RCEM: NI 12-hour A&E waits rise 43-fold as new study links overcrowding to increased death risk

Friday 25 September 2026

A major new study involving Emergency Departments in Northern Ireland has found that the risk of death was higher as overcrowding worsened — against a backdrop where the Royal College of Emergency Medicine (RCEM) says 12-hour waits here have increased 43-fold since 2015 while attendances rose by just 6%.

Researchers found that for every 10% increase in Emergency Department occupancy, the risk of death from any cause within 28 days was 1% higher.

The research estimated that Emergency Department overcrowding could have contributed to 554 excess deaths each week across the UK during the study period, compared with departments operating with one treatment space for every patient. Researchers stressed there was considerable uncertainty around that estimate, giving a plausible range of 33 to 1,083 excess deaths per week.

Northern Ireland included in major study

The research, presented at the European Emergency Medicine Congress, analysed 19,034 patients treated at 134 hospital Emergency Departments across England, Wales and Northern Ireland during five periods in 2025.

Researchers compared deaths occurring within 28 days of treatment with how crowded each Emergency Department was on the day the patient was treated. Occupancy was calculated by comparing the number of patients being treated with the number of available spaces, such as cubicles.

The study found that, on average, Emergency Departments were operating at 175% occupancy. Corridor care, where patients receive treatment in non-standard clinical spaces such as corridors, was also linked to an increased risk of death in line with the risk associated with occupancy.

12-hour waits rise 43-fold as attendances increase 6%

The findings come amid a dramatic deterioration in Northern Ireland’s Emergency Department waiting times which RCEM says cannot simply be explained by more people attending A&E.

According to RCEM, since 2015 the number of people waiting 12 hours or more in Northern Ireland has increased 43-fold, despite attendances increasing by only 6% over the same period.

RCEM has argued that the central problem is at the “back door” of hospitals, where patients can become stuck because beds are unavailable, rather than simply the number of people arriving at Emergency Departments.

Dr Michael Perry, RCEM Vice President for Northern Ireland, said:

“The crux of the issue is at the ‘back door’ of the hospital, not that we have too many people coming to A&E. Too many patients are stuck occupying beds when they are medically fit to be discharged.”

RCEM estimates 1,032 deaths associated with long waits

RCEM’s State of Emergency Medicine in Northern Ireland report, published in April, estimated that 1,032 excess deaths during 2025 were associated with waits of 12 hours or longer in Northern Ireland’s Emergency Departments while awaiting admission — equivalent to almost 20 each week.

The figure is an estimate of excess deaths associated with prolonged waits and does not mean that 1,032 individual deaths were formally determined to have been caused by an Emergency Department delay.

RCEM reported that the corresponding estimate was 1,122 in 2024 and 1,063 in 2023. In 2020 it was 461, while in 2016 it stood at 60.

Dr Perry said:

“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.”

He added:

“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.”

New study examines overcrowding itself

The new research examines a related but different issue: whether the level of crowding inside an Emergency Department is associated with a patient’s subsequent risk of death.

Researchers found that for every 10% increase in occupancy, the risk of death from any cause within 28 days was 1% higher.

The study’s estimate that overcrowding could have contributed to 554 deaths each week across the UK and RCEM’s separate estimate of 1,032 excess deaths associated with long waits in Northern Ireland during 2025 should not be added together. They examine different, although related, measures of pressure on emergency care.

Dr Ryan McHenry, from the University of Glasgow and an Emergency Medicine doctor in the West of Scotland, said:

“We found that increased crowding in emergency departments is associated with increased mortality for patients admitted to hospital.”

He added:

“This is important because we know that emergency departments are now often very crowded, and reducing that crowding has the real potential to save lives.”

The researchers stressed that there was considerable uncertainty around the extrapolated UK-wide estimate. They said further studies were needed to confirm the findings and produce a more precise estimate of the harm associated with overcrowding.

Northern Ireland clinicians report patients coming to harm

Separate evidence gathered by RCEM has provided a stark picture of conditions inside Northern Ireland’s nine major Emergency Departments.

A snapshot survey completed by lead consultants at all nine major EDs on 8 December 2025 found 401 people waiting for inpatient beds, with 49% receiving care in a non-designated space such as a corridor, on the floor or on a chair.

RCEM reported that ED cubicle occupancy of patients waiting for an inpatient bed was at 137%. One patient had been waiting in an Emergency Department for 124 hours — more than five days.

All clinicians who responded said they believed patients were coming to harm in the conditions, while every department reported delayed discharges due to a lack of social care arrangements as a major reason for overcrowding.

It feels frankly unsafe

The RCEM survey also captured the experiences of doctors working inside Northern Ireland’s overcrowded departments.

One respondent said their Emergency Department was above capacity with “no resuscitation space, ten-hour waits at the front door, and ambulance offloads waiting eight hours”, adding: “it feels frankly unsafe.”

Another consultant told RCEM that morale among staff was at an all-time low, with people dreading coming to work because they could not deliver the high standard of care they were striving for and staff felt vulnerable and exposed.

Explaining what happens when patients cannot move into hospital beds, Dr Perry said:

“Our walls aren’t elastic, so people end up in areas where they should never be receiving care in or stuck in ambulances waiting to even get through our doors.”

Record waits continued into 2026

RCEM’s analysis of official statistics for January to March 2026 found 23.5% of attendances at Northern Ireland’s major Emergency Departments — an average of 12,309 patients each month — waited more than 12 hours before being discharged, admitted or transferred.

Only 30.5% were dealt with within the four-hour target, according to RCEM, representing the worst four-hour and 12-hour performance for Northern Ireland’s Emergency Departments for any quarter on record.

A total of 1,280 patients waited more than two-and-a-half days. The median wait for patients who went on to be admitted to a hospital bed was around 16 hours — also the highest for any quarter on record — while 449 admitted patients waited more than three days in January alone.

RCEM Northern Ireland Vice Chair Dr Sara McGurk said: “It’s chaos in our departments. We have patients lining corridors facing waits for beds which can be measured in days.”

RCEM points to problems at the back door

RCEM says tackling overcrowding requires action across the wider health and social care system rather than focusing solely on Emergency Departments.

Patients requiring admission can remain in A&E because no hospital bed is available. At the other end of the hospital, patients who are medically fit to leave can remain in beds because the community or social care arrangements needed for a safe discharge are unavailable.

This reduces the number of beds available for patients waiting in Emergency Departments and contributes to what is commonly described as “exit block”.

RCEM has called for a whole-system approach to tackling overcrowding, with responsibility for patient flow spread across the entire patient pathway.

RCEM urges governments to act

Responding to the new research, RCEM President Dr Ian Higginson said:

“People are dying in association with overcrowding in Emergency Departments. This should be cause for alarm among policymakers, and yet we are not seeing any urgency.

“The findings of this crucial study from the Trainee Emergency Research Network (TERN) add yet more evidence about this utterly normalised and unacceptable state of affairs.

“RCEM continues to call for the governments of the four UK nations to act to address the catastrophic effect overcrowding and long waits in our EDs on our patients – who are suffering harm and will continue to do so because of a failure to act.”

Dr Higginson also warned of the impact on staff and said politicians needed to focus their efforts on the main causes of the problem rather than “apparent quick fixes which patently aren’t working”.

He added:

“Governments must make tackling overcrowding, long ED waits and the associated risk to patients an urgent priority. RCEM has made detailed recommendations on how this can be done, and is open to working with any policymaker to make them a reality.”

What the evidence does and does not show locally

The new study includes Northern Ireland, but it does not provide separate mortality estimates for individual Emergency Departments such as Antrim Area Hospital or Causeway Hospital.

Likewise, RCEM’s estimate of 1,032 excess deaths associated with waits of 12 hours or longer while awaiting admission applies to Northern Ireland as a whole. It should not be used to estimate deaths at individual Northern Trust hospitals without hospital-level evidence.

What the evidence does show is that Northern Ireland’s long-wait problem has grown far faster than attendance levels. RCEM says 12-hour waits have increased 43-fold since 2015 while attendances have risen by only 6%.

The new research adds further evidence about the potential consequences of overcrowding. Researchers found that increasing Emergency Department occupancy was associated with increasing mortality risk, while RCEM says tackling overcrowding, long waits and the associated risk to patients should be treated as an urgent priority.