Concerns about the future of health provision at the South West Acute Hospital (SWAH) were aired at a heated public meeting in Enniskillen on Tuesday evening.

Around 60 people attended the public consultation meeting, hosted by Department of Health officials, which aimed to gather feedback on the proposed criteria that will be used to reform Northern Ireland’s health and social care services in the near future.

Health Minister Michelle O’Neill was not in attendance.

Among the revelations made were:

  • SWAH’s emergency department is only allocated ONE of the 120 training grade doctors sent to A&Es across Northern Ireland each year;
  • Stroke services will be the first area of the health service to be reviewed; and
  • Fermanagh neurology patients have waited more than two years for a consultant to see them at SWAH.

The most recent review of the health service – the Bengoa report – concluded: “It is better if specialist services are concentrated in a few centres rather than seeing few patients in very many centres” and “you cannot provide sufficiently safe medicine unless you concentrate a good amount of patients with that disease in one place.” 

It was those statements that prompted Labour Party NI member Donal O’Cofaigh to state: “The whole consultation exercise is biased against the provision of localised treatment in this county.”

In response, an official stated: “Bengoa said the specialisation applies to some services.”

Many members of the public voiced scepticism at yet another expert review on how to overhaul the ailing health system.

Brian Gallan, Consultant Stroke Physician and Geriatrician at SWAH took issue with criteria one, which would take action if “there is clear evidence that the outcomes of patients using these services are below acceptable levels.” He stated: “Equitability is something that should be included in the criteria to make sure that rural populations are not being indirectly discriminated against.”

He queried if the criteria “is it based on quality of care or volumes?” adding: “Because you may have a good quality service but lesser volumes – but is that really fair to be using lack of volume as a reason for the service not to continue?”

On the issue of junior doctors, another criteria suggests taking action on a hospital if “the training of junior doctors cannot be provided to acceptable levels.”

In response, Dr. Ian Crawford, Consultant in Emergency Medicine at SWAH (who stressed that he was not speaking in an organisational capacity) told the meeting: “Currently the Northern Ireland Medical and Dental Training Agency (NIMDTA) allocates 120 training grade doctors across 10 emergency departments. [SWAH] is one of the 10 EDs and we currently receive one of the training grade doctors. The remainder of our service is delivered by non-training grade doctors and we are struggling to recruit those so we rely almost entirely on agency locum doctors with all the associated risks that go with that.”

SWAH is “handicapped by having to rely so heavily on agency medical staff,” Dr. Crawford said.

Read: £4m spent on temporary staff at South West Acute Hospital

He told officials: “Only by having a regional approach to the medical workforce by ensuring equitable allocation of training grade doctors across sites and services can we expose these training grade doctors to the unique rewards and challenges of working in a rural setting.

“By not doing so we are doing them a great dis-service, we are doing our patients a great dis-service and we will stand no chance of recruiting consultant colleagues to lead the service in the future.”

In response, a health official said: “We hope to address this in the Workforce Strategy. The solution is not straightforward.”

Read: Politicians not moving on expert advice says SWAH consultant

Impartial Reporter:

From the Bengoa report

The meeting also heard “there is great anxiety among older people about what is going to happen to them.”

Patricia Donald, South West Age Partnership said: “We have great concern about our stroke unit and we hope that rather than sending people to Belfast, they can be sent to our hospital in Enniskillen.”

In relation to the elderly, the proposed criteria suggests new models of shared care between primary and community care teams. In response, Dr. Gallen said: “As a geriatrician I would be very open to these models of shared care. The Acute Care at Home Scheme is currently in operation in the northern part of the Western trust. Unfortunately there was no consultation with us, oddly, over whether that was to happen in our section of the Trust, in fact, we weren’t acknowledged. It’s really important that these schemes are rolled out across all of Northern Ireland, not just piloted in one area for several years and therefore resources are moving to just one part of the Trust.”

Unison representative Jill Weir told officials: “When you are doing a review of services make sure and ask the local people what they think of their services, not somebody up in Belfast deciding what’s right for Enniskillen. We are able to do things here that anyone else can do, so start sending services here – use our hospital.”

She added: “We need to start taking care of the people who take care of us. Our staff they feel undervalued."

Read: SWAH operating at “crisis point”

"Our nurses are paid less than nurses in England, Wales and Scotland for doing the same work. I know a lot of our doctors and nurses are going to Australia for a better life and we cannot blame them, but some are also moving to the rest of the UK where pay is better than in Northern Ireland. We need to keep our nurses here.”
She also appealed for home care services to remain in the public sector rather than being allocated to the private sector.

The officials will feed all the responses from the meeting back to the Health Minister.