Northern Ireland A&Es pushed beyond capacity as doctors warn ambulance policy is putting patients at risk

Emergency Department at Antrim Area Hospital

Emergency departments across Northern Ireland are becoming dangerously overcrowded as a result of a new ambulance handover policy designed to speed up patient transfers, according to frontline emergency medicine leaders.

A snap survey carried out by the Royal College of Emergency Medicine (RCEM) has revealed that more than half of Emergency Department Clinical Leads believe the policy is worsening conditions inside already stretched A&Es — despite improving ambulance handover times.

The warning came as RCEM’s Vice President for Northern Ireland, Dr Michael Perry, appeared before Stormont’s Committee for Health on Thursday, May 28, where he described overcrowding in emergency departments as “extremely dangerous” and warned that patient safety is being put at risk.

The controversial “release to rescue” policy requires ambulance patients to be offloaded within two hours of arriving at an emergency department, regardless of the department’s existing capacity levels.

Doctors warn overcrowding is becoming more dangerous

RCEM conducted the survey between 21 and 26 May, asking senior clinical leads from all nine emergency departments across Northern Ireland about the real-world impact of the policy.

The results painted a worrying picture for already under-pressure hospitals.

Five of the nine emergency department clinical leads said the policy had improved ambulance handover times but had simultaneously increased overcrowding inside their departments.

Some respondents also expressed concern that the policy had been introduced without meaningful consideration of emergency department staff or the operational realities facing hospitals.

Eight of the nine clinical leads said safe and effective patient handovers from ambulance crews were still being carried out.

However, RCEM says the core problem is what happens after patients arrive inside the hospital.

Dr Perry said ambulance staff and emergency teams were working under immense pressure to move patients safely and quickly into care.

“Our ambulance colleagues are working extremely hard, as we all are, to ensure a patient’s arrival into A&E happens in a timely and safe manner,” he said.

“The Government’s ‘release to rescue’ policy aimed to speed up ambulance handovers at Emergency Departments, and our survey of clinical leads suggests that, by and large, the policy is working — patients are arriving at EDs safely via ambulance.

“However, the departments they enter are overcrowded and far beyond capacity.”

Fears policy is shifting pressure deeper into hospitals

Dr Perry said RCEM had warned when the policy was first introduced that it risked transferring pressure from ambulances directly into emergency departments rather than solving the wider crisis.

“When this policy was announced, we warned that it might make ED overcrowding worse, and it is now clear this has proven to be the case,” he said.

“Overcrowding in EDs is dangerous, inefficient and leads to compromises in patient care. When departments are overcrowded, the sickest patients are more likely to deteriorate, or even lose their lives.

“Ultimately, this policy has, as we feared, put patients at risk — the opposite of what it was intended for.”

The findings are likely to deepen concerns about the growing pressures facing Northern Ireland’s healthcare system, where long waiting times, staffing shortages and delayed hospital discharges have already placed emergency services under sustained strain.

For patients and families across Northern Ireland, the warning raises fresh fears over delays in treatment, overcrowded waiting rooms and growing pressure on frontline medical staff heading into another difficult summer period for hospitals.

RCEM says ‘exit block’ is the real crisis

The survey also highlighted frustration among emergency department leaders over what they see as the real cause of the crisis — poor patient flow through hospitals.

Clinical leads said greater attention needs to be focused on so-called “exit block”, where patients who are medically fit to leave hospital remain stuck in beds because appropriate social care or community support is unavailable.

This lack of available beds creates a bottleneck throughout the entire hospital system, leaving emergency departments unable to move incoming patients into wards and treatment spaces.

Dr Perry argued policymakers were focusing on the wrong end of the system.

“Once again, policymakers have put their focus in the wrong place,” he said.

“The ‘back door’ of our hospitals is what needs the attention.

“If exit block is tackled, patient flow would be substantially improved and the dangerous overcrowding — that this policy is making worse — would be addressed.”

The issue is expected to remain under intense scrutiny at Stormont as pressure continues to grow on Northern Ireland’s health service ahead of next winter.