Patient safety should be first - surgeons speak out on emergency general surgery

A leading surgeon in Northern Ireland has said colleagues from across the UK and Ireland felt they had no option but to intervene when it appeared politics not patient safety was influencing discussions on the provision of emergency general surgery (EGS).

The surgeons issued a statement after Health Minister Mike Nesbitt resigned following a fall out with Ulster Unionist Party (UUP) leader Jon Burrows over withdrawing EGS from Causeway Hospital.

Damian McKay, an Ulster Hospital surgeon, said he and others were "concerned, disappointed and frustrated".

The new Health Minister Robbie Butler has said his decisions will be based on "expert evidence opinion" as well as the "voices of the people".

McKay, who is a general and colorectal surgeon, was speaking on behalf of the three surgical associations in the UK and Ireland who issued a joint statement on Friday in response to the disagreement.

Burrows had declared he would never support the withdrawal of the EGS service during a public meeting, a view Nesbitt said he only discovered by "monitoring the media".

The surgeons said "recent developments" risked further delaying the implementation of the 2022 review of EGS services in Northern Ireland, which recommended having the service at fewer sites.

McKay told BBC News NI: "The key message should always be patient safety first and political votes second.

"Health outcomes should not be dictated to by Facebook and social media groups – it should be determined by evidence and the evidence around Causeway has been there since 2025."

The statement is from surgeons from the Association of Coloproctology of Great Britain and Ireland, the Association of Upper Gastrointestinal Surgeons and the Association of Surgeons of Great Britain and Ireland.

In 2025, the Northern Health Trust recommended that EGS should only be provided at one of its hospital sites and that the service should move to Antrim Area Hospital.

It said it wanted to prevent collapse and instead plan for change in the area.

It is understood the Department of Health (DoH) was still waiting for a final recommendation to come from the minister.

However earlier this month, more than 200 people gathered at Coleraine Town Hall to call on the health minister to stop EGS being moved to Antrim.

Campaigners warned that it would create a domino effect leading to other services being withdrawn.

Speaking on Wednesday, after Nesbitt's resignation, Burrows acknowledged the need for reform but said "how we deliver reform is every bit as important as what we ultimately decide".

He said "safe, sustainable services," are the priority and reform must also address "health inequalities and regional imbalance, and recognise that people in different parts of Northern Ireland do not currently enjoy equal access to timely healthcare".

McKay, who is currently the medical director for cancer at the Northern Ireland Cancer Network SPPG which operates within the DoH, said the statement from the three surgical associations was significant and the first time they had come together.

In the statement, the surgeons warned Butler that failure to modernise surgical services risked "perpetuating existing workforce pressures, limiting access to care and widening inequalities in patient outcomes".

The surgeons said the recommendations from the review of EGS services in 2022 reflected "the realities of modern surgical practice" and were "consistent with the direction of travel seen across all four nations".

McKay said the statement was published to show that the "reform process has been going on for almost two decades".

"This is not a knee jerk reaction – for years the Northern Health Trust has been relying heavily on locums, cover was stretched across two different sites and there has been a real risk of service collapse.

"We have been trying to prevent that from happening."

The Belfast and South Eastern health trusts have each consolidated EGS on one site and have completed this part of transformation. But the issue remains unfinished and contentious in the Western, Southern and Northern health trusts.

McKay said surgeons want the best for their patients and when a vacuum is allowed to develop services become fragile.

"For a population of 1.9 million, three centres performing emergency general surgery would be commonplace in other parts of the UK and the world," he said

It is thought if Northern Ireland had a blank hospital canvas those three sites would be at Altnagelvin, Craigavon and Belfast.

McKay said running too many emergency surgeries on too many sites also had an adverse impact on cancer waiting times.

He said the same surgeons were dealing with EGS and cancer operations, which wasn't efficient.

"When we attend UK council meetings, surgeons from Northern Ireland are disappointed, even shocked, at just how behind Northern Ireland is compared to the rest of the UK when it comes to how we deliver care – our waiting times especially around cancer are among the worst," he said.

In the run up to next year's local election, the surgical associations are warning MLAs to think of the entire health population of Northern Ireland and not just what is happening in their own political patch.

Speaking to BBC News NI on Friday, Butler said that he would work to convince people that "any changes that come, wherever that may be, is made in the best interests of the people".

"But the people need to also be at the centre of any decisions that are made," he added.

Butler said he felt there was a "disconnect" between the medical officials and the people who are going to be affected by changes to Causeway Hospital.

"What my job is at the moment is to try and repair that disconnect and then take my time not to make a hasty decision but to make the right decision, and that's my promise to the people of Causeway."

He said any changes or improvements "need to be sustainable and deliverable".