The Northern Health and Social Care Trust held the last in a series of engagements with the community, at the Dunsilly Hotel, Antrim, on Wednesday evening, to outline a proposal for the future of surgery in the area.
It was one of a number of ‘listening events’ held by the Northern Trust which is holding a public consultation into a proposal to move all emergency surgery to Antrim Hospital and planned operations to Causeway Hospital in Coleraine.
William Taylor, of Farmers for Action, expressed concern about the plan to remove emergency surgery from Causeway Hospital, describing farming as “an unsafe industry”.
Mr Taylor addressed the panel saying:
“We need hospitals to be open and active and in the locality. We are most concerned about the direction of travel.”
Kevin McMahon, divisional director surgical and clinical services, replied that the “majority of trauma goes to Belfast”. He added that not all farming accidents are “catastrophic” and could be presented at A&E.
He stressed that emergency departments will be maintained at both Causeway and Antrim Hospitals “24/7”.
The meeting also heard that assessments for patients attending Causeway’s emergency department with potential surgical problems will continue “around the clock” and patients who require admission for emergency surgery will be transferred by ambulance to Antrim Hospital.
It was also stated the Trust has “no intention to downgrade Causeway Hospital” and that it is “very much open for business”.
James Patterson, clinical director for general surgery, said:
“The surgeons in the Northern Trust care very much about the quality of service we provide to our patients.
“Unfortunately, the way our service is organised at the moment means we can’t always provide that level of care. Our waiting lists are too long, especially for less urgent procedures such as gall bladder surgery. We are concerned that stretching our resources across two in-patient emergency units is making our service unsustainable.”
The Trust has already said it “recognises that a change to Causeway Hospital’s surgical service will bring additional demand to the Antrim Hospital site”.
It says it plans to open additional surgical beds and is discussing how to address “increased demand” which is anticipated for the intensive care unit.
Gillian Traub, director of operations, said concern has been expressed through feedback from the community about the capacity of the Northern Ireland Ambulance Service to support the proposal.
She indicated that 23 new ambulance journeys are likely to be required every week between Causeway and Antrim. However, she noted that 18 required weekly to transport patients from Causeway to Antrim for scanner appointments will no longer be necessary due to a new MRI being made available at Causeway Hospital.
She acknowledged some patients will have to travel further for planned surgery and went on to say a rural transport taskforce will be set up to work with the community to “provide some solutions”.
In response to a query by Adele Tomb, of the SOS Causeway Hospital campaign group, Mr McMahon said the MRI scanner “will not impact on any other service area and will not decrease any other area”.
Adele claimed that some people are “starting to bypass Causeway and go to Antrim”.
Mr McMahon replied:
“We are not seeing bypassing of Causeway. At the minute, it is really busy. Antrim was phenomenally busy yesterday (Tuesday). We are not seeing patients moving like that. We do ask people to trust us. If anyone needs a transfer, a consultant surgeon will support that transfer.”
Neill Martin, divisional director of strategic planning, performance and ICT, reiterated:
“We are committed to Causeway remaining as an acute hospital.”
Currently, the Northern Trust provides a range of surgeries at both Antrim and Causeway Hospitals.
These are: emergency general surgery, the treatment of patients for acute abdominal problems, soft tissue infections, bleeding and trauma; general surgery that focuses on diseases of the digestive tract and abdominal cavity; elective general surgery that is planned in advance such as gall bladder, hernia repair and other minor surgeries as well as major colorectal such as bowel resections often for the treatment of cancer and high volume surgery such as gall bladder removal.
At present two-thirds of the Trust’s emergency surgery is managed at Antrim Hospital, treating approximately 6,600 patients each year, 12 per day in Antrim and six at Causeway.
Antrim has nine funded consultant posts and Causeway, six. The Trust says it “cannot relocate surgeons to Antrim because a minimum of six is required to manage the on-call demands of emergency surgery in Causeway”.
It has been stated the Antrim surgical team has had to “reduce its elective activity to manage the emergency workload resulting in an increase in waiting lists for patients including those with a cancer diagnosis”.
“Our ability to meet our targets for cancer waiting lists and red flag referrals continues to be a challenge without dedicated elective capacity and access for our patients,” the Trust says.
The Trust anticipates a quarter of consultant surgeons are likely to retire in the next three to five years and says there will “not be enough doctors completing general surgery training locally to fill all of the consultant vacancies that are expected to arise”.
“The inability to recruit and retain consultant surgeons in the future is a real risk to the sustainability of our general surgery service. It is important to plan our workforce pro-actively rather than waiting for and reacting to an inevitable collapse in the service.
“A more efficient use of our resources would be to have one site specialising. in emergency and major colorectral surgery and the other focused on high volume procedures.
“This would help us address our very long waiting lists for procedures which present a lower clinical risk but still have a significant impact on quality of life.
“Our primary focus throughout our review of general surgery is the safety of our patients. While we do not have concerns about the safety of our current surgical services, we are concerned that the sustainability issues we have highlighted could make safe services difficult to maintain in the future.
“We would prefer to act in a planned way to protect the safety of our services and our patients rather than wait and respond to a crisis.”
The public consultation will run until November 29. Following a recommendation by the Trust board, a decision will be made by the Department of Health.