By
The South West Acute Hospital in Co Fermanagh. Photo courtesy John McVitty, The Impartial Reporter
“IT'S got such a poor reputation now that people don’t want to work there.”
Former doctors at the South West Acute Hospital (SWAH) in Co Fermanagh have claimed that widespread mismanagement is putting patient safety at risk.
Several doctors who used to work at the Enniskillen hospital spoke to The Detail to raise their concerns about how the facility, which was only officially opened in 2012, is being run.
The doctors, all of whom have left the hospital in recent years, said they feared for the safety of patients, with some stating they had raised complaints which had been ignored or not properly addressed.
The doctors, most of whom did not wish to be named, highlighted a string of issues including:
- Complaints about patient safety being ignored
- Poor management
- Severe understaffing
- Huge issues with the recruitment of staff
- An over-reliance on costly locum cover
- Difficulty accessing theatres
- A toxic culture which has led to staff being severely overworked
Emergency general surgery has been suspended at the hospital since November.
The Western Trust, which runs the hospital, said it suspended surgery for public safety reasons after it struggled to recruit consultant general surgeons to SWAH.
A public consultation on the service closed last month.
The Trust’s board will discuss the outcome of the consultation at a meeting this summer, however any decision to permanently stop emergency general surgery will need approval from the Department of Health and any future health minister.
Essam Gharib, a former consultant surgeon and director of surgery at the hospital, said that SWAH needed to become a regional centre for particular specialisms if it is to survive.
“Many times I explained to the powers that be that to recruit and successfully retain doctors, we have to have specialities,” he said.
“I suggested to them to place bariatric surgery for Northern Ireland in SWAH, which would have been ideal for the whole health services in Northern Ireland.
“Also continuing colorectal surgery would provide the consultant number for emergency rota of seven to eight consultants.
“Adding two breast surgeons, with providing pathology services on site on operative days or the following day results, would even increase the number of consultants further.”
He added: “If these specialities are provided in SWAH, there will not be any difficulty in recruiting and retaining doctors. It’s a dream place to live in, knowing by talking to young trainees."
South West Acute Hospital in Co Fermanagh. Photo courtesy John McVitty, The Impartial Reporter
Other doctors echoed Mr Gharib’s concerns.
One described the Trust as “hopeless”, adding that SWAH “needed an identity” as a regional centre for some specialisms.
The doctor said there was a “lack of clinical leadership” because the hospital “didn’t want the doctors in charge”.
They said they had raised concerns about procedures which they felt were “putting patients at risk” but had been dismissed.
The doctor said there was “a very heavy dependence on locums and no scrutiny or structure on the management”.
“I was very happy there (in Co Fermanagh) and it broke my heart to leave,” they said.
A third doctor said staff were expected to deal with “unbelievable” amounts of work.
“There is a sick organism there. The only thing they do is have meetings,” they said.
Mismanagement
A fourth doctor said they believed the hospital was being mismanaged.
They claimed they had made several complaints that patients’ cases were not being managed properly, but were ignored.
“In the NHS there is a whole story of poor managerial practice, people ignoring stuff, just thinking more about public image rather than patients,” they said.
They added: “In Northern Ireland there doesn’t appear to be any strategic oversight by the Department of Health.”
A fifth doctor said the hospital’s reliance on costly locum cover was growing because “it’s got such a poor reputation now that people don’t want to work there”.
“You look at the high staff turnover - if you’re going to be working there you’re going to be under extreme pressure because there’s not enough staff,” they said.
They said the hospital had “no leadership” and that they felt “ground down” by the working culture.
“There can be a lot of toxicity in some of the departments,” they said.
They added: “And then they wonder why junior doctors don't want to go and work there.”
The doctor said they did not understand how the hospital was being managed.
“It’s strange because they have a brand new hospital,” they said.
They added: “They’ve taken away (emergency) surgery. Did they really think about that because now all the obstetricians and gynaecologists are leaving.
“What did they think is going to happen next - no obs and gynae, no paediatrics, anaesthetics will go - it’s a whole knock-on effect.”
Another doctor - the sixth The Detail spoke to - highlighted issues including the lack of an acute orthopaedic service at the hospital.
They said they had such difficulty in accessing theatres for surgery that they feared “I'll just lose my competence if I stay there longer”.
They added that one of their patients included a young woman who had been given an urgent referral but was waiting to see a surgeon as an outpatient for five years.
Western Trust
A spokeswoman for the Western Trust said patient safety is “fundamental to the Western Trust’s commitment to delivering high quality, patient and client focused services and the Trust has systems for reporting patient safety concerns”.
She said the Trust also has a “robust serious adverse incident investigation process”.
“All SAIs are taken very seriously by the Trust and the public should feel reassured that the Trust has systems in place and that learning from SAIs is shared across all of the services to prevent any possible future reoccurrence and to minimise the impact of such incidents,” she said.
She said that trusts across the UK are experiencing staff shortages and that the Western Trust had particular problems “due to its distance from the major population centre”.
“It is important to provide safe and high quality care in our hospitals and in our community facilities, to that end the use of locum doctors is unavoidable,” she said.
She added that the Trust has processes to “encourage any staff member or senior leaders within the organisation to raise concerns on all issues”.
On concerns about difficulty accessing theatres, the spokeswoman said: “Due to theatre staffing challenges at SWAH in previous months a number of theatre sessions were not scheduled.
“However, theatre staffing has now been resolved and theatre capacity for elective procedures has increased and the Trust will be back to commissioned levels by June 2023.”
Department of Health
A spokeswoman for the Department of Health said Northern Ireland’s five health trusts and trade unions are working with the department “in developing a regional framework policy which sets out the accountability and governance within HSC organisations to encourage people to engage with the process for raising a concern and ensure they feel safe while doing so”.