Opinion

Deirdre Heenan: We need to be honest with the public over hospital changes

The Western Health and Social Care Trust has been criticised for its messaging about the removal of emergency general surgery from the South-West Acute Hospital (SWAH) in Enniskillen.
The Western Health and Social Care Trust has been criticised for its messaging about the removal of emergency general surgery from the South-West Acute Hospital (SWAH) in Enniskillen. The Western Health and Social Care Trust has been criticised for its messaging about the removal of emergency general surgery from the South-West Acute Hospital (SWAH) in Enniskillen.

Not surprisingly there has been anger, dismay, fear and confusion since it was announced by the Western Health and Social Care Trust that emergency general surgery was to be removed from South-West Acute Hospital (SWAH).

Much of the distress and alarm could have been avoided by management of the trust levelling with the public, outlining clearly what this means for the hospital and equally important what it does not mean.

Instead, what ensued was the proverbial dog’s dinner of mixed messaging, incoherence, and hysteria. It is hard to imagine how such a sensitive, emotive issue could have been handled any worse.

Many initial reports suggested that the knock-on effect of this would inevitably place a question mark over the long-term sustainability of the entire hospital. Twitter’s army of armchair commentators were quickly on the case to add their tuppence worth. This was depicted as a conspiracy to remove services from rural communities, a slippery slope, the beginning of the end for emergency health care in Fermanagh.

The ham-fisted communication by the Western trust has damaged relations and further eroded confidence and trust in the management of health and social care. Honesty is essential when dealing with difficult, complex decisions. Suggesting on the one hand that this decision is due to the inability to recruit and retain staff, whilst on the other hand stating that centralising general emergency surgery is desirable as it would ensure better outcomes, is contradictory.

Why is the trust actively recruiting for positions that are clearly unsustainable? Following a special meeting in October to discuss the removal of this specialism the Western trust chief executive said the local health management body wanted to “be up front with the public” about the issue. Yet to date they have been anything but. Why is this being described as a temporary decision? Have the Western trust decided letting the public down gently is the easiest option? Also attending a fraught public meeting in the town hall in Enniskillen virtually from Derry hardly demonstrates respect for the local population.

GP Shortage by Ian Knox
GP Shortage by Ian Knox GP Shortage by Ian Knox

It is hard to believe that the truth is so hard to deliver. The Review of General Surgery published in June 2022 noted that delivering this specialism across a wide number of sites was neither appropriate nor feasible. Travelling to bigger units gives better outcomes and is safer than continuing with poorly resourced units reliant on locums. It concluded that the status quo was not providing resilient services nor consistent care across Northern Ireland. There was an urgent need to reconfigure provision to improve the efficiency and quality of care.

The SWAH has struggled for years to recruit and retain consultant general surgeons. The decision to pull the plug should have been made years ago, rather than limping along via extortionate locum payments.

To date clinical input into long running debates on the future configuration on vital services has been extremely limited. Consultants are usually notable for their silence, preferring to steer clear of controversy and leave the politics to others. However, in a welcome move, consultant general surgeon Barry McAree put his head above the parapet to inform the debate. He stressed that this move should have happened a long time ago, adding if the Bengoa review been properly implemented this change would have happened in a more planned, controlled fashion. His position was supported and reinforced in a public statement from his clinical colleagues who were also involved the Review of General Surgery.

We are now subject to an almost daily diet of stories illustrating a system struggling to cope with extreme, relentless pressures. The focus is on fire-fighting, rather than implementing planned changes. Waiting lists have spiralled out of control with one in four people currently waiting for care, the worst cancer waiting times in the UK, hospitals operating at over 100 per cent, ambulances queuing outside emergency units and thousands waiting on social care packages just some of the issues. Our health and social care system is bedevilled by poor productivity, fragmentation, ineffective governance, and a lack of accountability. The sense of a system out of control and heading towards a cliff edge is seeping into the public consciousness.

A lack of political courage, an unwillingness to take difficult decisions, has meant health care reform has been long promised here but hasn’t happened. There is almost unanimous political agreement that change must happen, but no one actually wants to grasp the nettle. Dithering, delay and drift means transformation has stalled. When the reconfiguration of services becomes a reality, parish pump politics raises its head and the entirely predictable refrain of “save our local services” rings out.

Trust and faith in the healthcare system is ebbing away and that is dangerous. There is a long-term future for SWAH as a centre for excellence in elective care which will see a team of surgeons based in Enniskillen and ensuring that the state-of-the-art theatres are fully utilised. Having a local hospital provides prestige, employment and understandably people will fight to protect services. Buy-in from the public requires information honestly delivered by respected, trustworthy sources, information that may seem counter-intuitive, information that is viewed as a matter of life and death.

Of course, people are going to be suspicious, long held beliefs are challenged and that is why timely, candid communication is crucial.