More than 1,000 deaths linked to A&E waits in Northern Ireland as system branded a “catastrophe”

Antrim Area Hospital ED, and Ballee Cemetery, Ballymena

More than 1,000 people in Northern Ireland are estimated to have died in 2025 after waiting 12 hours or more in Emergency Departments, according to a major new report warning the system is no longer functioning safely.

The Royal College of Emergency Medicine (RCEM) said 1,032 excess deaths were associated with long waits last year — the equivalent of almost 20 lives lost every week — as pressure inside hospitals continues to intensify despite demand remaining largely unchanged over the past decade.

The findings, published in the college’s State of Emergency Medicine in Northern Ireland report on 17 April, have triggered urgent calls for political action, with warnings that avoidable harm is now occurring at scale.

Deaths more than double in five years

The report shows the estimated mortality linked to long waits has more than doubled since 2020, when the figure stood at 461, and surged dramatically from just 60 deaths in 2016.

While the 2025 figure is slightly lower than 1,122 in 2024 and 1,063 in 2023, RCEM warns this does not represent meaningful improvement, but rather a system “plateauing” at crisis level.

Dr Michael Perry, Northern Ireland Vice President of RCEM, said the figures reflect devastating real-world consequences.

“Behind these numbers are stories of families ripped apart by avoidable deaths which have happened because successive governments have failed to grab the ED crisis by the horns.

“We must not let the slight reduction on the previous year give us false assurance that the problem is being fixed. Such a glacial pace of progress is not good enough.

“Our health service has the highest rates of long waits in EDs, and deaths per capita resulting from them, of any UK nation. That statement should shock our policymakers to the core.

“Politicians and system leaders need to treat this like the catastrophe in need of redress that it is.”

Performance collapse despite stable demand

One of the report’s most striking conclusions is that the crisis cannot be explained by more people attending Emergency Departments.

Attendance figures have remained almost static over a decade:

• 2016: 632,629 attendances

• 2025: 629,657 attendances

This represents a 0.5% decrease, yet performance has deteriorated sharply.

In 2025, only 33.44% of patients were seen, admitted, or discharged within four hours — far below the 95% ministerial target and the worst performance recorded since data collection began in 2011.

At the same time, more than 132,000 patients waited 12 hours or longer — a figure RCEM says is 26 times higher than the 4,955 recorded in 2016.

Around one in five patients experienced waits exceeding 12 hours, while 8.3% — or roughly one in 12 — waited at least 24 hours.

In one extreme case highlighted in the report, a patient waited more than 124 hours, which equates to over five days.

Overcrowding pushing care into corridors

The report details how sustained overcrowding is forcing care into spaces never designed for treatment.

• 49% of patients were being treated in non-designated areas

• One in three patients were managed in temporary escalation spaces such as corridors

• Cubicle occupancy reached 137%, meaning 37 patients out of every 100 had no appropriate clinical space

RCEM warns this has serious implications for patient dignity, infection control, and the ability of staff to deliver safe care.

System gridlock driven by discharge delays

The central problem identified in the report is not entry into the system, but exit.

Emergency Departments are becoming blocked because patients who need admission cannot access beds. In turn, hospital beds are unavailable because patients who are medically fit for discharge cannot leave.

RCEM links this directly to pressures in social care and community services, which are struggling to support timely discharge.

This creates a cascading effect:

• Patients arrive at ED

• Require admission

• No beds available

• Remain in ED

• Departments become overcrowded

• Incoming patients face longer waits

The result is a system “jammed” at the point of discharge, rather than overwhelmed by arrivals.

Ambulance delays worsening as hospitals fill

The report also connects overcrowding to ambulance response delays.

When Emergency Departments are full, ambulance crews cannot hand over patients quickly, leaving them unable to respond to new emergencies.

RCEM highlights evidence from England showing rapid offloading protocols can improve handover times but risk worsening crowding if underlying hospital flow issues are not addressed.

The college warns against adopting such measures in isolation.

Excess deaths based on established evidence

RCEM’s estimate of 1,032 excess deaths in 2025 is based on research suggesting one additional death occurs for every 72 patients waiting between eight and 12 hours for admission.

Applying this evidence to Northern Ireland’s waiting-time data produces a cumulative estimate of 6,323 excess deaths since 2016.

The report stresses these are statistical estimates, not individual recorded causes of death, but argues the link between prolonged waits and increased mortality is well established.

Frontline staff warn of routine harm

The report includes testimony from clinicians describing conditions inside Emergency Departments.

Staff reported morale is “at an all-time low”, with some saying they dread coming to work because they cannot provide the standard of care patients need.

In a survey of clinical leads:

• 100% said patients were coming to harm under current conditions

• Delayed discharge due to lack of social care capacity was identified as the primary driver of overcrowding

RCEM presents this as evidence that harm is not a future risk, but an ongoing reality.

Political pressure mounts over pace of reform

Alliance health spokesperson Danny Donnelly MLA said the figures show lives are being lost due to slow progress on reform.

“These shocking statistics underline yet again that the failure to transform Northern Ireland’s health system isn’t some abstract debate for politicians – it is costing people their lives.

“Last year, we had the equivalent of close to 20 deaths each week in our Emergency Departments because of the unacceptable length of time people were waiting for care. That is 20 families left devastated and grieving the loss of their loved ones because the Health Minister has presided over health reform at a snail’s pace while services deteriorate around him.

“ED doctors are right to describe the current situation as a catastrophe. With the size of the Department’s budget each year, it is simply unacceptable that corridor care has been allowed to become the norm, and patients and bereaved families are demanding answers from the Minister on his plan to reverse that trend.

“We need joined-up working between emergency, community and social care so that medically fit patients can be discharged from hospital and capacity freed up for new ones coming in. The solutions are on the table, and the Minister must be held accountable for delivering them before any more lives are needlessly lost due to overcrowding in our Emergency Departments.”

RCEM sets out roadmap for reform

The college says the crisis is solvable but requires coordinated action across the entire health system.

Key recommendations include:

• Ending corridor care and deaths linked to long waits by the end of the decade

• Adopting a whole-system approach to patient flow across hospitals, community care, and social services

• Introducing 7-day working to accelerate discharges

• Using bed occupancy as a core system performance measure

• Ensuring accountability across trusts and system leadership

• Treating deaths linked to long waits with the same seriousness as those in other medical specialties

Dr Perry added:

“The good news is that this is a fixable problem. While, sadly, we cannot help the loved ones who have already experienced a bereavement at the hands of a broken system, we know what measures can prevent future heartbreak.

“Our report contains the answers. Accountability, a whole-system approach to patient flow and targets to ending corridor care and deaths associated with long waits will make the difference.

“We look forward to hearing from policymakers eager to put these measures in place.”

A system under strain with consequences measured in lives

The report concludes that Northern Ireland’s Emergency Department crisis is driven not by rising demand, but by failures in hospital flow, delayed discharges, and insufficient social care capacity.

With attendances stable but delays escalating sharply, RCEM argues the system’s ability to move patients safely through care has broken down — with consequences now measured in thousands of deaths.

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At a glance

• 1,032 excess deaths linked to long ED waits in 2025

• Equivalent to almost 20 deaths per week

• Deaths have more than doubled from 461 in 2020

• Up from 60 deaths in 2016

• Only 33.44% of patients seen within four hours (target: 95%)

• Over 132,000 patients waited 12+ hours in 2025

• Around 1 in 12 patients (8.3%) waited more than 24 hours

• ED attendances down 0.5% since 2016, but waits up 26-fold

• 49% of patients treated in non-designated spaces

• 100% of clinical leads report patients coming to harm