The Department of Health has published a 10-year strategic plan and accompanying three-year delivery plan to reform adult social care in Northern Ireland, acknowledging severe pressures from workforce shortages, rising demand, and budget constraints. Agreed by the Social Care Collaborative Reform Board, the plans set out 33 immediate actions to shift care towards prevention, early intervention, and community-based support, while leveraging technology to improve efficiency.
Ambition Versus Reality: The Strategic Framework
Published on 23 March 2026, the Strategic Plan and Delivery Plan establish six priorities for the next decade: placing citizens at the heart of decision-making; supporting unpaid carers; focusing on prevention and early intervention; examining the current approach to homecare and care homes; investing in the workforce; and building a sustainable adult social care system. The accompanying three-year Delivery Plan (2025-2028) identifies 33 specific actions to be taken forward immediately.
Key actions include:
- Undertaking an examination of the current approach to the delivery of Homecare to determine what changes can be made to better meet needs;
- Working to develop a comprehensive preventative adult care/support framework to help enable people to remain safe, healthy and well at home;
- Fully embracing digital, technology and AI solutions, including harnessing assistive and adaptive technology to enable people to exercise choice and control;
- Improving the uptake of Self-Directed Support (SDS) options.
Minister Acknowledges “Severe Pressures” Across the System
Health Minister Mike Nesbitt said the reforms are necessary because the current approach is unsustainable:
“The severe pressures within adult social care and support services in Northern Ireland are well known.
“Challenges with workforce recruitment and retention, increased demand for social care services, greater complexity of need, and delayed hospital discharges are leading to growing pressure on budgets and impacting on the capacity of services to respond to need.
“We therefore can’t just keep doing more of the same. We need different approaches, including a greater focus on earlier preventative measures and more community-based support, as well as finding more efficient ways to deliver services including throughthe use of technology where appropriate. We also need to focus on ways of attracting, retaining, supporting and developing the social care workforce. My Department has already published a 10-year Social Care Workforce Strategy, and I remain fully committed to funding the Real Living Wage at the earliest affordable opportunity.”
Workforce Crisis and Funding Constraints
The Minister’s commitment to the Real Living Wage comes after he confirmed in November 2025 that independent sector social care staff would not yet receive the uplift, despite £209 million being directed to other health staff groups. The independent sector employs the majority of Northern Ireland’s 40,532 registered social care practitioners.
The workforce pressures are stark. According to Department of Health statistics, there were 6,310 vacancies actively being recruited across Health and Social Care as of 30 September 2025, representing a 17.3% increase on the previous year. Meanwhile, data from June 2025 indicates that 18% of delayed discharges for longer-stay patients were due to waiting for care home beds, exacerbating hospital capacity issues.
The financial context is equally challenging. The Northern Ireland Confederation for Health and Social Care (NICON) has noted that after accounting for in-year allocations, the 2025/26 Health budget represents a real increase of just 2.6%, falling short of the 9% additional need identified by independent assessments.
Minister Nesbitt acknowledged this tension, stating:
“The plans that my Department have published today are intended to deliver the vital reform needed to respond to this complex combination of challenges.
“The plans are a careful balance of ambition and realism in the current financial climate. We have sought to prioritise actions which we consider are either the most necessary or have the potential to have the greatest impact.”
Critical Questions Remain Over Delivery
Several critical questions remain about how these reforms will be delivered:
- How will the Department fund the 33 actions in the delivery plan given the “unprecedented” budget constraints and the projected £400-500 million overspend facing health and social care?
- What specific measures will accelerate the uptake of Self-Directed Support, which has been discussed for over a decade but remains underutilised compared to other UK jurisdictions?
- Given the continued delay in funding the Real Living Wage for independent sector staff, what immediate incentives will be offered to address recruitment and retention in the short term?
- How will success be measured, and what accountability mechanisms will ensure the Social Care Collaborative Reform Board delivers tangible transformation rather than further consultation?
- Will the examination of homecare delivery address the rural access issues that make it difficult to provide care in harder-to-reach areas?
The Road Ahead
The Department has positioned social care as central to the Minister’s “shift left” vision and Neighbourhood Model of care, intended to reduce reliance on hospitals. Minister Nesbitt added:
“Social care is fundamentally preventative in nature and therefore is a vital element of my shift left vision and Neighbourhood Model of care.
“It plays a critical role in maintaining the health and wellbeing of individuals and communities by addressing needs early and reducing reliance on and demand for more intensive and more expensive health and social care services.
“These plans taken together provide a roadmap for the reform of our social care system over the next decade. Success will depend on close partnership and cooperation from both the statutory and independent sectors, and of course, a collective willingness to advance the reform agenda.
“I am confident, however, that with the required commitment and leadership, we can ensure we have a person-centred, strengths-based social care sector that is fit for the future and capable of providing better outcomes for all.”
Both the 10-year Strategic Plan and three-year Delivery Plan are now available on the Department of Health website. The Social Care Collaborative Reform Board—formerly the Social Care Collaborative Forum—will oversee implementation, supported by dedicated Implementation Groups working in partnership with the Department.
What to watch: Whether the promised “earliest affordable opportunity” for Real Living Wage funding materialises in the 2026/27 budget, and if the 33 delivery plan actions begin to show measurable reductions in delayed discharges and vacancy rates within the next 12 months.