Soaring costs for locum doctors and clinical negligence claims are putting Northern Ireland's health system under serious financial pressure, a spending watchdog has warned.
The Audit Office said the healthcare sector's heavy reliance on locum doctors was becoming unsustainable, with rising costs placing health budgets under huge strain.
A new report on locum doctors and patient safety by comptroller and auditor general Kieran Donnelly found £83 million was spent on locum doctors in 2017/2018, while the total cost of settling negligence claims in 2016/2017 was almost £400m.
It showed total expenditure on locum doctors had almost trebled from £28.4m in 2011-12 to £83m in 2017-18.
By 2017-18, both the Northern and Western Trusts spent more than 22 per cent of their total medical pay bill on locums.
"Efforts taken to reduce this dependency have had very limited success," Mr Donnelly said.
"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."
The review also found that trusts were very heavily reliant on locum doctors provided via agency, which are more expensive than using HSC doctors to provide cover.
Total agency spend rose to £73.5m in 2017-18, accounting for 90 per cent of all locum doctor costs.
Mr Donnelly's report, entitled Locum Doctors and Patient Safety, also found a 56 per cent increase in the total cost of settling clinical negligence claims and the estimated costs for unsettled cases.
They rose from £252.3m (for the period 2007-8 to 2011-12) to £393.5 million (for the period 2012-13 to 2016-17).
Mr Donnelly described the significant rise in the costs of settling clinical negligence claims as "concerning".
"These costs divert scarce resources away from front-line services and potentially result in patients waiting longer for treatment," he said.
The report found that the total number of adverse incidents reported increased from almost 75,000 in 2012-13, to 92,000 in 2017-18.
But the total number of serious adverse incidents reported reduced, from 626 in 2015 to 349 in 2018.
"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 HSC sector," Mr Donnelly said.
"It is essential that the HSC sector exercise constant vigilance in this area to ensure the safety of patients."
