Danny Donnelly has given notice of a question for urgent oral answer to the Minister of Health.

Mr Donnelly asked the Minister of Health to outline his plans for reducing the number of deaths resulting from long waits for care in emergency departments.

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The Royal College of Emergency Medicine (RCEM) report, 'The State of Emergency Medicine in Northern Ireland', highlights the serious risks associated with prolonged waits in our emergency departments (EDs). Those associated risks include avoidable harm and death. The report estimates that long waits could be associated with 1,032 excess deaths in 2025. While my officials would point out that that is a slight reduction compared with the figures for 2024 and 2023, the level of preventable harm remains unacceptably high, and the reduction is not a trend.

I am very conscious of the concerns raised in the report about the clinical risks linked to prolonged waiting times. Although it is difficult to establish direct causality between waiting times and outcomes, there is clear evidence that extended delays in EDs increase overall clinical risk. The Getting It Right First Time (GIRFT) review of emergency medicine here highlighted the significant patient safety risks associated with ambulance handover delays and prolonged waits in EDs.

In response, my Department is working with the health and social care trusts, including the Ambulance Service, to implement Release to Rescue guidance to try to ensure that no ambulance wait is longer than two hours for a handover at an ED. My officials have briefed the Royal College of Emergency Medicine on that guidance, and we hope to begin to implement it from 27 April. Alongside that, my Department has worked with trusts to improve flow through the unscheduled care system, contributing to a small improvement in category 1 ambulance response times in the Belfast area. While that is welcome, performance remains below the required standard.

My Department continues to act to improve hospital flow, reduce ED congestion and ensure that patients receive timely, safe and effective care. Urgent care centres, minor injury units and Phone First services are fully operational across the region, helping to divert appropriate demand away from EDs. Funding has also been provided to expand hospital-at-home and same-day emergency care services, alongside additional support for the Ambulance Service, strengthening Hear and Treat and See and Treat pathways.

I thank the Minister for that answer. Over 1,000 excess deaths a year being associated with overcrowding and long waits in A&E is a catastrophe. In previous responses to questions for written answer about excess deaths in A&E, the Minister pointed to urgent care centres, Phone First, minor injury units and additional emergency medicine consultants. Those steps are welcome, but the Royal College of Emergency Medicine is clear that attendances at EDs have barely changed, while long waits and associated deaths have risen sharply. Does the Minister accept that, unless patient flow improves across the wider system, particularly through tackling delayed discharge and strengthening capacity in our communities, those measures will not be enough to reduce dangerous waits and the harm associated with them, and what will he do about that?

I agree with the Member, and I have made the point several times in the Chamber. It is about flow through the hospitals. On many occasions, the focus of the media and the House has been on the front door, including delays in ambulance handovers and delays in getting patients, about whom there had been a decision to admit in the emergency department, into a bed in an acute hospital.

However, the problem is at the back door. It is about — the Member has used my phrase — community capacity. What are we doing about it? We are looking at a long-term solution, because you cannot flick a switch and fix it. The Member is well aware that the first thing that we need to do is get to a point where we can introduce the real living wage — something that I wanted to do last September. I stand ready to do that and to backdate it to 1 April. However, to do it, I need a budget, and, as yet, the Executive have not yet come to an agreement on a Budget for this year nor, indeed, on the much preferred multi-year Budget.

Minister, people go to hospital emergency departments because they are sick and need help. They do so in the belief that our health system is supposed to care for them and that it should function to save lives. I differentiate between the health system and healthcare staff, who go beyond care. For the health system scenario, this is a damning report. The Royal College of Emergency Medicine details what it describes as a "catastrophe" unfolding in our hospital emergency systems. As Mr Donnelly said, there were 1,032 excess deaths in 2025 associated with 12-hour emergency department waits. Minister, do you accept the report, its eight recommendations and its conclusion that emergency department overcrowding is a result not of growing demand but of system failure? More importantly, on the actions that you have outlined, when will our population in the North see measurable changes?

I accept that it is about the flow, as I said to Mr Donnelly. I cannot give you a timeline for the fix, because it will require investment. The more investment that is put into it, the quicker the fix will be realised.

You said that there were 1,032 excess deaths last year. The year before, the number was 1,122. The year before that, it was over 1,000 again, at 1,063. That was in 2023. So there is a trend there, although we have not introduced a trend of reducing that number. I looked at the last report that I am aware of from the Royal College of Emergency Medicine on the NHS in England. In 2023, 1·5 million-plus people waited for over 12 hours in emergency departments in England. That led to nearly 300 excess deaths per week. The situation is not right in England, it is not right here, and we are struggling to find the fix.

Minister, this is a catastrophic situation for our community in Northern Ireland. The Royal College of Emergency Medicine indicates that the number of people attending ED has been relatively static since 2016, yet the number of patients who waited 12 hours or longer was 26 times greater in 2025 than it was in 2016 — 132,606 compared with 4,955 — and that more lives are being lost: almost 20 per week. It is clear that care packages and the lack of domiciliary care in the community are some of the most significant issues in trying to resolve this problem. The winter plan was threadbare on that, and you only talk about increasing the living wage. You need to increase capacity within the community. If you do not increase capacity, lives will continue to be lost and more families will be plunged into grief.

Is there a question, Mrs Dodds?

Will you increase capacity?

If I have the budget to increase capacity, of course I will increase capacity. If I was not clear, let me say that when I talked about introducing the real living wage, that was the first step that I was referring to. I want to make that clear. It is not the be-all and end-all, but with budget, it will be the first thing that I can do with relative ease. Yes, we need to increase capacity. We need more people providing care at home — so-called domiciliary care — and we need more beds in care homes within the community. That will take time, but it will also take budget and commitment.

Minister, what other urgent care services are available that can safely manage non-emergency demand outside of emergency departments?

There are several. When you factor in the number of people who visit those centres, that maybe talks to what Mrs Dodds referred to: the fact that the number of people presenting at EDs has not radically increased. One of the reasons for that has to be the fact that we are providing so many alternative pathways for them. Approximately 40 rapid-access clinics have been either established or enhanced across all the geographic trusts. The pathways offer around 100,000 appointments per annum, and those can all be scheduled. Therefore, they offer timely access to specialist opinion and investigation, and they are fundamental to providing ED alternatives, with referrals from GPs, Phone First and our urgent care centres. Urgent care centres offer treatment to patients with urgent medical conditions that are not immediately life-threatening but require face-to-face assessment and/or timely access to diagnostics within a 24-hour period. That is a viable alternative to ED attendance. In the absence of a physical structure that is capable of accommodating one or more urgent care services or streams, those are individually referred to as streams that sit within or alongside other units of our healthcare services. My Department has successfully commissioned urgent care centres and streams in all trust areas. We also have same-day emergency care, and we have a number of alternative pathways.

Minister, the RCEM report recommends ensuring that:

"there is senior accountability for ending overcrowding and that hospital trusts, Health and Social Care Northern Ireland and the Northern Ireland Executive play their role in ending overcrowding".

It is really difficult to find a solution when nobody is prepared to accept responsibility for the problem. Is it you who is not fixing the problem or is it the Executive not giving you money to fix the problem that is the actual problem? Until we know what it is, we are never going to find a solution and are just going to continue to go round and round.

I am not sure that we should be posing an either/or question. Certainly, I am working within my brief and my responsibility, and, on health and social care, the buck stops with me. How you fashion the delivery and the improvements that are required depends on certain aspects that can be provided by the Executive, and one of them is budget. We are currently in a financial year, which started on 1 April, with us facing, by the current estimate, a shortfall of £760 million. Something that would be very important in EDs would be to increase the number of hours in the day when there are senior decision makers in the ED because that really helps, as we know from previous periods of industrial action. When you have senior decision makers making those decisions, that helps the flow in an ED. That is on me, but being able to afford to put in more senior decision makers depends on budget, and you can argue that that is on the Executive.

Minister, on the back of the previous question, everybody has already mentioned the need for additional domiciliary care. First, can we get a guarantee that the real living wage will be implemented if and when a Budget is agreed? Do you agree that the Executive do not have the capacity? You have just said that there is a shortfall of £760 million. The Executive do not have the money. We pay our taxes. People here work hard. The people whom we are talking about — domiciliary care workers, healthcare workers and nurses in the district — are all paying their taxes. The British Government are not giving them back their taxes in order that they are able to put diesel in their cars. We need to increase the mileage payment as well, which is ridiculously low.

Question.

It was already low, but, considering what they are facing now at the petrol pumps, it is out of anybody's ability to be able to cover it. Will you agree that the British Government need to step up here —

Minister.

— and that we need to be united on that?

I agree with the Member that we need to ask the United Kingdom Government to look again at our Budget provision, because, if you look at Scotland, you will see that it is being funded above assessed objective need. Wales is also being funded above and beyond assessed objective need, and we are arguing that we are not. That, clearly, is not fair, because, as the Member says, we pay our taxes, the same as the Scots and the same as the Welsh. We as an Executive have not given up.

The Member will, I think, be aware that a letter was sent to the Prime Minister asking for a meeting with the four parties of the Executive so that we could eyeball the ultimate decision maker and make the case that it is not fair. The shortage of money plays into the public perception that devolution is not delivering. For anybody who values the peace process, the 1998 agreement and the subsequent agreements, it should be a matter of the utmost concern that the public are losing faith in the devolved process, which is the only way to go in this place.

There is a lot of focus in the report on the large number of deaths, and rightly so. Minister, how are staff in emergency departments being affected by current pressures, and how is the Department supporting ED staff, given the reports of stress, poor mental health and unsafe working environments?

The staff, particularly those working in emergency departments — I have visited emergency departments a lot in my time as Minister — suffer a moral harm, in that they have been trained to a high level to deliver world-class healthcare. Whether it is a nurse, doctor or allied health professional, they find themselves in such a pressurised position that, often, although they know exactly the best thing to do for patient after patient, because of the pressure and the environment in which they are operating, they are not able to deliver the best that they know they can deliver; rather, they are making decisions on the basis of what the least worst option is for the patient. For example, you may have four resuscitation beds in an emergency department, but five or six patients needing resuscitation, so you are making a horrible decision about which one or two patients can be left in the emergency department and outside the resuscitation unit. I do not believe that those nurses and doctors are trained for that. When I am in emergency departments, I ask the nurses and doctors whether they were trained to expect such situations, and the answer is no.

I thank the Minister for coming to the Chamber. However, so many times you come to the Chamber, Minister, agree with Members, and say, "Yes, it's bad, it's really bad, so it is", but, in case you have forgotten, you are the Minister. Do something about it. We have heard time and again how things are getting so bad and crippling in our health service. Since sitting on the Health Committee, I have come to the realisation that the question has to be asked: if the Health Department had 100% of the Executive's Budget, would things be any better? Since you have been in office — this also applies to your predecessor — we are yet to see a prioritisation of what it is that you want to work efficiently to make savings that will actually make changes. We had the winter plan, which was, essentially, services that already existed dressed up in different clothes, and it did not deliver for people. You said that you could not implement the real living wage. You had a budget last time and did not implement it. That is what we were talking about last time, so what will change so that we do not see in excess of 1,000 deaths again this year?

When I invited Professor Rafael Bengoa to come back in 2024 and reboot his report, 'Systems, Not Structures: Changing Health and Social Care', he gave me a valuable piece of advice. He said, "Be really tight on what you want to achieve, and articulate it clearly so that people understand, but be very loose about how you achieve it, because you are not a nurse, domiciliary care worker, GP, surgeon, clinician or hospital administrator. Go and ask the people who understand how the system works how we make it better". That is what I did with the Big Conversation: we had four workshops that led to the winter plan for the winter just past. If the Member wants to say that those experts do not know what they are talking about, she can fill her boots.

My office was contacted recently by a constituent whose family member had two spells in the South West Acute Hospital. In spite of being in hospital for over a week and a half, the lady was never admitted to a ward, spending the entire stay either on a trolley or in a chair in A&E. In the final few days, she was in a ward corridor.

The family are clear that they have no criticism to make of the staff: quite the opposite. I simply ask this: how can a relatively new hospital have been overwhelmed to such a degree?

I am not aware of the circumstances of the particular case. I very much regret that that happened to the individual and her family. Unfortunately, the case is probably not an outlier. I am sure that many if not all Members have similar stories of constituents who do not get the service that we would want them to get. I am frequently contacted by people who make the point that Mrs Dillon made, which is that they are taxpayers and pay their National Insurance and that they have done so not just for years but for decades. They therefore believe that they are entitled to a better service, and I do not disagree with them.

I do not know the specifics of the challenges that the South West Acute Hospital faced that meant that it was over capacity on that occasion. We have a growing population and an ageing population, however, and, if anybody can crack how to better deliver care for the elderly, they will crack most of the problems in the health and social care system.

The figures are completely shocking. The underfunding of our NHS and the waits in ED are leading to mass deaths. There has been a desensitisation to that in some quarters. In 2016, 60 people died in EDs; since then, 6,000 people have died. That is shocking. Who will be held accountable for that? Whose head will roll because of that shocking figure?

Minister, you talk about solutions. In the past five years, £60 million has been spent on private ambulances. Do you not think that that is an extortionate spend by our health trusts? If you do, will you commit to putting that money back into the NHS — into the NIAS — and ensuring that we have capacity to look after and treat sick people?

In an ideal world, I would be with Mr Carroll in saying that the delivery of health and social care would be done entirely by Health and Social Care (HSC). We are far from being in an ideal world, however. For example, to tackle waiting lists through the initiatives that we began with last year's budget and that we hope to continue when we get a budget for this year, we will inevitably have to go to the independent sector, because we would otherwise not have the capacity in the HSC. Yes, I get what the Member says. His argument would be, "That is because you are putting money into the independent sector rather than investing it in building capacity", but, if we were to do that, tackling waiting lists would slow down and people would suffer, and the logic of that is that more people would die.

Minister, I want to be absolutely clear about something. Your permanent Secretary has said that, without a multi-year Budget, healthcare transformation, which would include tackling what, Gerry Carroll correctly says, are the shameful levels of excess deaths because of emergency care issues, cannot be tackled. In the Chamber earlier, your party leader lambasted the failure to set a multi-year Budget. You, on the other hand, have now said that, in effect, we cannot set one in the current context because of a lack of funding. Is it your position that a multi-year Budget is required, and do you support the proposals for such a Budget that the Minister of Finance made earlier this year?

A multi-year Budget would be much better than a one-year Budget, but a one-year Budget would be much better than the position that we are in. I am not unique among Ministers in saying that the budget allocation that the Finance Minister has proposed is not enough for me to do everything that I need to do, never mind everything that I want to do. I am not an outlier in saying that. It just happens that my quantums are a lot bigger than anybody else's, even those of the Department of Education. As with last year, however, should we come to a position in which the question, "Do you support this allocation, even though it leaves you hundreds and hundreds of millions pounds short of what you think you need?" is put to me, my answer will be "Yes, but", and the "but" will refer to the fact that my budget is short of what I need and that something will need to happen between now and the end of the financial year or there will be an overspend.

Last year, as the Leader of the Opposition knows, what happened was the loan on the Treasury reserve. I got the thick end of £200 million from that. Had I not got it, we would not have been able to balance the books by that amount. It is worse this year. I am hoping for a Hail Mary pass — some sort of miracle — along the way, but I am not for walking away, because challenges should not be viewed as insurmountable obstacles that justify inaction.

At its meeting on Thursday of last week, the Health Committee had a discussion with the Royal College of Psychiatrists on the pressures that it faces with its workforce and waiting lists. Importantly, we had a discussion about vulnerable people who are left waiting without the live-saving care and support that they need.

We are speaking today about the same types of issues for people presenting at emergency departments. Does the Minister have any sense of how many people present to emergency departments in mental health crisis and, in many instances — I am sure that Members all know of examples from their constituencies — leave without support and end up worse or, potentially, dead?

I do not have that number, but I am sure that it exists and will certainly try to get it for the Member.

On the issue that the Member spoke about, my focus is on the desire of the Police Service of Northern Ireland to move at pace — I think that it wants to move more quickly than before — towards a system called "Right Care, Right Person". The Police Service says that its officers are not trained in mental health matters, so they need to withdraw, and that they should not be spending many hours sitting in EDs with patients. I get all that, but I remain concerned that there may be a hiatus between the police withdrawing and the health service being able to fill the gap. All we need is one patient to leave an ED and self-harm or harm somebody else and we will have another crisis and another moment at which people describe the health and social care system as "broken". I do not think that it is broken. Many of the pathways into it are badly damaged, hence the long waiting lists, but I believe that, once a person gets to the point at which care is administered, it tends to be world class. There are exceptions, of course, where things go wrong, but, by and large, it tends to be world class.

Minister, one line stands out in Royal College of Emergency Medicine's press release, which is that Northern Ireland:

"has the highest rates of long waits in EDs, and deaths per capita resulting from them, of any UK nation."

It further states that almost 20 lives are lost each week because of long waits in ED. That is a catastrophic situation. The fact that the winter plan was threadbare has been outlined to you. What will you do to ensure that other families are spared such grief and that no more lives are lost?

We are working on the Release to Rescue initiative to try to improve ambulance waiting times. There is a proposal that we start to roll that out on 27 April, which is only a week away. I have engaged with stakeholders, trade unions, the Ambulance Service and, more recently, the chief executives of the trusts. We are a little shy of certainties and reassurances. One thing that we need to do is to start to discuss how we might perform Release to Rescue emergency department by emergency department and hospital by hospital. To be clear, the intent of Release to Rescue is that no patient will wait for more than two hours in an ambulance before being handed over to the trust.

Last week, we heard the disturbing news that there were over 1,000 excess deaths in emergency departments in the North in 2025. Corridor care was referenced as a contributory factor, with staff, medical teams and patients often overwhelmed by overcrowding and long waits. Will the Minister commit to working towards the report's recommendation that corridor care be eliminated by the end of the decade?

That is certainly an ambition. Corridor care is not unique to Northern Ireland. I think that I have said that I was in a brand new build in Washington DC — a new wing of the Georgetown University Hospital — that cost in the order of $700 million. It has a very large emergency department, compared with ours, in terms of its physical size and its capacity.

There was corridor care throughout it, with trolleys head to toe. I asked the clinician, "Has something happened? Is this unusual?", and he said, "No. This is a day-to-day occurrence, to the point where we have corridor care teams. We have doctors and nurses, and all they do is corridor care". That illustrates how difficult this will be. I do not want anybody to be waiting in a corridor, on a chair or on a trolley, so, yes, there is an ambition to see the back of it as soon as possible.

I asked the Minister some questions for written answer on this issue a number of months ago, and the answer I got back was, "The Department does not retain the data to be able to answer this question". That begs the question — this is not my question here; I will come to it — about whether there is an issue with collating data or sharing data. There is a real question about transparency.

I caution the Minister about pointing to a minuscule reduction in the number of deaths compared with the previous year as some measure of success. The sad fact is that there are people who, despite being really sick, do not want to go to an emergency department for this very reason. Given the links with overcrowding and long waits — I have raised the issue of Altnagelvin ED many times —

Mr Durkan, we are already out of time. This item was allocated half an hour, so do not take another half an hour to ask a question.

Do we have a geographical breakdown of those deaths?

I do not have a geographical breakdown, but I can certainly ask whether one can be made available or whether we can do the research to provide the Member with one. To be clear, when I said that there has been a small decrease, I said clearly that that was not a trend. It is not good enough. Yes, we say that those figures are shocking, but they are very similar to those for last year and the year before. In one sense, they should not be shocking, but they are shocking because of their scale.

(Madam Principal Deputy Speaker in the Chair)

That ends questions to the Minister on the question for urgent oral answer.