Northern Trust stands by Causeway surgery plan after Health Minister resigns

Causeway Hospital, Coleraine

The Northern Health and Social Care Trust has stood by its proposal to centralise emergency general surgery at Antrim Area Hospital, warning that the current two-hospital model is becoming “increasingly unsustainable”.

Its intervention follows Mike Nesbitt’s resignation as Health Minister after a political dispute with Ulster Unionist Party leader Jon Burrows over the proposed removal of emergency general surgery from Causeway Hospital in Coleraine.

The Trust said the change still requires a formal Department of Health decision and confirmed that it would respect the eventual outcome. However, it warned that a planned reorganisation remains preferable to the risk of an unplanned “service collapse”.

Decision left for incoming Health Minister

Mr Nesbitt’s departure leaves the proposal without a ministerial decision at a crucial point in the process.

The Trust’s preferred option would consolidate emergency general surgery at Antrim Area Hospital while placing most planned general surgery at Causeway Hospital.

A Northern Trust spokesperson said:

“The type of service change the Trust is proposing is subject to the Department of Health’s formal decision-making process. We remain committed to that process and will respect its outcome.

“Our priority is to ensure that the Trust’s general surgery service continues to be safe, stable and sustainable for our patients, staff and wider community.”

UUP leader Jon Burrows has said he expects to confirm a nominee for the health portfolio soon following discussions with party colleagues.

The incoming minister will inherit responsibility for deciding whether the Northern Trust’s recommendation should proceed, be changed or rejected.

Trust warns existing model is becoming unsustainable

Emergency general surgery is currently provided across Antrim Area and Causeway hospitals.

The Trust said maintaining a full emergency service on both sites is becoming increasingly difficult, particularly because of challenges providing continuous surgical cover.

Its spokesperson said:

“While we recognise the strength of feeling around our transformation proposals, the situation remains that the current model of providing emergency general surgery across our two acute sites is becoming increasingly unsustainable, and this was the basis of our Board’s recommendation in May 2025.

“We are also deeply aware of the concerns expressed by our surgical colleagues that it has become increasingly challenging to provide 24/7 emergency rota cover at both hospitals.”

Under the proposal, patients could continue to attend Causeway Hospital’s Emergency Department and be assessed there. Those requiring admission for emergency general surgery would be transferred to Antrim Area Hospital.

The Trust has previously maintained that Causeway would retain its 24-hour Emergency Department and continue providing acute inpatient and general surgery services.

Independent review backed consolidation at Antrim

The Trust said its proposal was developed following clinical engagement and an assessment of the existing service against Department of Health standards for emergency and planned surgery.

That work was carried out alongside members of the Trust’s surgical team.

The spokesperson said:

“The Trust’s proposal to transform General Surgery services has been informed by extensive clinical engagement and is in line with national policy, guidance and standards.

“As part of the development process, the Trust assessed its current service configuration against the Department of Health’s evidence-based standards for emergency and elective general surgery and concluded that our existing model requires transformation to meet the new standards. This assessment was undertaken in conjunction with the Trust’s surgical team.”

The Trust also disclosed that its proposal had been examined by Getting It Right First Time, known as GIRFT—a clinically led NHS improvement programme that uses service data, comparisons and established practice to assess safety, sustainability and patient outcomes.

GIRFT carried out an independent review of the proposed reconfiguration in March 2026.

According to the Trust, the review concluded that the current arrangement for emergency general surgery was not sustainable and found that consolidation at Antrim Area Hospital would be “clinically and operationally appropriate”.

Causeway concerns at centre of political dispute

The proposal has generated strong opposition across the Causeway Coast and north coast, where residents and representatives have raised concerns about longer journeys, ambulance capacity, pressure at Antrim Area Hospital and the potential effect on Causeway’s wider range of services.

Mr Burrows, who represents North Antrim, recently told a packed meeting in Coleraine that he supported retaining emergency general surgery at Causeway.

That intervention brought him into direct conflict with Mr Nesbitt, who accused the UUP leader of introducing a new political “red line” on an issue within his ministerial responsibility.

In his resignation letter, Mr Nesbitt wrote:

“This letter concerns the fact you appear to have introduced a second ‘red line’, regarding Emergency General Surgery at Causeway Hospital.

“I am not the sort of Minister who is happy to discover the Leader’s view of issues under my purview by having to monitor the media.”

Mr Nesbitt said he had offered Mr Burrows a way to manage the disagreement but had not received what he considered a timely response.

He said the UUP leader’s intervention had created “shock waves” across the health and social care system before confirming his resignation.

Burrows says reform cannot be done to communities

Mr Burrows subsequently said the UUP remained committed to meaningful health service reform but argued that how changes were delivered was as important as the decisions ultimately taken.

He said safe and sustainable services must remain the overriding priority, alongside action to address health inequalities and regional differences in access to care.

However, Mr Burrows acknowledged that he did not believe the correct balance had been achieved between clinical evidence, staff engagement and community confidence.

He said:

“Clinical evidence must be central to decision making, but reform cannot simply be done to communities. There must be genuine engagement with the clinicians and staff delivering services and with the people who depend on them.

“I don’t believe we have got that balance right, and the strength of feeling around Causeway shows what happens when communities feel decisions are arriving rather than being made with them.”

Mr Burrows has called for a Northern Ireland-wide discussion about the future of the health service in which the evidence, risks, costs, benefits and alternatives behind proposed changes are made transparent.

Trust warns against unplanned service collapse

Despite the political upheaval and community opposition, the Trust said it would continue trying to maintain safe services across both hospitals while awaiting a decision.

However, it warned that the existing arrangement could become impossible to sustain if staffing and rota pressures continue.

The spokesperson concluded:

“In the absence of a Ministerial decision, we will continue to do all we can as a Trust to ensure our general surgery service remains as safe and stable as possible, with patient safety our utmost priority.

“Our preference remains for a planned and managed change that will ensure we can avoid a potential service collapse.”

The debate now moves beyond whether Northern Ireland’s health service requires reform. The central question facing the next Health Minister will be whether the Trust’s clinical and operational case justifies centralising emergency surgery at Antrim—or whether another sustainable model can retain the service at Causeway while meeting the required safety standards.