise the impact of home care hours already commissioned.
Expectation
Trusts must encourage providers to be more agile in relation to their capacity, being mindful of the need to consider increasing fuel costs and wear and tear on cars especially in rural areas.
Response
As part of the Trust Reform of Home Care Services, it is proposed core home care service will be service delivered through geographical zones and commissioned on an outcomes-based, predominantly block basis, with a defined approach to address rurality. Zoning is intended to reduce travel, support more consistent capacity, and enable clearer accountability for service delivery.
Expectation
Trusts must engage with providers to ensure there is no downturn in discharge capacity over holiday periods and weekends.
Response
The Trust will participate in the SPPG proposed regional meeting to support cross sectoral working with Independent Sector Care Home and Home Care providers support the communication of key messaging around winter plans and preparedness such as ensuring discharge capacity is maintained throughout weekends, bank holidays and peak winter periods.
Regular communication will be maintained with providers throughout winter to monitor workforce availability, home care capacity, care home vacancy levels and emerging service pressures.
As part of the Trust Reform of Home Care Services, the model of service delivery is currently under review. It will require continued engagement with providers to ensure discharge capacity is available 7 days per week.
Expectation
All Trusts must work to fully implement the CareLine Live system to maximise savings to schedules which could then be recycled back into the system to address elements of unmet need or to support schedules experiencing staff absences and therefore to maintain existing services safely.
Response
Careline Live rollout is in progress as part of our Strategic Reform of Home Care Services.
Data monitoring and escalation
Expectation
Trusts must use data to drive operational decision-making.
- Key Metrics:
- Bed occupancy
- ED waiting times
- Ambulance handovers
- Length of stay
- Staff absence
- Infection rates
- Real-time data should support escalation and system-wide coordination.
Response
NHSCT uses a wide range of data to inform operational decision-making and the reform of unscheduled care delivery.
A weekly unscheduled care scorecard is circulated widely.
The Business Intelligence team has developed an Acute Ambulance Arrivals app, covering age, care home arrivals and admissions, together with an Unscheduled Care Qlik dashboard showing 13-week trends in Emergency Department activity, ambulance attendances and related measures.
Further content is being developed for phase two of the Unscheduled Care dashboard, including bed occupancy across commissioned and escalation beds, and discharges analysed by ward and time band.
NHSCT will monitor a balanced suite of performance, flow, capacity, workforce and community-based measures to assess the effectiveness of winter actions. Success will be demonstrated through improvements in urgent and emergency care performance, reduced delays across the patient pathway, greater use of alternatives to admission, improved discharge flow, strengthened community capacity and a resilient workforce able to respond safely to winter pressures.
Governance and assurance
Expectation
Trust Boards are accountable for:
- Approval of winter plans
- Oversight of delivery and performance
- Regular review of operational pressures
Response
Trust Board reviewed the initial draft of the Winter Plan on 27 Aug 2026, prior to its submission to SPPG. Trust Board’s next scheduled meeting is 24 Sept, which is later than the date proposed by DoH for the publication of the winter plan.
Trust Board will continue to have oversight of delivery and performance, and of operational pressures, throughout the winter period.
The Trust will participate in enhanced arrangements for overseeing surge at both Trust and regional level. This will include engagement with PHA surveillance and intelligence reporting, participation in regional oversight meetings and regular sharing of operational performance information. The Trust will utilise surveillance information relating to influenza, RSV, COVID-19 activity, outbreaks and vaccination uptake to inform operational decision-making, escalation responses and resource deployment.
The Trust will continue to work through the Regional Coordination Centre to support consistent communication, information sharing and a one-system approach to managing winter pressures across Northern Ireland.
Expectation
Trusts must:
- Provide regular performance reports to the Department
- Ensure appropriate internal governance arrangements
- Maintain executive-level oversight throughout the winter period
Response
The Trust will provide reports to the Department as required.
The Trust has well established operational and executive-level oversight and governance through OMT, SMT, Executive Team and Divisional Accountability arrangements.
NHSCT will participate in the enhanced regional winter surge oversight arrangements being coordinated by SPPG and PHA. This will include engagement with PHA surveillance and intelligence reporting, participation in regional commissioner oversight meetings and regular sharing of operational performance information. The Trust will utilise surveillance information relating to influenza, RSV, COVID-19 activity, outbreaks and vaccination uptake to inform operational decision-making, escalation responses and resource deployment. NHSCT will continue to work through the Regional Coordination Centre and other established regional forums to support consistent communication, information sharing and a one-system approach to managing winter pressures across Northern Ireland.
Neighbourhood Model of Care
The recently published Policy Framework for Neighbourhood Health and Wellbeing and Three-year 2% Resource Guideline set out an operating and funding model based around 17 Integrated Neighbourhood Teams (INTs) acting as provider alliances, working within GP Federation areas. Over time these teams will plan and deliver care together, with a clear focus on identifying need earlier, improving access, preventing avoidable deterioration, and supporting people to stay well at home. It is intended that the INTs will have initial plans for joint working this winter, with a deliberate focus on the needs of vulnerable older people who live in their local areas, aiming to deliver earlier, proactive care that helps people stay well at home for longer and avoid unnecessary hospital visits and stays.
Although INTs will be at an early stage of development this winter SPPG should actively support them to develop focussed plans for neighbourhood health and wellbeing in winter surge.
Expectations for INTs in Winter Surge Planning
INTs should work to develop plans which focus on the objective of reducing winter pressures through proactive, integrated care for vulnerable older people who live in their locality.
1. Proactively Identify and Support Those Most at Risk
Integrated Neighbourhood Teams should use risk stratification and local intelligence from GP practices, community pharmacy, social care, community nursing and the voluntary and community sector to identify vulnerable older people at greatest risk of deterioration or hospital admission during winter. Consideration should be given to enabling each individual to receive a proactive review and an agreed anticipatory care plan covering medicines, long-term conditions, frailty, falls, nutrition and social support.
Expected outcomes
- Reduced emergency admissions.
- Earlier intervention before crisis develops.
- Improved continuity of care.
2. Deliver Rapid Community-Based Clinical Response
Integrated Neighbourhood Teams should establish or strengthen rapid multidisciplinary responses that can assess and treat deteriorating older people at home wherever clinically appropriate. This should include timely access to community nursing, hospital at home, GP and independent prescriber input, pharmacy medicines optimisation, allied health professionals, social care and voluntary sector support, aiming to avoid unnecessary Emergency Department attendance and hospital admission.
Expected outcomes
- More care delivered closer to home.
- Reduced hospital occupancy.
- Faster recovery in familiar surroundings.
3. Optimise Medicines and Prevent Harm
Integrated Neighbourhood Teams should prioritise medicines optimisation for vulnerable older people before and throughout winter. This should include completing targeted medication reviews, support for adherence, proactive prescribing and
deprescribing where appropriate, promoting access to influenza and COVID vaccinations, and early intervention where medicines-related problems may contribute to deterioration.
Attention should be given to people with frailty, polypharmacy and recent hospital discharge.
Expected outcomes
- Reduced medicines-related admissions.
- Improved treatment adherence.
- Safer transitions of care.
4. Strengthen Community Partnerships to Address Wider Determinants
Integrated Neighbourhood Teams should help raise awareness of local statutory, community and voluntary sector partners to address the wider determinants that contribute to winter deterioration, including fuel poverty, loneliness, nutrition, transport, carer resilience and access to practical support. Where available this may include a directory of available community assets and clear referral pathways.
Expected outcomes
- Reduced social isolation.
- Improved resilience and wellbeing.
- Better support for unpaid carers.
5. Monitor Impact and Reinvest Resources
Trusts should utilise the 2% neighbourhood investment to support interventions that demonstrably reduce winter demand on hospital services. SPPG should monitor agreed measures including emergency admissions, delayed discharges, ambulance conveyances, hospital bed days avoided, patient experience and staff collaboration. Learning should be shared rapidly across neighbourhoods to inform continuous improvement and future investment.
Expected outcomes
- Evidence of return on investment.
- Reduced pressure across urgent and emergency care.
- Sustainable shift towards prevention and community-based care.
Response
The Trust has established a Neighbourhood Model Oversight Board and has initiated discussions with our local GP Federation Leads, pending the formal establishment of INTs by SPPG.
Along with our primary care partners we have given initial consideration to the identification of vulnerable older people at risk of deterioration or hospital admission, along with potential interventions to help maintain them at home.
Further information to include the details of VCSE and Pharmacy representation, alongside information on remuneration, governance and administrative arrangements is anticipated in the coming weeks.
In anticipation of the establishment of INTs the Trust is developing a Neighbourhood Action Plan which focuses on three key priorities for this winter:
- Care Home Support Team and revised care home falls pathway
- Hospital at Home expansion proposals
- Causeway MDT community caseload support work.
In the Northern Trust area, the existing Connect North social prescribing infrastructure, a partnership between the Northern Trust and Age NI, is available to support Integrated Neighbourhood Teams (INTs). This includes a publicly accessible online Directory of Services, containing over 1,300 community-based supports, activities and interventions that can be searched by postcode.
In addition, the Connect North social prescribing pathway provides access to one-to-one support from Connect North Link Workers through community drop-in sessions and direct referral routes.
INTs will be supported to utilise these resources to increase awareness of, and access to, local support services, helping staff and communities connect individuals to services that address social, emotional and practical needs, as well as the wider determinants of health and wellbeing.
Glossary
| Acronym | Description |
|---|---|
| CCG | Clinical Communication Gateway (system used by GPs to refer into secondary care) |
| CMO | Chief Medical Officer |
| DAU | Direct Assessment Unit |
| EOSC | Elective Overnight Stay Centre |
| ERT | Early Review Team (internal team within the Trust) |
| GIRFT | Getting it Right First Time |
| HEWS | Hospital Early Warning Score |
| HRODCC | Human Resources, Organisational Development and Corporate Communications (internal division within the Trust) |
| ICT | Information and Communication Technology |
| INT | Integrated Neighbourhood Team |
| IS Providers | Independent Sector Providers |
| LOS | Length of Stay |
| MDT | Multi-Disciplinary Team |
| NCSPS | Nursing, Corporate Services and Paediatric Services (internal division within the Trust) |
| NHSCT | Northern Health and Social Care Trust |
| OPAT | Outpatient Parenteral Antimicrobial Therapy |
| PHA | Public Health Agency |
| Qlik | Brand name for business intelligence platform |
| RCC | Regional Coordination Centre |
| REACH | Responsive Support, Education and Anticipatory Care with Care Homes (internal team within the trust) |
| Release to Rescue | initiative that reduces ambulance handover delays and helps return ambulance crews to community response more quickly |
| RSV | Respiratory Syncytial Virus |
| SAFER | An NHS recognised improvement approach designed to support timely discharge and improve patient flow through hospitals |
| SAPPHIRE | Safe Access to Patient data for Public Health, Intelligence, Research and Evaluation |
| SDEC | Same Day Emergency Care |
| SENSIBLE care | A patient centric framework of care focused on shared decision making and “what matters” to the individual. |
| SPPG | Strategic Planning and Performance Group (within Department of Health) |
| VCSE | Voluntary Community Sector |
| VMS | Vaccine Monitoring System |
| WTE | Whole Time Equivalent |
Published 18 Sept 2026
Alternative formats
NHSCT Response To Winter Planning Guidance 2026/2027