Staff are battling constant conflict and verbal abuse, following the suspension of emergency surgery at South West Acute Hospital in Northern Ireland. 

Staff at South West Acute Hospital (SWAH) feel “constantly in conflict” with each other as they continue to grapple with the suspension of emergency general surgery, which sees some patients transferred to a different site up to an hour and a half away. 

Under-pressure workers also describe being verbally abused by patients and relatives frustrated at waiting times in A&E and being moved to Altnagelvin Hospital, in Londonderry, a report by the Regulation and Quality Improvement Authority (RQIA) outlines. 

RQIA investigators examined how well the system is working after emergency general surgery was suspended at SWAH in December 2022, because there weren’t enough surgical staff. 

While the report paints a bleak picture of hospital and ambulance staff morale, progress has been made in other areas. Fewer patients need to travel to Altnagelvin thanks to more robust assessments and 97% of those who are transferred now go straight to a surgical bed, rather than waiting in the emergency department. Western Trust has also increased the number of surgeons and improved consultant cover. 

Between November and February, inspectors spoke to doctors, nurses, managers, ambulance personnel, patients and relatives to build a picture of how the service operates more than three years after the changes were introduced.

Broken down

Among the concerns raised were the delays waiting for ambulances, disagreements over the urgency of transfers, poor communication and uncertainty over who was responsible for patients while they waited to be moved.

Emergency department teams at SWAH said they often found themselves caught between anxious relatives demanding answers and ambulance crews dealing with competing pressures across Northern Ireland. Things have got so bad that the “professional relationship” with ambulance staff has “broken down”, the report says. 

Meanwhile, crews expressed concern about the impact repeated transfers had on emergency cover elsewhere and some were experiencing burn out due to the on-going issues. 

The watchdog said Western Trust has evidence of good clinical outcomes for patients who spend time in the in-patient surgical wards at Altnagelvin Hospital and has made “significant improvement” in the direct-to-bed admissions for transferred patients from SWAH.

However, it is clear that further improvements are needed, with the RQIA issuing four formal recommendations covering communication, working relationships, continued monitoring and the handling of incidents.

Western Trust said the findings demonstrate “continued improvement in patient outcomes” while also identifying further opportunities to strengthen the system, which are being implemented.