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LAST week it was confirmed the A&E at the Lagan Valley Hospital would no longer be open overnight because of a shortage of junior doctors. This week the Chief Executive of the South Eastern Trust, Hugh McCaughey, and the Director of Hospital Services, Seamus McGoran, spoke to Star editor David Fletcher.
DF: Why did this happen so suddenly? Could no-one have foreseen there would be a shortage of junior doctors?
HMcC: We have been warning for the last two years
that this problem was looming. In an interview with the Star last year I
warned that this was a continuing difficulty. These are training posts
for one year so each August we have to try and recruit new junior
We knew there would be changes because the European Working Time Directive has cut the hours junior doctors can work so you need more to cover the shifts, but it was thought that would be at least partly offset by the changes which were proposed by the Developing Better Services plan several years ago. Under that plan the A&E unit at the Lagan Valley would close.
There have been occasions during the last year when we thought we might have to close the unit overnight because of staff shortages.
We managed to avoid that, but each August the junior doctors apply for the training posts and we just couldn't get enough.
We're not alone. Junior doctors have a choice of the areas they want to specialise and many are not opting for emergency departments. There are posts for junior staff in emergency departments right across Northern Ireland which are unfilled.
DF: Surely the Lagan Valley has advantages in in its location and the size of the popuhation it serves?
SMcG: Physical location isn't the problem. It's
ideally situated. It's the services the hospital provides which cause
The 90s was the last opportunity for the Lagan Valley to become a district general hospital, but the decision was made then to concentrate services in six major sites. Even they haven't filled all their training posts.
Across Northern Ireland this August hospitals tried to recruit 24 junior doctors for A&E. They got nine.
We were to be allocated six for the Lagan Valley, we got two. We were in the same situation last year but managed to get locums and coped.
The system is designed to operate like this every year. We have three permanent doctors whom we employ. That means we have to get six others each year. If you are a young doctor who wants to enhance your prospects in emergency medicine your first choice for a training post will be in a major hospital and that makes it harder for us to recruit for the Lagan Valley.
DF: Lisburn councillors felt very aggrieved that when Trust officials met them just before you announced the overnight closure you didn't give them the full information.
HMcC: When we met the councillors we could not definitely say what was going to happen. We were still working to recruit more doctors and then we had to inform the Board, the Department and the minister. But we were very clear about the seriousness of the situation.
SMcG: The situation was changing day by day, hour by hour. In fact, it was 2pm on the day after we met the councillors that we managed to get another doctor from August to December. Then we got another to work in August and September. That allowed us to keep the unit open until 8pm instead of 5pm.
DF: People are concerned that other A&E units are already at breaking point. How will they be able to cope with the influx of people who would have gone to the Lagan Valley?
SMcG: We are trying to keep as many patients as we
can in the LVH. We have a high level of confidence that up to 80% of
people will still be treated there. Around 70% of people who come to the
A&E at the Lagan Valley do so between 9am and 8pm anyway and we believe
some others will come earlier or wait until the morning.
We are also working with the Belfast Trust to get people who may require admission to a medical bed transferred back to the Lagan Valley.
There's no question some people will be inconvenienced and there's a real challenge not to increase the waiting times. Some of that depends on strategic and policy decisions by the government.
DF: Many people believe this is the thin end of the wedge and the real aim is to close the A&E permanently.
HMcC: It isn't. We sincerely hope this will be a
temporary measure. We will continue to try to recruit junior doctors but
this risk has been with us for many years and the situation is not going
to get any better.
The issue of the future of the emergency department at the LVH is separate.
Under Developing Better Services the A&E would be replaced by a minor injuries unit, but we think there can be something better.
Working with GPs, the council and the community we want to keep the front door of the hospital open so you can go there and everyone who could and should be admitted to the LVH is, while those who have to go elsewhere first can come back as quickly as possible. We want to create a model that can be sustained well into the future so we don't have this situation every year.
SMcG: This is no way to run a service and we want to
get a sustainable way forward.
We are totally committed to the Lagan Valley and the midwife led maternity unit is a fantastic example of how services can change successfully. The Trust has had some criticism over the Downe Hospital but today it has more staff, more services and more activity than ever. That's pretty good.
DF: Are you confident about the future of the Lagan Valley?
HMcC: Absolutely. The Lagan Valley will be very
different but it will still be providing all the services we can
There is no doubt this uncertainty undermines people's confidence and until we make changes that's going to continue, but I am certain there are going to be working hospitals at the Lagan Valley, Ulster and Downe well into the future.
Jonathan Craig MLA
Basil McCrea MLA
TWO Assembly members have differed on who they believe is ultimately responsible for the reduction in opening hours at A&E.
The DUP's Jonathan Craig blamed the Trust for wasting resources while Basil McCrea of the UUP has criticised the DUP Health Minister Edwin Poots, accusing him of 'hiding behind the decisions of officials'.
"The Minister must give us assurances that this is only a temporary measure," said Mr. McCrea. "He must also, as a matter of urgency, investigate the recruitment of junior doctors and ensure there is a way to solve this problem. Above all else, he must give the public his full commitment that the A&E at Lagan Valley Hospital will be returned to full cover or explain the reasons why not."
Mr McCrea said there was serious concern that this would mean the end
of the A&E in Lisburn. "It is absolutely unacceptable for the Minister
to hide behind the decisions of officials," he continued. "He makes the
final decisions, not the Trust. The people of Lagan Valley suspect that
this announcement will eventually result in the closure of the A&E unit.
If this is the mind of the Minister, he should explain to the people of
Lagan Valley that this is the case, and what measures he
will put in place to provide alternatives.
"It appears that junior doctors prefer general practice, which is oversubscribed, rather than emergency service which is undersubscribed. This is a policy issue which the Minister must deal with," he concluded.
However, Mr. Craig laid the blame at the feet of the South Eastern Health Trust.
"The Trust has seriously let the people of Lagan Valley down and cost the taxpaying public thousands of pounds as a result," he said. "This is a double blow to the people of Lagan Valley.
"As a result of A&E closing from 8pm to 9am an additional Ambulance has had to be placed on duty in order to cope with taking patients, in need of Emergency Care, to an alternative hospital. This is costing the Trust an additional £250,000. "This is wholly unacceptable.
"Furthermore a Patient Care Ambulance has been acquired 7 days week in order to be able to take patients awaiting non-emergency treatment to any hospital but Lagan Valley." He questioned why the Trust could not recruit enough junior doctors to keep the unit open 24 hours a day.