A submission to the Western Trust’s Public Consultation on the temporary removal of Emergency General Surgery (EGS) at the South West Acute Hospital (SWAH) has said the decision taken was “an appropriate decision”.

This is the belief of The Royal College of Surgeons of England and The Royal College of Surgeons of Edinburgh who submitted a joint response to the consultation.

The response said the temporary suspension of EGS was appropriate, because the SWAH was unable to meet “two core areas of the clinical standards outlined in the Review of General Surgery”.

These were workforce and clinical interdependencies such as radiology and endocrinology, bleeding rota and renal medicine.

Also, the submission agreed the actions taken were reasonable and addressed some of the challenges faced by the service and will facilitate patients receiving treatment in a timely, suitable and safe environment based on their clinical need.

The response, while agreeing that there would be an impact on rural needs by increasing journey times for ambulances to get a patient to a suitable emergency general surgery facility, shows they believe it is reasonable “as a greater risk would ensue from attempting to continue to provide an emergency surgical service at the current staffing level”.

“It has increasingly been the case that smaller rural hospitals across the board, in the UK and worldwide, have failed to recruit consultant general surgeons.

“It is important to note that this is not because of a lack of effort, nor is it a reflection on the SWAH, the Trust or other hospitals or the local areas in question,” the response stated.

The Royal Colleges say that for the service to return there would need to be higher levels of staffing of multiple roles across the surgical and peri-operative team, including theatre nurses, blood bank staff, radiology, endoscopy and other diagnostic services, as well as Intensive Treatment Unit (ITU) provision, all on a 24/7 rota basis, and therefore, the additions of a given number of consultant general surgeons would allow the service to return.

“This issue of staffing of the entire surgical and peri-operative team means that an attempt to maintain surgery at the SWAH would result in a second-class service at the hospital, when compared to the provision given at the alternative units at Altnagelvin Hospital and Craigavon Hospital.

“The issue of transfer and ambulance times therefore needs to be balanced against the risk to patients of a potentially sub-standard offering at the SWAH.

“The judgement of the Royal Colleges is that the latter is the greater risk to patient safety,” continued the response.

In conclusion, the joint response said: “The decisions taken are thus reasonable, and appropriate measures have been taken to, so far as possible, mitigate the negative impact on the rural communities of County Fermanagh.”

Western Trust Medical Director Dr. Brendan Lavery welcomed the Royal College of Surgeons’ response.

He said: “From the outset we have been clear that the decision to temporarily suspend emergency general surgery at the SWAH was taken to protect the safety of our patients, and it is clear from the Royal Colleges’ clinical expertise that they support our current position to deliver a safe service.”

Dr. Lavery continued: “The Royal Colleges’ response reflects the many facts the Trust has been underlining before and during this temporary suspension, and that this is not solely a reflection on the Western Trust, but is an issue across HSC and the UK.

“We would like to again thank all those who responded to our recent consultation, and reiterate our commitment to ensuring the safety of our patients.”

Former Consultant Surgeon Essam Ghareeb, who has spoken out against the Trust’s removal of EGS, said: “The [joint] RCS statement is a repeat of long-standing opinion regarding amalgamation of services and forming major centres.

“While this is understandable and makes sense in some subspecialties in surgery, it has major faults.

“Providing safe services for a named section of the population is the responsibility of the government, and not the Royal College of Surgeons.

“So, appointing surgeons to a hospital to cater for the needs of its population does not need the approval of a RCS,” added Mr. Ghareeb.