Northern Trust emergency general surgery to move to one site

The Northern Health Trust has proposed moving Emergency General Surgery (EGS) onto one hospital site most likely at Antrim Area Hospital.

Currently, it is spread between the Antrim Area and Causeway Hospitals.

At Thursday’s trust board meeting, it sought permission to launch a 14-week public consultation on grounds that duplication across two sites means surgery is vulnerable.

If approved, it would mean that high volume low complex surgery which can be planned would be carried out solely on the Causeway site.

'Not sustainable'

Senior management said that both hospitals are under pressure and the current dual system is “not sustainable”.

Making the case for change, the trust said that covering two surgical rotas would become unsustainable.

It also said that staff recruitment, retention, skill mix and maintaining quality care must be a priority.

It said that by proposing the move it is “pre-empting the total collapse of the surgical service” which is showing signs of becoming vulnerable.

The Chief Executive, Jennifer Welsh, said the review of general surgery was about creating a “safe, stable and sustainable service”.

BBC News NI understands that Antrim Area is the preferred option as it is the larger of the two hospitals.

There are concerns about the future of the workforce as approximately 25% of the Northern Trust’s surgeon consultants are likely to retire in three to five years.

While Northern Ireland has a general medical workforce problem – there are not enough doctors being trained in general surgery to match anticipated retirements.

The proposed move is like what happened at both Daisy Hill in Newry and the South West Acute Hospital in Enniskillen where there was widespread opposition.

Making their case for change the Northern Trust said while there will be greater surgical activity in Antrim they have recently invested in Causeway with the new ambulatory unit and the move would ensure its future as a hub for general surgery.

What is emergency general surgery?

EGS looks after patients who require general surgical assessment, diagnosis or treatment in an unplanned way, often following presentation in the ED.

It is usually fine to assess, stabilise and transfer patients unto a more suitable site for surgery.

The surgery is performed by highly skilled surgeons who typically operate on common abdominal complaints including elective gall bladder surgery, hernia repairs and bowel repairs.

Colorectal cancer surgery which includes surgery for diseases of the colon, rectum and anal canal, particularly cancer of the rectum will also be carried out in Antrim.

What is general surgery?

General Surgery focuses on diseases of the digestive tract and abdomen.

As the title indicates, this is a wide-ranging area of surgery with many subspecialties.

The defining feature of general surgeons is that they have a wide range of knowledge and skills to deal with all kinds of surgical emergencies, with an emphasis on acute abdominal problems.

They also carry out a large number of elective operations.

According to the Northern Trust, the proposal around general surgery would not affect the emergency departments at either hospital.

In June 2022, the Department of Health set out standards hospitals will be required to meet to continue providing emergency and planned surgery.

The review emphasised the “pressing need for change, given current issues of sustainability and keeping pace with the development of the speciality”.

According to the Northern Health Trust, general surgery doesn’t meet the proposed standards which is driving the need for change.

Gemma Brolly, chair of the SOS Causeway Hospital Campaign, told BBC programme Good Morning Ulster, that they were against "making huge plans on potential problems" rather than "solving problems that currently exist."

"We know we have a full complement of surgery staff at Causeway Hospital which are working really well."

"Unfortunately the staff in Antrim are under serious pressure so therein lies the issue."

"I don’t know why all of a sudden after 20 years it's a problem."

The pressure group said that they were told by the trust that "at present the beds that are free cover just half of what the demand would be and the answer they have to that is that they would move other services out of Antrim Hospital to other hospitals to make room for this."

"If you take emergency surgery out of Causeway hospital, how long will your emergency department exist for?"