15 September 2026

RQIA has today published its follow-up Inspection Report on the temporary Emergency General Surgery (EGS) Pathways in the Western Trust. This report covers a follow up inspection conducted between 29 July and 4 August 2026 in both the South West Acute and Altnagelvin Hospitals. The report published today assessed the Western Trust’s implementation of the Quality Improvement Plan set out in the RQIA’s Inspection Report publish on 10 June 2026.

The Inspection, and the recent follow-up report, forms part of RQIA’s actions following its 2024 Review, published in January 2025, of the pathways associated with the suspension of EGS services at South West Acute Hospital in December 2022.  That Review identified two “urgent” recommendations:

• Patients assessed in SWAH and accepted for admission to the Altnagelvin surgical service should be admitted directly to the surgical ward and should not be required to attend or wait within the ED at Altnagelvin. The Trust should ensure the achievement of this ‘direct to ward’ admission for transferred patients is accurately calculated and reported regularly to provide assurance it is sustained.
• There is a need for the Department of Health to consider the provision of a more sustainable and resilient ambulance capacity to strengthen the model supporting emergency surgical services within the Trust area, and address concerns about the impact on NIAS services more widely in the area.

Key findings in this follow-up inspection, relating to these earlier urgent recommendations, include:

1. The Trust’s current recorded activity data demonstrated that ED to ED transfers have been markedly reduced, with the last cases reported at the end of January 2026, and none reported since. This is a positive outcome and should be sustained.
2. Additional NIAS Ambulance capacity has not been put in place. RQIA has written to the Department of Health in accordance with Articles 4 and 35(3) of the H&PSS  (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 advising that the Department should take appropriate steps to address this matter, which has remained outstanding since the original RQIA Review recommendations of October 2024, by the commissioning of additional NIAS emergency ambulance and crew capacity.

The follow-up inspection finds that the safety and reliability of the EGS patient transfer service is paramount to providing a sustainable service. RQIA has advised the Trust Senior Team of the need to focus on the provision of a safe and reliable patient transfer service from SWAH to Altnagelvin Hospital, when it has been decided in SWAH that a patient requires admission. RQIA has informed the Trust that for the EGS transfer service to be considered safe and reliable, no patient identified as requiring admission to Altnagelvin for EGS should be required to, nor feel the need to, make their own arrangements for transport from SWAH to Altnagelvin. Any cases where this occurs should be subject to reporting within the Trust assurance processes and investigated so that action can be taken to address the underlying issues.

An audit is underway in the Trust to assess the outcomes achieved for patients who are managed at the SWAH itself. This is to be available within the Trust assurance process by mid November 2026, and is then to be shared with RQIA. As the majority of patients who present at SWAH with symptoms indicating a need for EGS services are not transferred to Altnagelvin, it is vital to identify and assess the outcomes for those patients.

Assurance is an ongoing process and must include outcomes for all patient groups.  Performance on transfer times, extreme outliers and patient experience form an integral part of the outcome data and must be included on an ongoing basis.

These are some examples of essential elements of effective governance oversight and assurance, which the Trust Board must establish.

All of the findings of the follow-up to the inspection against the areas for improvement are set out in the published Follow-up to Inspection Report, as are the actions needed and timeframes.