ED crisis deepens across NI as waits rise — Antrim and Causeway among most pressured hospitals

Emergency departments across Northern Ireland are facing escalating strain, with new Department of Health figures confirming rising demand, worsening waiting time performance, and a sharp increase in the number of patients enduring extreme delays — with the Northern Trust area, including Antrim Area Hospital and Causeway Hospital, firmly at the centre of the pressure.

The latest statistics, covering January to March 2026, show only 40.2% of patients were treated, discharged or admitted within four hours — a further deterioration from 43.6% in the same quarter last year and far below the 95% target.

At the same time, more than 12,500 patients waited over 12 hours in March alone, highlighting a system under sustained and intensifying pressure.

Demand continues to rise across emergency departments

Emergency care demand continues to increase across Northern Ireland.

In March 2026, there were 72,086 attendances at emergency departments — up 837 (1.2%) on March 2025.

Across the full quarter, attendances reached 201,992 — an increase of 7,467 patients (3.8%) compared to the same period last year.

The majority of patients — 55,823 (77.4%) — attended major Type 1 emergency departments, where the most acute pressures are being felt.

The Phone First system recorded 16,563 calls in March, with 10,743 (64.9%) directed to emergency departments, while 5,820 patients were managed without needing to attend.

Despite this triage system, demand continues to flow into already stretched hospital emergency departments.

Performance against key targets continues to fall

Performance across emergency departments has worsened against key benchmarks.

In March 2026, just 30.8% of patients attending Type 1 emergency departments were seen within four hours.

By contrast, 82.7% of patients attending Type 3 units were treated within the same timeframe, underlining the severe pressure concentrated in major hospitals.

Only 52.9% of patients began treatment within two hours of triage — down significantly from 61.1% the previous year.

While patients are initially assessed relatively quickly — with a median triage time of 15 minutes and 95% seen within 1 hour 20 minutes — delays escalate sharply after that point.

The median time from triage to treatment now stands at 1 hour 47 minutes, with 95% of patients waiting up to 9 hours 41 minutes to begin treatment.

Extreme delays increase as long waits become entrenched

The most severe delays continue to rise.

In March 2026, 12,549 patients spent more than 12 hours in emergency departments — up from 10,977 a year earlier — representing 17.4% of all attendances.

At the same time, 6.7% of patients left before their treatment was complete, while 5.1% returned within seven days with the same condition.

These figures underline the sustained strain across the system, with growing implications for patient outcomes and continuity of care.

Patients spending longer in emergency departments

The time patients spend inside emergency departments continues to increase.

For patients discharged home, the median total stay in a Type 1 emergency department rose to 5 hours 20 minutes — up from 4 hours 48 minutes the previous year.

For patients requiring admission, the median time increased to 14 hours 22 minutes — up from 13 hours 28 minutes.

At individual hospitals, delays are even more severe.

Altnagelvin Area Hospital recorded the longest median time from arrival to admission at 21 hours 28 minutes.

These extended stays highlight the growing impact of bed shortages and delays in transferring patients out of emergency departments once a decision to admit has been made.

Northern Trust under sustained pressure

The Northern Health and Social Care Trust, serving a population of over 463,000 people, continues to experience some of the most intense pressures within Northern Ireland’s hospital system.

Its two main acute sites — Antrim Area Hospital and Causeway Hospital — reflect the wider crisis, with high demand, prolonged waits, and significant admission delays.

Antrim Area Hospital — Northern Ireland’s busiest emergency department

Antrim Area Hospital remains the busiest emergency department in Northern Ireland, handling 7,588 attendances in December 2025 alone — the highest of any hospital in the region  .

Recent system pressure data highlights the scale of ongoing demand.

During one week in April 2026, the emergency department recorded 1,821 attendances, with 503 patients waiting more than 12 hours and only 27% of patients treated within four hours  .

This places Antrim among the most pressured emergency departments in Northern Ireland.

The combination of:

• the highest patient volumes in the region

• large numbers of patients waiting over 12 hours

• and low four-hour performance

illustrates a system under sustained and extreme strain.

Patients are typically assessed quickly, but delays escalate significantly when waiting for treatment or admission — reflecting a bottleneck beyond the emergency department itself.

Causeway Hospital — high delays despite smaller volumes

Causeway Hospital, while handling fewer patients than Antrim, is facing similar structural pressures.

During the same April 2026 reporting week, Causeway recorded 1,050 attendances, with 182 patients waiting more than 12 hours and 41% treated within four hours  .

Earlier Department of Health data also showed Causeway reporting one of the longest median waits from arrival to admission — 19 hours 19 minutes in December 2025  .

These figures demonstrate that while Causeway operates at a smaller scale, patients are still experiencing prolonged delays, particularly when admission is required.

Delays driven by capacity and patient flow issues

The data points to a consistent and critical issue across Northern Ireland’s emergency care system.

Patients are being assessed relatively quickly on arrival — but delays escalate sharply when they require treatment, admission, or transfer to a ward.

This reflects system-wide bottlenecks, including:

• limited bed capacity

• delayed discharges

• and slow patient flow through hospitals

As a result, emergency departments are effectively holding patients for extended periods, contributing to overcrowding and longer waiting times.

Shift in patient behaviour adds further pressure

The report also highlights a continued decline in GP referrals.

In March 2026, just 12.5% of emergency department attendances were referred by a GP, down from 13.4% the previous year.

This indicates that more patients are presenting directly to emergency departments, further increasing pressure on frontline services.

Encompass system rollout and data classification

The statistics are the first to fully reflect the rollout of Encompass — Northern Ireland’s new digital patient record system, designed to create a single electronic care record across health services.

The system was introduced in phases:

• South Eastern Trust — November 2023

• Belfast Trust — June 2024

• Northern Trust — November 2024

• Southern and Western Trusts — May 2025

Due to the transition, the figures are currently classified as “official statistics in development”.

The Department of Health states that while caution should be exercised, the data remains a meaningful and reliable representation of system performance.

A system stabilising — but still far from recovery

While some indicators suggest minor improvements compared to peak pressures, the overall picture remains one of a system operating well beyond its limits.

Demand continues to rise, waiting times remain significantly above targets, and extreme delays are becoming embedded.

For patients across County Antrim and the wider Northern Trust area, the figures confirm a persistent reality:

being assessed quickly does not guarantee timely treatment or admission.

Without significant improvements in hospital capacity and patient flow, pressures on emergency departments are expected to continue.

Report breakdown.

1. Big picture: NI-wide performance (Q4 2025/26)

Still far below target

• Only ~41% of patients spent under 4 hours in EDs (Type 1)

• Target = 95% → system is operating at less than half target performance 

Long waits remain widespread

• 11,325 patients waited over 12 hours in Dec 2025 alone

• That’s ~17% of all attendances 

Slight improvements—but from a bad baseline

• % under 4 hours slightly improved year-on-year

• Median total ED time (admitted patients) fell to ~13h 36m (down from ~16h+)

Translation: things are marginally better, but still structurally overwhelmed.

2. Demand pressures (key driver of everything)

• 66,737 ED attendances in Dec 2025 (steady demand)

• Type 1 EDs (major hospitals) handle the majority → highest pressure

• GP referrals dropped slightly → more self-presenting patients

The system isn’t just inefficient—it’s consistently overloaded.

3. Northern Trust – critical pressure zone

The Northern Health and Social Care Trust covers ~463,000 people and includes both:

• Antrim Area Hospital

• Causeway Hospital

Key takeaway: Northern Trust is one of the most pressured systems in NI—and the data backs it up.

4. Antrim Area Hospital – the pressure epicentre

Busiest ED in Northern Ireland

• 7,588 attendances (Dec 2025) → highest in NI

Waiting times (performance signals)

• Avg wait ~204 minutes (~3h 24m) 

• Median triage → treatment: ~1h 57m 

Real-time pressure snapshot (April 2026)

• 152 patients waiting

• 58 waiting over 12 hours

• 66 waiting for a bed 

What this actually means

• Antrim is:

  • The busiest ED

  • With high long-wait volumes

  • And severe bed-blocking (admission delays)

This combination = system bottleneck

• Patients arrive faster than they can be processed or admitted

• Leads to corridor care + extreme waits

5. Causeway Hospital – smaller but still under strain

Activity & performance

• Lower attendance than Antrim (regional ED)

• Avg wait ~231 minutes (~3h 51m) 

• Median triage → treatment: ~1h 12m 

Pressure snapshot

• 53 patients waiting

• 20 waiting over 12 hours

• 23 awaiting admission 

Interpretation

• Causeway:

  • Slightly better front-end flow (quicker to treatment than Antrim)

  • But still suffers from:

    • Long waits

    • Admission delays

It’s not collapsing like Antrim—but still structurally constrained

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At a glance

• 201,992 ED attendances in NI (Jan–Mar 2026), up 3.8% year-on-year

• 72,086 attendances in March 2026

• Only 40.2% seen within four hours (down from 43.6%)

• Just 30.8% met the four-hour target in Type 1 EDs

• 12,549 patients waited over 12 hours (17.4%)

• Median triage time: 15 minutes

• Median wait to treatment: 1h 47m

• Median ED stay: 5h 20m (discharged), 14h 22m (admitted)

• Antrim Area Hospital: busiest ED in NI (7,588 attendances in Dec 2025)

• Antrim: 1,821 weekly attendances, 503 waiting over 12 hours

• Causeway: 1,050 weekly attendances, 182 waiting over 12 hours

• Causeway: 19h 19m median wait to admission (Dec 2025)