Winter Plan 2026/27

Winter Surge Plan 2026/27

Working together to keep health and social care services safe, responsive and accessible throughout winter

Introduction

Winter places additional pressure on health and social care services every year. This plan explains how we are preparing to support patients, service users, families and carers throughout Winter 2026/27. Our priority is to provide safe, effective care while helping people access the right support at the right time and in the right place

This Winter Plan is based on winter surge guidance provided by the Department of Health and sets out the actions we will take to prepare for the months ahead to support patient flow across the system, reduce avoidable admissions, strengthen discharge planning arrangements and ensure that available community services are fully utilised to support people to remain well or receive care closer to home where appropriate.

As we prepare for Winter 2026/27, we are committed to:

• Delivering safe, high-quality care
• Supporting timely access to services
• Protecting vulnerable people
• Maintaining workforce resilience
• Working collaboratively across the Provider Trusts and the health and social care system.

Winter Surge Plan 2026/27 – Accessible

• Our Winter Surge Plan

  Our Winter Surge Plan describes how we will work with patients, service users, carers, staff, partner organisations and communities to deliver safe, effective care throughout the winter months. It sets out the practical actions we will take to prepare for winter, reduce avoidable admissions, support the flow of patients through our hospitals, improve discharge arrangements and strengthen community-based services. It also highlights the important role that all of us can play by choosing the most appropriate service when we need care and by taking steps to look after our own health and wellbeing throughout the winter period.

  While we will make every effort to maximise available resources, increasing demand, service growth pressures and financial controls mean that patients and clients will at times experience unavoidable delays. To ensure patient safety, resources will be prioritised to areas of greatest clinical and care need which may result in longer waiting times for some services.

• Our key priorities for Winter 2026/27

  Our Winter Surge Plan is focused on four key priorities:

  • Whole system working: working together to keep services safe, responsive and accessible throughout winter.
  • Prevention: supporting people to stay well and protecting the most vulnerable.
  • Ensuring operational readiness: keeping services prepared and responsive through robust operational management and clear escalation plans.
  • Improving hospital flow: optimising alternative pathways, protecting rapid access and treatment services and supporting timely discharge.
• Whole system working

  Our aim – Working together to keep services safe, responsive and accessible throughout winter

  What we will do this winter

  Key to this will be continued partnership working across the health and social care system through established arrangements with other Trusts, NIAS, primary care, independent sector providers, SPPG and the Regional Control Centre to co-ordinate and manage pressures collectively. A regional forum led by SPPG, involving Trusts and independent sector providers, will further support cross-sector collaboration to manage increased pressures.

  This will include continued collaboration with NIAS and primary care to strengthen direct access routes. We will also work closely with NIAS to maintain our current ambulance handover performance. This will be further supported with the planned expansion of the Hospital Ambulance Liaison Officer (HALO) role in SWAH.

  We will work collaboratively with SPPG to support the development of Integrated Neighbourhood Teams in the latter part of this year and community-based services aimed at reducing emergency admissions, particularly for vulnerable groups and frail or older people.

  Planned enhanced regional arrangements for overseeing surge planning/ delivery and ensuring timely sharing of information will support a coordinated and consistent operational response across the region.

  In line with regional surge plan arrangements, available critical care capacity within Trust units will be maximised and the Trust will support the transfer of patients to other centres where/when appropriate. In the event that all available critical care capacity is in use, the escalation plan is to use theatre space which would require a downturn of elective activity.

  Agreed regional arrangements to maintain access for paediatric patients to acute inpatient units will be implemented. Plans are in place to allow flexible expansion of our paediatric assessment unit capacity and extended hours of operation as required in response to increased demand which will support rapid assessment and treatment and avoid unnecessary admissions.

  What this means for you

  We will work with our healthcare partners to ensure patients receive timely access to care and to minimise delays.

   

• Prevention

  Our Aim – Supporting people to stay well and protecting the most vulnerable

  What we will do this winter

  We will implement a robust plan to support delivery of vaccination programmes for eligible groups, pregnant women, children, other vulnerable groups and our staff, including flu, Covid-19, RSV, Pertussis and MMR.

  Across our inpatient care of the elderly and rehabilitation wards we will implement a targeted vaccination programme for frail older people and other clinically vulnerable adults.

  Health visiting and school nursing teams will deliver vaccination programmes for pre-school and school age children, including in special schools with targeted support for vulnerable children and families to improve access to immunisation services and reduce health inequalities. With statutory and community partners, we will deliver vaccinations across a range of health and care settings for vulnerable groups, including those with severe mental illness, disabilities, substance misuse issues, homelessness and complex care needs, with targeted outreach for lower uptake groups to reduce health inequalities, prevent avoidable admissions and improve winter resilience.

  The Trust recognises the vital role of staff vaccination in protecting patients, maintaining workforce resilience and supporting safe service delivery during winter pressures. To maximise uptake we will provide convenient access to seasonal influenza vaccination through hospital-based clinics, outreach provision and access at weekends and key shift handovers.

  Delivery will be supported by a named vaccination lead, a clear delivery schedule and regular review of uptake by staff group, service and location with targeted actions where uptake is lower, particularly for teams serving people at greatest clinical or social risk.

  We will work closely with PHA to support regional and local health initiatives including public information campaigns focused on self-care and appropriate service use.

  Prevention

  In conjunction with community and voluntary sector partners we will implement the Age Friendly Strategy for the Fermanagh and Omagh District with a focus on improving access to information and support, supporting people living with dementia and early intervention to improve outcomes.

  An Early Frailty Intervention Cooperation and Working Together (CAWT) Project incorporating community based professional staff in cross border localities will help to identify and support people living with frailty or at risk of developing frailty at an earlier stage.

  We will continue to develop early intervention and prevention pathways in partnership with Community and Voluntary partners and in our Trust managed GP practices including improved focus on chronic disease management through dedicated diabetes clinics and increased asthma and respiratory testing, multi-disciplinary frailty clinics with advanced care plans, and additional GP clinics from November 2026 to provide more support during the cold/flu season.

  Palliative Care key worker support will enable early identification, anticipatory care planning, timely prescribing and care in the patient’s preferred place of care.

  Infection prevention and control measures, including hand hygiene and environmental cleaning standards, will be reinforced and strengthened across all Trust services.
  We will continue to provide support for carers, recognising their vital contribution to health and wellbeing outcomes.

  What this means for you

  Vaccination remains one of the most effective ways to protect people, especially those who are most vulnerable, from serious respiratory illness during winter. More people will be protected against winter illnesses and supported to stay well, reducing the need for hospital treatment wherever possible

  We encourage people to:

  • Get vaccinated if eligible.
  • Order repeat prescriptions early.
  • Check on vulnerable neighbours and relatives.
  • Use community pharmacy services.
  • Stay active and keep warm.
• Ensuring Operational Readiness

  Our Aim – Ensuring robust operational management and clear escalation plans

  What we will do this winter

  Site coordination hubs and daily monitoring arrangements will provide oversight of hospital and community services, enabling timely responses to service and workforce pressures while supporting patient safety. Collaboration through the Regional Control Centre will support a coordinated system-wide approach.

  The Hospital Site Escalation Plan provides a clear framework for identifying and responding to emerging pressures through defined triggers and agreed actions. Surge and business continuity plans will be activated as required to maintain patient safety, service continuity and patient flow in response to increased demand, outbreaks or other emerging risks identified through Public Health Agency surveillance information, escalation notifications and local intelligence .

  Senior clinical, nursing, and operational leaders will provide visible leadership across hospital and community services, including evenings, weekends and holiday periods. Enhanced leadership and decision making support will be mobilised during periods of increased pressures.

  Seven-day services will continue across key urgent care areas including the Ambulatory Care Unit, Same Day Emergency Care, discharge lounge and community nursing home and hub model.

  We will protect planned care wherever possible by maximising day case and dedicated elective capacity. Normal planned reduction in elective activity at Christmas and New Year will create additional capacity for urgent and emergency care where required.

  Enhanced workforce planning arrangements will support safe staffing levels during periods of increased demand, particularly over Christmas, New Year period and early January. Workforce plans will be reviewed regularly to ensure safe staffing levels are maintained across priority services through proactive management of annual leave, targeted use of additional staffing resources, escalation arrangements and deployment of staff to areas of greatest clinical need where appropriate.

  Contingency arrangements will remain in place to support patients who experience delays in accessing mental health inpatient beds, ensuring they continue to receive safe and appropriate care.

  What this means for you

  Our services will remain prepared and responsive during periods of increased demand, helping to maintain safe care and minimise disruption.

• Improving Hospital Flow - Optimising alternative pathways

  Our aim – Optimising alternative pathways, protecting rapid access and treatment services and supporting timely discharge

  What we will do this winter

  We will maximise existing community services and pathways to keep people well at home, reduce unnecessary Emergency Department attendances and support admission avoidance where appropriate. Key actions include:

  Deployment of Trust vehicles will help our domiciliary care teams reach people more quickly in rural areas, particularly in the Fermanagh area, supporting timely care at home and reducing delays

  We will continue to support direct referrals from GPs, ambulance services and care homes to our Hospital at Home service to ensure that this service is maximised. Options to expand the service are also being considered.

  Further strengthened referral pathways from NIAS to District Nursing, Palliative and Community Respiratory services will support admission avoidance and facilitate care closer to home.

  Community nursing is now one streamlined hub & home model operating 8am-12 midnight with direct access for patients known to the service.
  There will be continued collaborative engagement with domiciliary care and care home providers to identify opportunities to enhance community capacity, respond to increasing complexity of need, test innovative models of service delivery and strengthen integrated approaches to achieving timely access to care and support.
  We will also continue to provide support for care homes through our dedicated care home support teams to avoid unnecessary hospital attendance.

  What this means for you

  More support will be available closer to home and there will be reduced need for hospital admission where appropriate helping to ensure hospital services are available for those with the greatest clinical need.

• Improving Hospital Flow - Protecting rapid access and treatment services

  Aim – Optimising alternative pathways, protecting rapid access and treatment services and supporting timely discharge

  What we will do this winter

  When people need to attend our hospitals, we will protect same day, rapid access and short stay capacity to ensure they receive timely care and return home as quickly as possible.

  We are exploring options to expand the ambulatory care unit at Altnagelvin to support patient flow and ensure that patients are rapidly assessed, treated and, where appropriate, able to return home on the same day without the need for admission.

  The Emergency Same-day Surgical Assessment (ESSA) pathway at SWAH will continue to support the management, treatment and care of surgical ambulatory patients contributing to patient flow from the Emergency Department (ED) and avoiding unnecessary admission.

  The Acute Medical Unit will be protected to support patient flow through a quality improvement project to reduce length of stay and improve patient flow through the unit.

  Plans are being progressed for a frailty pathway to include dedicated assessment spaces in Altnagelvin and access to onward referral pathways at Waterside Hospital where appropriate.

  Timely AHP assessment and intervention will also be prioritised at the front door with a focus on frailty, falls, deconditioning and functional assessment.

  Existing rapid/direct access pathways will be promoted to avoid ED attendance where appropriate, including the Minor Injuries Unit, Urgent Care & Treatment Centre, early pregnancy, gynaecology, ENT and eye casualty pathways. Targeted work will improve timely access to specialty in-reach to EDs and strengthen cross-specialty collaboration.

  EDs will continue to have direct access to the Paediatric Assessment Unit for assessment and the ward for admission with outreach by nurse practitioners at times of pressure to support the direct assessment and admission pathway.

  What this means for you

  Faster access to a greater range of appropriate urgent care services, reduced need for hospital admission where appropriate. More timely assessment and onward referral where needed for frail patients reducing delays for these patients awaiting admission in ED.

• Improving Hospital Flow - Supporting timely discharge

  Aim – Optimising alternative pathways, protecting rapid access and treatment services and supporting timely discharge

  What we will do this winter

  Inpatient capacity will be protected through proactive early discharge planning, promotion of early wards rounds and a focus on a home first approach to minimise delays.
  We plan to develop one integrated discharge team to make the process of leaving hospital more joined up and straightforward.

  We will continue to deliver pilot initiatives that support timely hospital discharge. The Discharge to Assess pilot enables medically stable patients to return home sooner, where assessments and recovery support can be provided in a more appropriate home setting. The Reablement pilot supports individuals discharged from Altnagelvin Hospital and Intermediate Care facilities who need domiciliary care, helping them regain independence and recover at home across the Waterside and Cityside areas.

  In addition, available intermediate care capacity in Waterside Hospital will be fully utilised with options to support further expansion under review.

  Access to home care services across Fermanagh will be enhanced through the implementation of transition teams who will focus on supporting hospital discharges with assessments at home. Social Work involvement will be optimised to facilitate timely discharge planning and enable more care to be delivered closer to home.

  The Trusted Assessor role will support timely allocation of care home placements and the early review team and occupational therapy rehabilitation resources will be maximised to ensure homecare capacity and resources are fully utilised. A dedicated domiciliary care delayed discharge coordinator is in place who will help expedite homecare arrangements for patients leaving hospital.

  What this means for you

  Safer and more timely discharge. Leaving hospital at the right time can support your recovery, help you to stay independent and reduce the risk of complications associated with long hospital stays. We will work closely with patients, families and carers to plan for discharge, ensuring ongoing care and support arrangements are in place to help you recover in the most appropriate setting for your needs.

• Supporting Our Workforce

  Our staff work extremely hard throughout the year, and winter brings additional pressure across hospital, community and support services. We are grateful for their continue commitment, flexibility and compassion. We will support our staff by:

  • Providing wellbeing programmes and support resources including advice and support on nutrition and exercise, stress management, building resilience and mental health support.
  • Monitoring levels of flu and COVID-19 vaccination uptake reached for all staff groups.
• Digital and Data

  We will use digital tools and data to support effective operational management and decision making including:

  • Use of available digital tools (eg encompass and performance dashboards) and data intelligence to support proactive, data-driven care, monitor pressures, support escalation processes and ensure service users receive care in the most appropriate setting at the earliest opportunity.
  • Continued use of UKCONs Triage digital assessment enabling 24hr Telephone triage assessment cover 7 days a week.
  • Promotion of the MyCare app to improve patient access to health and care information, including their appointments.
  • Use of digital applications to improve visibility of care home availability, provide trend analysis to inform actions and support discharge planning.
• Communications

  We will support operational delivery with appropriate public and staff messaging and targeted communications and public campaigns through digital channels.

  We will:

  • Provide regular updates during periods of service pressure.
  • Promote alternatives to Emergency Departments to help people to access the right care first time.
  • Share winter health advice.
  • Work with community organisations and local media and support regional public health awareness messaging and campaigns.
  • Use social media to provide timely information.
  • Encourage staff and public uptake of vaccinations for flu, COVID-19 and RSV.
  • Encourage families to support a Home First approach to patient discharge.
• How you can help this winter

  Get Vaccinated
  Protect yourself and those around you

  Choose the Right Service
  Use community pharmacy, GP services or urgent care pathways where appropriate

  Support Timely Discharge
  Work with patients and their relatives/carers to return home safely after treatment

  Stay Well This Winter
  Keep warm, stay active, plan ahead for repeat prescriptions and seek advice early