Causeway hospital doctor's 'domino effect' warning shows there is 'no single clinical consensus' - Jon Burrows

UUP boss Jon Burrows says the comments show that there is “no single clinical consensus” on a bid by the Northern Trust to relocate Emergency General Surgery (EGS) from Coleraine to Antrim.

A row over the plans exploded last month, resulting in the resignation of the health minister Mike Nesbitt.

He was unhappy that party leader Mr Burrows had expressed outright opposition to the changes, which were backed by senior officials in the health service.

Professional bodies have issued statements supporting the “modernisation and transformation” of surgical services – and the Northern Trust’s Director of Surgical and Clinical Services has also said teams at its hospitals “believe that we need to change how our services are organised”.

However, a senior doctor who works in Causeway Hospital has told the News Letter that many staff “have serious reservations” about the proposed shift of EGS to Antrim Area. He has requested that he is not named publicly.

This medic says that a “dismantling domino effect” would likely follow if EGS is relocated from the North Coast hospital – threatening the viability of the medical team, gastroenterology service, Emergency Department (ED), intensive care unit, and many other services.

The doctor says Antrim ED cannot cope as it is with numbers, and it is not uncommon for patients living within the Antrim catchment area to be diverted to Causeway ED.

Adding a large volume of complex emergency surgical patients from Causeway (around 1000-1500 patients per year) to “an already overwhelmed ED and surgical department in Antrim doesn’t make sense – it’s hard to see this move would improve patient safety”, the doctor said.

They said that under new proposals, “a number of surgical staff in Causeway would be expected to relocate” – and the “human cost of this has not been weighed up”.

“Causeway medical staff are concerned that under these proposals many emergency surgical patients not requiring immediate surgical intervention would end up under the care of the medical team rather than surgeons.

“This would be inappropriate and unsafe practice, and would add to an already extremely challenging workload for the medics”. the NHS doctor said.

The senior medic also told the News Letter that it is important that the public “aren’t misled into believing that they’re hearing the views of all medical and surgical doctors on the ground when the media talks about the ‘medical opinion’ or the ‘clinical consensus’.

“There are many of us with genuine clinical concerns about the impact these proposals would have on patient safety and the long-term viability of Causeway as a site for emergency care”.

Responding to the comments, Ulster Unionist Party leader Jon Burrows MLA said: “These are very serious and detailed concerns from a doctor working on the ground at Causeway. Questions about Antrim's existing capacity, ambulance pressures, rural travel times, workforce assumptions and the potential knock-on effect on Causeway's other services must all be properly tested.

“While we will continue to be informed by clinical expertise, it is noteworthy that clinicians themselves are making clear there is no single clinical consensus.

“I was pleased that, so early in his tenure, the Minister visited Causeway, listened directly to staff and clinicians, and met the Causeway SOS group. He has made clear that no final decision has been taken and no formal request for a decision has not even reached his desk.

“The Minister is listening to people, testing the assumptions and interrogating the full evidence. Ultimately, he will be guided by what is right for patients. My party and I support that evidence-led approach.

“Reform must improve patient safety and secure Causeway's future, but legitimate concerns cannot be brushed aside. I will continue to advocate strongly for Causeway Hospital and represent constituents to ensure they have prompt access to the services they need”.

A Northern Trust spokesperson said: “We recognise the very genuine concerns among some of our staff and wider community around the proposed reconfiguration of our general surgery service.

“We are also acutely aware of the concerns that have been expressed by our surgical team that it is not possible to sustain an emergency general surgery rota across our two acute sites in Antrim and Causeway.

“In order for us to avoid service collapse, we have taken a proactive approach to plan for a managed service change so that we can ensure our service is safe, stable and sustainable for our community, and for our staff. This included a 14-week public consultation.

“We fully recognise the existing pressures at Antrim Area Hospital and acknowledge there are concerns about the potential impact of additional emergency surgical activity. This has been carefully considered throughout the review process and has informed our planning and modelling work. Our review of general surgery services was not initiated as a response to Emergency Department pressures. It arose from concerns regarding the sustainability of the current surgical model. The Trust’s proposal to transform general surgery services has been informed by extensive clinical engagement and is in line with national policy, guidance and standards.

“Causeway Hospital is, and will remain, an acute hospital with a Type 1 consultant-led Emergency Department. We have recently strengthened our Causeway workforce by successfully expanding our ED consultant team as well as appointing six permanent Specialty Doctors, a consultant cardiologist and consultant paediatrician, with further recruitment taking place in the coming months.

“We have also invested £1.8m in expanding ambulatory (same day emergency care) pathways at the hospital.

“We remain committed to the Department of Health’s formal decision-making process and while we await a decision, we are continuing to work with our clinical and surgical teams in Antrim and Causeway to plan for potential service change”.