Surgeons Speak Out on Patient Safety as Causeway Hospital Emergency Surgery Debate Reaches Critical Point
Senior surgeons have added their voices to the intensifying debate over the future of emergency general surgery at Causeway Hospital in Coleraine, warning that patient safety must be the paramount consideration as the Northern Health and Social Care Trust pushes to centralise services at Antrim Area Hospital. Campaigners, meanwhile, have warned that removing emergency surgery would trigger a "domino effect" that could ultimately hollow out the hospital's acute services entirely.
Background
Causeway Hospital in Coleraine has served the communities of the Causeway Coast and Glens area — including Coleraine, Ballymoney, Ballycastle, Portrush, and Portstewart — since it opened in 2006, replacing the older Coleraine Hospital. It provides a range of acute services including a 24-hour emergency department, maternity services (which were controversially moved to Antrim Area Hospital in 2023), and emergency general surgery.
Emergency general surgery covers unplanned procedures such as appendicitis, bowel obstruction, and perforated ulcers — conditions that require rapid surgical intervention and where delays can be life-threatening. The Northern Health Trust recommended in May 2025 that EGS should be centralised at Antrim Area Hospital, arguing that providing the service across two sites had become unsustainable due to staffing pressures and the difficulty of maintaining the necessary surgical expertise at both locations.
The proposal requires sign-off from the Health Minister, a position now held by Robbie Butler of the UUP following Mike Nesbitt's resignation. Butler has indicated he will approach the decision carefully and without the "red lines" that characterised his predecessor's tenure.
Key Developments
Surgeons speaking to BBC News NI this week emphasised that patient safety must come first in any decision about service configuration. While declining to take a public position on the specific Causeway proposal, several senior figures noted that the evidence base for centralising complex emergency surgery — which shows better outcomes at higher-volume centres — is well established in the international literature.
The Northern Health Trust has been explicit about its reasoning. "The current model of providing emergency general surgery across two sites is becoming increasingly unsustainable and our preference is for a planned and managed change to avoid potential service collapse," a trust spokesperson said. The trust has committed that Causeway will retain its 24-hour emergency department and will be developed as an elective and diagnostic hub.
Campaigners from the SoS Causeway Hospital group, who drew more than 200 people to a public meeting at Coleraine Town Hall last week, reject that framing. Gemma Brolly, the group's spokesperson and Aontú deputy leader, warned that "when emergency surgery goes, other dominoes fall." She pointed to the experience of maternity services, which were moved to Antrim in 2023 and have not returned, as evidence that service withdrawals tend to be permanent.
Why It Matters
The Causeway Hospital debate is a microcosm of a challenge facing health systems across the UK and Ireland: how to maintain safe, sustainable services in areas with dispersed populations when the clinical evidence increasingly favours centralisation at high-volume centres. The tension between clinical best practice and community access is genuine and does not admit of easy resolution.
Northern Ireland's health service is under particular strain. It has the longest waiting lists in the UK, a chronic shortage of consultants in several specialties, and a funding settlement that has consistently lagged behind need. Against that backdrop, the trust's argument that the two-site EGS model is unsustainable deserves to be taken seriously — even if the community's concerns about access are equally legitimate.
The experience of other hospitals that have lost emergency surgery — including Daisy Hill in Newry and South West Acute in Enniskillen, where EGS has been temporarily suspended — suggests that the trust's concerns about sustainability are not unfounded. But it also illustrates the cumulative impact of service withdrawals on communities that are already feeling the effects of underinvestment.
Local Impact
For residents of the Causeway Coast and Glens area, the prospect of losing emergency surgery means potentially facing a journey of 45 minutes to an hour to Antrim Area Hospital in a medical emergency — a journey that, in cases of acute abdominal conditions, could be the difference between life and death. The area's geography, with significant rural hinterlands and limited public transport, makes the access question particularly acute. Coleraine Borough Council has passed a motion opposing the move, and local MLAs across party lines have been vocal in their opposition.
What's Next
Health Minister Robbie Butler is expected to receive a formal business case from the Northern Health Trust in the coming weeks. He has indicated he will take time to review the evidence before making a decision. The Department of Health has said that any final recommendation must demonstrate improved health outcomes for the population. A decision is expected before the end of 2026, with the Assembly election in May 2027 adding political urgency to the timeline.
