The risk of pregnant women and their babies dying in the Fermanagh and south Tyrone area could increase if the Western Health and Social Care Trust presses ahead with plans to remove emergency surgery from the South West Acute Hospital (SWAH), senior surgeons have warned.

Obstetric and gynaecological consultants have told health authorities of the dire consequences of any “disintegration” of services, saying “harm will come to patients and the reality of this needs to be made clear to the public”.

The proposal – which could see acute surgical service provision halted due to recruitment issues – was mooted last week and will have a potentially “catastrophic effect” on the mostly rural community, according to the experts.

In a signed letter, reported upon in The Sunday Independent by former Impartial Reporter journalist Rodney Edwards, they say the plan is “unsafe for patients in its current form” and puts hospital staff in a “very vulnerable situation”.

Proposals

The proposal could see patients having to make a round trip of several hours in some cases to another hospital for surgery, or be transferred by ambulance for almost two hours in an emergency, such as a road traffic accident.

The surgeons say the plan is “simply not practical nor fair to our patients” and add that having to take additional journeys to other hospitals “could increase women’s morbidity/mortality risk, and risk to their babies”.

They also say they “cannot mitigate” for inadvertent bowel injury in which every patient undergoing abdominal or gynaecological surgery “is consented for that risk”.

“It could happen in the unstable patient with a ruptured ectopic pregnancy that requires emergency out-of-hours intervention.

“What happens in these events?

“Is it really being implied, that such a patient is transferred from SWAH theatre in an ambulance to another hospital one-a-half-hours away by an already overstretched ambulance service?”

Challenging

Acknowledging that recruitment and retention of staff has been “extremely challenging”, they say their disappointment at the plan “far from conveys the depth of our frustrations”.

The letter went on: “We cannot be in a situation where we are in theatre with a major complication and a general surgeon that cannot be mobilised to assist within a timely fashion.”

They say that the suggestion of having no surgical support in a rural area with poor road networks to neighbouring hospitals is “frankly unacceptable”,

“We are a group of enthusiastic, talented consultants who want to provide a high-quality safe service to our population.

“This development makes it impossible for us to continue this service without appropriate arrangements being put in place to provide access to surgical expertise”.

The surgeons “cannot support the current proposed change to acute surgical services at SWAH at present”, but “acknowledge that acute surgical services cannot be sustained in its current format and collectively believe the proposal for our unit is unsafe for patients, and in its current form puts our staff in a very vulnerable situation”.

External review

They’ve suggested an external review “may be essential” to ensure a suitable arrangement is made by the Trust”.

Last week, Health Minister Robin Swann said: “The situation regarding emergency general surgery at tjhe SWAH will undoubtedly be a matter of serious concern in the local community.

“I would stress that no decision has been made and no recommendation has come to me from the Trust board.”