Clinical outcomes improve after consolidation of emergency surgery in Derry, says Dr. Brendan Lavery

Dr. Brendan Lavery was asked about the impact of the withdrawal of emergency general surgery at the South West Acute Hospital in December 2022 during a briefing of the Stormont Health Committee.

Health committee chair Philip McGuigan asked: “Two years after the collapse, are the clinical outcomes for the people of Fermanagh the same as they were prior to it?”

Dr. Lavery replied: “The good news is that the outcomes are actually better. We use a company called CHKS, which analyses the admissions across every trust in England, Wales and NI.

"CHKS looks at every admission — thousands of admissions — and does a statistical analysis of age, sex, comorbidities and the diagnosis that the patient was admitted with, using 260 categories of diagnoses.

"CHKS uses all that data to generate a risk-adjusted mortality index (RAMI), which is the number of deaths divided by the number of expected deaths.

"Effectively, the baseline is 100, so, if the figure is more than 100, that means that more patients are dying than would be expected. If the figure is less than 100, you are doing well. At the time of the temporary suspension, the figure for the South West Acute was 110, and the figure for Altnagelvin was 85.

"We got the figures in July or August last year. Effectively, the RAMI scores for Altnagelvin have continued to fall — to the extent that, if you extrapolate the data to look at mortality rates, you find that, due to the change that we have made, every 40 days, one patient survives who would not have survived.”

Dr. Tomas Adell, from the Department of Health, reminded the committee how the service ‘collapsed’ at SWAH in December 2022 due to staffing pressures.

"It is not the way to do a service change. We all recognise that,” he said.

Dr. Lavery said RAMI scores continue to improve following the amalgamation of services.

"That is probably because we have a much bigger surgical cohort, things are centralised, our rotas are better and, basically, things are happening a lot more quickly because of the number of staff that we have,” he said.