Two urgent recommendations from the health regulator on emergency general surgery pathways linked to South West Acute Hospital have not been fully implemented more than a year after the report was commissioned.

The Regulation and Quality Improvement Authority, in a review released in January 2025, recommended that patients assessed at SWAH in Enniskillen and accepted for admission at Altnagelvin be admitted directly to a surgical ward. It also called for more sustainable ambulance capacity to support the changed service model.

Campaign group Save Our Acute Services said neither recommendation has been delivered. A group spokesperson said the community in Fermanagh and South West Tyrone is geographically disadvantaged and called on the Health Minister to intervene and restore emergency surgery at SWAH on a sustainable basis.

The Western Trust said significant progress has been made. From May 2025 to February 2026, 97% of patients went directly to a bed. The trust said 100% direct admission is not always achievable due to wider system pressures and that those with the greatest clinical need are prioritised for safety reasons. It added that independent findings showed the emergency surgery changes reduced mortality, complications and readmissions while meeting 2022 standards.

A Department of Health spokesperson said the department continues to work with the Western Trust on implementing the recommendations and provides regular updates to the Health Committee. On direct admission, the department confirmed around 97% of patients now go straight to a bed, but repeated that 100% is not always possible.

To address ambulance capacity, the department said the Release to Rescue element of the Regional Ambulance Handover Protocol was introduced on 27 April 2026. Early data suggests ambulances are being released more quickly to respond to calls. Recruitment by the Northern Ireland Ambulance Service in the West Division has also reduced vacancies and increased staffing levels.

An RQIA spokesperson said responsibility for enforcing the recommendations lies with the Department of Health, which must determine what action is required. The line of accountability runs from the HSC Trust Board to the department.