It has emerged claims made by the Western Health And Social Care Trust (Western Trust) around the risks of employing locum general surgeons due to previous adverse incidents with patients were not exactly as stated.

During a special meeting on November 17, 2022 to brief Fermanagh and Omagh District Council on the emergency surgery crisis at the South West Acute Hospital (SWAH), a member of senior management explained the Western Trust had taken a decision to cease using locum surgeons due to concerning levels of Serious Adverse Incidents (SAIs) associated with this.

Setting out the difficulty in recruiting staff, Professor Ronan O’Hare told members: “We don’t have any surgeons. They are walking with their feet.

“It’s me who has to sit in front of relatives and explain to them and patients where things have gone wrong.

“We’ve had a series of locum surgeons come in. The Trust made a decision not to bring in any more locums and since that date we have had no Serious Adverse Instances.

“Before that, we had eight [SAIs] relating to 13 locum consultants.”

A Freedom of Information (FOI) request was submitted to the Western Trust asking for the basic reasons (for example, post-procedure haemorrhaging, secondary conditions, death) for the eight SAIs as a direct result/association with 13 locum consultants at the SWAH, as disclosed to councillors.

This  was submitted on November 21 2022 – four days after the claim was made – but it required a reminder on April 11 this year, having become seriously overdue, before a response was received a fortnight later.

This confirmed all eight incidents related to involvement of agency locum staff working within general surgery at the SWAH, between January, 2019 to October, 2022.

However, it stated these were in fact formally categorised as Adverse Incidents, with just one requiring escalation to the Serious Adverse Incident investigation process.

The response confirmed all Adverse Incidents and SAIs were investigated in accordance with Western Trust and Regional Policy requirements, but further details were refused because “the small number of incidents and detail requested has the potential to be identifiable and linked to individual patients and their families/carers” if released into the public domain.

According to the Department of Health, a SAI is defined as: “Any event or circumstance that led or could have led to unintended or unexpected harm, loss or damage”, whereas an Adverse Incident is: “Any event or circumstances that could have or did lead to harm, loss or damage to people, property, environment or reputation.”

If, as the FOI response stated, the Adverse Incidents – serious or otherwise – stopped in October, 2022, and even allowing for that to be the first of the month, it was just six weeks before the Western Trust announced the pending suspension of emergency surgical services at the SWAH, briefing councillors accordingly on November 17, 2022.

This meant the Trust effectively claimed the cessation of locum surgeons meant no Adverse Incidents for just overs just six weeks, when their concerns were sparked by eight incidents over the course of three years and 10 months.

The Western Trust was asked to provide the date of the decision to cease using locum surgeons and if it stands over the claims made around eight SAIs.

In response, a  spokesperson said: “Eight Adverse Incidents occurred between January, 2021 and October, 2022, which were primarily linked to care provided by locum surgical consultants.

“The Trust considered limiting the use of locum consultants but decided, in the interests of maintaining safe services locally for the population of Omagh and Fermanagh, that locum consultants would be used when it was appropriate and safe to do so.

“The last remaining locum consultant in general surgery at the SWAH was employed until January, 2023.”

As this did not provide the requested date of the original decision to stop using locum consultant surgeons, the question was sent back; however, the Western Trust has not responded at the time of publishing.

In addition, the response did not distinguish between what were originally deemed eight SAIs, which the FOI request showed was actually one at this level, with the other seven categorised as Adverse Incidents.