Soaring negligence claims of £400m and locum bills of £83m pile pressure on Northern Ireland health service

The health service in Northern Ireland is spending nearly three times as much on locum doctors as it was six years ago, auditors have found.
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The cost of settling medical negligence claims has also soared in recent years, from £252.3 million over a five-year period up to 2012, to £393.5 million over the five-year period up to 2017.

The Northern Ireland Audit Office publishes two reviews today, which find that the increased costs of both locum doctors and medical negligence claims are “putting Northern Ireland’s health system under serious financial pressure”.

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The auditors found that total expenditure on locum doctors had almost trebled from £28.4 million in the 2011-12 financial year to £83 million in 2017-18.

The cost of locum doctors has increased almost three-fold in just six yearsThe cost of locum doctors has increased almost three-fold in just six years
The cost of locum doctors has increased almost three-fold in just six years

Two health trusts, the Northern and Western, spent more than 22% of their total medical pay bill on locums.

Much of the expenditure on locum doctors is being paid to ‘non-contracted agencies’ rather than doctors employed directly by the state.

“Total agency spend has risen from £23.1 million in 2011-12 to £73.5 million in 2017-18, and now accounts for 90% of expenditure on locum doctors,” the audit office found.

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“Most trusts are also increasingly reliant on non-contracted agencies, which often charge the highest rates.”

Auditor General Kieran Donnelly said: “The health and social care sector’s heavy reliance on locum doctors is becoming unsustainable, with rising costs placing local health budgets under huge strain.

“Efforts taken to reduce this dependency have had very limited success.

“To help ensure that patients’ needs are best met and provide better value for money, it is now imperative that the department and trusts collectively progress the transformation agenda and formulate strategies for delivering a suitably resourced and sustainable medical workforce.”

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The report on medical negligence finds a 56% rise in the cost of settling such cases, from £252.3 million between 2007-08 to 2011-12 when the audit office last examined costs, to £393.5 million for the period 2012-13 to 2016-17.

Mr Donnelly said: “The very significant rise in the costs of settling clinical negligence claims is concerning.

“These costs divert scarce resources away from frontline services and potentially result in patients waiting longer for treatment.

“Whilst steps have been taken to try and enhance local patient safety standards, and evidence suggests that more incidents are being reported, further work is required to embed a strong safety culture across the Health and Social Care (HSC) sector.”

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The Northern Ireland auditor general added: “It is essential that the HSC sector exercise constant vigilance in this area to ensure the safety of patients.”

The report also found that the total number of adverse incidents reported increased from almost 75,000 in 2012-13, to 92,000 in 2017-18 – something the audit office described as “positive” since the reports can “potentially help the sector learn and share lessons”.