Voices of Fermanagh : The removal of emergency general surgery from South West Acute Hospital

Abstract

The purpose of this study is to examine the representation and communication among stakeholders affected by the removal of emergency general surgery (EGS) from South West Acute Hospital in Fermanagh, Northern Ireland. By using thematic analysis, this research explores public discussions, policy discourse, and media coverage to assess how different stakeholder groups - patients, healthcare professionals, policymakers, and community advocates - have been portrayed and engaged in the ongoing debate. The study aims to determine whether voices remain unheard, how stakeholder communication is perceived by others, and how public dialogue has evolved since the removal of emergency surgical services in November 2022. The findings may support healthcare policymakers and advocacy groups in understanding the impact of service reductions on public discourse and decision-making. The study is grounded in theories of healthcare accessibility, rural medical service centralization, stakeholder engagement, and trauma care networks.

A qualitative thematic analysis was conducted using a total of 94 documents on public discussions, media articles and policy documents. The articles were from 15 sources, of which 11 are news platforms of local, regional and international coverage and the remaining 4 sources were government or service provider publications. The research analysed the thematic patterns, frequency of stakeholder inclusion, and perceived impacts of emergency general surgery removal.

The findings suggest that government bodies and community members are well represented in the public discourse, however service providers and staff members are underrepresented or need advocating for in narrating experiences and as part of the decision-making process. The debate on the topic covered by the media demonstrates experiences of public distrust in decision-makers, existing policies and governance. Since November 2022, discussions have shifted from initial backlash and protests to policy negotiations and rural healthcare advocacy efforts.

The study concludes that centralization of emergency surgical services disproportionately impacts rural communities, contributing to longer pre-hospital times and heightened health risks. Improved stakeholder engagement strategies - such as community-led consultations, increased media transparency, and healthcare literacy programs - are necessary to bridge the communication gap. The research recommends policy adjustments that prioritize rural health equity, ensure social accountability, and strengthen local decision-making processes.

Keywords: stakeholder engagement, rural healthcare, trauma networks, emergency surgical service removal, Northern Ireland healthcare policy