To ask the Minister of Health to detail the rational as to why strokes have been downgraded from Category 1 to Category 2 in Northern Ireland Ambulance Service response mapping.

My Department can confirm that there has been no downgrading of stroke calls within the Northern Ireland Ambulance Service (NIAS) response categorisation.

Recent updates to categorisation have been made to improve recognition of more subtle signs of stroke, including loss of balance or coordination and onset of vision, reading and writing problems, beyond the more typical symptoms of facial weakness, limb weakness and sudden speech problems.

Most 999 calls for acute stroke are categorised as Category 2, in line with practice across most of the UK and Ireland. This reflects their position as emergency calls which are serious but not immediately life-threatening, placing them on a par with conditions such as myocardial infraction (heart attack) and serious trauma. Category 2 calls are responded to as emergency calls and have a target response time of 18 minutes.

Calls for patients with suspected stroke may receive a Category 3 or be passed for secondary clinical triage if symptoms have been present beyond the effective treatment window or if no clinical evidence of acute stroke is found during triage. Category 3 calls have a target response time of 1–2 hours.

Category 1 is reserved for immediately life-threatening situations requiring urgent intervention, such as cardiac arrest, choking and anaphylaxis, with a target response time of 8 minutes. Stroke patients will be upgraded to Category 1 if they present with priority symptoms such as severe breathing difficulty, loss of consciousness or persistent fitting.

The importance of timely ambulance responses for patient outcomes was highlighted in the ‘Getting It Right First Time’ (GIRFT) Review of Emergency Medicine. Ambulance handover delays at emergency departments (EDs) significantly impact NIAS’s ability to respond to emergency calls in the community, making improvements in handover times a key priority for my Department. NIAS receives over 200,000 calls annually and dispatches crews to approximately 170,000 incidents.

At a regional workshop in August 2025, attended by the Permanent Secretary, Chief Medical Officer and Chief Nursing Officer, all Trusts agreed to implement initiatives aimed at reducing delays, with a target of achieving the two-hour standard by December 2025. To support this, £10 million has been repurposed for measures such as:

Expansion of Hospital at Home services to increase community-based capacity;

Additional short-stay inpatient beds to facilitate timely discharge;

Frailty assessments and multidisciplinary reviews at the front door of acute hospitals;

Expansion of Same Day Emergency Care (SDEC) and ambulatory pathways across acute medicine, respiratory, cardiology and surgical specialties; and

Increased capacity for early review teams and discharge co-ordination.

NIAS is also implementing service innovations to manage calls differently and free up ambulances for the most serious cases. This includes:

Operating an Integrated Clinical Hub within the Emergency Operations Centre for enhanced clinical decision-making; and

Expanding Hear and Treat and See and Treat models, enabling more patients to be managed safely without hospital conveyance. To support these pathways, £1.3 million was allocated for the development of an Integrated Care Hub.

Further investment through growth funds has supported enhancements to urgent care centres and clinical hubs, and expanded community-based services to improve patient flow. Combined with winter support measures, these actions aim to reduce handover delays and ensure safe transfers. Additionally, 21 emergency medicine consultants have been appointed to strengthen ED capacity and improve timely clinical decision-making.

This is a system-wide challenge, and my department is committed to leading co-ordinated action to deliver these improvements. Work is also underway with NIAS to ensure sufficient ambulance and staffing capacity to meet Category 1 and Category 2 response time standards through the development of a 10-year workforce and financial plan.