NIAO warning over significant costs

The auditors have published a follow-up report, examining changes since it reported on locums in 2011 and patient safety in 2012. Both reports were the subject of the Northern Ireland Assembly Public Accounts Committee inquiries.

Clinical negligence costs had increased by 56% – from around £252m in the period 2007/08 to 2011/12 to £393.5m for the period 2012/13 to 2016/17. There was evidence that staff were reporting a high proportion of patient safety incidents, which could help the sector learn and share lessons. Adverse incidents increased from almost 75,000 in 2012/13 to 92,000 in 2017/18.

Steps have been taken to lay the ground for a new duty of candour and for Northern Ireland to join a new patient safety management information system being developed in England and Wales.

Comptroller and auditor general Kieran Donnelly (pictured) was concerned about the rising costs of clinical negligence, which diverted funds away from patient care.

He added: ‘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 HSC sector. It is essential that the HSC sector exercise constant vigilance in this area to ensure the safety of patients.’

The report said that while locum spending was £28.4m in 2011/12, this had almost trebled to £83m by 2017/18, with annual costs rising by nearly 57% between 2015/16 and 2017/18. In the latter year, both the Northern and Western trusts spent more than 22% of their total medical pay bill on locums.

The review found that trusts are heavily reliant on agencies to provide locums, with total agency spending rising from £23m in 2011/12 to £73.5m in 2017/18 – it now accounts for 90% of spending on locum doctors. The NIAO said most trusts relied increasingly on non-contracted agencies (those without agreed rates). In 2017/18 29% of total agency spend went to non-contracted agencies.

Mr Donnelly said the heavy reliance on locum doctors was becoming unsustainable. He added: ‘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 of Health and trusts collectively progress the transformation agenda and formulate strategies for delivering a suitably resourced and sustainable medical workforce.’