The new acute hospital at Enniskillen will open with 46 fewer beds than were publicly expected in two years' time. It won't be until 2018 that the bed numbers are expected to rise to an anticipated 312.

And it has also emerged that there is now serious doubt about the building of a new hospital in Omagh. The business case for the acute hospital for the south-west at Enniskillen refers to the need for a new hospital in Omagh to complement services.

The Impartial Reporter has gained sight of the summary of the full business case for the new hospital which has only been released for public view this week, even though contractors have been on the Wolf Lough site for months.

The website for the new hospital unequivocally states "the new acute hospital will provide up to 315 in-patient and day case beds" and in a fact file that it will have "circa 300 beds".

And the extensive Outline Business Case, previoulsy published, devotes chapters to bed numbers and concludes that 295 beds would relate to acute hospital provision alongside 20 co-located intermediate care beds, ie 315 beds on the acute hospital site.

However, the full business case on which services at the new hospital will be based states: "Based on the updated bed modelling undertaken as part of this full business case, the Trust NOW outlines a new Acute Hospital opening of 269 beds in 2012, 293 beds in 2015 and 312 in 2018.

The shift from 269 beds to 312 beds will mean the difference of 50 nursing posts.

Under the title of "Pay Cost Decreases", the document refers to "Nursing costs of 42 beds not opened (312 beds at Outline Business Case to 269 beds at Full Business Case opening".

Pressures on the figures projected in the Outline Business Case are explained. "The . . Outline Business case assumed significant savings in nursing costs by applying enhanced working efficiencies and the development of new roles. These savings have now been included as part of the Trusts' Comprehensive Savings Review initiatives and attendant budgets are now not available as a saving contriution to the Full Business Case".

Concerns that a £190m new enhanced local hospital planned for Omagh may never be built could also have serious implications for the future of health care in Fermanagh, two Omagh GPs have said.

SDLP Councillor Dr Josephine Deehan and West Tyrone MLA Kieran Deeney were speaking after the Health Minister announced that financial constraints and cuts in the health budget meant that plans for the project have been stalled.

Work was set to commence this year at the site close to the Tyrone and Fermanagh Hospital with it's opening set to coincide with the opening of the New Acute South West Hospital in Enniskillen in 2012.

Responding to an assembly question from Sinn Fein's Pat Doherty on Friday, Michael McGimpsey said that due to budget constraints facing his department he said he could not give a firm commitment to any project in the planning stage until he was able to confirm that necessary funding is available.

"This applies to the Omagh Local Hospital as to all other planned projects. The Trust and my officials are working together to resolve a number of outstanding issues in relation to the business case,".

He said he remained committed to the Omagh Hospital project and hoped that it will progress as planned.

The new complex is to have around 200 beds in total, with just over 100 beds in the new hospital providing urgent care and treatment, general medicine, intermediate care, renal services and day surgery.

It is expected to support services at the New Acute South West Hospital as well as giving Tyrone people better access to services leading to fewer trips to hospital and reduced waiting times.

An acute state-of-the-art centre for mental health offering psychiatric intensive care facilities for those with challenging behaviours and an addiction treatment unit could also never materialise at the site.

By not starting work on the project, Councillor Deehan believes this could have serious implications for the Erne Hospital, which is already under severe pressure coping with volumes of patients coming in from Omagh every week.

Only last Sunday Councillor Deehan claimed she couldn't admit a patient into the Erne Hospital because there was no medical beds available.

"I had to send a very ill patient to Altnagelvin during out of hours on Sunday because of a shortage of beds and I didn't want to do that. I know several GPs have had to do the same because of the severe pressure mounting at the Erne Hospital and it's increasing all the time. The pressure needs to be lifted at the Erne and the workload has to be re-distributed equally to Fermanagh, Derry and Omagh. If there is no money in place to develop this hospital then we are facing a very uncertain time here in the West." West Tyrone MLA Kieran Deeney said the mental health-care needs of Fermanagh and Tyrone people are being ignored once again.

"There seems to be one rule for the east and one rule for the west. This new hospital proposal was a silencer for the people of Omagh who campaigned tirelessly to have acute services retained. This hospital will never be built in the forseeable future. The impact on the future of mental health services is also very concerning. The Tyrone and Fermanagh Hospital for years has been at the centre of providing excellent mental healthcare facilities for the two counties. A third of every GP appointment is mental health related but if this acute centre doesn't open, then where can we refer them? It will come to the stage that no health professional will ever want to come to the West to work and I wouldn't blame them," he said.