Surgical bodies warn Health Minister against further delays to emergency surgery reform

Entrance to Causeway Hospital site in Coleraine.

Three leading surgical organisations have written to Northern Ireland’s new Health Minister Robbie Butler MLA warning that further delays to reforming emergency general surgery risk worsening workforce pressures, limiting access to care and widening inequalities in patient outcomes.

The intervention comes amid continuing debate over the future configuration of emergency general surgery in Northern Ireland, including the Northern Health and Social Care Trust’s recommendation to centralise emergency general surgery at Antrim Hospital while concentrating the majority of planned general surgery at Causeway Hospital.

The three professional bodies have urged stakeholders to ensure recommendations arising from Northern Ireland’s Emergency General Surgery (EGS) Review can progress “without further delay”.

However, their joint statement supports the principles and implementation of the wider Northern Ireland review. It does not specifically endorse the Northern Trust’s proposal for Causeway and Antrim hospitals, which remains subject to Department of Health assessment and an eventual decision by the Health Minister.

Surgical leaders warn against further delay

The letter to Mr Butler was issued jointly by the Association of Coloproctology of Great Britain and Ireland (ACPGBI), the Association of Upper Gastrointestinal Surgeons (AUGIS), and the Association of Surgeons of Great Britain and Ireland (ASGBI).

It was signed by Professor Jim Khan, President of ACPGBI; Mr Andrew Smith, President of AUGIS; and Mr Christian Macutkiewicz, President of ASGBI.

The organisations said they are “concerned by recent developments in Northern Ireland that risk further delaying the implementation of the review of Emergency General Surgery (EGS) services in Northern Ireland”.

The letter does not specify which recent developments the organisations are referring to, but it is understood to be addressing the political change if direction and ongoing controversy surrounding Northern Trust’s vision for changes with emergency surgery at Causeway, and Antrim Area hospitals.

Representing surgeons across the UK and Ireland, the three associations pointed to significant pressures already facing surgical services.

“These challenges include persistent workforce pressures, difficulties in maintaining sustainable emergency services, and unacceptable delays in access to both emergency and elective surgical care,” they said.

“We are particularly concerned that Northern Ireland continues to experience some of the poorest cancer waiting time performance in the UK, with direct consequences for patients and healthcare staff.”

Decisions should be based on clinical evidence

The associations emphasised that the Emergency General Surgery Review was clinically led and developed following extensive engagement with healthcare professionals, service leaders and external stakeholders.

They said its recommendations reflect “the realities of modern surgical practice” and are consistent with the direction of travel elsewhere, where specialised and emergency services are organised to ensure patients can access safe, timely and consultant-delivered care.

The three bodies placed particular emphasis on the evidence that should determine how surgical services are configured.

“The three Associations strongly support the principle that decisions regarding the configuration of surgical services should be informed by clinical evidence, patient outcomes, workforce sustainability and population needs,” they said.

“Whilst recognising the importance of public and political engagement in healthcare planning, we believe that long-term service transformation must remain grounded in the best available clinical evidence and prioritise the safety, sustainability and quality of patient care, both in elective and emergency settings.”

They added:

“We therefore urge all stakeholders to work collaboratively to ensure that the recommendations arising from the Northern Ireland Emergency General Surgery Review can progress without further delay.”

Warning over consequences of failing to modernise

The surgical organisations also issued a direct warning about the consequences of failing to reform services.

“Failure to modernise surgical services risks perpetuating existing workforce pressures, limiting access to care and widening inequalities in patient outcomes,” the joint statement said.

The three bodies concluded by offering their support to clinicians, healthcare organisations and decision-makers responsible for reshaping services.

“We stand ready to support colleagues, healthcare organisations and decision-makers across Northern Ireland in advancing clinically led, evidence-based service reform and in delivering sustainable, high-quality surgical care for the patients and communities they serve.”

Why Causeway is at the centre of the debate

The intervention comes at a significant point in the long-running debate over emergency general surgery in the Northern Trust, with the future configuration of services at Causeway and Antrim hospitals still awaiting a ministerial decision.

The Department of Health’s Review of General Surgery established standards aimed at ensuring emergency and elective surgical services could be delivered safely and sustainably amid workforce pressures and changing clinical practice.

The Northern Trust has said those standards cannot be fully met while maintaining the existing configuration of emergency and elective general surgery across both Antrim and Causeway hospitals.

Following public consultation, the Trust board approved a recommendation in May 2025 to centralise emergency general surgery at Antrim Hospital, while the majority of planned general surgery would take place at Causeway.

At the time, then Northern Trust chief executive Jennifer Welsh issued a stark warning over the sustainability of maintaining emergency general surgery at both acute hospitals.

She said 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 recommendation cannot, however, be implemented by the Trust alone. It requires Department of Health consideration and ultimately approval by the Health Minister.

That process remains unfinished.

Department says no decision has been made

Appearing before Stormont’s Health Committee on Thursday, senior Department of Health officials stressed that no decision had been taken on the Northern Trust proposal.

Mike Farrar, interim Permanent Secretary at the Department of Health, told MLAs that when the general surgery review was published, the “status quo was not meeting the standards confirmed in the review”.

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

“No proposals have been put at this point to ministers and no decision had been taken,” Mr Farrar said.

“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.”

The issue now falls within the portfolio of new Health Minister Robbie Butler, who succeeds fellow Ulster Unionist Mike Nesbitt at a time when the future configuration of hospital services remains under significant political and public scrutiny.

At Thursday’s committee meeting, MLAs raised questions about rurality, ambulance response times, capacity at Antrim Hospital, transparency around the evidence used to reach a decision and the potential wider consequences for Causeway Hospital.

Concerns over wider future of Causeway

Department officials sought to distinguish the proposed change to emergency general surgery from the wider future of Causeway Hospital itself.

Mr Farrar acknowledged concerns surrounding the hospital, telling MLAs:

“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 also made clear that improved health outcomes would be fundamental to whether officials ultimately recommend the Northern Trust proposal to 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.

What would actually change at Causeway

Department officials told MLAs the proposal relates specifically to specialist emergency abdominal surgery and would not mean patients could no longer attend Causeway Hospital when requiring emergency care.

Tracey McCaig, interim chief operating officer of the Strategic Planning and Performance Group (SPPG) at the Department of Health, said most patients would continue to attend Causeway for assessment, pain relief and treatment, with transfer required where clinically appropriate.

“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,” she said.

Ms McCaig said the number requiring transfer was expected to be limited.

“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 also stressed there would be no change to the existing trauma network.

“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.”

Causeway emergency department will remain

Department officials also explicitly ruled out plans to close Causeway Hospital’s emergency department.

Ms McCaig emphasised that there would continue to be a “level one ED (emergency department) service” at Causeway.

When North Belfast Alliance MLA Nuala McAllister later asked directly whether the Department planned to close the emergency department at Causeway Hospital, the Department’s response was: “No”.

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

The Department has also said Antrim Hospital’s ability to accommodate additional emergency surgery patients will form part of its assessment of the Northern Trust proposal.

Clinical voice added to continuing debate

The joint intervention by ACPGBI, AUGIS and ASGBI now adds the collective voice of three professional surgical organisations to the wider debate facing Mr Butler as he takes responsibility for Northern Ireland’s health service.

Their letter does not determine what should happen specifically at Causeway and Antrim, nor does it explicitly endorse the Northern Trust’s proposed configuration.

It does, however, deliver a clear message to the new Health Minister and other decision-makers on the wider reform programme: decisions about surgical services should be driven by clinical evidence, patient outcomes, workforce sustainability and population need — and implementation of the Emergency General Surgery Review should not face further delay.