In the consultation document detailing the Department of Health's (DoH) proposed reconfiguration of hospital services in Northern Ireland, the South West Acute Hospital (SWAH) will not have an Intensive Care Unit (ICU) as it is designated as a 'General Hospital'.

According to the 'Hospitals - Creating a Network for Better Outcomes' document, available to the public on the DoH website, the three 'General Hospitals' - SWAH, Daisy Hill and Causeway - would provide acute and general medicine, accommodating a service for all patients presenting at the site for urgent and emergency care (supported by agreed ambulance bypass protocols either where deemed appropriate by NIAS, or following discussion between NIAS and hospital clinicians); radiology, including CT; laboratory services, (to be defined); an enhanced care area with a stabilisation and retrieval team and anaesthetic cover.

ICUs will be in the five proposed 'Area Hospitals' which includes Altnagelvin in the Western Trust area.

The document states: "It will therefore be critically important to maintain these core services at the General Hospitals. It is expected that General Hospitals will also provide a menu of other services, tailored to meet local population health need. This may include delivery of surgery and other elective care on behalf of the region, consistent with our Elective Care policy."

'General Hospitals' share many of the challenges of the 'Area Hospitals' and in reality are competing with them for resources but 'General Hospitals' are the ones "most vulnerable to unplanned change in service" according to the consultation document.

Looking at challenges and enablers for 'General Hospitals' looks into interdependencies, elective surgery and workforce.

The core specialities and services in SWAH must "work together as a unit and provide a significant volume of the General Hospital services needed by a local population" such as the Emergency Department, inpatient specialities, planned general medicine specialities such as cardiology, diabetes and respiratory as well as Care of the Elderly inpatient beds.

To justify the anaesthetic cover and maximise the use of existing theatre capacity "sufficient" elective surgery should be planned and delivered on these sites.

In terms of workforce SWAH and Altnagelvin must work in partnership in a fully integrated way. 

Rotas will have to be "realistic and sustainable" while local variation of services may require a "bespoke staffing solution including the introduction of new roles and different skill mix".

The consultation document points out that 'General Hospitals' may develop in different ways outside of the core services with SWAH's theatre specification lending itself to orthopaedic, gynae and general surgery.

While Health Minister, Mike Nesbitt, said last week that no acute hospital was in danger from the reconfiguration local health campaign group, Save Our Acute Services (SOAS) believed if the policy is implemented, SWAH will be downgraded and was a "cause for concern".

The draft consultation does not mention any plans for Emergency General Surgery to return to SWAH with Minister Nesbitt saying the proposal to separate emergency and elective surgery will secure the future of acute hospitals.