Reshaping general surgery services will produce better, safer and more consistent care for patients across NI.
That is the pledge from Health Minister Robin Swann as he today published a Review of General Surgery in Northern Ireland. It sets out standards that hospitals will be required to meet to continue providing emergency and planned (elective) general surgery.
These standards will help inform the wider design plan being developed for the future shape of hospital services in NI.
The Review maps out a new future for general surgery, which will involve changes to the current pattern of services. This will include establishing Elective Overnight Stay Centres. These will involve planned procedures for high volume, intermediate complexity cases where at least one night in hospital is required.
The Mater Hospital in Belfast is earmarked as the first of these new centres. Further locations will be identified in line with the wider design plan for the hospital system.
The Review emphasises the pressing need for change, given current issues of sustainability and keeping pace with the development of the specialty.
There have been major changes in general surgery over the last two decades with surgeons now more sub-specialised and focused on specific areas such as colorectal surgery, upper gastrointestinal surgery etc.
This means larger staffing teams are required, which can lead to recruitment issues and an increased reliance on locum cover. In addition, access to interventional radiology and endoscopy facilities is not consistent across the hospital network.
Across Northern Ireland, there is wide variation in performance across surgical specialties both with regard to time spent in hospital and the levels of surgery carried out as daycase.
A further challenge involves cancellation of planned general surgery procedures due to emergency surgery cases requiring staff and theatre space. This can be addressed by greater separation of elective and emergency surgery provision.
Launching the Review of General Surgery document, the Health Minister said:
“I very much welcome the development of these standards for emergency and elective general surgery.
“They will be used to drive decisions on the reshaping of services and will help inform the wider design plan initiative which I recently announced for our hospital network.
“The Review of General Surgery has been clinically led and I am very grateful to the review’s chair Professor Mark Taylor and colleagues for this vitally important work.
“The case for reshaping general surgery services is unanswerable. As this report underlines, we are not currently providing the best possible care for all our patients. Whilst our surgeons and wider multi-disciplinary teams do outstanding work, current arrangements do them a disservice.
“We must press ahead with changes to ensure better, safer and more consistent care for patients, wherever they live in Northern Ireland.”
Professor Mark Taylor, the review chair, is a Consultant in General and Hepatobiliary Surgery.
He stated: “I believe this Review will make an important contribution to the transformation of our health service. I am very pleased to have been involved in this work and I would like to express my sincere thanks to the many individuals who have contributed to it.”
Professor Taylor continued: “The changing nature of surgical speciality means delivering emergency general surgery across multiple smaller sites with a lower patient turnover is becoming increasingly difficult in terms of rotas, staff recruitment and retention, skill mix, and maintaining quality care.
“If we don’t secure change in a planned way, it will happen anyway in an unplanned and piecemeal fashion as services in a number of locations increasingly struggle to keep going.”
The evidence base for the Review has been established with reference to guidance from the Royal Colleges, Association of Surgeons of Great Britain and Ireland (ASGBI), CEPOD, Nuffield Trust and NHS organisations including Getting It Right First Time (GIRFT), regulatory bodies and benchmarking programmes.
The evidence based standards for both emergency and elective general surgery have been developed and refined with input from all general surgeons in Northern Ireland, other clinicians, HSC Trusts, managers and service users.
• General Surgery is a wide-ranging surgical specialty that focuses on diseases of the alimentary (digestive) tract. Over the years more sub-specialism has developed across general surgery; for example, colorectal surgery, upper gastrointestinal surgery etc.
• Elective general surgery means surgery that is planned in advance, as opposed to emergency or unplanned treatment.
Emergency general surgery relates to the treatment of patients presenting with conditions such as acute abdominal pain, infections, bleeding and trauma.
• The Review of General Surgery was commissioned by the Health Minister last year. It sets out required standards for both emergency and elective general surgery. The aim is to achieve better patient outcomes, shorter hospital stays, consistency of quality care across Northern Ireland and enhancement of best practice.
• The Review sets out why changes are required to the way general surgery services are provided. The status quo is not providing resilient services or consistent care across NI.
There is currently wide variation in performance across surgical specialties both with regard to time spent in hospital and the levels of surgery carried out as daycase.
Key issues include: staffing challenges with greater sub-specialism within General Surgery meaning more surgeons are needed to provide the full range of care; cancellation of planned procedures due to theatre and staff being required for emergency cases; variations in access to interventional radiology and endoscopy facilities; achieving the sufficient patient throughput levels needed for training and development and maintenance of skills.
• In terms of elective general surgery, the Review recommends the development of Elective Overnight Stay Centres. These will involve planned procedures for high volume, intermediate complexity cases where at least one night in hospital is required.
These Centres will complement the work of daycase elective care centres, which cover a number of medical specialties including general surgery. NI’s first two daycase elective care centres are located at the Lagan Valley and Omagh hospitals.
• The standards for emergency surgery set by the Review will also inform the re-shaping of services. Some hospitals as currently configured will not meet these standards.
Prior to March 2022, there were emergency surgical units in eight hospital sites in NI. In March 2022, emergency surgical services were suspended at Daisy Hill Hospital, due to issues sustaining a consultant surgical rota. Emergency general surgical services are currently provided at all the remaining seven sites.