Patients’ concerns as hospital shake-up consultation closes

Equal access to healthcare across Northern Ireland and ensuring services are convenient for older people are among public concerns over plans for a new hospital network.

A six-week consultation – which closes on Friday – has been gauging public opinion.

The proposed plans would see services spread and shared across counties and patients expected to travel further for specialist treatment.

The Department of Health (DoH) said the consultation was not about proposed service changes and that any reorganisation would be subject to engagement with local communities.

Some of those who took part in public meetings told BBC News NI that people living in rural areas must not be treated like “second class citizens”.

Others said they had “no trust in management” and called the consultation a “tick box exercise”.

A DoH spokesperson said the consultation had “successfully facilitated engagement across NI and contributed to the vital debate on the future of health and social care services”.

“The purpose of the reconfiguration framework consultation is to seek views on how our hospitals can cooperate more effectively as a network to best serve the population,” they added.

Public bodies have a legal duty to consult the public when they are proposing to change how and where services are delivered.

The consultation looks at why hospitals need to be reconfigured or changed and how the proposed new system would be managed as an integrated network.

It is also looking at what particular medical services could be delivered at particular locations and the timing of reviews which could lead to changes in the future.

Helen O’Sullivan – who lives in the Western Health Trust area – said the people of County Fermanagh should not be treated as second class citizens and should have access to emergency general surgery at the South West Acute Hospital (Swah) in Enniskillen.

“Many people here are two hours plus from Altnagelvin [in Londonderry] or Craigavon – so our everyday reality has to be considered,” she said.

The proposed new network would retain the current model of four categories: Area, general, local hospitals and regional centres.

• Area hospitals are NI’s largest hospitals, offering emergency and planned treatment, with 24-hour emergency departments, paediatrics, obstetrics, specialised clinical teams and critical care
• General hospitals would include unscheduled (unplanned for) care, but geared to a specific more isolated geographical location. These hospitals will compete with the area hospitals for resources
• Local hospitals would continue to offer a broad mix of community services including diagnostic and mental health support, but if they are to remain open, they will have to justify that they meet their population’s needs and are cost effective
• Regional centres would deal with the likes of breast cancer, strokes, cataracts, and neurology, with the aim of reducing hospital waiting times

Reshaping the hospital network has been debated for decades, but Health Minister Mike Nesbitt insisted this was the first roadmap aimed at a clear path to recovery for services.

Change requires potentially difficult political decisions.

While the document does not pinpoint where all the new medical speciality hubs will be located and which services or even hospitals may close, it does spell out that “all hospitals will not do all things”.

Nesbitt said it was not about cost cutting or closing hospitals but “ensuring effective use of space and resources”.

Some critics have said the document does not come close to informing the public about what those changes might mean.

It does not spell out specific changes, but hints at services being more streamlined and travel essential if patients want a timely diagnosis.

At public meetings in the Northern Health Trust, some people said they were “shocked with the lack of detail” and they found the document “vague and shady”.

Others said it lacked population data, which is necessary to assess how a health trust must adapt to the changing needs of its population.

Gemma Brolly – who lives in the Northern Trust – said the needs of an ageing population were critical.

“All we ever hear is about our older population on the north coast, and yet if we continue to take services away and centralise services in other trusts, how are those older people going to reach those places?” she said.

According to the DoH, staff are stretched across too many hospitals, which causes services to collapse.

Centralising would create a more resilient service and properly managed change should in time deliver savings, it has said.

That network would deliver unscheduled, elective and community hospitals across Northern Ireland and – according to the DoH – make the best use of existing buildings.

The locations of the general hospitals of Swah, Daisy Hill in Newry and the Causeway in Coleraine, and the services they will deliver, is perhaps the most contentious area of the plans.

There has been public opposition to changes and proposed moves made to emergency general surgery and maternity services at these sites.

Their geographical locations and challenge of maintaining rotas are their biggest challenges which makes some of their services vulnerable.

People living in the Southern Health Trust have said that if Daisy Hill hospital is downgraded further, lives will be placed in jeopardy.

Francis Gallagher from the SOS Daisy Hill Campaign group said rural areas were being forgotten about.

“People that need life-saving treatment and who don’t live close to Daisy Hill Hospital will not get that in time and they could die or if they had a stroke would be a lot worse before they reach Craigavon [Area Hospital],” he said.

To complete the consultation document, a detailed read of the 70 page Reconfiguration Framework Document published in July 2024 is necessary.

Readers then choose their response to questions from five options ranging from strongly agree, to strongly disagree.

This is just the start of a long process.

But the department says that to have your opinion noted and to make a difference the majority needs to take part.

Area hospitals: Belfast Hospitals Campus, Craigavon Area Hospital, Antrim Area Hospital, Ulster Hospital in Dundonald, Altnagelvin Hospital in Derry.

Local hospitals: Ards, Bangor, Dalriada in Ballycastle, Downe in Downpatrick, Lagan Valley in Lisburn, Lurgan, Mid-Ulster in Magherafelt, Moyle, Omagh, Robinson in Ballymoney, South Tyrone in Dungannon, Waterside in Derry, Whiteabbey.

General hospitals: Swah, Daisy Hill, Causeway

Regional centres: Royal Victoria Hospital in Belfast, Royal Jubilee Maternity Hospital in Belfast, Royal Belfast Hospital for Sick Children, Musgrave Park Hospital in Belfast, Belfast City Hospital including the Cancer Centre; Altnagelvin North West Cancer Centre in Derry.