There are more people working in the health service than there has been for the past five years, yet staff are under increased pressure due to growing waiting lists and vacancies in key areas.
From June to December last year there were 1,652 additional vacancies within the Northern Irish health service, rising from 6,357 to 8,009 during that six month period.
That includes 229 consultant, locum and specialty or associate doctor [SAS] posts as well as 2,850 nursing and midwifery roles.
Read more: 6,000 patients waiting over five years for surgery in Northern Ireland
This is the highest number of vacancies within the health service since over the past five years, with 3,747 being recorded in March 2017.
Even though there are a high number of vacancies, the health service is also employing more people than at anytime over the past five years with staffing levels increasing by 7,800 to 64,380, according to the Department of Health.
However, despite this health workers are still under pressure due to understaffing, with this being primarily caused by the huge waiting lists in Northern Ireland, which are the worst in the UK, and vacancies in specialist roles whose absence can have knock-on effects across the service.
122,267 patients are on waiting lists in the inpatient and day case categories, with 66,302 of these waiting a year or more for their surgeries, which is more than half of those on the waiting lists and 6,000 have been waiting five years or more.
The Royal College of Surgeons has said that the government needs to develop a strategy for the health workforce in the short, medium and long term so that the service is able to meet the demands of patients.
Professor Mark Taylor, Northern Ireland director of the Royal College of Surgeons (of England), said: “Resolving our workforce challenge in the coming years represents an issue of the highest importance not just for health system leaders but for society as a whole. Our population is getting older and an important part of this demographic shift is the development of chronic illness. This needs to be considered against current and future skills mixes of staffing required.
“We also have a population in NI that is waiting much longer than it should for routine elective operations so this can make operations much harder and complex.
“We believe there should be a statutory duty on government to publish a regular assessment of health and care workforce projections and requirements in the short, medium and long term. If we don’t know what the future patient demand looks like, then how can we plan for a workforce that meets those needs effectively.”
The British Medical Association Northern Ireland has warned that the health service is collapsing and that UK colleagues have been shocked at the extent of the issues within it and recently passed a motion calling for urgent action to address the problems as a conference in London this week.
BMA NI consultants committee chair Dr David Farren said: “While staff are doing their best to maintain services for patients it is beyond clear that the health service in Northern Ireland is collapsing. We can see from our waiting lists alone that patients are not getting the treatment they need within an acceptable timeframe. Our colleagues in other nations were shocked today when the extent of our issues were outlined.
“The Department of Health needs to be honest with the public about the problems, problems, trying to fudge waiting lists by using different targets to the rest of the UK is misleading and unfair. Be honest about how bad things are and the reasons behind the waiting times. Our waiting lists are not measured in the same way as England and are less stringent and this also hides the true picture of what patients and doctors are facing.
“We urgently need additional expertise brought in to advise the Department and Trusts on what they need to do stabilise the health service and bring it back from the brink of collapse, who would work alongside local medical leaders to modernise our health service. We don't need more people telling us what is wrong, but we do need additional skills and expertise to deliver change. Part of the change that is needed is more transparency in decision making and allocation of funding.
“Trusts must also do more to prioritise the wellbeing of staff. Our surveys have told us that staff do not feel valued and are reporting high levels of burnout and stress. There needs to be appropriate occupational health services for staff across Northern Ireland and meaningful engagement with staff on what Trusts can do to help staff with their wellbeing.
“BMA in Northern Ireland has repeatedly said that there needs to be urgent action to stabilise the health service and really tackle the underlying issues that are causing it to be in a never-ending cycle of collapse. Movement on the protocol this week is welcome, we now urgently need to get the Assembly and Executive back up and running.”
A Department of Health spokesperson said: "Despite the financial constraints facing the Department over recent years, supporting workforce supply into the HSC system through expansion in training places and additional recruitment has been, and continues to be, a priority. Over the period December 2017-2022, the whole-time equivalent (WTE) HSC workforce (excluding bank and domiciliary care workers) increased by more than 7,800; that is by 13.9%, to 64,380.
"In 2022/23, this has included increasing the number of commissioned places for a primary medical degree to 306, with the opening of the new Graduate Entry Medical School at Magee and an expansion in medical specialty programmes delivered by NIMDTA.
"The annual new intake to the GP programme was also increased by 10 to provide a total of 121 training places, building on continuing work to invest in our GP workforce which has seen the number of GP trainees increase by more than 70% from 2015 levels. A total of 376 training places have been secured in Allied Health Professions, which represents an additional 41 training places this year, with an additional 300 pre-registration nursing and midwifery training places commissioned, making 1,325 in total, a record high.
"Alongside this strategic workforce planning, our international nurse recruitment programme has resulted in an additional 1,461 nurses being recruited to work across HSC, of which a total of 364 have arrived this financial year, up to the end of January 2023. A total of £8m has been allocated in 2022/23 to fund the recruitment of international nurses."
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