'No patient safety issues' after surgery suspension

A review into arrangements put in place to support the suspension of emergency general surgery at the South West Acute Hospital (SWAH) has found no immediate patient safety concerns.

However, the report said several issues affecting patients at the County Fermanagh facility needed to be tackled urgently.

Emergency general surgery was temporarily withdrawn from the Enniskillen hospital in December 2022.

The Western Health Trust (WHT) said it was necessary to protect the public's safety after it had problems recruiting surgical staff.

The review of arrangements was carried out by the Regulation and Quality Improvement Authority (RQIA), which inspects healthcare facilities in Northern Ireland.

It said some patients were being subjected to a "double wait" at emergency departments, having been assessed at SWAH and then transferred to Altnagelvin Hospital in Londonderry where they have to wait for a second time.

The review said patients transferred from SWAH to Altnagelvin should be admitted directly to a surgical ward there.

The RQIA also questioned the degree of ambulance cover required for SWAH following the general surgery suspension.

It said this needed to be looked at urgently to ensure there was adequate provision for transferring patients to Altnagelvin.

At the time of suspension, the Western Health Trust said the move was temporary, but did not say when it expected emergency general surgery would resume.

Since then patients from Fermanagh who have had to travel to Altnagelvin Hospital have held several protests voicing their anger at the move.

The emergency department and other services including obstetrics have continued to operate as normal.

The WHT said the review supported its own findings that there had been "no patient safety concerns" arising from the suspension of emergency general surgery.

Trust Chief Executive Neil Guckian said it "did not choose to suspend this service lightly" as it "could no longer be safely maintained without permanent consultants".

"Any trust would prefer a planned and managed change rather than the emergency suspension of a service, and in these circumstances there will be learning to take forward for the region."

He added: "The independent data that we have indicates that emergency general surgery patients who come to Altnagelvin for their general surgery treatment have good outcomes, and these have not worsened as a result of this change."

The WHT said the review supported its own findings that there had been "no patient safety concerns" arising from the suspension of emergency general surgery.

Trust Chief Executive Neil Guckian said it "did not choose to suspend this service lightly" as it "could no longer be safely maintained without permanent consultants".

"Any trust would prefer a planned and managed change rather than the emergency suspension of a service, and in these circumstances there will be learning to take forward for the region."

He added: "The independent data that we have indicates that emergency general surgery patients who come to Altnagelvin for their general surgery treatment have good outcomes, and these have not worsened as a result of this change."

Donal O'Cofaigh from Save Our Acute Services (SOAS) said the terms of reference for the report had been "limited from day one" as it could not consider the decision to remove emergency general surgery.

"We do not believe it goes far enough.... it is an important milestone for our community, there is a recognition that there are problems with the provisions in place since the removal of emergency general surgery," he said.

"It is important that we now see action from the minister on the back of this.

"It takes two hours to get from Altnagelvin from where I live, and in an emergency or in a trauma scenario that is simply too long."

In a statement, Health Minister Mike Nesbitt said the report was not a review of the suspension of emergency general surgery, but an assessment of the provision put in place following the decision.

"First and foremost, the review did not identify immediate patient safety issues arising from the pathways. It did, however, identify areas where improvements to pathways can be made," said Nesbitt.

He said the department would work with the Western Trust to implement the recommendations.

Earlier this month, SOAS launched a discussion paper on a roadmap for the restoration of services at the hospital.

It proposed three strands to establish a critical mass of healthcare activity at SWAH, on a local, regional and north-south basis.

The group said the Department of Health should return general surgery to the hospital, identify it as a receiving centre for major trauma stabilisation, and as a centre for specialist procedures.

Emergency general surgery relates to the treatment of patients with conditions such as acute abdominal pain, infections, bleeding and trauma.

It includes operations such as removing a patient's gall bladder, appendix or part of the bowel.

If left unattended these conditions can become life-threatening.

According to the Western Trust, SWAH dealt with about five such cases a day and that was not enough to sustain a dedicated emergency general surgical team.