Operations and appointments may be impacted by winter surge, Western Trust warns
The Western Trust has said that scheduled surgeries and some appointments may have to cancelled this winter if the already significant pressure on emergency departments at Altnagelvin and elsewhere escalates significantly.
Geraldine McKay, Western Trust Director of Unscheduled Care, Medicine, Cancer and Clinical Services cautioned that such a move may be necessary as she spoke of the Trust’s preparations ahead of the expected upsurge in patients over the coming months.
Speaking at a media briefing on Monday, Mrs McKay said: "During the coming months we may find it difficult to provide all of our planned services, and by planned I mean elective services, whilst also balancing the risk of unscheduled care and critical demand.”
The Trust has, she said, taken steps and would continue to take measures to try to mitigate that risk and to “protect elective care as much as possible”, including looking the capacity of elective facilities at Omagh and South West Acute Hospital.
"To date we’ve been able to manage and protect our Elective Care. We have had extreme pressure over the last couple of weeks. We haven't as a Trust stood down any elective care as yet but it could happened, it could be possible, but we will do our very best to protect it."
Ms. McKay said that over winter demand for services rises significantly, and in order to protect hospitals and community services the Trust had prepared its winter plan “setting out our arrangements to manage the predicted increase in demand for our services, particularly within our emergency departments but also to improve flow through our hospital sites”.
When asked about the concerns raised by attendees and others over the situation at Altnagelvin’s Emergency Department (ED), staffing levels and the pressures on staff working there, she said: "I'm very aware of the situation with members of the public,” she said. “I would like to apologise to anyone who has a poor experience in our Emergency Department. But I would say that our staff work diligently every day to make sure patients are seen in a timely manner, typically those that are sickest and require urgent care.
"We have reviewed our staffing in EDs recently. Over the last couple of of years we have increased our Band 5 nursing at Altnagelvin ED by 28, and at SWAH by 14. We do review it regularly to make sure we have enough staff to care for patients.”
Addressing the current and projected situation in A&E departments, she continued: "Our Emergency Departments continue to see high numbers of attendees and an increase in acuity, particularly in our elderly patients and those over 65 and 75.
"80 per cent of patients attending our Emergency Department will be discharged from our department but one in five will require admission to hospital for further investigations or treatment. On any given day there may be up to 60 or 70 patients or more awaiting admission across our two acute hospital sites. This impacts on the ability of our staff to assess the high number of patients each day. Shortage of spaces on our wards and high numbers waiting on admission both lead to lengthy emergency department waits."
Plans are in place over the winter at times of extreme pressures to increase capacity at other wards to deal with the overflow from A&E if necessary.
Geraldine McKay said winter routinely brings additional pressures such as respiratory disease especially in children and the elderly, while adverse weather leads to increase falls.
The Trust has now splits emergency attendances at Altnagelvin between the main Emergency Department and the new Minor Injuries Unit. Over the course of the year to the start of April 2025, there had been 59,600 attendances at the Emergency Department and over 10,600 at Minor Injuries.
This compares with 67,225 attendances in total in 2021/22.
The number of people presenting at South West Acute A&E has similarly rose to around 41,130 attendances over the past year, up 6% since 2021/22. There was a further increase at Omagh Urgent Care & Treatment Centre where over 21,613 attendances were recorded last year.
Measures developed to relieve pressures on A&Es include increasing capacity at the Ambulatory Care Unit at Altnagelvin and Same Day Emergency Care facility at SWAH, and patients attending ED can be transferred to those units for assessment and treatment if there outcome is not requiring admission. In Derry, the Trust has expanded referral pathways to the Ambulatory Unit.
"We have implemented clinical co-ordinators to ensure that ambulances are offloaded in a timely manner and our ambulances are turned around quickly. We are also currently working with our colleagues in NI Ambulance Service to review pathways where they can bring patients directly to our Ambulatory Care Unit. We also implemented eight in-patient beds in the Ambulatory Unit through funding received from SPPG centrally."
These beds, she said, are for patients who can be discharged within 24 to 48 hours and won't require admission.
Senior teams meet four times a day to review situations, while site escalation plans have been developed for when certain facilities are at severe and extreme pressure.
"Patient safety will always be our priority whilst we balance these risks. In addition we want our staff to be safe and well and remain at work.”
Thanking all Trust staff who “come to work diligently every day to care for our patients and the public,” Geraldine McKay acknowledged that their work was “not always easy and at times extremely challenging”.
"I want,” she said, “to reiterate what we can offer to the public. Our emergency departments are open. They are there 245/7 to treat patients who require emergency care. Please do not hesitate if you or anyone out there has an illness that they believe requires immediate, urgent, emergency, life-saving care. However if you are unsure there are other options they can consider: self care; Children's Symptoms Checker; your local pharmacist can also help you or direct you to the right place; your GP; Primary Eye Care assessment and referral service; Mental Health Care; Emergency Dental Treatment; Minor Injuries Unit are open; Urgent Care Centre in Omagh. We will continue to promote our Phone First Service - the Western Trust service operates seven days a week 365 days a year.
"We also ask you to work with us to help us discharge your loved ones in a timely manner. it is really, really important that we have flow throughout our hospital services."