Debate contribution: Healthcare: Integrated 111 Service

Debate contribution by Mr Danny Donnelly on 18 May 2026.

MLA

Mr Danny Donnelly

Party at the time

Alliance Party

Date

18 May 2026

Type

Debate contribution

Business

Opposition Business

Heading

Healthcare: Integrated 111 Service

Assembly identifier

Official Report component 5548794

Read the official Assembly record

Text

I welcome the intention behind today's motion to explore a more integrated approach to urgent care in Northern Ireland and help patients access the right care. An integrated 111 service could effectively represent a tidying-up of the existing Phone First and out-of-hours systems. However, without clear evidence of significant unmet need, specifically around system navigation as opposed to the need for wider structural transformation, there is a risk that we are putting the horse before the cart in meaningfully addressing the pressures in our emergency departments. The Royal College of Emergency Medicine report published earlier this year makes for deeply concerning reading. It clearly outlines the fact that overcrowding and long waits in emergency departments are not primarily the result of increased demand. The number of people attending emergency departments has changed relatively little, while the number of long waits and the mortality associated with them has risen dramatically. The number of 12-hour waits has increased by more than 14% from March last year to March this year — 14%. The winter preparedness plan has clearly failed. Almost a quarter of emergency department attendees waited for more than 12 hours before being discharged, admitted or transferred. A decade ago, only 1% of patients waited that long. The report also estimated that 1,032 excess deaths last year could be attributed to long waits for admission, and there have been over 1,000 excess deaths a year for the last three years. Importantly, the Royal College of Emergency Medicine vice chair in Northern Ireland stated:

"This is a fixable problem – and we need policymakers to focus on the interventions we know work: speeding up discharge from the 'back door' of hospitals and freeing up beds."

That is exactly the issue with confusing better navigation of the system with actual transformation of the system itself. The pressures facing our health service, particularly emergency departments, stem mainly from the lack of capacity in the community and the inability of patients to flow through hospitals to access care in the community. As a nurse and an MLA, I have seen that at first hand. When I visited Antrim A&E in December, there were over 100 medically fit patients who could not be discharged into the community, in comparison with around 50 decisions to admit (DTAs) who were stuck in A&E without being able to get to a ward. It is fundamentally about delayed discharge. It is about social care, investment in community services, nursing home capacity, workforce pressures and whether community care services exist in sufficient capacity to allow patients to leave hospital safely and in a timely manner. Therefore, while anything that can help reduce unnecessary demand on emergency care and help patients access the right care should absolutely be considered, it would be disingenuous and inaccurate to overstate the role that an integrated 111 service could play right now in increasing community capacity or early intervention and prevention and, therefore, the pressures facing emergency departments. If you want to acknowledge the shift-left agenda and focus on prevention, early intervention and strengthening community provision and the role that that plays in decreasing pressure on EDs, you should look at increasing capacity in the community and ensuring that crisis points are avoided. That means looking at a renegotiated, fairer contract for community pharmacy, fair pay and conditions for care workers and ensuring that there is proper funding for GP surgeries and a fully funded mental health strategy, because prevention, early intervention and strengthening community provision needs to come at a much earlier stage in order to meaningfully tackle the sustained and growing pressures that face our emergency care settings. Yes, let us improve navigation into the system, but, more important, let us fix the reasons why the system is gridlocked in the first place.

629 words. Text as published by the Northern Ireland Assembly.

Assessment

Not qualifying

Jev’s structured answers

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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