Budget briefing and system discussion: NICON webinar report
Key points
There is an expected overspend of at least £200 million across the Health and Social Care (HSC) system in Northern Ireland this year and significant savings plans are already in place.
We do not yet have yet have full clarity on how the UK budget will impact health and social care in NI. However, the current assumption is that next year’s budget will be ‘flat cash’ and there will be no additional ‘bail out’ money provided by the UK government in year.
Taken together, this presents a very challenging financial climate for health and social care in NI.
We need ‘radical transformation’ within health and social care to meet current challenges. There may be a need for significant change such as considering additional options for revenue raising and developing new workforce strategies.
We already have a direction of travel provided by the Health and Social Care Reset Plan. The current challenges we are facing may galvanise the system to produce the radical transformation we need.
Background
On Monday 1 December 2025, NICON organised a webinar to consider the implications of the new UK budget for health and social care (HSC) in Northern Ireland. The session was led by Brigitte Worth, Finance Director, Strategic Policy and Performance Group (SPPG), and Eimear McCauley, Executive Director of Finance, Contracts and Capital Development, Western HSC Trust (WHSCT). We also heard from Roisin Coulter, Chief Executive, South Eastern HSC Trust (SEHSCT), alongside a range of other HSC leaders and key partners.
During the webinar, participants examined the key tenets of the budget in the context of focusing on delivery of the Health and Social Care Reset Plan.
The budget context
- There is an expected overspend of at least £200 million across the HSC system this year and significant savings plans are already in place.
- We do not yet have full clarity on the impact of the UK budget on the Department of Health (DoH) overall position.
- The current assumption for next year’s budget is that it will be ‘flat cash’, with all savings delivered recurrently.
- It is unlikely that there will be any additional ‘bail out’ money provided by the UK government in year. For the last three years, there has been a very significant injection of new money, which has help solve crises.
- Taken together, this presents a very challenging financial climate for health and social care in Northern Ireland.
Key messages from the webinar
- The NI Executive will need to seek solutions, manage their own budget, and step up to the challenges, especially if further financial support from the UK government will not be forthcoming next year.
- The NHS was created in 1948; times are very different now, with an aging population and major economic shifts. The post-war contract is coming under significant strain.
- Many areas of the system are already under immense pressure. During the webinar, we heard directly from our members about the pressures being experienced within secondary care, dentistry, pharmacy, general practice, and mental health services.
- We need ‘radical transformation’ within health and social care to meet current challenges. There may be a need for significant change such as:
- Revenue raising – the proposals that have already been placed on the table (such as car parking charges and means testing for domiciliary care and prescriptions) may not be enough. Other ways to raise revenue may need to be considered soon.
- New workforce strategies – we may also need to consider innovative workforce strategies to support broader transformation.
- We cannot work in silos – we must be work collectively to achieve change.
- Engagement with the frontline of health and social care has never been more important than it is currently. We need to ‘lean’ more into the knowledge of the clinical workforce and bring them into the conversation.
- Social care practitioners may be able to have a greater role in care if we shift our thinking.
- There must be an open dialogue with the public, which treats them as participants in the conversation, not passive recipients. The public should be seen as an asset that can help solve the problems we are facing within the HSC system. Changes in public perception may help shift political thinking as well.
- We already have a direction of travel provided by the Health and Social Care Reset Plan. The current challenges we are facing may galvanise the system and help us find the courage to produce the radical transformation we need.
“The way out of this, I think, is to make that big change, and to try to grasp that nettle. Another year of top slicing isn't going to work here; we need to look at what we're delivering and how we're delivering it. As well as not losing sight of the fact that the public isn't going to trust us with more funding unless we can demonstrate that we are also doing everything that we can to be as efficient and as productive as possible.” Brigitte Worth, Finance Director, Strategic Policy and Performance Group (SPPG)
“Perhaps the financial constraint will drive the radical change that we need. But what do we do as a system to stop being so reactive? How do we become more strategic?” Eimear McCauley, Executive Director of Finance, Contracts and Capital Development, Western HSC Trust (WHSCT)
Next steps
This webinar is the first event in NICON’s new ‘Reset’ discussion series, which will run throughout 2025/26. The series will gather together HSC leaders, partners, and expert speakers to consider the key elements of the Reset Plan for health and social care in NI.
A recording of the webinar is available upon request to NICON Members - email robyn.scott@niconfedhss.org.
If you have any general questions about the webinar or this briefing, please email contact@niconfedhss.org.
