South West Acute Hospital temporarily loses emergency general surgery

The South West Acute Hospital in Enniskillen has struggled to recruit and retain some specialist staff

Emergency general surgery is to be temporarily withdrawn from South West Acute Hospital (SWAH) in Enniskillen, the Western Health Trust has said.

The trust said this was necessary to protect the public's safety after it had problems recruiting surgical staff.

Despite saying the move was temporary, the trust did not say when it expected emergency general surgery would resume.

The emergency department and other services including obstetrics will continue to operate as normal.

Other - mostly lower grade - surgeons will remain on site at the County Fermanagh hospital.

People will have to travel to other hospitals for emergency general surgery

They will stabilise patients before they are transferred by ambulance to the likes of Altnagelvin Area Hospital in Londonderry, Craigavon Area Hospital in County Armagh or Sligo University Hospital across the border in the Republic of Ireland.

• Live: Reaction to decision to withdraw emergency general surgery from SWAH

Local groups have said they are concerned that the road infrastructure does not support a quick transfer of patients from Enniskillen to Altnagelvin, Craigavon or hospitals in Belfast.

In a further move it has been confirmed the hospital is to become Northern Ireland's third elective surgical hub.

In October, emergency general surgery was "temporarily" moved from Daisy Hill Hospital in Newry to Craigavon Area Hospital.

Campaigners gathered outside Enniskillen Town Hall on Thursday to protest against the trust's decision

Why is emergency general surgery stopping at SWAH?

Geraldine McKay, the trust's director of acute services, explained the decision was taken because of a lack of consultant surgeons.

She said a consultant in the general surgery team had recently resigned.

The decision means that emergency general surgery will stop at SWAH on 18 December.

"Despite our previous and ongoing efforts to recruit, we have not been successful to date in securing the necessary consultant workforce," Ms McKay said.

"The trust is therefore now unable to maintain the required workforce to sustain and deliver a safe emergency (unplanned) general surgical service to our population from SWAH.

"Put simply, we cannot provide an emergency general surgery service without a consultant surgical team in place to provide the required 24/7 cover."

Geraldine McKay from the trust took questions from reporters after Thursday's meeting

What efforts were made to recruit staff?

Ms McKay said the trust had done everything it could to maintain services and was disappointed by the announcement.

She explained they had held six recruitment rounds since 2016 and in that time the hospital had gained five consultant surgeons.

However, during the same period SWAH lost six consultants - three of whom retired while the other three moved on to other jobs.

"Unfortunately we have now come to a position whereby, come the end of January, I will have no substantive [staff] consultants in post in South West Acute Hospital in the general surgical specialty."

Speaking about the implications for patients, Ms McKay said: "I completely understand the anxieties of the population of Fermanagh and south Tyrone, especially rural areas."

Ms McKay said she was aware one of the key anxieties is what would happen in the case of a major road crash.

"We have agreed with emergency department team and trauma network that SWAH will remain a trauma-receiving unit," she said.

What is emergency general surgery?

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 deals with about five such cases a day and that is not enough to sustain a dedicated emergency general surgical team.

Local residents expressed concern about patients' safety in an emergency

In a briefing on Thursday afternoon, the trust said there would be no change to emergency C-Section births, though if a patient is deemed at risk they will opt to deliver elsewhere.

What has the local reaction been?

"Fermanagh is so isolated… It's madness, people will die," County Fermanagh resident Jimmy Hamill told BBC News NI.

He was among people who began to gather outside Enniskillen Town Hall on Thursday evening in reaction to the announcement.

Mr Hamill described the move as "lunacy" and said he believed it was part of a "choreographed plan".

A former SWAH medic also questioned the "temporary" nature of the move, suggesting the trust had used that word euphemistically.

"In my experience, having worked in the health service for over 40 years, once the word temporary is used, therefore it becomes permanent," Prof Mahendra Varma told the BBC's Evening Extra programme.

"So I don't accept what the Western [Trust] board is saying with regards to it being temporary."

Last month, Prof Varma warned that patient safety would be put at risk if SWAH lost its emergency surgery

The retired consultant cardiologist was among the medics who were involved in the establishment of the hospital 10 years ago.

Prof Varma also told the programme he did not believe the trust had made enough efforts to replace retiring surgeons.

Another former SWAH worker, Diane McCaffery, described the decision as "shocking".

Ms McCaffery is a retired emergency care manager who worked at SWAH's cardio assessment unit

She told BBC News NI she has seen first-hand how emergency surgery has saved lives. She said she thinks this decision is "catastrophic" and that Fermanagh residents were the "poor relatives of this country".

The Western Trust said existing services including its emergency department and obstetrics remained unchanged.

It added there would be "minimal to no impact" on the other existing services at SWAH.

The trust said it was liaising with colleagues in the Northern Ireland Ambulance Service and the Southern Health Trust on the new arrangements.

When the hospital becomes Northern Ireland's third elective surgical hub it is planned that it will tackle waiting lists.

The trust said this would secure the hospital's future.

The other surgical hubs are based in the Mater in Belfast and Daisy Hill.

They will provide surgery for both day case and overnight procedures which are planned in advance.