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The SOS Daisy Hill Hospital group has written to Health Minister, Mike Nesbitt, Department of Health Permanent Secretary, Mike Farrar and Health Committee Chairman Philip McGuigan seeking clarification on the remit of the ministerial advisory panel set up to address the crisis at Causeway Coast Hospital, South West Acute Hospital and Daisy Hill Hospital in Newry. It follows yesterdays rally in Newry where thousands turned out to protest at proposed removal by the Southern Trust of maternity services from Daisy Hill Hospital.
The campaign group says any review must look beyond frontline services to examine Health Trust management structures, administrative costs, the effectiveness of the five-Trust model and the Department of Health’s long-term workforce planning.
Citing the proposed suspension of maternity services, following the earlier removal of stroke and emergency services, the group calls for a study of the cumulative impact on patient safety, ambulance response times and rural communities across Newry, South Down and South Armagh, and asks for Rural Needs and Equality Impact Assessments to be published.
In the correspondence SOS Daisy Hill puts nine questions to the Minister and, if these matters fall outside the panel’s remit, asks for a separate independent review.
The full letter is published below:
To: The Minister of Health, Mr Mike Farrar , Mr Philip Mc Guigan Chairman of N Ireland Health Committee and relevant senior officials, Department of Health, Northern Ireland
Subject: Ministerial Advisory Panel — Daisy Hill Hospital, Patient Safety, Health Trust Management and Workforce Planning
Dear Minister and Mr Farrar,
On behalf of SOS Daisy Hill Hospital, I am writing to seek clarification regarding the remit of the panel established by the Minister to advise on the current crisis affecting Causeway Coast Hospital, the South West Acute Hospital (SWAH) in Fermanagh and Daisy Hill Hospital in Newry.
We welcome efforts to address the serious challenges facing these hospitals. However, we believe the review must examine not only frontline services but also the management structures, workforce planning and previous decisions that have contributed to the current situation.
We would therefore appreciate confirmation of whether the panel’s terms of reference include a review of Health and Social Care Trust management structures, administrative costs, the effectiveness of the current Trust model and the Department of Health’s long-term workforce planning strategy.
1. Daisy Hill Hospital: The Cumulative Impact of Service Losses
The proposed suspension of maternity services at Daisy Hill Hospital, following the previous removal of stroke and emergency services, has caused profound concern among residents of Newry, South Down and South Armagh.
These developments raise serious questions about the future accessibility, sustainability and safety of acute healthcare for our communities.
The removal or suspension of essential services can increase travel distances, place additional demands on ambulance provision and receiving hospitals, and create particular difficulties for rural residents, expectant mothers and patients requiring time-critical treatment.
We recognise that clinical decisions must be based on patient safety. However, the public is entitled to see the clinical evidence, risk assessments, workforce analysis and alternative options underpinning decisions of such significance.
The burden of proof must rest with those proposing to remove, suspend or centralise essential services.
We therefore request that the panel examine the cumulative impact of previous service losses and the proposed maternity suspension, including the consequences for patient outcomes, ambulance response times, travel times and the capacity of neighbouring hospitals.
2. Rural Needs and Equality
The Rural Needs Act (Northern Ireland) 2016 requires public authorities to consider rural needs in relevant policy and service-delivery decisions.
SOS Daisy Hill is concerned that the cumulative consequences of healthcare centralisation for rural communities in South Down and South Armagh may not have received sufficient consideration.
Residents without private transport, those dependent on public transport and patients living in geographically isolated communities may face particular difficulties accessing services elsewhere.
We ask the Minister to confirm:
● Whether a Rural Needs Impact Assessment has been completed for the proposed maternity suspension and whether it will be published.
● Whether the previous removal of stroke and emergency services was subject to adequate rural-needs assessment.
● What Equality Impact Assessments have been undertaken and how their findings influenced the decisions.
● How the Department will ensure that rural communities are not disproportionately disadvantaged by further service centralisation.
These assessments must be meaningful and evidence-based, rather than treated as procedural formalities.
3. Health Trust Management and Financial Efficiency
While frontline services are being reduced or suspended, it is reasonable for the public to ask whether equivalent scrutiny is being applied to the management structures responsible for planning and delivering healthcare.
Northern Ireland’s five Health and Social Care Trusts have separate executive and administrative structures, alongside the central Department of Health and its associated bodies.
Effective leadership is essential, but the cost, efficiency and contribution of these arrangements should be independently assessed.
We ask whether the panel will examine:
● The costs of senior management and executive structures across the Department and Trusts.
● Potential duplication of administrative, governance and support functions.
● Opportunities to consolidate management arrangements and achieve recurring savings.
● Whether the current Trust structure represents the most efficient model for delivering health and social care.
● Whether savings could be redirected towards essential frontline services.
If these matters fall outside the panel’s remit, we request that the Minister commission a separate independent review.
Our position is straightforward: if frontline services must justify their costs and performance, management structures should be subject to the same standards of accountability and scrutiny.
4. The Department’s Long-Term Workforce Planning
We are also concerned that repeated proposals to centralise services may be responding to workforce shortages without adequately addressing their underlying causes.
A sustainable health service requires effective long-term planning for recruitment, training, retention and succession across all clinical specialties.
Where staffing difficulties threaten a local service, the public should be able to establish whether those difficulties could have been anticipated or addressed through better workforce planning.
We therefore ask whether the panel will examine:
● The Department’s long-term workforce planning strategy.
● Staffing vacancies and recruitment and retention difficulties affecting Daisy Hill Hospital.
● Whether alternative staffing arrangements could sustain safe local services.
● The extent to which workforce shortages have influenced decisions to remove or suspend services.
● Whether the Department has a credible, adequately resourced plan to address future workforce requirements.
We believe that services should not be withdrawn without a transparent assessment of whether sustainable alternatives have been properly explored.
5. Reviewing Previous Service Reconfigurations
Previous decisions to remove stroke and emergency services from Daisy Hill, together with the proposed suspension of maternity services, must be considered as part of a wider assessment of healthcare provision in the region.
It is not sufficient to argue that earlier decisions have already been made and should not be revisited.
We ask the panel to examine the evidence supporting these decisions, the anticipated clinical and financial benefits, and whether those benefits have been achieved.
The review should also consider the cumulative impact on patient safety, travel times, ambulance provision, receiving hospitals and health inequalities.
The same standards should apply to Causeway Coast Hospital and SWAH. Communities across Northern Ireland deserve consistent, evidence-based decision-making and confidence that no hospital’s future has been predetermined.
6. Questions Requiring a Formal Response
We respectfully request written answers to the following questions:
1. Do the panel’s terms of reference include a review of Health Trust management structures, executive costs and administrative duplication?
2. Will the panel examine whether the current five-Trust model remains the most efficient arrangement for Northern Ireland?
3. Does its remit include examining the Department of Health’s long-term workforce planning strategy?
4. Will it review the proposed suspension of maternity services at Daisy Hill and the previous removal of stroke and emergency services?
5. Will it assess the cumulative impact of these decisions on patient safety and access to healthcare in Newry, South Down and South Armagh?
6. Will it examine ambulance response times, travel distances and the additional pressures on receiving hospitals?
7. Will the relevant Rural Needs Impact Assessments and Equality Impact Assessments be reviewed and made publicly available?
8. Will the panel’s findings and recommendations be published?
9. If management structures and workforce planning fall outside its remit, will the Minister commission a separate independent review?
Conclusion
SOS Daisy Hill Hospital recognises the financial and operational pressures facing Northern Ireland’s health service. However, addressing these challenges requires more than repeatedly reducing or centralising frontline services.
The proposed maternity suspension at Daisy Hill, following the previous removal of stroke and emergency services, has created serious concerns about the safety and accessibility of healthcare for Newry, South Down and South Armagh.
These concerns must be considered alongside rural-needs obligations, workforce sustainability, previous reconfiguration decisions and the efficiency of the wider health service.
We call for an independent, evidence-led examination of the entire system, including management structures, workforce planning and the cumulative consequences of service centralisation.
We ask the Minister to confirm that the advisory panel has a sufficiently broad remit to address these matters. If it does not, we request that a separate independent review be established with clear terms of reference, public accountability and a defined reporting timetable.
The people of Newry, South Down and South Armagh deserve the same commitment to safe, accessible and sustainable healthcare as every other community in Northern Ireland.
SOS Daisy Hill Hospital remains willing to engage constructively with the Minister and the Department. However, constructive engagement must be accompanied by transparency, accountability and meaningful action.
We look forward to your response.
