Background Quality Report: Northern Ireland Hospital Statistics: Urgent and Emergency Care

Last Reviewed: 01 July 2025

Introduction

Principle 4 of the Code of Practice for Official Statistics states that statistical methods should be consistent with scientific principles and internationally recognised best practices and be fully documented. Quality should be monitored and assured taking account of internationally agreed practices. The full text of the Code is available at:

https://code.statisticsauthority.gov.uk/

Each Official Statistics output produced by Hospital Waits Information Branch (HWIB) within the Department of Health (DoH) contains key quality information in respect of the specific content of the statistical output. This information is provided in the definitions, notes to tables or notes to editors.

Publication

“Northern Ireland Hospital Statistics: Urgent and Emergency Care”. This publication was previously published as “Northern Ireland Hospital Statistics: Emergency Care”.

Department responsible

Hospital Waits Information Branch (HWIB), Information Analysis Directorate (IAD), Department of Health (DoH).

Release Date

Annual

Background

Information on the time spent waiting in emergency care departments in Northern Ireland is collected on a monthly basis but published annually. Patients attending emergency departments (EDs) are categorised as: a new attendance, unplanned review or planned review attendance. Information on waiting times refers only to new and unplanned review attendances, with the waiting time commencing when their details are recorded at reception of the ED, or when they have been transported into in the ED by ambulance staff. They stop waiting when they are discharged home or admitted to hospital from the ED.

Information is also presented on the time waited between key milestones during a patient’s journey, whilst they are being cared for in the emergency care department, including the time to triage (assessment) and time to start of treatment.

Information on emergency care waiting times is sourced from the Regional Data Warehouse1 and encompass2 on 8th day of each month for all ED’s.

Information on the number of attendances (new attendances, unplanned review attendances, planned review attendances, and total attendances) is sourced from the KH09(ii) aggregate return. The KH09(ii) return is provided on a quarterly basis.

HSC Trusts are provided with technical guidance outlining the methodologies to be used in the collection, reporting and validation of emergency care waiting times, which can be accessed at the link below:

https://www.health-ni.gov.uk/publications/emergency-care-activity-returns-and-guidance

Figures for HSC Trusts sourced from the new encompass system are considered to be ‘official statistics in development’.

Information is presented on Urgent Care services introduced in 2020, including the number of calls to the PhoneFirst service and attendances at Urgent Care Centres each month. This information is provided by HSC Trusts and collated and validated by the Strategic Planning and Performance Group (SPPG) on a quarterly basis.

The report also presents information on emergency response times for emergency calls, the number of calls received, and the number of incidents attended by the Northern Ireland Ambulance Service (NIAS). Information is received on the 10th of each month from NIAS and published on an annual basis.

Emergency calls will begin waiting once the following details of the call have been ascertained: - Caller’s telephone number; - Exact location of the incident; and - Nature of the chief complaint (this may be prior to allocation of the dispatch code).

The “clock stops” at the arrival of first vehicle of the type that transports the patient or if no patients are transported by an emergency vehicle, clock stops on the arrival (within 200m) of a fully equipped vehicle with ambulance staff trained to deliver clinical care to patient(s) at the scene of an incident.

Dimensions of Quality

Relevance

The degree to which the statistical product meets user needs in both coverage and content.

The “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication provides a yearly analysis of attendances at EDs by attendance type, and waiting times at each ED in Northern Ireland, including a breakdown by the Type of ED. Data on clinical quality indicators is also available on the time waited between key milestones during a patient’s journey, whilst they are being cared for in the emergency care department, including:

  • Total attendances each month
  • Time waited from arrival to triage
  • Time waited from triage to start of treatment
  • Number of re-attendances within 7 days
  • Number leaving before treatment complete
  • Time waited for patients admitted to hospital
  • Time waited for patients not-admitted, and
  • Attendances which were referred by a GP

Information on clinical quality indicators are not accredited official statistics but are provided to give a more comprehensive overview of activity at EDs across Northern Ireland. The variables used to calculate clinical quality indicators are recorded on the ED patient record where possible but are not mandatory fields, these fields will not always be populated but when populated are accurate and are validated annually, and during the encompass rollout are validated quarterly. Mapping codes for destination on discharge, referral source and arrival method in the new encompass system are under review.

Data on Urgent Care services includes a monthly breakdown of:

  • Number of PhoneFirst calls each month
  • Number of Urgent Care Centre attendances
  • Number of patients referred to ED from Urgent Care services

The “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication also provides information on emergency response times for emergency calls, the number of calls received, and the number of incidents attended by the NIAS, including the following:

  • Number of emergency calls received;
  • Number of Category 1 incidents;
  • Category 1 mean and 90th percentile response times;
  • Number of Category 1T incidents;
  • Category 1T mean and 90th percentile response times;
  • Number of Category 2 incidents;
  • Category 2 mean and 90th percentile response times;
  • Number of Category 3 incidents;
  • Category 3 mean and 90th percentile response times;
  • Number of Category 4 incidents;
  • Category 4 mean and 90th percentile response times;

Information from the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication is used by a wide variety of users for a range of purposes. The Northern Ireland Assembly devolved administration and the DoH (statutory users) use the information to support the formulation and evaluation of emergency care policy. The data is used in the development and to monitor the draft Commissioning Plan Direction Targets and Indicators, to benchmark performance within and between HSC Trusts in Northern Ireland, for Ministerial Briefing and to respond to Private Office enquiries and parliamentary/assembly questions.

Private companies may use the publication to monitor and target emergency care services, academics for research, and other government Departments and Agencies to inform cross-cutting policy and strategy development.

HWIB ensures that the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication remains relevant to users in a number of ways. The main stakeholder, the Department of Health’s policy section, is consulted with annually during business planning meetings, to ensure the publication is up to date and cover all relevant policy areas, within the remit of the data collection.

Furthermore, throughout the year, policy colleagues are consulted with, and feedback is received in regards to changes and needs.

Outside the department, a regional Hospital Information Group and other data and information specific groups exist, hosted by encompass, SPPG, HSC Data Institute and HSC Trusts to ensure that the requirements of statutory users can be met.

Feedback received through readership and online user satisfaction surveys help to shape the information collected and the content of the publication. In this way, the needs of the user communities are continuously monitored, and if appropriate and practical, acted upon.

Accuracy and Reliability

The proximity between an estimate and the unknown true value.

Emergency care attendances are recorded for 100% of EDs in Northern Ireland, with the time waited reported for all new and unplanned review attendances at these EDs during each calendar month. As this data collection represents a census of all new and unplanned attendances at EDs there is no error associated with statistical sampling techniques.

HSC Trusts are provided with technical guidance outlining the methodologies to be used in the collection, reporting and validation of emergency care waiting times, which can be accessed at the link below:

https://www.health-ni.gov.uk/publications/emergency-care-activity-returns-and-guidance

This guidance indicates that each HSC Trust will provide HWIB with a KH09(ii) return on a quarterly basis. The collated data on attendance type are stored in a dedicated database on a secure drive before being processed and validated. HSC Trusts that have moved to encompass still supply a KH09(ii) return, but the data can be downloaded directly from encompass. Once encompass KH09(ii) data has been validated and matches their returns for a year then the KH09(ii) return will no longer be supplied by the Trusts and the downloads from encompass will replace the returns. Information is validated with each HSC Trust at the end of the year prior to publication.

This guidance indicates the date that HWIB will extract the information on waiting times from the Regional Data Warehouse and encompass each month for all EDs. Downloaded data is stored in a secure drive before being processed and validated. During this stage, attendances which do not meet criteria outlined in the technical guidance are excluded. HWIB then liaise with each HSC Trust regarding any queries which result from validation of the data, i.e. inappropriate dates, excessive waiting times.

Data on source of referral, destination on discharge from ED and method of arrival on ED administrative systems is recorded as free text in the Data Warehouse. To enable analysis of this at a regional level, HWIB manage the coding of these variables, querying new codes identified each month with the relevant HSC Trust. A mapping exercise is ongoing for the new encompass system.

HWIB, SPPG and HSC Trust information staff meet regularly through a number of Information groups (i.e. Hospital Information Group, ED User Group and Information Standards Working Group) to discuss issues regarding collection, definitions, data quality or anything else of relevance, although any concerns can also be communicated via telephone or email at any stage. Additional meetings are held monthly and weekly with HSC Trusts and encompass to ensure a smooth transfer from the Data Warehouse to encompass.

In addition to this, HSC Trusts have their own internal quality assurance checks and carry out data validation checks to ensure consistency in the data produced by HWIB. Any data quality issues are dealt with reactively and resolved as they arise. HSC Trusts have dedicated data quality resources to proactively manage data quality challenges across the organisations. Clinical Coding Departments carry out internal data quality audits and are externally audited by SPPG.

HWIB validates emergency care waiting times information by:

  • Performing trend analysis on previous month/year’s data;
  • Identifying outlying data on time waited for triage, treatment or admission / discharge;
  • Carrying out checks on the date/time of key milestones during a patients’ attendance at ED, to ensure that these are correct and not out of sync.

Any irregularities identified are queried with HSC Trusts for response. HSC Trusts are asked to provide a response on the query and confirm if the data is correct. If not correct, the HSC Trust indicates the correct information and an explanation for the error. Data will then be updated on the administrative system, which will be loaded into the regional Data Warehouse for the start of the following day, or updated on encompass. HWIB will re-download data for the HSC Trust and re-generate the data once the HSC Trust indicates that the administrative system has been updated. In the case of a return the HSC Trusts will send in an amended return and HWIB will update their databases.

HSC Trusts are provided with technical guidance outlining the methodologies to be used in the collection, reporting of Urgent Care services, which can be accessed at the link below:

https://www.health-ni.gov.uk/publications/emergency-care-activity-returns-and-guidance

Currently additional validations on HSC Trust data that have moved to encompass are carried out quarterly. Once the data is downloaded from encompass and analysed using HWIB code in preparation for publication, the attendance figures are validated with HSC Trusts and any figures that do not match are investigated and corrected either on encompass in the HWIB code.

PhoneFirst calls and Urgent Care Centre attendances are reported on during each calendar month. Currently data for PhoneFirst and Urgent Care Centres is provided by the SPPG. The SPPG receive data from the HSC Trusts directly and clean and collate the data before sending it on to HWIB. Information presented in this brief is based on a monthly aggregated return made available to HWIB on sharepoint.

All information presented in the publication is downloaded by HWIB and provided by SPPG on a monthly basis. Information is validated and quality assured by SPPG and HSC Trusts prior to release to HWIB. At the end of the financial year, HWIB carries out a detailed series of validations to verify that the information is consistent with HSC Trust information. Trend analyses are used to monitor annual variations and emerging trends. Queries arising from validation checks are presented to HSC Trusts for clarification.

Ambulance information is recorded for all Local Commissioning Groups (LCG’s) in Northern Ireland, including emergency response times for emergency calls, the number of calls received, and the number of incidents attended by the NIAS, during each calendar month. As this data collection represents a census of all calls and incidents attended by the NIAS there is no error associated with statistical sampling techniques.

The NIAS will provide ambulance information on the 10th of each month. Data is stored in a secure drive before being processed and validated at the end of the financial year. HWIB then liaise with the NIAS regarding any queries which result from validation of the data, i.e. unusually large number of calls, excessive waiting times etc. HWIB and NIAS communicate regularly via telephone or email to discuss issues regarding collection, definitions, data quality or anything else of relevance. In addition to this, NIAS have their own internal quality assurance checks and carry out data validation checks to ensure consistency in the data produced by HWIB. Any data quality issues are dealt with reactively and resolved as they arise. The NIAS have dedicated data quality resources to proactively manage data quality challenges. NIAS carry out internal data quality audits and are externally audited by SPPG.

HWIB validates ambulance information by:

  • Performing trend analysis on previous month/year’s data; and,
  • Identifying outlying data;

Any irregularities identified are queried with the NIAS for response. The NIAS are asked to provide a response on the query and confirm if the data is correct. If not correct, NIAS indicates the correct information and an explanation for the error. Data will then be updated on the administrative system, and HWIB’s records.

Timeliness and Punctuality

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates.

ED attendances, waiting times and ambulance data are published on an annual basis, approximately 7 weeks after the end of the financial year, although this may be extended during the roll out of encompass and the additional validations needed. Information published presents an analysis of ED attendances, waiting times, Urgent Care activity, and ambulance information during the last year with a comparison to the previous year/5 years.

As per the requirements of the UK Statistics Authority the month of publication is announced a year in advance and the day of publication one month in advance of publication (available on https://www.gov.uk/).

Information on attendances in EDs detailed in the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication is sourced from the Regional Data Warehouse, encompass and the KH09(ii) aggregate return submitted by each HSC Trust to HWIB on a quarterly basis. Information on waiting times in EDs is sourced from the Regional Data Warehouse and encompass on the 8th day of each month for all EDs.

Data for Urgent Care services is downloaded from sharepoint when made available by SPPG on a monthly basis.

Ambulance information is sourced directly from NIAS on the 10th of each month.

Accessibility and Clarity

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

The annual ‘Northern Ireland Hospital Statistics: Urgent and Emergency Care’ Accredited Official Statistics publication includes data visualisations, tabular data and commentary. In addition to this, all data tables are published in both Excel and Open Data Spreadsheet formats and data can be downloaded from the latest quarterly interactive data dashboard found here:

https://www.health-ni.gov.uk/articles/emergency-care-waiting-times

The report includes notes for readers which cover: background to Official Statistics; guidance on using the data and information on the types of EDs, PhoneFirst and Urgent Care Centres. It also details important links to additional guidance for readers on: the data collection, provision of data, data quality, contextual information, security and confidentiality, guidance on comparing ED waiting times across the UK and additional guidance on important terms and phrases.

“Northern Ireland Hospital Statistics: Urgent and Emergency Care” publications are currently produced in PDF format and available to view / download on the Department’s website free of charge:

https://www.health-ni.gov.uk/articles/emergency-care-and-ambulance-statistics

Coherence and Comparability

Coherence is the degree to which data that are derived from different sources or methods, but refer to the same topic, are similar. Comparability is the degree to which data can be compared over time and domain.

Information in the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication on the number of new attendances, unplanned review attendances, planned review attendances, and total attendances per quarter is sourced from the KH09(ii) aggregate return. The KH09(ii) return is provided to HWIB on a quarterly basis by each HSC Trust.

Information on emergency care waiting times and new and unplanned attendances reported in the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication is based on information recorded by each ED in their respective administrative systems which record ED activity (encompass & Data Warehouse). HWIB access this information from the Regional Data Warehouse and encompass systems on the 8th of each month for all EDs. Data for Urgent Care services is downloaded from sharepoint monthly when made available by SPPG.

Comparability of emergency care data is dependent on the subject area, as prior to 2014, the level of detail available on emergency care waiting times was limited for each ED.

Between 2008 and 2014, the only ED waiting times information released related to performance against the ED waiting times target for each department, i.e. under 4 hours, 4 to 12 hours and over 12 hours.

However, following the introduction of the ED clinical quality indicators in April 2014, comparable information is available for each of the areas below:

  • Total attendances each month;
  • Time waiting from arrival to triage;
  • Time waiting from triage to start of treatment;
  • Number of re-attendances within 7 days;
  • Number leaving before treatment complete;
  • Time waited for patients admitted to hospital;
  • Time waited for patients not-admitted; and,
  • Attendances which were referred by a GP.

Users should take into consideration, changes in the provision of emergency care services at specific sites in Northern Ireland when making comparisons with previous months. Such changes in the provision of services can be found in the document ‘Emergency Care Waiting Time Statistics - Additional Guidance’ document at the following link:

https://www.health-ni.gov.uk/publications/emergency-care-waiting-times-additional-guidance

ED attendances and waiting times information is also broadly comparable across each of the four UK jurisdictions; although, there are a number of key differences in how emergency care waiting times are reported in each. With this in mind, we would ask readers to be cautious when making comparisons across the UK. In particular, readers should avoid making comparisons between Northern Ireland and England on the 12 hour measurement, as these are not equivalent measures. Additional information on comparing emergency care waiting times information for Northern Ireland and England is detailed on pages 12 – 14 of the ‘Additional Guidance’ document at the link below:

https://www.health-ni.gov.uk/publications/emergency-care-waiting-times-additional-guidance

DoH statisticians have also liaised with colleagues in England, Scotland and Wales to clarify differences between the emergency care waiting times reported for each administration and have produced a guidance document to provide readers with a clear understanding of these differences:

https://www.health-ni.gov.uk/publications/emergency-care-waiting-times-additional-guidance

HSC Trust are provided with technical guidance outlining the methodologies to be used in the collection, reporting and validation of emergency care attendances and waiting times, which can be accessed at the link below:

https://www.health-ni.gov.uk/publications/emergency-care-waiting-times-additional-guidance

This guidance indicates that data on ED attendance type is submitted to HWIB by each HSC Trust on a quarterly basis in the form of a KH09(ii) aggregate return. The date HWIB will extract the ED waiting times information from the Regional Data Warehouse and encompass in each month for all ED’s is also indicated.

Ambulance information in the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” publication is based on information recorded by NIAS. HWIB receive an aggregate summary of ambulance information from NIAS on the 10th of each month.

In November 2019, a new Revised Clinical Response Model (CRM) was introduced by the NIAS, which changed the way calls were handled and categorised by the NIAS. This led to a change in the way the NIAS handled urgent and emergency calls but brought the NIAS in line with the national Ambulance Response Programme (ARP). Consequently, it was not possible to compare information on calls by category with information prior to the change on 12th November 2019.

Ambulance information is not comparable across the four UK jurisdictions. With this in mind, we would ask readers to be cautious when making comparisons across the UK.

Trade-offs between Output Quality Components

Trade-offs are the extent to which different aspects of quality are balanced against each other.

None

Assessment of User Needs and Perceptions

The processes for finding out about users and uses, and their views on the statistical products.

Data presented in this publication helps to meet the information needs of a wide range of internal and external users. Within DoH, the “Northern Ireland Hospital Statistics: Urgent and Emergency Care” statistical publication is used by policy officials to monitor demand / provision of emergency care and ambulance services, to help assess HSC Trust performance, to help assess NIAS performance, for corporate monitoring, to inform and monitor related policy, for Ministerial briefing and to respond to Private Office enquiries and parliamentary/ assembly questions.

It is also used by researchers looking at NIAS and HSC Trust performance and by service users and other members of the general public to hold NIAS and HSC Trusts and government to account.

User feedback is invited in this publication. Readers are provided with contact details for the relevant statistician. Further details are placed on the statistics website:

https://www.health-ni.gov.uk/topics/doh-statistics-and-research/official-statistics-and-user-engagement

Performance, Cost and Respondent Burden

The effectiveness, efficiency and economy of the statistical output.

Emergency attendances are sourced from the KH09(ii) aggregate manual return submitted by each HSC Trust to HWIB on a quarterly basis. New and unplanned review attendances and waiting times are generated directly from the administrative systems used to manage the emergency care service in each emergency care department.

Ambulance data is generated directly from the administrative systems used to manage the NIAS service. Using data which is already available within administrative systems places a reduced burden on data providers and also means that HWIB avoid the costs of implementing dedicated data collection exercises.

Confidentiality, Transparency and Security

The procedures and policy used to ensure sound confidentiality, security and transparent practices.

Emergency care attendances data is sourced from the KH09(ii) aggregate manual return submitted by each HSC Trust to HWIB on a quarterly basis. The collated data on attendance types are stored on a dedicated database on a secure drive before being processed and validated. Information is validated with each HSC Trust at the end of the year prior to publication.

Emergency care waiting times data is extracted from the information from the Regional Data Warehouse and encompass for all EDs. The downloaded data is stored in a secure drive before being processed and validated. Data is then processed as per the agreed technical guidance.

Ambulance data is received from NIAS on a monthly basis. The data is stored in a secure drive before being processed and validated.

All information produced is aggregated and treated for confidentiality prior to release. HWIB’s ‘Statistical Policy Statement on Confidentiality’ can be found in the Statistics Charter at:

https://www.health-ni.gov.uk/publications/doh-statistics-charter

  1. Regional Data Warehouse is a secure repository of information sourced from HSC administrative and management systems. Data is refreshed and updated on a daily basis.↩︎

  2. Encompass is a new electronic patient record system, first introduced in the South Eastern Health and Social Care (HSC) Trust on 9th November 2023, the Belfast HSC Trust on 6th June 2024, and the Northern HSC Trust on 7th November 2024. Encompass will replace the Regional Data Warehouse.↩︎