Family voices concerns over staffing levels at Altnagelvin

Patients and staff at Derry’s Altnagelvin Hospital are being severely negatively impacted by the suspension of emergency general surgery (EGS) at Enniskillen’s South West Acute Hospital (SWAH), it has been claimed.

Speaking to The Derry News, Helen Hamill from Enniskillen recalled the terrifying family medical emergency which highlighted the potentially fatal consequences of the SWAH EGS suspension.

She also voiced concern about the “intolerable pressure” it was putting on resources in Altnagelvin.

Ms Hamill’s father, also from Fermanagh, spent five weeks in Altnagelvin in March, as a result of the suspension of the SWAH EGS suspension.

“Daddy had upper and lower gastrointestinal bleeds and to be honest, we did not know if he would arrive at Altnagelvin alive or dead,” she said.

The decision to ‘temporarily’ suspend emergency surgery at SWAH was taken in December 2022 by the Western Health and Social Care Trust. At the time the Trust said it was necessary as it “faced challenges recruiting general surgeons to cover the emergency general surgical rota”.

However, the suspension remains in place, with emergency general surgery continuing from the Altnagelvin Hospital site.
In July, the Trust proposed all emergency general surgery services for its area be delivered from Altnagelvin on a permanent basis.

Following the intervention of Health Minister Mike Nesbitt, the Trust paused the public consultation on the proposal. Mr Nesbitt had cited “ongoing and repeated challenges with the delivery of the consultation exercise”.

Ms Hamill said she was recounting her family’s experience out of concern for every single patient and every member of staff and their well-being.

She explained: “We know the current situation in WHSCT is not sustainable. I want to give some details of our experience regarding NI Ambulance Service, Altnagelvin and SWAH.

“I actually detailed my concerns in writing to the Royal College of Nurses, and copied the Chief Executive of the Trust; the director of the Public Health Agency; and the chief executive the Regulation and Quality Improvement Authority (RQIA).

“It was not a letter of complaint about care. It was a letter representing the voices of the staff and what I had been told. It was on their behalf.

“Dad had a life-threatening intestinal bleed, in Enniskillen. He was taken to the resuscitation area in Altnagelvin in the only paramedic NIAS crew ambulance on cover that night. We were told at the time, had they been off-loading at Altnagelvin, dad would not have survived.

“So, I was two minutes away from my dad's house. The ambulance took two hours to get him gently to Altnagelvin, trying their best not to enable another bleed of the same quality. My sister and I followed the ambulance in an eerie silence, fully aware there was every likelihood when we got there my father would be dead.

“On reflection, having been through Altnagelvin and in three wards in SWAH, I have to say, it is terrifying to see the staff so poorly and severely depleted. Their reliance on agency nurses, locum doctors and university students is unsustainable.”

Ms Hamill said she had spoken to staff in all areas of all the hospitals.

“The nurses are consistently running at far less than the recommended safe staffing level on an ongoing basis,” said Ms Hamill.

“Dad was in an emergency surgical ward where the ratio is supposed to be one staff member to six patients. However, there were three nurses on that ward of 28 emergency surgical patients. The ward ran day and night, often with below 50% of safe guidance of core staff levels.

“The staffing was particularly challenging and frightening for us at night when dad needed blood transfusions with the associated monitoring that required. It was just not available.

“The staff were so run off their feet and they did not have time to take appropriate care of the patients. They have told us that they are doing their best and that they are escalating their concerns regularly but they are being ignored.

“Staff came to me and asked for me to shout, to keep shouting, to shout to politicians and I shouted back that they also needed to shout and they said that they did but they felt nobody listened to them.

“I am petrified when I think about the people with nobody shouting for them.

“One nurse in one night was covering 12 very sick emergency surgical patients. Two others were on 16 emergency surgical patients. One of those was a bank nurse.

“The bank staff on many occasions talked about their lack of status, their lack of fitting in, and about the lack of permanent posts which prevented them becoming permanent staff, full-time settled staff.

“I have had significant conversations with a number of nurses, managers, and doctors. All have told me they raised the issue of understaffing on the wards with senior management. If that is the case, then they are not being listened to.

“I am genuinely scared for the patients in the Western Trust. I have no doubt many patient outcomes must be adversely affected by the lack of adequate and appropriate staffing.

“This kind of care cannot be the norm. It cannot be acceptable and we must never allow it to become normalised, so we will continue to raise concerns about the lack of staffing and about staff burnout. Every patient matters, every staff member matters and Save Our Acute Services listens to both and we always will.

“Save Our Acute Service’s Roadmap was a vision, a plan to see sustainable, safe care across this Trust and much beyond it. We firmly believe the necessary return of emergency surgery to SWAH on a 24/7 basis will provide a safe anchor to all specialisms. It is fundamental to us in the far southwest corner of the province.”

In August, Mayor of Derry City and Strabane District Council, Cllr Ruairí McHugh, met the Chair of Fermanagh and Omagh District Council, Cllr Barry McElduff, alongside representatives from Save Our Acute Services and the chief executives of both councils.

Mayor McHugh said: “Our discussions centred on the serious impact the loss of acute emergency surgery at SWAH would have - not only on patients and families in Fermanagh and Omagh but also across Derry and Strabane.

“We are united in our determination to ensure these vital services are retained and strengthened. Access to high-quality emergency care is a right not a privilege, and we will continue to work together to press for solutions that put the needs of our communities first.

“We will keep engaging with local campaigners and decision-makers to make sure the voice of the people is heard loud and clear.”

A spokesperson for the Western Health and Social Care Trust told The Derry News: “The temporary suspension of EGS at SWAH commenced in December 2022 and since this time the Trust has monitored patient numbers being transferred to Altnagelvin Hospital.

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“This equates to approximately 2.5 patients per day who require the input of the General Surgical Team. On average, 79% of the patients who are transferred to Altnagelvin for EGS from SWAH go direct to a bed in Altnagelvin. The 21% who don’t go directly to a bed is approximately between 2/3 patients per week.

“Overcrowding at the Altnagelvin Hospital Emergency Department is not due to the number of patients attending from SWAH due to the temporary change. Altnagelvin ED has approximately 1,200 patient attendances per week. The Trust would therefore contend that ED to ED transfers from SWAH does not materially add to the numbers in our ED Department at Altnagelvin hospital.

“Emergency Department pressures is now regularly experienced in acute hospitals across Northern Ireland and Great Britain, including Altnagelvin and SWAH. The vast majority of patients who are waiting long period in our Emergency Department for inpatient beds are medical patients and not surgical patients.”

The spokesperson continued: “It is also important to note that both of our Acute Hospital sites now have access to ambulatory and surgical assessment facilities - treatment without the need for admission. This system avoids the need for patient admission; provides a safety net for review; and ensures that inpatient beds are used in an efficient way.

“Most of the emergency general surgery patients presenting at SWAH are now assessed and treated the same day or next day in the ambulatory unit at SWAH, avoiding the need for a transfer to Altnagelvin. Approximately 4.7 patients per day are seen at the ambulatory unit in SWAH, and emergency patients requiring a minor general surgery operation can now be scheduled in SWAH Elective Overnight Stay Centre or Omagh Day Procedure Centre thereby reducing the need for a transfer to Altnagelvin for their treatment.”

Commenting on staffing, the spokesperson continued: “The Trust now has a stable, permanent Consultant workforce to provide Emergency General Surgery Trust-wide, with no agency locums at Consultant or Middle Grade. The Trust also has a robust nurse staffing stabilisation programme which has enabled permanent recruitment of additional staff, including in both our EDs.”