Surgeon warns Northern Trust emergency surgery model is ‘fragile’ amid workforce pressures

The debate continues around the allocation of medical services between the Northern Trust’s Antrim Area Hospital and Causeway Hospital. Inset: Dr Eunice Minford, clinical director of surgery

Clinical director tells Trust board safety cannot be guaranteed if service reaches a ‘point of collapse’

A leading consultant surgeon has warned that the Northern Health and Social Care Trust’s current emergency general surgery model is “fragile”, as she set out the case for consolidating the service at Antrim Area Hospital.

Speaking at a meeting of the Northern Trust board at Antrim Hospital on Thursday morning, Dr Eunice Minford, clinical director of surgery, highlighted why she believes the proposed change is “necessary at this time”.

Emergency general surgery is currently provided across both Antrim Area Hospital and Causeway Hospital in Coleraine.

The Northern Trust has recommended to the Department of Health that emergency general surgery should be consolidated at Antrim, while Causeway would have an increased focus on planned, or elective, surgery.

However, the proposal has not yet been approved.

Department of Health officials told Stormont’s Health Committee last week that no decision had been reached and that the process was “not complete”, with the Department awaiting a business case from the Northern Trust.

‘Patient safety is at the heart of everything we do’

Addressing the board, Dr Minford stressed what she described as the four key considerations behind the proposed change: safety, sustainability, standards and specialisation.

“Patient safety is at the heart of everything we do. To have patient safety, we require a sustainable workforce,” she stated.

“Emergency general surgery hubs will have all the resources that are required and make sure the patient gets the operation they need by an expert surgeon in that field.”

Dr Minford also highlighted the need for a workforce model capable of recruiting and retaining staff.

While stressing that the current service is safe, she described the model as “fragile” and warned that safety “cannot be guaranteed” at a “point of collapse”.

She highlighted pressures including consultant vacancies and “unexpected gaps” caused by illness, resulting in “high locum dependency”.

Dr Minford also described a weekend on call as “quite an onerous workload for one consultant to manage”.

She said the Trust has “an ageing surgery cohort”, with many surgeons aged over 50, while “younger, fitter surgeons” are also finding weekend shifts difficult.

Trust highlights reliance on locum surgeons

Dr Minford told the board that Causeway has six consultants, with four on the rota and two locums, while Antrim has 10, with 4.5 on the rota and 5.5 locums.

She said this places “extra pressure on permanent consultants, contributing to burn-out and stress”, which can in turn affect staff retention.

Consolidating emergency surgery on one site, she argued, would create a “larger pool of surgeons”.

Dr Minford also noted that the Northern Trust is the only health trust in Northern Ireland operating general and emergency surgery across two sites, creating the challenge of sustaining two separate on-call rotas.

She told the board that both elective and emergency surgery could be strengthened by allowing each hospital to focus on its primary purpose and concentrate expertise.

“An elective hub means elective surgery can be done at high volume. This results in improved waiting times,” she continued.

“This is a fantastic opportunity for Causeway Hospital to become a major centre for elective surgery with high productivity doing high volume surgery to become a centre of excellence and a surgical training hub.”

‘Doing nothing’ is not an option

Dr Minford warned that “doing nothing” was not an option.

She highlighted concerns about losing consultant surgeons, difficulties with recruitment and an increasing dependence on a “shrinking locum group”.

If emergency general surgery remains across both sites, she said, the Trust risks reaching a position where it does not have the skilled workforce required to sustain two emergency surgery on-call rotas.

Trust board chair Anne O’Reilly said:

“You have reaffirmed and reiterated what needs to be done for us in relation to the future of emergency general surgery. You have made your position extremely clear and made us acutely aware again of the fragility of issues around the workforce. That has been made crystal clear.”

She reiterated the Northern Trust’s commitment to the recommendation it made in May 2025 and said it would “continue to keep working towards that”.

The proposal remains subject to approval by the Health Minister and Department of Health before any change can be implemented.