NHS under pressure - Northern Ireland

This page is an overview of the main pressure points in the NHS Northern Ireland.


NHS pressures waiting list

This page gives an overview of key pressures faced by Health and Social Care (HSC) in Northern Ireland. We also have analysis for pressures on the national health systems in England, Wales, and Scotland. Note that available data is not always comparable across all nations.

Last updated: 4 January 2024


NHS backlog

Northern Ireland is facing a substantial backlog of care exacerbated by the pandemic.

Waiting lists continue to grow

High waits for elective care existed before the pandemic. As of September 2023, waiting lists remain high, with a continuous increase for outpatient cases since March 2020.

In September 2023, there were almost 116,000 patients waiting for an inpatient or day case admission and about 429,000 patients waiting for a first consultant led outpatient appointment at hospitals. This amounts to a total of approximately 545,000 people waiting for elective care in Northern Ireland, the highest recorded since the dataset began in June 2008. This is around 1.4 times higher than in March 2020, at the start of the pandemic and 4.8 times higher than in June 2008.


Consequently, people are now waiting longer for treatment. The number of patients waiting between one to two years for a first consultant-led outpatient appointment has risen drastically from about 117,000 in March 2020 to over 212,000 in September 2023 – a 81% increase.


Performance against waiting times targets

Performance of the Health and Social Care (HSC) Trusts in Northern Ireland against the waiting times targets introduced in 2016/17 has declined dramatically since their introduction.

This decline is especially notable against targets to have 55% of patients waiting less than 13 weeks for inpatient/day case treatment and for no patients to wait longer than 52 weeks.

The percentage of patients waiting less than 13 weeks for an inpatient/day case treatment reached an all-time low in June 2020, with only 11% of patients. While there was progress in the following months, the percentage of patients waiting less than 13 weeks has plateaued well below the 55% target, and remains at approximately 21% as of September 2023.

In September 2023, more than half (52%) of patients were waiting longer than 52 weeks for an inpatient or day case admission to hospitals. While this is a minor improvement from the 55% of patients waiting in September 2022, it is a major increase from the beginning of the COVID-19 pandemic in March 2020, where around one third of patients (32%) were waiting longer than 52 weeks.

Similarly, the target to have 50% of patients waiting less than 9 weeks for a first consultant-led outpatient appointment and the target to have no patients waiting longer than 52 weeks have both never been achieved. The margins between current performance and the desired targets are widening. In September 2023, only 17% of patients were waiting less than 9 weeks, compared to 35% in June 2016 when this target was introduced.

The percentage of patients waiting longer than 52 weeks for their first consultant-led outpatient appointment peaked in March 2021: 57% of those patients had been waiting more than a year. In September 2023, this fell to 49% of patients, a slight decrease from 50% in September 2022.


Cancer targets are not attained

Health and Social Care Trusts are failing to meet the waiting time targets for cancer care services at hospitals in Northern Ireland.

While the proportion of patients starting treatment within 31 days of a decision to treat previously remained consistently at or near the 98% target, it has gradually decreased in the last decade, and currently sits at around 88%.

The proportion of patients starting treatment within 62 days of an urgent GP referral for suspect cancer has been declining. The 95% target has never been met and the gap is only widening. In June 2023, only 37% of patients started treatment within 62 days.

The percentage of breast cancer patients seen within 14 days of an urgent referral has repeatedly fluctuated over time but has improved since a record low in December 2021. However, the overall proportion of patients seen within 14 days remains low and well beneath the 100% target, which has not been met since 2012.


Patients are waiting longer for emergency admissions

Pressures on emergency care in Northern Ireland are rising. Since the pandemic, waiting times at A&E have progressively increased, leading to a higher proportion of people now waiting over 12 hours.

In September 2023 – the latest A&E data available - about 64,700 people attended A&E departments in Northern Ireland. 50% of those patients were seen in under 4 hours, a major decline against the 91% seen within 4 hours in April 2008, when this data collection began.

Over 1 in 10 patients (14%) waited over 12 hours for an emergency admission in September 2023. While this a slight improvement to the first few months of 2023, it is a significant increase when comparing to the 5% in September 2019, before the pandemic began.



Medical staffing (secondary care)

The overall growth of the Health and Social Care (HSC) workforce in Northern Ireland has slowed down in the last couple of years. In March 2023, the HSC workforce stood at 65 thousand whole-time equivalent (WTE), an almost 14% increase since March 2018, but has remained stagnant in the past year, growing by less than 1% since March 2022.

The Medical & Dental staff group made up 7.5% of the total HSC workforce.

Expansion in the medical workforce has stagnated. As of March 2023, there were 4,750 WTE Medical staff employed. The workforce has only grown by 0.2% from March 2022 to March 2023.

The largest cohort were consultants with 1,972 WTE (41%). Registrars were the next largest group with 1,522 WTE (31%).


Vacancies are fluctuating

The total number of vacancies [1] under active recruitment in secondary care in HSC Northern Ireland has oscillated over the years. The definition of a vacancy used by the Department of Health only includes those being actively recruited, which excludes a number of posts not filled by a permanent doctor, for example, those awaiting approval for recruitment or where recruitment has previously failed and there is no live advertisement for the role.

BMA Northern Ireland research has shown that the number of posts not filled by a permanent consultant are more than double the reported vacancy total across Northern Ireland. This under-reporting is likely replicated in other branches of practice.

The total number of vacancies under active recruitment in the Medical & Dental staff group has fluctuated over time but has remained high since December 2021. A record high of 425 vacancies in the Medical & Dental staff group was observed in June 2023 - this is equivalent to a vacancy rate [2] of 7.5%.

Note on definitions
  • [1] HSC NI has defined a ‘vacancy’ as any position that is currently with the recruitment team and being actively recruited to. This will include those going through pre-employment checks, until a start date has been agreed. Vacancies that are on hold by managers are not included.
  • [2] The vacancy rate is calculated by adding the number of active posts* and the number of vacancies actively being recruited and then dividing this by the number of vacancies actively being recruited.

As of September 2023, there were 182 vacant consultant posts – a 80% increase since March 2017. There were 56 SAS (Associate Specialist/Staff Grade/ Specialty Doctors) vacancies actively being recruited in the same month, which is a slight decrease from the 69 vacant SAS posts the previous quarter.



Pressures in general practice

The overall GP workforce across Northern Ireland has grown slowly since 2014. On a headcount basis, there were 1,956 GPs, including locums, as of March 2023. The total GP headcount excluding locums in March 2023 was 1,448. While this is a 23% rise in the number of GPs since March 2014, it is only a 2% increase since March 2022. Note that headcount figures do not distinguish between those working full time and those working less than full time. As a result, headcount figures do not account for WTE (Whole Time Equivalent), and therefore will not reflect GPs’ full capacity.

The changing demographics of the GP workforce are reflected in the charts below. In terms of gender profile of GPs, there has been a gradual descending trend in the number of male GPs with a steeper increase in the number of female GPs. In March 2023, 60% of the GP workforce was female compared to 40% male. This is a pronounced shift in gender profile since 2014 when 46% of GPs were female and 54% were male.

The older age bands are comprised of a higher percentage of male GPs than female GPs. In March 2023, over half of GPs in the 55-59 and 60+ age groups were male, while there were more female GPs in the younger age groups. 70% of GPs in the 25-39 age band were female compared to 30% male GPs.

While there is an increasing number of Salaried GPs, the trend for GP Partners has remained relatively stable.

At the same time, the number of patients is rising yearly. In March 2023, there were over 2 million patients registered with a GP practice in Northern Ireland - a 6% increase since March 2014.

It remains to be seen whether the rising number of registered patients will be sustained by the slow growth of the GP workforce.