Background and initial decision
On 7 October 2025, Trust Board approved the closure of the Public Consultation on Emergency General Surgery and formally agreed a sequence of steps towards the design and development of a new Vision Plan. This approach was requested by the Health Minister and is intended to be forward-looking, people and place based, and focused on the health and care needs of Fermanagh and West Tyrone, including specific work relating to South West Acute Hospital.
The background to this work includes the temporary suspension of Emergency General Surgery at SWAH in December 2022, which was implemented as an emergency measure due to significant and ongoing difficulties in recruiting and retaining the consultant workforce required to maintain a safe and sustainable emergency general surgery rota. That decision was taken in response to immediate operational risk and was not a decision on the permanent configuration of services.
The Trust subsequently undertook a public consultation on the temporary change to Emergency General Surgery at SWAH, with findings presented to Trust Board in July 2023. Trust Board later approved moving towards a public consultation on a permanent change in June 2025; however, that consultation did not proceed following the Minister’s request to pause and instead develop a broader Vision Plan for health and care services across Fermanagh and West Tyrone.
The Vision Programme therefore moves the discussion beyond a single service issue and into a wider planning process which will consider the future role of SWAH alongside Omagh Hospital and Primary Care Complex, community services, primary care, mental health, social care, children’s services, older people’s services and wider population health need.
Key dependencies agreed by Trust Board include:
- Identification of population health needs and future projections
- Consideration of primary care and community care interfaces
- Research evidence on the role of rural hospitals
- DoH policy developments on Neighbourhood Model
- Enhanced public engagement & involvement
Context for the Vision Programme
Fermanagh and West Tyrone is a large rural geography with distinctive population health, access, workforce and service sustainability challenges. The Vision Programme is being developed in the context of increasing demand, changing demographics, growing complexity of care, workforce pressures, the need for stronger community and primary care interfaces, and the opportunities presented by new technology, prevention, care closer to home and cross-border collaboration.
The Trust has also provided clear information on the current status of Emergency General Surgery, including independent CHKS benchmarking which indicated improved outcomes since the temporary service change, including reductions in mortality, complications and readmissions. This information has been shared through public briefings, Trust Board updates, public representative sessions, council briefings and the Trust’s online information hub.
The Trust’s position remains that SWAH is an important acute hospital within the Northern Ireland hospital network. Its acute services provision includes a 24/7 Type 1 Emergency Department, maternity services, full resuscitation facilities and Intensive Care Unit. The Vision Programme will consider how SWAH, Omagh Hospital and community services can work together as part of an integrated future model for the area.
Governance and assurance
The Vision Programme is overseen through the Fermanagh and West Tyrone Health and Care Futures Steering Group, established in October 2025, which reports to the Improvement Through Involvement Committee and provides regular updates to Trust Board. Trust Board considered the Engagement Plan on 7 May 2026 and approved the programme to proceed to the next phase.
The Trust has also engaged with external partners including DoH policy and communications leads, SPPG, PHA and PCC. The Patient Client Council has been engaged at officer and Chief Executive/Director level to provide constructive input into the engagement approach. A Fermanagh and West Tyrone Strategic Partnership Group has been approved to support the next stage of the visioning work and to help ensure the process remains connected to community, partner and stakeholder insight. This Strategic Partnership Group will be established from early September 2026.
All feedback will be recorded, themed and analysed through agreed project governance arrangements. Interim updates will be provided through the governance route, with analysis of actionable insights expected to be presented to Trust Board from November 2026, subject to any impact from parallel HSC savings plan work and associated engagement or consultation requirements.
Approved Engagement Plan: three strands of work
The Trust Board has approved an Engagement Plan which sets out three connected strands of work: staff engagement, public and community engagement, and stakeholder and public representative engagement. These strands are supported by a communications and information campaign, central governance arrangements and a consistent approach to recording, analysing and reporting feedback.
The Trust has also been asked in May/June 2026 to undertake additional work arising from the HSC savings plans, which may have associated impacts. This could require engagement on both issues to run concurrently. If so, delivery of the full Fermanagh and West Tyrone engagement programme may take longer, given available resources and to ensure there is very clear parallel lines involving this Engagement work and the possible consultation work of the HSC Savings plans. This will also ensure there is less direct group engagement in July and August 2026, which will allow for the summer holiday period – an issue which had previously been highlighted by Public Representatives. Trust Board has also been advised and has approved this approach.
Strand 1: Staff engagement. Staff engagement will run through Directorate Engagement Leads, staff briefings, director-led sessions, established team and professional meetings, the Staff Information Hub, the We Are West App and online and paper questionnaire routes. The aim is to ensure staff understand the purpose and scope of the programme, have opportunities to contribute, and can help identify practical opportunities, risks and conditions for successful change.
Strand 2: Public and community engagement. Public engagement will be delivered from June to September 2026 (with provisional allowance that this may run through October 2026 – depending on competing demands). This will be delivered through online questionnaires, paper and accessible routes, pop-up engagement, community group sessions and targeted outreach. The Trust is working with Fermanagh and Omagh District Council community planning structures, including the Integrated Wellbeing Network and the Community and Voluntary Sector Forum, to reach rural communities, Section 75 groups and people who may not traditionally engage.
Strand 3: Stakeholder and public representative engagement. The Trust will continue direct engagement with MLAs, MPs, council representatives, party groups, key external stakeholder groups, business stakeholders, SOAS, PCC, DoH, SPPG, PHA, community planning partners and other relevant organisations. This will support informed discussion, consistent messaging, promotion of engagement opportunities and early identification of concerns or issues requiring follow-up.
The Engagement Plan is clear that this is not a formal consultation on specific service changes. It is an exploratory engagement exercise designed to understand population need, community expectations, attitudes towards potential future models of care, and what would need to be in place for change to be safe, trusted and sustainable.