The Independent Health and Care Providers (IHCP) has said years of political failure to reform Northern Ireland’s social care system are now contributing to a ‘hidden dying’ crisis across the wider health service.
The warning follows publication of a report from the Royal College of Emergency Medicine which associated 1,032 excess deaths in 2025 with long waits in overcrowded emergency departments, while clinical leaders identified delayed discharges due to lack of social care capacity as the biggest cause of overcrowding.
Speaking during a briefing to the Northern Ireland Assembly Health Committee on Thursday (May 28), RCEM said conditions in Northern Ireland were the worst anywhere in the UK and stressed that the crisis was fundamentally linked to discharge delays rather than demand at the “front door” of hospitals.
RCEM said the problem lay overwhelmingly with lack of social care capacity, including home care support and care home availability, while one in eight patients medically fit to leave hospital could not be discharged.
According to the recent RCEM report, more than 132,000 patients waited 12 hours or longer in emergency departments in 2025, while only 33.44% of patients were discharged, admitted or transferred within four hours — the worst performance recorded since records began in 2011.
The report also stated that the deterioration in emergency department performance “cannot be attributed to an increase in demand”, noting that attendances have remained broadly consistent over the past decade.
Pauline Shepherd, Chief Executive of IHCP, said the findings reflected years of ignored warnings from social care providers about growing pressures within homecare (domiciliary) and care home services.
She said: “Today’s evidence to the Health Committee reinforces what social care providers have been warning for years — the system cannot function safely when patients who are medically fit to leave hospital have nowhere appropriate to go.
“For many years, providers have warned that Northern Ireland’s social care system is under severe and growing pressure, yet meaningful reform has continually been delayed.
“This report links delayed discharges caused by lack of social care capacity to severe overcrowding in emergency departments, where long waits are associated with excess deaths.”
“When medically fit patients cannot leave hospital because appropriate homecare packages or care home beds are unavailable, hospital beds remain blocked and pressure builds throughout the entire health system. Social care can no longer be viewed separately from hospital performance or patient safety.”
Ms Shepherd said Northern Ireland’s ageing population would place even greater strain on services unless urgent action is taken.
“Our population aged over 80 is expected to double within the next 10 to 15 years. We do not have the hospital bed capacity in Northern Ireland to deal with that future demand without major investment in homecare, care homes and community-based services.
“How we sustain existing services — and expand them for the future — is one of the most important challenges facing Northern Ireland today.”
IHCP said it had spent more than a decade calling for an independent economic review into the real cost of delivering care in Northern Ireland, warning that the current funding model used for independent homecare and care homes no longer reflects the realities facing providers.
The organisation said repeated warnings over workforce pressures, rising costs and the long-term sustainability of care provision had not been met with sufficient urgency.
IHCP has called for:
- the urgent introduction of the promised Real Living Wage for carers to support recruitment and retention in the care sector;
- an independent root-and-branch review into the future needs and cost of care provision in Northern Ireland;
- and an urgent review of the methodology used to calculate independent homecare rates and appropriate funding to sustain current services, particularly in rural areas.
Ms Shepherd added: “The longer meaningful reform is delayed, the greater the pressure that will continue to build across both social care and the wider health service.
“This issue affects every community in Northern Ireland — real people and real families. Political leaders of all parties and none, and in every constituency, need to prioritise reform to stem the escalation of this ‘hidden dying’ crisis in their communities.”