Kieran Downey, Deputy Chief Executive of the Western Health and Social Care Trust, has said that the Trust will “only get one shot” at establishing a best model for the future of health care in the region. Mr. Downey was speaking ahead of an intensive period of community engagement in relation to Pathfinder, an initiative that he will head.

Pathfinder has been established with the support of the Department of Health with a remit of looking at the future provision of health services within the region of Fermanagh and West Tyrone. The Trust are holding meetings in communities all across the county during December and January with Mr. Downey stating that it was “important that we talk to everyone”.

Mr. Downey, in a wide-ranging interview with the Impartial Reporter, said that it had got to the stage that the Trust “did not want to be fighting fires every day in South West Acute Hospital” in relation to recruitment issues.

He also stated that “there will be difficult conversations to be had” in terms of future service provision and that “people cannot expect that every single service will be in every single hospital.”

Mr. Doweny, however, is adamant that Pathfinder is “unique, fresh and hasn’t been tried anywhere else” and is a “genuine attempt” to ensure that people have their say on what they believe the future of health provision should look like.

“Pathfinder is different. This is the biggest piece of community engagement that I have ever been involved with and I think the Trust will ever be involved with. We will only get one shot at this and we have put our heads above the parapet and said we need to do something different.” he said, before adding:

“There is an old saying; ‘If you continue to do what you continue to do you will always get what you always get’. What we have done in the past, it has sustained us and we have managed it but there has been some stumbling through and I know in my own heart that we can do it better.”

Mr. Downey believes that ensuring the best health care provision in the region requires the marrying together of various strands including a well-functioning network of services across the Trust area, improvements in domiciliary care, more services aligned with GPs, better recruitment of staff and the need

Speaking specifically on the issue of services within the South West Acute Hosipital Mr. Downey wanted to assure people that he was focused on making the hospital “work as hard as possible for local communities”:

“The South West Acute Hospital was hard fought as was the Omagh Hospital and Primary Care Complex. They are here to stay, we have invested in them and we are very lucky to have them but we need to make sure that they work as hard as possible for local communities.”

However, Mr. Downey did admit that there were difficult conversations to be had in terms of the location of some services:

“We also have to realise that we can’t have every service in every hospital. It is just not possible, and I know that that will be a difficult conversation to have with people. We have to look towards a network to provide the services. South West Acute Hospital will be part of that network and people will be travelling there to utilise certain services while other services may be located elsewhere within the network. But we should not feel under threat. It is about how best can we deliver the services and ensure that where gaps arise doctors can easily transfer from one place to another.”

Engagement Programme and future information on Pathfinder can be found at this link from next week:

The Impartial Reporter also asked Mr. Downey about a number of specific issues surrounding South West Acute Hospital and health care in the county and region:


When the Pathfinder initiative was first announced press releases focused on South West Acute Hospital and its future role and cited the Pathfinder initiative that had been carried out in Newry to copper fasten the A&E department in Daisy Hill.

Over the following number of months official communication from the Trust indicated that Pathfinder would look at all provision within Fermanagh and West Tyrone and this led to criticism in some quarters that accused the Trust of moving the goalposts. It was put to Mr. Downey that it would have been better to name the initiative something other than Pathfinder, given the fact that it is regional based:

“If that would have helped then there is a lesson to be learned. I always look at things through a learning lens. I come at things from the basis that if that’s what people’s perception are then we have to look at it. What I would say is that why it was initially talked about as a SWAH pathfinder was because we were having a particular problem in the summer in obstetrics and we wanted to reassure our staff. There were reports in the media and elsewhere that were really doom and gloom and with the best of intentions we moved quickly to try and settle our own staff.”

“But I want to say that Pathfinder is different. People have challenged me and said ‘why are Fermanagh and West Tyrone putting their head above the parapet first. Would you not be better waiting to see what Newry or Belfast or someone else done and then ride on the back of that’ but we thought, why not go first.”



One of the major issues within Fermanagh has been fluctuating state of EMI provision. In short this is Nursing homes and care homes. Ashbrooke closed in 2017 and Drumclay is due to close in the coming months. We asked Mr. Downey about this effect and what needs to be done in the community to ensure better provision of services.

“We always talk about working hard to improve flow and that means that flow from the hospital into the community. When that is working well everyone benefits but unfortunately sometimes that flow can be interrupted by a range of things such as lack of EMI (elderly mentally infirm) provision and as a result people can be waiting in hospital longer, which is not what we want. We want a solution in the community. We have had issues in this area.

I met with GPs recently and I spoke to them about Pathfinder and they are up for this because they know that we need different solutions to this, especially around domiciliary care. But we also need to see can we fast track services, such as physiotherapy, so they exist alongside GPs. Because early intervention will help everyone. If we have one strap line that we want to use for Pathfidner it would be that it must be ‘The right care first time’. I know we will make a big difference by getting that right.”



Recent figures released by the Department of Health showed that South West Acute Hospital Emergency Department met the four hour target of admittance to hospital or discharge for 63.8 percent of patients. This was down from 78.9 percent for the same month last year. The Department of Health has a 95 percent target for this metric. It was also revealed that there was 900 percent rise in patients waiting longer than 12 hours for treatment. Mr. Downey was asked what can be done to improve the Emergency Department at South West Acute Hospital.

“We will be looking at it and we want to hear people’s experiences of ED. I think the department (of health) announced yesterday that they are going to do a regional review and when I heard that I thought, isn’t it better to get a look before that happens and take responsibility for our own services. We need to look and see if everyone who is coming needs to be seen in the ED, is there an alternative service we can provide and then how can we speed it up for people who do need the ED. We don’t want to see these increases. And we need to talk to people, especially in rural areas, who are so far away from emergency departments and see what their experience has been.”



During the summer it was reported that obstetrics and maternity at South West Acute Hospital were at crisis point due to “staffing issues”. This newspaper reporter that there was a shortfall in trainee doctors in particular, and that Junior doctors were placed not by the Trust or Department of Health but rather by the Northern Ireland Medical and Dental Training Agency (NIMDTA). A trainee doctor who spoke to the Reporter claimed that the emphasis from NIMDTA was to fill the larger centres first and that this could be a reason as to why SWAH was losing out. We put this, as well as the general point about recruitment pressures at the hospital, to Mr. Downey:

“We are working with NIMDTA day and daily and they are aware of the issues across the region. If we can get a better network established of doctors transferring across hospitals then you will see the junior doctors following suit in that manner and I think that will strengthen our hand greatly. We have to create the conditions to make doctors want to stay and I think we absolutely can do that.

“We got to the stage where we didn’t want to be fighting fires day in and day out because it takes up a lot of energy and it can be very expensive, for example, having to employ locums and agency staff to prop up services. And we thought we needed to get better value for the money

That is what pathfinder is about. We said to the department that we wanted to have a real look at Fermanagh and West Tyrone where the workforce issues were most acute.”