Western Trust ends ED-to-ED surgical transfers but ambulance gap persists

RQIA's follow-up inspection of the temporary Emergency General Surgery pathways finds transfers between emergency departments have stopped, but additional ambulance capacity is still not in place.

By the Care Shield Compliance Press Desk··3 min read·Northern Ireland

What RQIA found

The Regulation and Quality Improvement Authority (RQIA) has published a follow-up Inspection Report on the temporary Emergency General Surgery (EGS) Pathways in the Western HSC Trust. The report was published on 15 September 2026. It covers a follow-up inspection carried out between 29 July and 4 August 2026 at both the South West Acute Hospital (SWAH) and Altnagelvin Hospital.

The inspection assessed how far the Trust had implemented the Quality Improvement Plan set out in RQIA's earlier Inspection Report, published on 10 June 2026.

On the first of two earlier urgent recommendations, the Trust's recorded activity data showed that transfers from one emergency department to another have been markedly reduced. The last cases were reported at the end of January 2026 and none have been reported since. RQIA describes this as a positive outcome that should be sustained.

On the second, RQIA found that additional Northern Ireland Ambulance Service (NIAS) capacity has not been put in place.

The two urgent recommendations

The inspection and follow-up form part of RQIA's actions following its 2024 Review, published in January 2025, of the pathways associated with the suspension of EGS services at SWAH in December 2022. That Review made two recommendations it classed as "urgent":

  • 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 emergency department at Altnagelvin. The Trust should ensure achievement of this 'direct to ward' admission is accurately calculated and reported regularly.
  • The Department of Health should consider providing more sustainable and resilient ambulance capacity to strengthen the model supporting emergency surgical services in the Trust area, and address concerns about the impact on NIAS services more widely.

Letter to the Department of Health

Because the ambulance capacity has not been delivered, RQIA has written to the Department of Health under Articles 4 and 35(3) of the H&PSS (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. The letter advises that the Department should take appropriate steps to address the matter by commissioning additional NIAS emergency ambulance and crew capacity.

RQIA notes the issue has remained outstanding since the original Review recommendations of October 2024.

Patient transfers from SWAH to Altnagelvin

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 to focus on providing a safe and reliable transfer service from SWAH to Altnagelvin once a decision has been made at SWAH that a patient requires admission.

RQIA has told the Trust that for the 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 transport arrangements from SWAH to Altnagelvin. Any cases where this happens should be reported within the Trust's assurance processes and investigated so that action can be taken on the underlying issues.

Audit and ongoing assurance

An audit is under way in the Trust to assess outcomes for patients who are managed at SWAH itself rather than transferred. This is to be available within the Trust assurance process by mid November 2026 and then shared with RQIA. RQIA says this matters because the majority of patients who present at SWAH with symptoms indicating a need for EGS services are not transferred to Altnagelvin.

RQIA states that 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. RQIA describes these as examples of essential elements of effective governance oversight and assurance that the Trust Board must establish.

The full findings against the areas for improvement, together with the actions needed and timeframes, are set out in the published Follow-up to Inspection Report.

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Sources

  1. RQIA Statement: RQIA publishes follow-up Inspection Report on the temporary Emergency General Surgery (EGS) Pathways in the Western HSC Trust — RQIA (Northern Ireland) , 15 September 2026

Questions people ask about this

What did the RQIA follow-up inspection of the Western Trust EGS pathways find?

It found ED to ED transfers have been markedly reduced, with none reported since the end of January 2026, but that additional NIAS ambulance capacity recommended in the 2024 Review has not been put in place.

Why has RQIA written to the Department of Health about ambulance capacity?

RQIA wrote under Articles 4 and 35(3) of the H&PSS (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 because the recommendation for additional NIAS emergency ambulance and crew capacity has been outstanding since October 2024.

What happens next in the Western Trust?

An audit of outcomes for patients managed at SWAH is to be available within the Trust assurance process by mid November 2026 and then shared with RQIA. The full actions and timeframes are in the published Follow-up to Inspection Report.

How this was written. Care Shield’s press desk drafts from primary sources — the statute book, regulator publications and government announcements — and publishes automatically once every factual claim traces to a named source. The sources are listed above so you can check them. It is not legal advice, and it is not a substitute for reading the regulation that applies to your service. If you find something wrong, tell us at hello@careshieldcompliance.co.uk and we will correct it in public, on this page.

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