Northern Ireland’s health service is expected to face a £600m budget shortfall, after the health minister committed to delivering a pay rise for nurses this year.
Mike Nesbitt warned that financial planning would be “unprecedented” in scale and would involve “extremely difficult and painful” savings measures for Health and Social Care (HSC) trusts.
“I do not want health service staff to be demoralised by inaction and another year of uncertainty on pay”
Mike Nesbitt
However, he further warned that by not implementing this year’s pay deal, there would be “substantial risks” for the health service including the threat of strike action and challenges with workforce recruitment and retention.
It comes as Mr Nesbitt last week accepted the NHS Pay Review Body’s recommendations on pay for 2025-26, which will see Agenda for Change staff given a 3.6% pay rise.
However, he noted that it would be up to his Stormont colleagues to agree to fund the deal.
In a written statement to the assembly this week, Mr Nesbitt set out that his department was facing a £600m budget shortfall in 2025-26, including £200m to cover the pay deal.
He suggested that HSC trusts would need to make savings to account for the gap.
He said: “My permanent secretary is finalising financial plans that will be unprecedented in their scale and ambition.
“They will involve an extremely difficult and indeed painful series of savings measures for HSC trusts.
“I can assure the assembly that I will drive forward savings to reduce the projected shortfall.”
The health minister said there was an “undeniable risk” that the Department of Health in Northern Ireland could be on a path towards potential overspend, but that it was not an “inevitability”.
He said the risk could be countered through various means, including in-year additional monies to the department, “executive-wide prioritisation” and a “sustained drive” by the HSC system to secure savings and efficiencies.
Mr Nesbitt told his assembly colleagues that he would “do everything I can to achieve a breakeven budget” but would need their support.
“For the sake of staff morale and the stability of our health service, this pay award must be delivered without delay”
Rita Devlin
Importantly, he concluded that there were “substantial risks” in not proceeding with the pay increases for HSC staff for this year.
“I do not want health service staff to be demoralised by inaction and another year of uncertainty on pay. They deserve better than that,” the statement said.
“This is about treating with respect the people who keep us healthy, fix us when we are broken and keep us alive when death becomes a potential outcome.”
Historically, nurses in Northern Ireland have been the last to receive pay awards in the UK.
It was not until March 2025 that they received their full backpay for the 2024-25 deal – almost a year after it was due.
A memorandum of understanding signed last year by the Department of Health in Northern Ireland and the collective health trade unions stressed the need for ongoing pay parity with NHS staff in England.
In his statement, Mr Nesbitt reiterated this: “Members will know that pay parity with England for Agenda for Change staff is a well-established and hard-fought principle. I intend to maintain it.
“Failure to do so would undoubtedly lead to industrial action with all the disruption to patient care that will involve.
“Not to mention the negative impact on the focus to reduce waiting lists, or the overdue need to reform healthcare delivery.”
Overall, Mr Nesbitt said the risk of potential budget overspend “must be balanced against the significant risk to service provision”.
“The only way through our financial challenges is by working collectively together, agreeing strategic priorities that will produce better outcomes,” the statement said.
Rita Devlin
The Royal College of Nursing Northern Ireland executive director, Rita Devlin, welcomed the minister’s comments and said it was “a sentiment we strongly support”.
She said: “To move forward, the Northern Ireland executive must demonstrate strong and decisive leadership to ensure that nursing staff and other healthcare workers are fairly and equally compensated for their vital work.
“The RCN has consistently stated that we will not accept any departure from pay parity with our colleagues in England and Wales.
“For the sake of staff morale and the stability of our health service, this pay award must be delivered without delay.
“Our workforce is already under immense pressure – they should not have to carry the added burden of financial insecurity.”
More on nurse pay in the UK
