Health Minister Mike Nesbitt has unveiled a major update to Northern Ireland’s nursing and midwifery staffing guidance, refreshing a policy framework that has guided workforce planning for 12 years. The Refreshed Delivering Care Policy Framework, published today, provides Health and Social Care Trusts with updated tools to determine safe staffing levels amid rising patient demand and budget pressures.
The launch marks the first overhaul of the Delivering Care framework since its 2014 inception, recognising that population needs, service models, and workforce challenges have shifted dramatically. The updated guidance aligns with the Department’s Reset Plan and prepares the system for potential safe staffing legislation consulted on in 2024.
A Framework for Modern Pressures
The original Delivering Care framework was introduced in 2014 to establish regionally consistent approaches to nurse staffing. However, officials acknowledge that the Health and Social Care system now operates in a fundamentally different landscape, shaped by an ageing population with complex conditions, longer waiting lists, rising mental health demand, and widening health inequalities.
Chief Nursing Officer Professor Maria McIlgorm convened a task and finish group in autumn 2023 to lead the refresh. The resulting document places new emphasis on clarifying roles, responsibilities, and accountability from “ward to board,” while embedding evidence-based decision making into workforce planning.
- Regional consistency: Standardised methods for determining staffing ranges and skill mix across all fields of nursing and midwifery
- Operational ownership: Workforce planning responsibility sits with Health and Social Care Trusts and independent employers, supported by the framework’s methodologies
- Legislative preparation: Designed to support the system ahead of any future Safe and Effective Staffing legislation
- Accountability mechanisms: Strengthened reporting structures and shared accountability for staffing decisions
Minister: Staffing is a “Strategic Priority”
Launching the framework, Health Minister Mike Nesbitt stressed that workforce planning must adapt to current realities. He said:
“In the last 12 years since the Framework was first published our Health and Social Care system has faced a growing list of significant pressures, including an ageing population with more complex needs, longer waiting lists, rising demand for mental health and wellbeing support services, persistent health inequalities, and of course, highly constrained budgets. Against that backdrop, a re-examination of the Framework was necessary to ensure it remains fit for purpose.
“These challenges highlight why workforce planning must be robust, evidence based, and future focused. Ensuring we have the right staff, with the right skills, in the right place at the right time, therefore remains fundamental to maintaining safety and quality and in meeting future demand.
“This Framework makes clear that safe and effective staffing is not only a professional standard, but a strategic priority embedded throughout our system’s governance.
“It will also support the much-needed transformation of our Health and Social Care system to better meet the needs of our population, and is therefore aligned to both the Reset Plan, and the Department’s five-year vision for nursing and midwifery.”
Accountability from Ward to Board
The refreshed framework explicitly links safe staffing to staff wellbeing, recognising that sustainable care requires a valued and supported workforce. Professor McIlgorm highlighted the scale of the challenge, noting that nursing and midwifery represent the largest segment of the Health and Social Care workforce.
She said:
“Within the Health & Social Care system, Nursing and Midwifery represent the largest segment of the workforce. Ensuring the right staff, equipped with the appropriate skills, knowledge, and professional values, and deployed effectively, is critical to meeting evolving challenges and delivering improved outcomes and experiences for the population of Northern Ireland.
“We must prioritise workforce sustainability through effective recruitment and retention, valuing staff, and promoting wellbeing via robust workforce and workload planning and with clearly defined career pathways.
“This Framework outlines how we will achieve this for Nursing and Midwifery in Northern Ireland, while preparing for the potential introduction of safe staffing legislation.”
The Legislation Gap
While the framework strengthens guidance, it remains voluntary policy rather than law. Northern Ireland currently lacks specific legislation on safe staffing levels, unlike Wales and Scotland, which have enacted laws requiring health boards to maintain sufficient nurse staffing and report on compliance.
A consultation on Safe and Effective Staffing legislation closed in October 2024, with proposals to place legal duties on the Department and employers regarding workforce planning, reporting, and monitoring. However, legislation has yet to be introduced, leaving the refreshed Delivering Care framework as the primary tool for ensuring safe staffing.
The Royal College of Midwives has previously warned that Northern Ireland risks following England into a generational midwife shortage without urgent action. The refreshed framework’s success will depend on whether Trusts have the resources and staff available to implement its planning methodologies effectively.
Workforce Realities
The guidance arrives as the health service faces acute staffing pressures. Recent workforce statistics show that while overall staff numbers have grown to 67,866 whole-time equivalent posts, vacancies are rising faster. At the end of December 2025, there were 6,078 vacancies actively being recruited across Health and Social Care, an increase of 6.2% on the previous year.
Nursing and midwifery posts account for the largest gap, with 1,981 vacancies representing nearly one-third of all unfilled positions. The Belfast Trust alone was recruiting for 1,776 posts, while the Northern and Western Trusts have seen vacancy increases of 18.5% and 14.5% respectively over the past year.
Five Critical Questions
- Without legislative enforcement mechanisms, how will the Department ensure Trusts consistently apply the new framework rather than reverting to reactive, affordability-based staffing decisions?
- Given that nursing and midwifery vacancies currently exceed 1,900 posts, what immediate measures will accompany this framework to address recruitment and retention in the short term?
- How will the framework account for the specific workforce crisis in maternity services, where the Royal College of Midwives has warned of an ageing workforce and potential future shortages?
- When can stakeholders expect the Safe and Effective Staffing legislation—consulted on in 2024—to be brought forward to give these planning tools legal backing?
- How will the framework ensure that healthcare support workers, mentioned alongside nurses and midwives in the vision, receive equivalent workforce planning protection and career pathway clarity?
What to Watch For
Trusts are now expected to operationalise the refreshed planning methodologies across all nursing and midwifery settings. The framework’s effectiveness will become apparent in upcoming workforce statistics and, crucially, in whether the Department progresses from guidance to legislation. Stakeholders will be monitoring the next Assembly term for the introduction of a Safe and Effective Staffing Bill that would place the principles outlined today on a statutory footing.