Whole system flow: NICON webinar report

Background

Winter pressures on our HSC system in Northern Ireland have intensified over time, increasingly becoming a persistent, year-round challenge. As planning commenced for winter 2025, Health Minister Mike Nesbitt set in motion ‘The Big Discussion’, a whole systems conversation to learn from the previous winter. 

NICON organised a webinar on 16 January 2026 to take a closer look at the whole systems approach used in the Big Discussion. We heard inputs from key system leaders including Professor Maria McIlgorm, Chief Nursing Officer, DoH; Professor Cathy Harrison, Chief Pharmaceutical Officer, DoH; Maxine Paterson, Chief Executive, NIAS; Katy Rennick, Deputy Chief Nursing Officer, DoH; and Suzanne Pullins, Chief Executive, NHSCT.

Against the backdrop of a challenging flu season, we discussed the background, methodology, and outcomes of the Big Discussion as we prepared together for the remainder of the winter months.

This webinar was held as part of NICON’s 'Reset' discussion series, which will run throughout 2026.

Key points

• 'The Big Discussion' ran parallel to the development of a winter preparedness plan for NI, bringing together teams from across the Health and Social Care (HSC) system with partners.
• It sought to identify the drivers of demand that put pressure on the system year-round, but peak in winter, with the goal of developing long-term solutions to the increasing demand.
• Frailty was identified as a core issue early on – the Big Discussion intentionally looked at issues through the lens of the older person.
• A central theme throughout the Big Discussion was about getting people to the right service first time.
• Seven Big Discussion projects emerged from the process. These were: Keeping people well at home – enhanced care in care homes; Avoiding admission for end of life care; Provision of ‘sensible’ care; Frail elderly pathway for ED attendees post-fall; Advance care planning; Fractured neck of femur pathway improvement group; and Identification and risk stratification of frailty in over 65s.
• There has been a cultural and relational shift within HSC following the Big Discussion – a recognition that the whole system needs to move at the same time.
• Ultimately, participants viewed the Big Discussion as a longer-term solution for how we reset the system in NI to manage our population differently and get better outcomes.