10 June 2026

RQIA publishes Report of Inspection of the Emergency General Surgery (EGS) Pathways in the Western Trust, following the temporary suspension of services at South West Acute Hospital

Following the publication of RQIA’s Review of the Pathways Associated with the Temporary Suspension of Emergency General Surgery at South West Acute Hospital published in January 2025, RQIA carried out an unannounced inspection of the service, over the period 12 November 2025 to 19 February 2026.  The findings of that inspection are published today.

The aim of the inspection was to assess the effectiveness of the temporary emergency general surgery (EGS) pathways, and ensure quality and safety processes embedded.

The inspection was conducted at the two Emergency Departments; at South West Acute Hospital (SWAH) and at Altnagelvin Hospital; and the surgical wards at Altnagelvin Hospital. The inspection concluded on 19 February 2026 when feedback was provided to senior Trust representatives.

 

The inspection found that since the Review, the Trust has made progress in a number of areas across the Emergency General Surgery pathways. This includes improvement in “direct to bed” admissions from SWAH to Altnagelvin Hospital, when a decision has been made at the SWAH Emergency Department that a patient needs to be admitted to the Altnagelvin surgical wards. The Trust has recently reported achieving 97% of patients transferred from SWAH going directly to an in-patient surgical bed in Altnagelvin.

The Trust has also undertaken a number of audits, and the findings have informed actions, resulting in improvement. Information on the in-patient service at the Altnagelvin wards, through the CHKS report is now available; and the Trust also reported that a full staff complement in the surgical team has been secured.

The inspection identified four areas for improvement. These relate to:

 

•  the need for consistent application of EGS pathways with clear shared documentation and understanding across all the staff groups involved;
• the need for effective staff engagement, communication and collaborative team working;
• the need for audits to be undertaken consistently, and sustained to provide information on outcomes for patients, specific to the pathways and the population groups affected; and to enable insights to be developed to guide further improvement
• and the need for strengthening of risk and incident management and a sustained focus on applied improvements.

 

Commenting on the findings of the Inspection, RQIA Chief Executive Briege Donaghy said “We are often asked in our role as regulator if a service is “safe”. Sometimes it is thought this can be answered simply by one measure or factor. The reality is that it takes a number of systems, processes and applied learning to be in place to create the culture for a service to be safe and effective on an ongoing basis. Achieving a safe and high quality service needs a continuing focus on the clinical outcomes for patients; as well as close attention to patient and staff experience.  It requires constant review of the inherent risks in the service and that, when incidents occur, processes are in place that will ensure actions are taken to reduce the potential for them to recur.”

In the case of the Emergency Surgical Pathways in the Western Trust RQIA found several of these systems and processes are in place. The Trust have evidence of good clinical outcomes for patients who spend time in the in-patient surgical wards at Altnagelvin Hospital, and have made significant improvement in the direct to bed admissions for transferred patients from SWAH.

The inspection report sets out the issues that need continued focus, to ensure existing quality and safety systems and processes are extended and embedded, and that there is on-going evidence of outcomes for patients across the whole pathways and a positive working environment for all staff involved.

The Inspection Team were impressed with the expressed commitment and leadership shown by the Chief Executive and members of the Senior Management Team, in responding to the Inspection recommendations. The senior Team had commenced work on several issues immediately on receiving early feedback from the Inspection Team, and in advance of receipt of the RQIA Inspection final report.

We trust that the improvement actions set out in the Inspection Report will support the Trust in their focus on reinforcing the safety, effectiveness and sustainability of the service. Timelines have been set against all the required actions over the coming months, and RQIA looks forward to clear evidence of achievement.

The inspection report is available on the RQIA website here.

Ends