Health and care services

Addressing long-term workforce challenges

Following on from the transformation recommendations made by Professor Rafael Bengoa, the Department of Health has launched a new workforce strategy aimed at addressing current and future challenges out to 2026.

The need for transformation of the health system to meet the increasing demand of a growing and ageing population is long overdue in Northern Ireland. While the absence of an Executive and in particular a health minister has somewhat stalled progress on implementing major reforms, work is ongoing at official level to progress where possible those areas where pre-existing ministerial direction exists.

The Health and Social Care Workforce Strategy 2026: Delivering for Our People, recently published by the Department of Health, recognises serious challenges to the current system in the form of the supply, recruitment and retention of staff, and sets out a vision to ensure readiness in meeting the requirements of a transforming system.

Currently the majority (95 per cent) of directly employed health and social care (HSC) organisations work within the six HSC Trusts (Belfast, Northern, South Eastern, Southern, Western and Northern Ireland Ambulance Service). The largest HSC Trust is Belfast, accounting for 31 per cent of HSC staff, with the other main Trusts employing 14-16 per cent of HSC staff each. NI Ambulance Service HSC Trust employed 2 per cent.

Although this volume of staff has increased in recent years, vacancy figures highlight a growing need for more skilled staff. The March 2017 vacancy rate was around 5 per cent for posts currently in the system. The largest volume of vacancies was in registered nurse posts
(7 per cent), a rate which has been increasing over the last decade, suggesting a need for further expansion of the workforce.

Whilst the Strategy recognises that it cannot anticipate the future model and shape of health and social care provision out to 2026, it seeks to identify “the objectives which need to be achieved to ensure that we have the optimum number of the workforce, with the best mix of skills, for the issues that will exist in 2026”.

In planning out to 2026, the Strategy considers a number of underlying themes which will have workforce implications, namely: a continuing drive towards early intervention and prevention, establishing a parity of esteem for mental health provision, implementation of reform of social care and Brexit. Interestingly, on Brexit the Strategy recognises a potential impact on workforce supply from EU countries into Northern Ireland, “particularly health and social care workers who live and work around the Irish border and with the mutual recognition of professional healthcare qualifications.”

The Strategy outlines three main objectives to meet workforce need and need of the workforce by 2026:

By 2019: The Department and health and social care providers are able to monitor workforce trends and issues effectively, and be able to take proactive action to address these before problems become acute.

By 2021: Health and social care is a fulfilling and rewarding place to work and train, and people feel valued and supported.

By 2026: The reconfigured health and social care system has the optimum number of people in place to deliver treatment and care, and promote health and wellbeing to everyone in Northern Ireland, with the best possible combination of skills and expertise.

Given the level of uncertainty around the future outlook to 2026 and the need for flexibility the Strategy proposes three consecutive action plans for: 2018-20; 2021-23; and 2024-2026, allowing for formal review every three years.


Launching the Strategy, the Department of Health announced an initial allocation of £15 million in workforce development. A total of £5 million of this is to be directed towards the nursing, midwifery and Allied Health Professional workforce, including finding for 74 additional pre-registration nursing places, and 25 additional midwifery places.

The fund is also proposed to support other training investment in nursing, midwifery, nursing assistants, physiotherapy, radiography, paramedics and medical specialties.

10 key themes the workforce strategy aims to tackle

  1. Attracting, recruiting and retaining
  2. Sufficient availability of high-quality training and development
  3. Effective workforce planning
  4. Multidisciplinary and inter-professional working and training
  5. Building on, consolidating and promoting health and wellbeing
  6. Improved workforce communication and engagement
  7. Recognising the contribution of the workforce
  8. Work-life balance
  9. Making it easier for the workforce to do their jobs
  10. Improving workforce business intelligence
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