NI emergency departments struggling with only one in three patients seen within four hours in A&E

Emergency departments across Northern Ireland are under sustained pressure, with rising demand, sicker patients and long waits continuing to challenge the health service, new figures release today (Thursday 5 February 2026) from the Department of Health (DoH) show.

The latest bulletin covers all new and unplanned attendances at emergency care departments (EDs) during October, November and December 2025.

It provides a detailed picture of how long patients are waiting, how many are admitted to hospital, and how the system is coping with winter demand.

Understanding the types of emergency departments

Northern Ireland’s emergency care system is made up of different types of departments:

• Type 1 EDs – Major emergency departments (A&E): These are large hospital-based units that operate 24/7 and deal with all kinds of emergencies, including serious injuries, heart attacks, and life-threatening conditions. They can admit patients to hospital. Examples include the Royal Victoria Hospital and Ulster Hospital.

• Type 2 EDs – Specialist emergency units: These handle specific emergencies such as eye or dental problems. They are not general A&E units and are rare.

• Type 3 EDs – Urgent Care Centres (UCCs) and Minor Injury Units (MIUs): These smaller centres manage less serious injuries and illnesses, like sprains, cuts, or minor infections. They cannot handle major emergencies but can refer patients to Type 1 EDs if needed.

Focus on Antrim Area and Causeway Hospital Emergency Departments

Antrim Area Hospital and Causeway Hospital, both Type 1 emergency departments, illustrate the intense pressures facing Northern Ireland’s major A&E services this winter.

Performance against waiting time targets has remained well below ministerial standards. At Antrim Area, only 28–33% of patients were admitted or discharged within four hours between October and December 2025, far short of the 95% target.

Monthly counts of patients waiting over 12 hours ranged from 1,538 to 2,118, highlighting the substantial numbers of long waits. Causeway Hospital performed slightly better, with 4‑hour compliance of 45–49%, yet still significantly under target, and 612–666 patients each month experienced waits exceeding 12 hours.

Patient volumes at the two sites show the scale of demand. Antrim Area ED consistently saw 7,588–8,075 attendances per month, considerably higher than Causeway, which handled 4,046–4,342 attendances in the same period. This suggests Antrim Area faces greater overall pressure from sheer patient numbers.

Median times in the emergency department reveal further strain on patient flow:

• Patients admitted to hospital: Antrim Area had a median ED stay of 13 hours 54 minutes in December 2025, while Causeway’s admitted patients waited longer, at 19 hours 19 minutes, reflecting significant delays likely linked to limited inpatient bed availability.

• Patients discharged home: Median times were shorter, with 4 hours 58 minutes at Antrim Area versus 3 hours 56 minutes at Causeway, indicating faster throughput for discharged cases at Causeway.

Triage and treatment times show that front-end assessment is relatively prompt but treatment delays remain a challenge. In December, median arrival-to-triage times were around 15 minutes at Antrim Area and 13 minutes at Causeway.

However, the median time from triage to start of treatment was 1 hour 57 minutes at Antrim and 1 hour 12 minutes at Causeway, meaning many patients were not treated within the two-hour target once assessed.

Overall, these figures underline persistent pressures at both sites. Antrim Area’s higher patient volumes and lower four-hour performance illustrate the impact of heavy demand, while Causeway’s longer admission waits point to ongoing challenges with hospital bed flow.

Though Causeway achieves slightly better four-hour compliance than Antrim, both hospitals remain far below ministerial targets, reflecting the broader trend across Northern Ireland emergency departments of rising patient acuity, long waits, and capacity challenges.

For patients, these delays can be physically and emotionally exhausting. Families report long hours spent in crowded waiting areas, with some patients enduring more than half a day before being admitted to a ward.

One local resident described waiting in Antrim Area ED with a relative for over 12 hours, saying:

“It’s stressful not knowing when you’ll be seen or admitted, and the waiting rooms are always so busy.”

For staff, the combination of high patient volumes and complex cases adds to the strain, with nurses and doctors often working extended shifts to keep services running safely. The data paints a picture not just of statistics, but of real people facing long waits for urgent care every day.

Rising demand across emergency care in Northern Ireland

In December 2025, 66,737 people attended emergency departments, slightly up 0.5% from 66,410 in December 2024. Across the three-month winter period (October–December), a total of 204,357 attendances were recorded, 1.0% higher than the same quarter in 2024.

Most patients attended Type 1 EDs (53,517, 80.2%), while Type 3 EDs accounted for 13,220 attendances (19.8%). The sharp rise in Type 3 attendances (up 32.9% compared with last year) partly reflects the reclassification of some units from Type 2 or minor units to Type 3.

Phone First, a system where patients call before visiting an ED to assess whether they need emergency care, handled 13,780 calls in December. Of these, 8,477 (61.5%) were referred to an ED, while 5,303 patients received advice or alternative care without needing to attend in person.

Patients are sicker than ever

The figures show that emergency departments are seeing increasingly unwell patients.

• 29% of patients were triaged as Level 1 or 2 (most urgent) in December 2025, up from 28.3% a year earlier.

• 78.9% of Type 1 ED attendances were triaged as urgent or very urgent (Levels 1–3), an increase from December 2024.

Triage is the initial assessment by a nurse or doctor that decides how urgently a patient needs treatment. Patients in Levels 1–2 are very sick and need immediate attention.

Altnagelvin Area Hospital had the highest proportion of high-acuity cases (the severity, complexity, and urgency of a patient's condition, dictating how quickly and intensely they need care, especially in emergency and critical care settings) at 46.4%, while Causeway Hospital had the lowest at 17.7%, showing significant variation across sites.

Waiting times remain a major concern

Northern Ireland has a target for emergency care: 95% of patients should be treated, discharged, or admitted within four hours of arrival, and no patient should wait more than 12 hours.

The statistics show these targets are still being missed, especially in Type 1 EDs:

• Only 41.3% of all ED attendances were treated or admitted within four hours in December 2025.

• Type 1 EDs: 31.9%

• Type 3 EDs: 84.1%

No Type 1 department met the four-hour target during December. Performance varied widely:

• Best: Royal Belfast Hospital for Sick Children – 57.3% within four hours

• Worst: Royal Victoria Hospital – 17.3% within four hours

Long waits easing slightly but still widespread

The number of patients waiting more than 12 hours in ED fell from 12,325 in December 2024 to 11,325 in December 2025, still representing 17% of all attendances. These patients are experiencing extreme delays, often due to a lack of available hospital beds.

The Ulster Hospital reported the highest number of 12-hour breaches, with 2,242 patients waiting more than half a day in December alone.

Delays mostly occur after triage

The median time to triage (initial assessment) was 15 minutes, with 95% of patients triaged within 1 hour 17 minutes, a slight improvement from last year.

However, the median time from triage to start of treatment was 1 hour 31 minutes, with only 58.3% of patients beginning treatment within two hours of triage, well below the 80% target.

This shows that while patients are being assessed quickly, the bottleneck is in moving patients through tests, treatment, and admission, not at the front door.

Length of stay highlights bed pressures

For patients admitted to hospital from a Type 1 ED, the median time spent in the department was 13 hours 36 minutes, down from 16 hours 18 minutes last year—but still very long.

Patients discharged home spent a median of 5 hours in ED.

• Causeway Hospital had the longest median stay: 19 hours 19 minutes

• Royal Belfast Hospital for Sick Children had the shortest: 6 hours 18 minutes

This demonstrates that bed availability and patient flow remain the biggest factors behind long waits.

Other indicators

• Left before treatment complete: 5.7% of patients, down from 7.8% last year.

• Re-attendance within 7 days: 5.3%, slightly higher than last year.

• GP-referred attendances: 9.8%, continuing a downward trend, likely influenced by new digital recording systems.

Encompass: the new digital system

The statistics are collected through Encompass, Northern Ireland’s new electronic patient record system. It creates a single digital record for every patient, replacing multiple older systems.

Encompass was introduced gradually across health trusts between November 2023 and May 2025. During its implementation, figures are classified as “official statistics in development”, but the DoH confirms they provide a meaningful representation of performance.

Key trends

1. Rising demand: Attendances are increasing, particularly in Type 3 departments.

2. Higher patient acuity: More seriously ill patients are attending EDs.

3. Four-hour target missed: Especially in Type 1 EDs, indicating widespread pressure.

4. Long waits still common: Even with a slight reduction, 11,325 patients waited over 12 hours in December 2025.

5. Bottlenecks after triage: Initial assessments are quick, but treatment and admission delays drive long waits.

Big picture

Northern Ireland’s emergency care system remains under structural pressure. While there are small improvements in some measures, rising demand, higher patient acuity, and blocked patient flow continue to drive long waits and missed targets.

Type 1 EDs, in particular, are struggling to meet ministerial standards, highlighting the need for ongoing investment, improved patient flow, and additional hospital capacity.

The full statistical bulletin is available on the Department of Health’s Emergency Care Waiting Times website.