Debate contribution: Healthcare: Integrated 111 Service

Debate contribution by Mr Colin McGrath on 18 May 2026.

MLA

Mr Colin McGrath

Party at the time

Social Democratic and Labour Party

Date

18 May 2026

Type

Debate contribution

Business

Opposition Business

Heading

Healthcare: Integrated 111 Service

Assembly identifier

Official Report component 5548771

Read the official Assembly record

Text

I beg to move

Thank you very much, Mr Deputy Speaker. Our health service is under immense pressure. Patients know it, staff know it, the ambulance crews parked outside hospitals know it, and every family sitting in an overcrowded emergency department knows it. The statistics are stark: over 764,000 people attended emergency departments in Northern Ireland last year; more than 132,000 people waited for over 12 hours to be treated or admitted; and performance against the four-hour target has collapsed to 45%. That is not a system under strain; that is a system in crisis. When the system goes into crisis, it is our doctors and nurses, our healthcare assistants and allied health professionals (AHPs), our porters and admin staff — the people who keep our health service afloat — who feel the pressure. It is not we MLAs who are crying out for help but the staff and patients in our health service. The question that the Opposition pose is simple: what practical action are we prepared to take to provide help and ease the pressure? That is a question for all Ministers, not just the Minister of Health. While wider transformation is needed and we all understand the scale of reform that is required, interventions are available right now that could relieve pressure, improve patient experience and help people to access care more quickly. That is why the SDLP is calling for the reintroduction of a Northern Ireland-wide 111 service. Last year, we published our 'Help Can't Wait' proposals to deal with ambulance handover delays. We argued that ambulances should not be waiting outside hospitals for more than 45 minutes, because every minute that an ambulance is parked outside an emergency department is a minute when it is not available for somebody who is suffering a stroke, a heart attack or the results of a serious accident. We presented the case that, with modest investment in emergency department staffing, ambulances could be released from waiting at EDs and quickly get back on the road. That has been tried in London, and it works. At the time, some dismissed those proposals, but the Department has now introduced its two-hour target, which is a step in the right direction. The question now is whether the Minister is prepared to take the next necessary step of introducing a fully integrated 111 service.

Earlier this year, I undertook a fact-finding visit to greater Manchester to see the National Health Service's 111 service operating on the ground. What I saw was not a theory, a pilot or a glossy presentation but a functioning, integrated urgent care system that helps millions of people every year. The North West Ambulance Service (NWAS) handles approximately two million calls for the 111 service, and 90% to 95% of those calls are answered within 60 seconds. Importantly, the service is not a call centre but a front door into healthcare, as patients are triaged and then directed to the right care at the right time in the right place. Around 25% of callers are safely advised to self-care, perhaps via their local community pharmacy. Around 50% are directed to various primary care services. Only a minority require emergency department attendance or an ambulance dispatch. That means fewer unnecessary ambulance call-outs, fewer unnecessary attendances at emergency departments and better use of already stretched resources. Perhaps the most important thing that I saw was the level of integration. When somebody calls 111, staff can immediately see pathways to GP appointments, urgent care centres, minor injury units, pharmacies, community nursing and mental health support. I watched a live example of what happens when a patient phones seeking help. No GP appointment was immediately available, but, because the system is integrated, the handler arranged an appointment at an urgent care centre the following morning instead. That patient did not end up sitting for hours in an emergency department, did not call an ambulance unnecessarily and did not have to navigate the system alone. That is what good urgent care looks like. In fact, it is what an effective shift left looks like: not asking patients in a waiting room to shift left to make room for others to sit down but instead directing patients to the care that they need closest to home. One of the arguments that is sometimes made against 111 is that it will overwhelm GPs. Interestingly, that concern was raised in greater Manchester as well. We heard directly from Kristy Barlow, the chief operating officer at the Bolton GP Federation, that the opposite has happened, however. GP practices now reserve a limited number of appointment slots specifically for 111 onward referrals. It is around one slot per day per 3,000 patients. Over time, GPs became more comfortable with the system, because it was structured, predictable and clinically led. In Kristy's words:

"Bolton was behind the curve initially but is now firmly established, because patients and practices understand the processes better."

The reality here is that people in the North are already struggling to navigate a fragmented, unscheduled care system. Phone First does not work. Many do not know whether they should ring a GP, contact the out-of-hours service, attend a minor injuries unit, go to an urgent care centre or call 999. What therefore happens? People default to the emergency department, because it feels as though it is the safest option, and who can blame them? Having a 111 service would change that. It provides one simple number, one trusted point of contact and one clinically led system. It therefore guides people to the care that they need. For people living in rural communities, access to unscheduled care can feel uncertain and inconsistent. A properly integrated 111 service would give the reassurance that advice and support are available, no matter where somebody lives. No one in the Chamber is pretending that a 111 service is a silver bullet. It will not solve every structural challenge in our health service, eliminate waiting lists overnight or remove the need for long-term reform. It is, however, a proven intervention, and it is already working elsewhere. The evidence is clear that it reduces pressure on front-line services while improving patient access and experience. Is there a financial cost? Of course there is. However, like the costs for the proposals contained in our ‘Help Can't Wait’ document, they are modest. If greater Manchester can operate the service at a cost of £23 million per year, we estimate that pro rata it will cost around £6 million per year in the North. Why is the SDLP suggesting that we should have a fully integrated 111 service? Some 760,000 people per year attend an ED here, and over 1,200 people wait for more than two days to be seen. The SDLP says that that is not good enough. Imagine if those people had been able to dial 111 and had not needed to go to an emergency department in the first place. Some 12,000 patients per month wait for more than 12 hours to be seen. The SDLP says that there is a better way. Imagine if those people had been able to dial 111 and had received the right care, in the right place at the right time. Last year, over 1,000 excess deaths were attributed to the long waits for admission. The SDLP says that it does not have to be like that. Imagine if those lives could have been saved. Can we put a financial cost on saving somebody's life? Absolutely not. We cannot go on as we are. Our Health Department spends hundreds of millions of pounds more every year and demands that health trusts cut hundreds of millions of pounds in response. Therefore, while Health's budget goes up, our health outcomes are going down. Our staff are crying out for help, patients are not getting care in a timely fashion and something needs to change. A 111 service will not be a panacea, but it could drastically ease the pressure on our system and help to save lives. I urge Members to support the motion and say this to the Minister: introduce 111 and leave a powerful legacy for future generations.

1,361 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 15:37 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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