(Department was told suspension would lead to further patient travel)

INHERENT RISKS’ IN CEASING EMERGENCY GENERAL SURGERY AT SOUTH WEST ACUTE HOSPITAL
(Department was told suspension would lead to further patient travel)

BELFAST TELEGRAPH
LIAM TUNNEY

Tuesday 20th June 2023 at 06:00

The Department of Health was warned of “inherent risks” involved in ceasing emergency general surgery at the South West Acute Hospital (SWAH) in the days leading up to a decision to temporarily halt the service.
Campaigners against the move have also criticised civil servants of “indifference” for failing to record minutes during a key meeting ahead of the decision.
Emergency general surgery has been suspended at the Enniskillen hospital since December 17 2022, with patients having to travel to either Altnagelvin in Derry or Craigavon, Armagh in the meantime.
Email correspondence seen by this newspaper between the Department of Health (DoH), the Public Health Agency (PHA), Western Trust (WHSCT) and the Strategic Planning and Performance Group (SPPG) has revealed the SPPG had highlighted five main risks with the Trust’s plans.
The initial emails in the chain, dated October 12, show a letter from WHSCT Chief Executive Neil Guckian to the SPPG stating that the SWAH would be unable to fulfill its surgical rota by December 20 2022 due to the reduction of staff numbers.
In response to the email, the SPPG issued a submission to then-Health Minister Robin Swann outlining the request from the Trust to suspend emergency general surgery at the SWAH.
Within the document, Director of Hospital and Community Care Brendan Whittle said there were “a number of inherent risks” in the plan.
He cited further travel for patients, an increase in pressure on Altnagelvin and Craigavon Area Hospitals and an increase in pressure on the Northern Ireland Ambulance Service (NIAS) who would have to “convey patients over longer distances”.
Further communication from Mr Guckian on November 14 detailed the resignation of another general surgeon at the SWAH, and requested that emergency general surgery be suspended at the hospital from December 4 2022.

On November 16, a second submission to the DoH was submitted by Mr Whittle, directed to Permanent Secretary Peter May in the absence of a Health Minister.

The document again highlighted the risks around the cessation of surgery at the SWAH, with additional risks raised in the November submission.

Alongside the concerns around patient travel and increased pressure on Altnagelvin, Craigavon and the NIAS, potential negative media coverage is listed as a risk, as well as the ability to recruit consultant surgeons.

Despite its reservations, the SPPG did make a recommendation to that the Department approve the Trust’s proposal, saying the risks had to be balanced against the “greater risk” of delivering the service without sufficient surgical staff.

A Freedom of Information (FOI) request also revealed the Department of Health (DoH) did not keep minutes of a crucial meeting, after which a recommendation to suspend emergency general surgery at the South West Acute Hospital (SWAH) was brought to a Western Trust board meeting.

After a request for further clarification, the Department said a series of action points were noted following the meeting, which occurred the day before the Trust’s final decision to suspend the service was approved at a board meeting on November 17.

The email chain also indicated that the Public Health Agency (PHA) had raised concerns over the ‘scant detail’ in the Trust’s patient pathway plans the day before that meeting was due to take place.

“It is not clear from the letter the degree of engagement there has been with SHSCT in particular with respect to patients going there who would have been in SWAH,” they said.

“I am conscious that CAH (Craigavon Area Hospital) will also be absorbing activity following changes to DHH (Daisy Hill Hospital) surgery so even though absolute numbers transferred may be small it may be cumulative for CAH.

“Given we have had no prior involvement we cannot comment on pathways/bypass protocols, likely transfer numbers and the implications for CAH and Alt (Altnagelvin) without asking lots of questions.

“That makes it difficult for us to provide what the letter describes as ‘any required approvals from PHA’ in the timescale requested.

“We cannot simply ‘endorse’ things very quickly based on Trust assessment when we have not been involved in the detail.”

The email also queried the assessment that the move would have no financial impact, saying this would be “surprising”, but concluded “you cannot have a surgical service if you don’t have a surgical team”.

Also included in the correspondence were concerns raised by Permanent Health Secretary Peter May about his “capacity to take a decision of this nature in the absence of a Minister” should the move become permanent.

“This is clearly a major and controversial decision. On the face of it in the absence of a Minister or EFEF (Executive Formation and Exercise of Functions) type powers, it is not possible for me to take a decision which would certainly have been put to a Minister were one in post,” he said.

“There are however public safety issues at play here in that the service cannot safely be maintained. So the issue is probably whether the Trust can proceed in the absence of agreement from the Dept or whether it is feasible for me to approve this exceptionally in light of the public safety issues.”

Campaign group Save Our Acute Services (SOAS) said the lack of minutes taken in the meeting between the Trust and Department of Health showed an “inappropriately casual attitude”.

“SOAS are shocked at the indifferent attitude displayed by the Department of Health when agreeing the details on the temporary suspension of emergency surgery in SWAH,” said a spokesperson.

“A meeting of such significance should never be referred to as an “internal discussion” and it is absolutely essential that it would be accurately recorded.”

The group said former Minister Robin Swann had “refused to allow” the suspension of the service prior to the collapse of the NI Assembly in October 2022.

“We deserve better treatment than this. We are not second-class citizens. We can’t and won’t accept being treated in this way,” SOAS said.

The Department of Health said any decisions had been made with patient safety in mind.

“The first duty of any health system is to provide safe care and the Department is satisfied that the Western Trust’s decision to temporarily suspend the service has been taken on public safety grounds, due to a lack of consultant general surgeons,” said a spokesperson.

“In line with DoH NI Guidance Change or Withdrawal of Services – Guidance on Roles and Responsibilities, Departmental approval was not required for the Western Trust decision to temporarily suspend emergency general surgery at South West Acute Hospital.

“As the Department stated publicly in November 2022, any permanent decision to cease emergency general surgery will require approval from the Department/Health Minister.”