No decision made on future of emergency surgery at Causeway Hospital

Causeway Hospital

Friday 21 August 2026

No decision has yet been made on the future of emergency surgery at Causeway Hospital in Coleraine, MLAs have been told, with Department of Health officials stressing that the assessment process remains “not complete”.

Officials also told Stormont’s Health Committee that there are no plans to close Causeway’s emergency department and said any eventual business case must demonstrate better health outcomes before it would be recommended to the Health Minister.

Northern Trust recommendation awaits approval

In May last year, following a public consultation, the Northern Health and Social Care Trust board approved a recommendation to centralise emergency general surgery at Antrim Hospital, while the majority of planned general surgery would take place at Causeway Hospital.

The Northern Trust covers the Antrim and Newtownabbey, Mid and East Antrim, Mid Ulster and Causeway Coast and Glens council areas.

The board’s recommendation requires the approval of the Health Minister and Department of Health before it can be implemented.

Then chief executive Jennifer Welsh warned at the time that the Trust “cannot continue to provide emergency general surgery across both our acute sites. If we do not act now and plan for service change, we are facing an inevitable collapse”.

The Trust has already indicated that Department of Health standards for emergency and elective surgery, contained within the Department’s Review of General Surgery, cannot be fully met without reconfiguration.

Process ‘not complete’

Speaking at the Health Committee meeting on Thursday (August 20), Mike Farrar, interim Permanent Secretary at the Department of Health, told MLAs that when the review was published, the “status quo was not meeting the standards confirmed in the review”.

He highlighted the need to consider how services should respond to ensure they are safe, reliable and sustainable as demand increases.

Mr Farrar said the Northern Trust’s consultation and recommendations were a “response to that review”, but stressed that the process is “not complete”.

“No proposals have been put at this point to ministers and no decision had been taken,” he stated.

“We will have to arbitrate when a business case is formally put forward to us and then there would be a recommendation to a minister and the minister will ultimately make a decision,” he explained.

Questions over rurality and ambulance response times

Committee chair and North Antrim Sinn Féin MLA Philip McGuigan expressed concern over the amount of “political instability” surrounding the resignation of outgoing Health Minister Mike Nesbitt and the appointment of incoming Health Minister Robbie Butler, both Ulster Unionist MLAs.

Mr McGuigan asked what information would be provided as part of the decision-making process and whether the “rurality of the constituency” served by the Northern Trust would be taken into account alongside ambulance response times.

He also questioned whether the minister would make a decision “based solely on clinical evidence and on the best possible outcome for residents as well as the health service and staff”.

Tracey McCaig, interim chief operating officer of the Strategic Planning and Performance Group (SPPG) at the Department of Health, gave an update on the process involved, saying there would be a “significant level of assessment”.

She highlighted the importance of improving outcomes for service users in the area and indicated that the proposed change relates to specialist emergency abdominal surgery.

‘Small handful a week’ could require transfer

Ms McCaig said the number of patients the Trust expects would be affected by the proposed changes is relatively small and stressed that most people would still attend Causeway Hospital for assessment.

“The numbers the Trust have proposed would be impacted are relatively small and it is important to say at this point that actually the expectation is that most people will still come to Causeway, to be assessed to be settled with pain relief, for example, and given a date, maybe the next day within enhanced services that will be there to be able to provide them, or in extreme circumstances, where that is not optimal for the patient, will be assessed there and transferred.

“The transfer they do not expect to be significant numbers. You’re talking a small handful a week at maximum – small, small numbers because again what they have got is a process to be able to manage to handle that.”

She stressed there would be no change to the “trauma network or services”.

“That will still continue as it is and if you have a major traumatic accident around Portrush (for example), you are unlikely to be in Causeway. You may end up in the Royal for treatment and for support.”

Ms McCaig also emphasised that Causeway would retain a “level one ED (emergency department) service”.

Wider impact on Causeway to be ‘stress tested’

Mr McGuigan sought an assurance that any decision would not have a “knock-on impact” elsewhere in Causeway Hospital.

Ms McCaig said plans would have to be “stress tested”, while the wider regional perspective must also be considered.

“The general surgery hospital network is simply that. It is a network. It is really important that we consider both from the elective, i.e. planned, and the unscheduled, the emergencies, that we understand it on multiple planes. That’s what we would be looking but we would want it to be clinically-led, evidence-based.

“What we have to review is: does it sit within the policy which is the general surgery standards. It’s a multi-faceted review and it’s not just about the surgery.

“It’s about multi-disciplinary teams, it’s about the nursing context, it’s about ICU (Intensive Care Unit), HDU (High Dependency Unit), so we have multiple levels across the Trust, and also ambulance. That is part of the considerations.”

Calls for transparency over final decision

Upper Bann DUP MLA Diane Dodds said communication had failed, arguing that otherwise there would not be “ongoing angry meetings and people feeling let down and people feeling services are being withdrawn”.

She asked whether the data presented to the new minister and used to inform the eventual decision would be published, underlining the importance of transparency with the Causeway community.

Ms McCaig said she did not foresee difficulty with this, while noting that the data is “not the only thing” informing the decision and that there is a “multiplicity of things” to consider.

Mrs Dodds went on to say people do not believe transformation will be “better than what they have”, arguing there are “not specific actions and everything is piecemeal”.

Mr Farrar acknowledged wider concerns surrounding the future of Causeway Hospital.

“A lot of the concern which is around at the moment about Causeway is that somehow this is a step towards a closure of that hospital when actually there’s investment in that hospital and its activity, levels will continue,” he said.

He stressed that demonstrating improved health outcomes would be central to any recommendation ultimately placed before the Health Minister.

“When any business case is finally put forward from us to the new minister, if it does not demonstrate that there will be better health outcomes, then we would not be recommending to a minister that this is something to do,” he said.

Questions over sustainability at Antrim

Committee vice-chair and East Antrim Alliance MLA Danny Donnelly told the meeting: “We have seen a reduction in elective work at Antrim over the last six years.”

He said the proposal involved a very specific type of surgery being relocated to make the service more sustainable on one site and indicated that the Northern Trust is the only Trust in Northern Ireland operating the surgery service across two sites.

Mr Donnelly asked about the current stability of emergency general surgery, particularly at Antrim, and the “likelihood of collapse”.

Ms McCaig said she had “no evidence one way or the other” regarding any possibility of collapse.

North Belfast Alliance MLA Nuala McAllister also questioned whether Antrim Hospital would have sufficient capacity to accommodate all of the additional emergency surgery proposed under the changes.

She was told that Antrim’s ability to manage additional patients would form part of the assessment.

Ms McAllister then asked directly whether the Department planned to close the emergency department at Causeway Hospital.

The response from the Department of Health official was: “No”.

Asked whether the Department would be able to continue delivering all of the other services currently provided at Causeway Hospital outside emergency general surgery, she replied: “Yes and investing.”