The Northern Health and Social Care Trust say the removal of Emergency General Surgery (EGS) at Causeway Hospital is needed to avoid “service collapse”.
In a deputation to Causeway Coast and Glens Borough Council’s Corporate Policy and Resources Committee on Tuesday, September 24, Trust chief executive, Jennifer Welsh, said continuing EGS services at both Causeway and Antrim hospital was unsustainable, but assured members that Causeway Hospital’s Emergency Department (ED) would be “business as usual”.
Ms Welsh explained both hospitals currently provide EGS, elective general surgery, and high volume surgery, which are shorter, lower-risk procedures, but this current configuration was unsustainable due to potential staff shortages in the future.
“Antrim Area Hospital’s unscheduled surgical demand is double that of Causeway’s but that is not reflected in the surgical workforce between the two sites, as Antrim has nine consultant posts and Causeway has six,” she clarified.
“It’s not possible to simply relocate surgeons because we need six to manage emergency surgery within Causeway, so sustaining rotas across two sites makes the service very vulnerable and increases the risk of service collapse if there’s any unplanned change in staffing such as sickness.
“Additionally, we expect that around 25 percent of our consultant surgeons [will] retire in the next three-to-five years and there will not be enough doctors training locally to fill vacancies, so the inability to recruit and retain consultant surgeons in the future is a real risk to the sustainability of our general surgery service across both sites.
“We are very mindful of the recent collapse of general surgery emergency services in two other Trusts, so we believe it is important to plan our workforce proactively rather than waiting for and reacting to an inevitable collapse in the service.”
As part of an ongoing consultation exercise hospital staff were asked to appraise several provision options for both hospitals, and staff showed a preference for the centralisation EGS and elective general surgery in Antrim and high-volume elective surgery in Causeway.
“This is our preferred option because it provides the best configuration of emergency and elective surgery,” Ms Welsh said. “It would maintain safe and effective care for our population, provide a sustainable model for the future provision of general surgical services in the Northern Trust, and help us address our very long waiting lists for procedures.
“Many other parts of the UK and Ireland have changed the delivery of EGS, so it’s provided in bigger hospitals with elective surgery taking place in the smaller hospitals.
“The trust’s strategic vision for Causeway Hospital was published in March and includes a clear commitment to maintaining a 24 /7 ED, so getting the word out that Causeway is very much open for business is hugely important.”
UUP Councillor Darryl Wilson asked how the changes would affect the ED’s ability to operate, and said staff he had spoken to had “grave concerns that things will not be as they were”.
The Trust’s divisional director surgical and clinical services, Kevin McMahon, said the ED will still manage the “vast majority of surgical needs that the population will have”.
“It will still be a vibrant hub in terms of surgical presence,” he said. “There will be a consultant on site at night and we have agreed with the consultant body that there will be a no-quibble transfer to Antrim.
“There will be senior presence 24 /7, a consultant presence Monday 9 to 5, a consultant presence for the elective lists, and out-of-hours there’s a no-quibble transfer process.
“We are very focused on providing as much diagnostics at Causeway because we know that people need many more diagnostics than procedures, so you will get your diagnostics at the Causeway site and if you have to go down for surgery you’ll get your post -operative care in Causeway as well.”
DUP Councillor Mervyn Storey said he had “heard it all before” in terms of the Trust’s commitment to Causeway Hospital.
“An organisation is only good as long as its words can match its deeds,” he said. “And we’ve lost maternity services and mental health services to Antrim.
“Jennifer and I had a conversation a number of years ago about the Causeway becoming a surgical hub, and it’s still aspirational.
“Let’s remember there’s a Department [of Health] and their ambitions are not always favourable, so support [for] the Causeway Hospital is lacking, we’ve been dumbed down again over and above Antrim, and clinicians have not all bought into this.
“I have spoken to one senior consultant, and their view is that this is not a good move for Causeway Hospital. I do not see how we can sell to the public that what we are going to get is better than what we are currently having.”