Underfunding, overspending and trying to keep the lights on - a year in health

If money makes the world go round, the Northern Ireland Health Service is very much spinning on empty as it juggles underfunding, overspending and the everyday challenge that is keeping the lights on.

As we perch at the start of a new year, the economic prognosis is not optimistic, with warnings of severe financial constraint and further savings to be made.

In fact, as Health Minister Mike Nesbitt steps into 2026, he's already taken a huge bite out of this year's budget to the tune of some £130m to fund pay parity for health workers.

While Northern Ireland's annual health pay crisis has become as predictable as the Grinch trying to sabotage Christmas, the real test will be if the NI Executive executes plans to avoid the same crisis next time.

Still on the money, independent healthcare workers will also be at Nesbitt's heels to ensure they receive the promised Real Living Wage - it too will be overdue.

All eyes, ears and hips for that matter will remain on high alert as the public scrutinises hospital waiting list figures.

While anecdotally they are moving - the next quarter's figures will reveal by just how much.

Lists are at a record high with more than half a million people waiting for consultant appointments; new initiatives like the Waiting List Reimbursement Scheme should in practice improve lives.

In July, Professor Mark Taylor who was appointed to tackle the problem described the lists as a "national shame" - six months on and the professor said it is a trajectory that's going in the right direction.

It seems that almost every health and social care issue is in crisis, including General Practice.

According to the British Medical Association, the core issue is chronic underfunding to the sum of £80m.

While workforce problems will hardly be resolved in the next 12 months, there is an expectation that negotiations around the GP contract will take place which could lead to breaking the deadlock.

Compounding the challenges of a cash-strapped department and health trusts are the issues over faults at new buildings, with tens of millions having to be spent on problems at the new Belfast maternity hospital and the acute mental health facility at the City Hospital.

Tied up in all this is the minister's vision of a new neighbourhood health model which he hopes will activate the "shift left" policy to bring more services from hospitals into the community.

There are those who are curious to see how it will play out, including GPs who've been assured their roles within the model are essential.

They've said they haven't been consulted.

Social care rarely features in end of year look backs, and the same must be said as we look forward, as so far there's been no major policy change or funding uplift.

Until the social care workforce is expanded, including paid the Real Living Wage, the sector will continue to decrease with home care support adversely affected.

Those who speak up for the sector have said the challenge for the year ahead will be attracting and retaining present staff to meet growing demands.

With dementia cases projected to reach 43,000 here by 2040, support and demand for services can be predicted to be high and needs planned for.

Obesity remains a public health concern, and this complex chronic disease comes with risks of developing Type-2 diabetes, heart disease, stroke, and some cancers.

Tackling obesity requires a multi-faceted approach including Public Health Awareness, healthcare interventions and individual lifestyle changes.

In 2025, the Western, Belfast and Southern health trusts remained in the headlines over the future of the Southwest Acute Hospital, cultural and behavioural issues among staff in the Belfast Trust, also the cost of fixing unopened buildings namely the Maternity Hospital and existing ones chiefly the Acute mental health facility and there is the ongoing cervical smear scandal in the southern area.

Patients, staff, and the community in each area will demand that their respective complaints are resolved, in the Southern Trust the Ladies with Letters persist with their calls for a public inquiry into the cervical screening scandal.