You can have your operation, but be prepared to travel…

It is a general aspiration of the good people of Northern Ireland that there is a hospital, employer and a wide range of shops at the bottom of every street. I get that people like convenience and their local hospital, but the realities of modern medicine mean that as treatment gets more specialised, the only option is to centralise services at a few key sites.

Once upon a time, you had general surgeons who would turn their hands to everything from removing an appendix to amputating a foot. Now, things have gotten so specialised that if you come across a knee surgeon, the joke is whether they are a left knee surgeon or a right knee surgeon.

Specialisation is excellent for patients. Would you rather get operated on by someone who does that operation ten times a week or someone who does it ten times a year? It is common sense that you would want an expert on your condition.

The challenge has always been convincing the public of this as they see any attempt at centralisation as ‘running down their local hospital’.

A friend was waiting on a procedure, and she was asked if she would consider going to the Kingsbridge Private Hospital in Ballykelly. She jumped at the chance to get her condition sorted and said yes. The person on the phone was taken aback as they said they had phoned over 10 people that day, and they all refused to travel. Ballykelly was an hour from her house, so she was happy enough to make a day trip as long as she got treated.

Now, if you like me, you are probably wondering why on earth they built a private hospital in Ballykelly? I had to look it up on the map. It is outside Derry. But I suppose that is not really the point, you could equally be asked to go to the South West Hospital in Enniskillen.

I understand the issue from the patient’s perspective, especially those living in Belfast. Around 40% of the population of Belfast does not have a car. If you factor in the fact that poorer people have worse health, then I would not be surprised if over 50% of people on waiting lists in Belfast do not have a car. I am unsure if there is any arrangement with Taxi companies to transfer patients. It is easy to argue that it is not a big ask to get people to make their own way to a hospital, but if you factor in people with mental issues and other challenges, frail older people without close families, etc, it might be best to have some kind of transport scheme in place.

Also, there are practical issues like the language barrier. Can you drink the local water? Are there any special visa requirements to visit Fermanagh? Do you need shots? These practical issues will need to be ironed out.

Marie-Louise Connolly writes about this issue over at the BBC:

A leading Northern Ireland surgeon says specialist surgical hubs are the best way to tackle the backlog of operations.

Surgical hubs separate elective or planned surgery from emergency care, which means less serious operations are not cancelled.

Niall McGonigle said the surgical model, in operation since 2021, was already showing positive improvements.

He added that patients would need to be prepared to travel for their surgery.

Speaking to BBC News NI ahead of the publication of the latest hospital waiting list figures, the NI director of the Royal College of Surgeons said surgical hubs in Northern Ireland were in their infancy.

“When we look at the surgical hubs in England, they have delivered a huge volume of surgery,” Mr McGonigle said.

“They have brought down waiting lists in certain areas and I am sure that will be replicated here.”

Where are surgical hubs in NI?
Lagan Valley Hospital in Lisburn and Omagh Hospital provide day case surgery.

The Mater in Belfast, Daisy Hill in Newry and the South West Acute Hospital in Enniskillen offer overnight stays for more complicated cases where an anaesthetist and surgeon will remain in the hospital until their patient leaves.

Day surgery takes place on the same day as the patient arriving and leaving hospital for example cataracts

Overnight surgery means the patient requires an overnight stay and the surgeon and anaesthetist will remain on the hospital site, for example for a hernia.

Becoming a surgical hub has secured the future of the South West Acute Hospital, according to Mark Gillespie, director of surgery and paediatrics at the Western health Trust.

Built in 2012, the state-of-the-art hospital has been underutilised.

Mr Gillespie said the role of the hospital had been turned around, with more than 1,300 patients receiving surgical care since January 2023.

“We need more people to come,” he said.

“We need the population of NI to be bought into the idea of travel because that will give us more timely access to theatres and patients will be seen a lot quicker and will have a more positive experience.”

Mr Gillespie said the hospital had treated patients who live in the Belfast, the South Eastern and Southern health trust areas.

Build it, they might come if they are desperate enough…