1,032 people is a lot. It’s around half a dozen planes worth of people, assuming those planes are travelling from London to Belfast, or a few hundred carloads.

1,032 describes the number of people whose deaths last year can be attributed to long waits for a hospital bed in Northern Irish Emergency Departments.

It’s the equivalent of roughly 20 lives lost each week last year because our Emergency Care system has crumbled.

To put it bluntly: our EDs are on their knees and the patient journey from front to back of the hospital has broken down.

The patient journey has broken down

If you walked into the ‘front door’ of any ED in Northern Ireland, the picture you’d be met with is grim. Just inside, patients line waiting rooms waiting to be seen. Some of them will have been there since yesterday.

Last year, one in five major ED attendances (132,806) waited 12 hours or more before being admitted, discharged or transferred elsewhere. That’s roughly the equivalent of the population of Lisburn and the City of Derry combined.

Meanwhile, just a third of patients were discharged, transferred or admitted out of the ED within four hours. The government target is 95%.

A little further into the hospital, patients who we have deemed to need an inpatient bed – the sickest and most injured – are stuck waiting for admission. In January 2026, 449 of these patients waited more than three days on an ED trolley before they got a bed. And in June 2025, more than 500 waited more than two days.

Many patients awaiting admission would be experiencing ‘corridor care’, being treated in non-designated clinical spaces like disused offices, cafes, chairs, or, as the name suggests, a trolley in a corridor. Being treated in this manner is not good for a patient’s health, and this is where we see the conditions which can lead to the 1,032 excess deaths in a single year.

The wards to which these patients should be admitted are full. There are no available beds. On Tuesday, 26 May 2026, 550 (out of a total bed pool of just over 4,000) were taken up by patients who have completed their medical treatment but cannot leave hospital because they cannot be safely discharged because social care needs cannot be timely arranged and provided.

It’s important to acknowledge that much of this is not unique to Northern Ireland. But our waits are the longest, our four-hour performance is the worst – and the number of deaths associated with ED overcrowding per capita is the highest. We are the outlier.

We at the Royal College of Emergency Medicine recently published State of Emergency Medicine in Northern Ireland.  This report makes plain the scale and range of challenges we face, as well as their impacts – 1,032 excess patient deaths being the most sobering.

That figure is calculated using a research paper from the Emergency Medicine Journal (EMJ) which set out something called the Standard Mortality Ratio. This suggested that, for every 72 patients who experience long waits for admission into a hospital bed, in an Emergency Department, there will be one associated, excess, death.

We apply this figure to admitted waits of 12 hours or more. We then use this to estimate how many people, in a given period, may have died due to long waits in A&E. Using this model, we reach the 1,032 figure for 2025. In 2024, the number of excess deaths was even higher, at 1,122.

But the long-term trajectory of our EDs is not good; go back a decade and the number was only in the double digits.

Of course, any excess (avoidable) death in our departments is a tragedy. But the sheer scale in Northern Ireland, relative to population, is nothing short of obscene.

How did we get here?  

Politicians are not blind to the problem. To their credit, the issue is spoken about – and the Northern Ireland Executive has engaged with us as a Royal College. But a heartening conversation I have with a Minister of Health is not felt by an elderly man stuck on a trolley for three days, or my colleague who is at their wits end trying to look after a department at nearly 150% capacity with patients waiting for beds and trying to cope with about 250 patients arriving on a new day.

Things were not always like this. The scenes I have just described used to grab headlines when they occurred; they were a rarity. Now, it’s the daily reality.

As our State of Emergency report details, the number of 12-hour waits in Northern Irish EDs in 2025 was 26 times higher than it was in 2016 – an increase from 4,955 across the entire year to 132,606. Meanwhile, the number of patients attending Northern Irish EDs has increased by just 0.5%.

But instead of grappling with the crises of capacity in social care and hospital wards, every solution we have been presented with by government targeted the ‘front door’. Attendance avoidance, changes to ambulance handovers or to the EDs themselves will not dig us out of this mess.

A recently implemented ambulance offload policy, known as ‘Release to Rescue’, is a key example of this disconnect between the reality on the ground and the policy output of government.

The policy mandates that ambulances offload patients into EDs within two hours of arrival to free up capacity to attend more emergencies. To be clear, we completely support the timely offload of ambulances into EDs and releasing crews to emergencies in the community. Our concern is the implementation of a policy without clearly understanding or tackling the root cause of why this problem occurs in the first place. Handover delays occur when EDs are overcrowded.

Reduce overcrowding and we reduce handover delays.

Offloading patients into rammed EDs who have no clinical space to accept them increases overcrowding and harm to patients within the department.

RCEM recently surveyed clinical leads from all nine EDs across Northern Ireland. Over half said release to rescue improved ambulance handover times - but increased overcrowding. The feeling among some clinical leads was the policy was created and implemented without the consideration of ED staff. 

Political and economic instability in Northern Ireland over the past 10 years has far from helped. Our devolved government in Stormont, to a degree, has its hands tied in some respects. But one way or another - the current approach is not working.

The good news

The ED crisis is not a simple problem, and there are no simple solutions – particularly in a country so fiscally constrained. But the situation is not terminal.

We need a commitment from the Executive to eradicate corridor care. For that to happen, exit block and other issues relating to the ‘back door’ of the hospital must be the priority.

Part of the answer also lies in a comprehensive strategic plan to understand why our social care setup is struggling with demand and to implement the steps to fix it. This may require substantial investment into the sector – something the Northern Ireland Executive is hardly flush for. But an all-party, Executive-led approach, to this issue could pave the way for improvements to this system which is in dire need of support.

There must also be seven-day extended working across the system. Right now, EDs are one of few parts of the healthcare system which do not stop, and as a result we have become the backstop for the areas which do. Extending working hours for other areas could improve discharge speeds and ultimately improve flow.

The way patient flow is measured must also change. We believe that bed occupancy rates should be the metric throughout the system as it better reflects flow among patients at most risk of harm when things break down.

These changes, together, would bring us closer to a system which doesn’t trap the extremely sick and injured on trolleys in EDs – and trap medically fit patients in beds which are needed by other people.

Policy should reflect reality. What’s happening on the ground in EDs is a consequence of overcrowding and a lack of beds. But the interventions don’t match that. If we want to see real improvements – and fewer deaths – this must change.

Dr Michael Perry has been a consultant in Emergency Medicine for almost a decade and has served as the Royal College of Emergency Medicine (RCEM)’s Vice President for Northern Ireland since August 2025.

In that time, he has appeared in Northern Irish media dozens of times to talk about the crisis in Emergency Departments – and been called by NI Assembly Members to give expert evidence on the topic.