Leading surgeon voices support for centering emergency surgery at Antrim Hospital

Speaking at a meeting of the Trust board at Antrim Hospital on Thursday morning Eunice Minford, clinical director of surgery, highlighted the reasons why she believes this change is “necessary at this time”.

Currently, general surgery focusing on diseases of the digestive tract and abdominal cavity and emergency abdominal surgery in the Northern Trust is carried out at Antrim Hospital and Causeway Hospital, Coleraine.

The Northern Trust has recommended to the Department of Health that all emergency general surgery is carried out at Antrim Hospital and planned operations at Causeway.

Department of Health officials told Stormont’s Health Committee last week that no decision has been reached on the way forward and it is awaiting a business case from the Northern Trust.

Dr Minford stressed to the Trust board the need for safety, sustainability, standards and specialisation.

“Patient safety is at the heart of everything we do. To have patient safety, we require a sustainable workforce,” she stated.

“Emergency general surgery hubs will have all the resources that are required and make sure the patient gets the operation they need by an expert surgeon in that field.”

She also spoke of the need for a workforce model to enable staff to be recruited and retained.

She went on to say that although the current model is safe, it is “fragile”, adding that safety cannot be guaranteed at a “point of collapse”.

She noted pressures including consultant vacancies, “unexpected gaps” due to illness, resulting in high locum dependency, describing a weekend on call as “quite an onerous workload for one consultant to manage”.

She went on to say that the Trust has “an ageing surgery cohort” with many over the age of 50 and “younger, fitter surgeons” also finding weekend shifts difficult.

Causeway has six consultants, with four on the rota and two locums; Antrim has 10 with 4.5 on the rota and 5.5 locums resulting in “extra pressure on permanent consultants, contributing to burn-out and stress”, which Dr Minford said, can affect retention of staff.

She stated that consolidating emergency surgery on one site would result in a larger pool of surgeons and noted that the Trust is the only one in Northern Ireland to operate general and emergency surgery across two sites with the challenge of sustaining two on-call rotas.

She said that elective and emergency surgery would both be stronger when focusing on their primary purpose with expertise concentrated.

“An elective hub means elective surgery can be done at high volume. This results in improved waiting times,” the director continued.

“This is a fantastic opportunity for Causeway Hospital to become a major centre for elective surgery with high productivity doing high volume surgery to become a centre of excellence and a surgical training hub.”

She advised that doing nothing is not an option amid concern over losing consultant surgeons, recruitment and increasing dependence on a shrinking locum group, she considered, would result in the Trust not having the skilled workforce it needs to deliver two on-call emergency surgery rotas, if emergency general surgery is retained at both sites.

Trust board chair Anne O’Reilly said: “You have reaffirmed and reiterated what needs to be done for us in relation to the future of emergency general surgery. You have made your position extremely clear and made us acutely aware again of the fragility of issues around the workforce. That has been made crystal clear,”

She reiterated the Northern Trust’s commitment to the recommendation it made last May and committed to “continue to keep working towards that”.

The board’s recommendation requires the approval of the Health Minister and Department of Health before it may be implemented.

Consultant surgeons James Patterson and Eunice Minford. Pic: Local Democracy Reporting Service