Debate contribution: South West Acute Hospital: Future of Services

Debate contribution by Mr Mike Nesbitt on 9 September 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

9 September 2025

Type

Debate contribution (made as a minister)

Business

Adjournment

Heading

South West Acute Hospital: Future of Services

Assembly identifier

Official Report component 5086881

Read the official Assembly record

Text

Mr Deputy Speaker, thank you very much, and thank you to Mrs Dodds for stepping in for Deborah. When Deborah arrived here, she very quickly established a reputation for being a respected and effective Member of the legislative Assembly, but tonight, of course, the focus is not on Deborah the politician. It is on Deborah the wife, and I offer her and her husband every good wish as they prepare to welcome their first child and start that family. If I may, I will start with a general point, so please indulge me. When I first stood here, 15 months ago, as Minister of Health, I said that I wanted to be judged and I wanted to judge myself on whether my words and actions were delivering better outcomes for patients, service users and the 70,000-odd glorious staff who deliver health and social care. I was also encouraged that everybody — I mean everybody — who came up to me said, "If you're going to make the big, difficult decisions, we will support you". That is not always the case once we get into the nuts and bolts and the specifics. One of the things that I regret — it is something that I am encouraging people in Health and Social Care to fix — is that sometimes a change has been allowed to be perceived in the public consciousness not as delivering better outcomes but as a cost-saving measure. I am not interested in doing that, but I have to accept that, in recent years, Health's proportion of the overall Executive Budget has gone up from 46% to over 50%, and that direction of travel is not sustainable. It is not sustainable because every pound that we spend in Health is a pound not spent by the other Departments on tackling the social determinants of health inequalities and ill health, so we all have to work together. I was pleased that Mrs Dodds acknowledged that sometimes we rightly — it is our duty — put a focus on what is wrong and what goes wrong in health and social care delivery, but sometimes we do not put a focus on what goes right. Of course, in the majority of cases on a daily basis thousands of appointments, diagnoses and procedures go very well for people. I do not prescribe to or buy into the idea that the health service is broken, but I do know that many of the pathways to access health and social care are broken, and that is an important distinction. Moving to the debate, I will attempt to address some of the points raised. The South West Acute Hospital serves a significant portion of the Western Health and Social Care Trust population, which is approximately 300,000 people — a significant proportion of our people. The population of the Fermanagh and Omagh District Council area is estimated at 118,000 from the 2021 census. Since taking office, I have had the pleasure of visiting the SWAH on various occasions. The most recent visit was a few weeks ago, when I talked to some patients and staff. I visit many hospitals and healthcare facilities. I always get a sense and a feel just walking in the door. Is it a good feeling, or is it maybe that the air is being sucked out of me? I always get a really good feeling in the SWAH, which is a great modern facility. I often say that to deliver healthcare, you need buildings, beds, equipment and medicine, but all that counts for nothing if you do not have the right staff, qualified and motivated. That is where the problem began with this issue. We talked about the extra theatre and bed space. The hospital has the potential to do more, and I absolutely want to see it doing more. Let us remember — I think that Diana Armstrong made the point — that it has never been busier or more productive, and it has the potential to do even more because of those two non-commissioned theatres and beds. I am keen to do more at the SWAH, but let me move to the specific of emergency general surgery.

In November 2022, the trust decided to temporarily suspend EGS for patient safety reasons due to staffing challenges. I understand the concern caused by the trust's decision. The protection of patients from adverse clinical outcomes has to be my most important duty; I have to make sure that patients are safe. The decision was taken at a time when there was no Minister in post. The trust stated that its ability to safely staff and operate an emergency 24/7 rota for surgical care was inadequate and unsafe. I stress that point to remind Members of the genesis of that decision. Subsequently, the trust ran a public consultation exercise on the temporary suspension, the findings of which were published in July 2023. The strength of local feeling and of opposition to the suspension was clear. However, in lieu of the inability of the trust to stand up safe services and satisfy the clinical general surgery standards, the reconfigured Altnagelvin-led service remained in place. Members have mentioned RQIA. In 2024, it was alerted to some concerns from clinicians in the trust that had to be listened to about the robustness of the pathways at Altnagelvin. The Department of Health team asked RQIA to conduct a robust investigation and report on their effectiveness and sustainability. We got that report in the spring of this year. The outcome was presented at the Health Committee by RQIA officers on 13 March, alongside a response from the Western Trust. Essentially, there were 10 recommendations for the short and medium term for the further refinement and improvement of the pathways. While most of those had been achieved, some remained outstanding and needed to be strengthened. The strategic planning and performance group, which is the performance management arm of my Department, works with the trust monthly to monitor progress and assure me that matters are being adequately addressed. Mrs Dodds said that there was an issue at Altnagelvin because it, too, was under pressure. I say this to her: every hospital, facility and worker in the Health and Social Care network is under pressure. Our hospitals across the region face challenges and pressures. We are not an outlier — that is the position across the UK — but having a small population of 1·9 million means that specialist services are innately difficult to fund and maintain region-wide. You cannot put them in every hospital. I have made the point about the network that we have to realise that not every hospital will offer every procedure. If the procedure that you need is being performed by your nearest hospital once a week but, 20 or 30 miles away, the next hospital is doing it 10 times a day, five days a week, where will you go? Obviously, it will be safer to go to where it is done more frequently.

I am sorry; I have a lot to get through. I want to give some responses. Mrs Dodds normally asks me about 5,000 questions: I will answer four of them. I have done Altnagelvin. She talked about an awareness of the implication of rural healthcare delivery. I assure Mrs Dodds that we do rural impact assessments as well as equality impact assessments. The SOAS road map is interesting. I think that she wondered what my view of it was. It would not be appropriate for me to give my view. I do not want to be confused for the chair or the chief executive of the Western Trust. They have to make that decision, not me. I will be the person who signs off or does not sign off on the decision that they come to, but that is that. We are looking at the two uncommissioned theatres and wards as part of our waiting list initiatives. Mr McCrossan kindly said that I am a man of plain speaking: he is about to become a victim of that. He said that it is a brand new hospital and that it is shocking that we are discussing its future. We are not talking about whether it has a future: it does. We are discussing only one service, albeit a very important one. I want any patient who goes to the SWAH to get safe and timely attention and treatment and to be allowed the basic courtesies that are absent in our emergency departments in particular of holding on to your privacy and dignity.

I will finish by welcoming all the people who have come up from Fermanagh. I applaud you for your continued interest and your determination to do what, you think, is right for yourselves and your community. I promise that I will try to do my best for you. Thank you for coming up. I welcome you here and wish you a safe journey home.

1,495 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 13:05 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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