Nursing leaders in Northern Ireland have warned that a new government plan to overhaul the Health and Social Care (HSC) service will falter without immediate action on fair pay and safe staffing.
It follows the launch of an HSC reset plan by health minister Mike Nesbitt last week, which aims to stabilise, reform and deliver services amid a growing financial crisis in his department.
“We are extremely concerned about the messages within the plan on funding and pay”
Rita Devlin
The plan builds on Mr Nesbitt’s existing three-year strategy for the HSC and has been published during what he described as a “defining and watershed year” for the service.
The plan sets out a series of reforms and savings in response to a projected £600m shortfall across the Department of Health in Northern Ireland – of which £200m relates to the 2025-26 pay deal for HSC staff.
Earlier this year Mr Nesbitt accepted the NHS Pay Review Body’s recommendations for 2025-26, which will see Agenda for Change staff given a 3.6% rise. However, the deal is still awaiting sign-off from the Northern Ireland Executive.
The new plan stated that the department must now deliver £300m in savings, by taking forward “the most ambitious efficiency programme in HSC history”.
A suite of actions for this were laid out in the document, including reducing locum and agency costs; increasing workforce availability through absence reduction; removing unwarranted variation in care and procurement; optimising medicines spend; and reducing central budgets and administrative costs.
By September 2025, the plan promised an agreement with the executive on an approach to managing the remaining 2025-26 funding pressure of £300m, which includes money for the pay deal.
However, the Royal College of Nursing (RCN) in Northern Ireland said the plan does not go far enough to reassure its members, who were at risk of once again falling out of pay parity with their UK colleagues.
Professor Rita Devlin, RCN Northern Ireland executive director, said: “We are extremely concerned about the messages within the plan on funding and pay.
“It commits to securing £300m in savings but admits that this ‘can only be achieved through taking forward the most ambitious efficiency programme in HSC history’.
“When department of health officials have previously made it clear that further cuts on this scale can only be made by closing services, this is both worrying and counter-strategic,” she said.
Professor Devlin warned that RCN members “still have no indication of when they can expect to receive the 2025-26 pay uplift” that has been implemented in England and Wales.
She added: “To be told that a ‘plan and approach’ to resolving this inequity may not be agreed until September at the earliest is unacceptable.
“The Northern Ireland Executive needs to take firm, decisive and immediate action to fund and implement this award, not just because it is the right thing to do but because further delays will impact negatively on recruitment and retention.
“That, in turn, will undermine any attempts to deliver this HSC reset plan,” said Professor Devlin.
The reset plan made several other pledges relevant to nurses, including a renewed commitment to invest in the workforce by commissioning more nursing and midwifery undergraduate places for this academic year.
Mr Nesbitt pledged in May that the department will be funding 1,065 places – an increase from 1,025 last year.
The document further reiterated that the government would introduce a Safe and Effective Staffing Bill during 2025-26.
Meanwhile, it also promised to introduce a new neighbourhood model of care in the country by March 2026, which has echoes of the neighbourhood health service outlined for England earlier this month.
The model will see community pharmacy, GPs, voluntary and community organisations, trusts, independent providers, local government work more closely together in formal partnership to provide integrated care.
Professor Devlin said the decision to move care into the community was “unquestionably the right direction of travel” but could be undermined by a lack of substantial investment in the specialist community nursing workforce.
Other commitments in the HSC reset plan include:
Further investment in community care services and the independent social care sector
Commitment to tackling waiting lists through additional funding
Improving quality, safety and public confidence by implementing recommendations from public inquiries and key reports
Investing in children’s social services
Introducing a new public health programme to support people to manage their own health
Concluding a public consultation on a regional adult learning disability service model
Continuing work to establish a regional mental health service
Mr Nesbitt said: “This is a defining and watershed year for our health service.
“We have to deliver on reform and waiting list investment, while at the same time securing efficiencies and savings on a scale not seen before. There are both challenges and opportunities of huge significance.
“At the heart of the reform agenda must be concrete progress on neighbourhood care, bringing more services as close as possible to people’s front doors.
“This has been a long-term objective but meaningful delivery is required, including a new model of primary care and early intervention,” he said.
Meanwhile, Professor Devlin said: “While there is much to commend in this plan, it will not achieve its overall objectives until we address the simple fact that we do not have enough nurses to deliver health and social care to the people of Northern Ireland.
“That, in turn, will not begin to change until we start to pay our nurses fairly and develop a workforce plan to ensure that we match capacity and demand.”
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