Enniskillen hospital emergency surgery concerns: Surgeons explain why urgent NHS reforms needed across Northern Ireland

Last week the Western Trust announced the decision to withdraw emergency services from 18 December at the Enniskillen hospital.

Locals have said the withdrawal of the service is devastating, but surgeons have responded that it was necessary due to the risk of services becoming less safe.Emergency general surgery describes 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.The consultants - who sit on the Review of General Surgery Network - come from Northern Ireland's five health trusts.They said the loss of three surgeons in December and failure to recruit more led to the decision.The Department of Health said yesterday that a detailed statement distributed by the consultants "an important contribution to the debate" and that it includes "a detailed explanation as to why recruiting and retaining consultant general surgeons to smaller hospitals is proving increasingly difficult".A public consultation is now to be held on the future for emergency general surgery at the South West Acute Hospital (SWAH).

In their statement, the surgeons said that right across the UK, the trend has been to centralise emergency services in major city hospitals, as they are more likely to have 24-7 multidisciplinary teams and support services to deal with complex cases.This means that emergency surgeons increasingly bypass job opportunities at smaller hospitals as their facilities have smaller teams with less multidisciplinary support.Instead, they are opting for jobs at major hospitals where there is much better support across disciplines for emergency cases - and where they are more likely to get extensive experience to sharpen their skills and advance their careers.The UK trend has therefore been to use smaller hospitals to specialise in different non-emergency areas."We fully understand the support in the local community for their local hospital; and the desire to have services close at hand," they said."In an ideal world, everyone would live near to a major hospital that can provide every single medical specialty. That’s not the world we are living in."They said many patients in NI already bypass SWAH for various specialist treatments in Londonderry or Belfast."A local hospital is not always the best or the safest place to be treated," they added.People in Fermanagh who need the SWAH Emergency Department should still attend it as normal, they said. However if they call for an ambulance, it may now transport them to Londonderry or Craigavon, they added.They noted that the Department of Health has announced the SWAH will become an overnight stay elective surgical centre, not just for General Surgery but for many other surgical specialties."The creation of such centres will allow us to radically address the horrendous waiting lists we have in Northern Ireland.

"There is an onus on politicians, clinicians, civil servants to come together to drive the necessary changes forward otherwise we will continue to see services fail."