Northern Ireland’s healthcare crisis has become so familiar that its severity no longer shocks. Nowhere is this more evident than in neurology services - one of the most under-resourced areas of healthcare in the region.
With long-standing staffing shortages and widespread regional disparities, thousands of patients are left without access to timely and essential care. The result is continued, often preventable, ill health and hardship for many, along with rising costs to the economy.
A service in crisis
The numbers speak for themselves:
Approximately 20,000 people are currently waiting to see a neurologist in Northern Ireland.
More than 11,000 have been waiting for over a year.
Over 11,000 people have overdue review appointments.
The median wait time is 1 year and 26 weeks.
Some patients wait as long as seven years for care.
A recent Economist article put it starkly:
“If you are ever in Northern Ireland, pray that you never need a gallbladder removal, a neurology appointment or a hip replacement… People still love the National Health Service (or Health and Social Care, as it is officially known in Northern Ireland). Increasingly, however, they admire a service that no longer exists.”
Systemic challenges
Systemic issues worsen the crisis: Northern Ireland has just 25.3 WTE consultant neurologists, with limited 24/7 emergency cover beyond the Royal Victoria Hospital. Only two of 138 core medical training places are allocated to neurology, restricting future development. Broader workforce shortages are also severe - specialist nursing is at 57% capacity, Allied Health Professionals at 49%, and neuropsychology at just 20%.
Beyond the numbers: the human cost
Behind these statistics are real people experiencing real consequences. Just weeks ago, Epilepsy Action NI was contacted by a young man who had suffered his first seizure two years ago and was referred to neurology services by his GP. He was told the waiting time could be as long as six years. In the meantime, his condition has deteriorated. He continues to experience frequent seizures, has lost his job because of this, and is now homeless. He estimates he has visited the emergency department over 30 times in the past two years.
This is more than a personal tragedy - it’s an indictment of a system that allows often treatable conditions to escalate into crises. The lack of timely access to neurology care is leading to the deterioration of health conditions and a preventable rise in disability across Northern Ireland. Delayed access to neurology treatment poses a genuine threat to patient safety and, in some cases, can be life-threatening.
The economic toll
The personal toll is heartbreaking, but the economic implications are also significant. Direct costs include ambulance callouts, emergency admissions and longer hospital stays, whilst indirect costs due to lost productivity, and the impact on informal carers all contribute to a growing economic burden.
A 2024 study by The Economist Intelligence Unit estimated that 14.5 million people in the UK live with neurological conditions. The total direct and indirect economic burden is 4.3% of GDP, or £96 billion annually (2019 figures, now likely higher). The same study suggested that timely intervention and improved access to care could reduce these costs by one-third - equivalent to 1.4% of GDP or £30.8 billion.
A long-awaited Review, a risk of inaction
The Department of Health has just released a long-awaited consultation on the Regional Review of Neurology Services. This review provides a roadmap to bring services up to par with the rest of the UK. In his written statement announcing the release of the consultation the Health Minister stated: “The current constrained budget environment means that it will be highly challenging to find additional funding for this in the short term. Therefore, I will need to secure significant additional funding in future budget exercises to take this forward. However, I will carefully consider funding to implement the Neurology Review in the context of competing priorities and future budgets made available to my department.”
The Department’s draft budget Equality Impact Assessment places the review in the category of “No additional funding to support further development or reform of services.”
The status quo within neurology cannot be allowed to continue. Patients deserve better. Delaying essential reforms due to budget constraints is not just disappointing; it is dangerous. It is also a false economy.
Steps towards sustainable change
If the Executive is serious about reducing health inequalities and improving outcomes, several urgent steps must be taken:
Invest in neurology transformation and a neuro-specific workforce plan
Build on the neurology review recommendations to develop a strategic plan that includes future workforce projections to ensure equitable and sustainable care delivery across Northern Ireland.Develop clear and standardised patient pathways to improve communication and collaboration among healthcare teams, streamline service delivery, reduce unwarranted variation in care, and enhance patient outcomes
Set minimum standards for care
Ensure all Health & Social Care trusts can provide timely access to diagnosis and treatment—eliminating the postcode lottery.Improve data infrastructure
Enable consistent coding and collection of neurological condition data to support better care planning and resource allocation.Create accountability mechanisms
Build in oversight to ensure any planned reforms are implemented with measurable outcomes and timelines.
To unlock the funding required for meaningful health transformation, the Northern Ireland Executive must take a multi-pronged approach. This includes prioritising health within existing budgets, leveraging financial flexibilities such as in-year reallocations and departmental reserves, and making a strong case to the UK Treasury for additional targeted investment. Cross-departmental collaboration, public-private partnerships, and innovation funding can also help drive reform. Legislating for longer-term planning, improving data systems, and showing a clear return on investment can help build a strong case that transformation is both essential and economically sound.
Conclusion
The current state of neurology services in Northern Ireland is not just a health issue - it is a moral and economic one. Failing to invest in health transformation now will only entrench inequality, deepen the crisis, and inflate costs down the line. The Executive must see the writing on the wall: inaction is not neutral - it is an active choice with devastating consequences.
It is time to act. Anything less is a false economy.
Carla Smyth is Northern Ireland Manager for Epilepsy Action NI and Chair of Northern Ireland Neurological Charities Alliance, a coalition of nineteen neurological charities from across Northern Ireland.