Encompass failures affected 44,657 referrals, including 1,423 for suspected cancer

North Antrim MLA Paul Frew

Failures to tell GPs that hospital referrals had been rejected affected 44,657 referrals in Northern Ireland, including 1,423 for suspected cancer and 16,366 classified as urgent, a ministerial letter has revealed.

The figures were disclosed to North Antrim DUP MLA Paul Frew by former Health Minister Mike Nesbitt in correspondence dated 17 August, before his resignation.

Mr Nesbitt said the referrals had been received and clinically assessed within encompass. However, communications informing referring GP practices of rejection decisions were not always generated or sent — leaving practices without information needed to determine patients’ next steps.

His response said health trusts were reviewing affected referrals to establish whether further clinical action was required and identify any actual or potential patient harm.

Urgent and suspected cancer referrals affected

The figures identify 44,657 affected referrals across two reporting periods: 16,366 urgent referrals, 1,423 suspected cancer referrals and 26,868 in other categories.

The totals remain subject to further validation by health trusts and the regional encompass team and could be revised. They count referrals; the letter does not establish how many individual patients were affected.

Mr Frew raised the issue during Assembly topical questions on 29 June. He said he had been told the figure was just under 50,000 and asked the then minister to confirm the scale of the problem.

According to the MLA, Mr Nesbitt could not confirm the number at the time and undertook to respond in writing.

Frew: ‘My worst fears have been confirmed’

Responding to the figures, Mr Frew said:

“This is horrific! My worst fears have been confirmed and realised. Encompass was extremely expensive; it was supposed to be fail safe. This shouldn’t have happened, a complete systems failure that will cause torment for those people impacted.

“To make it worse we now know that out of the 44,657 affected referrals 16,366 were urgent referrals and 1423 were suspected cancer referrals. Think of the anguish this failure will have caused.”

Mr Nesbitt’s letter explicitly distinguished the communication failures from referrals disappearing within the system.

He wrote:

“It does not relate to referrals being lost within encompass. The referrals concerned were received and triaged within the system, however the communication informing the GP of the outcome was not always generated or issued as intended.”

Earlier failures account for most affected referrals

The largest group identified in the letter covers the period from each trust’s introduction of encompass to 24 November 2025.

That period accounts for 37,625 affected referrals, including 1,048 suspected cancer referrals, 14,226 urgent referrals and 22,351 in other categories.

A further 7,032 referrals were affected between 25 November 2025 and 14 May 2026. These comprised 375 suspected cancer referrals, 2,140 urgent referrals and 4,517 in other categories.

Mr Nesbitt said the two periods reflected different problems: earlier failures involving local working practices and processes, followed by a technical issue affecting the generation of referral rejection communications.

Technical correction and changes to working practices

The technical issue associated with the November 2025 to May 2026 group had been addressed through a system correction implemented in April 2026, according to the letter.

The correspondence nevertheless gives 14 May 2026 as the end of that reporting period. It does not explain the relationship between that date and the April correction.

The earlier cases were identified through subsequent investigation and concerned how referral outcomes were communicated after trusts began using encompass.

Alongside technical work, Mr Nesbitt said trusts and the regional team were reviewing referral management processes, reinforcing staff training and guidance, and strengthening checks to ensure agreed procedures were followed consistently.

Reviews to establish whether patients were harmed

In his response, Mr Nesbitt said patient safety was the Department of Health’s primary concern, with urgent and suspected cancer referrals being prioritised in reviews based on clinical risk.

He wrote:

“This includes reviewing referrals where communications were not issued as intended, assessing whether any additional clinical action is required, ensuring referring GPs have the necessary information, and identifying any actual or potential patient harm.”

The letter does not provide a trust-by-trust breakdown, meaning the number of affected referrals within the Northern Trust cannot be established from the information supplied. It also does not state how many reviews had been completed, whether any harm had been confirmed, or when the work would finish.

For patients and families, the outstanding question is whether the communication failures delayed further assessment or treatment. The correspondence sets out a review process, but leaves unanswered how many people needed additional care and whether they have now received it.