The only surprise is that people appear surprised at what is happening at Daisy Hill Hospital

“The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation and work to create a modern, sustainable service.” This was one of the stand-out comments featured in a report published following a major review of Northern Ireland’s health service. Next week marks the sixth anniversary since the release of the Systems, Not Structures – Changing Health and Social Care report and the warning sounded by Professor Rafael Bengoa has come to pass. Barely a day goes by now where a health trust doesn’t post on social media asking the public to only attend their local A&E in the event of a life-threatening emergency. Community care packages for the most vulnerable are almost non-existent, the Royal College of Nursing is balloting its members over strike action and the system is facing a projected £450m deficit. On Tuesday, community pharmacists warned they are weeks away from running out of vital medication, while it emerged emergency general surgery at the South West Acute Hospital has been described by the Western Trust as “fragile”. A glimmer of light came yesterday in the form of an announcement by the Health Minister that Daisy Hill Hospital in Newry is to become a specialist elective care hub. It is part of regional efforts to address Northern Ireland’s waiting list shame, which is now so severe patients are dying while waiting for hospital appointments. Yet, even though the development should provide reassurance over the future of the hospital as an essential part of the HSC network, it has raised fears the suspension of emergency general surgery at Daisy Hill will become permanent. Being realistic about the situation, it is difficult to see how the service will ever return to Daisy Hill. Essentially it comes down to a shortage of surgeons able and willing to work at the hospital. Northern Ireland simply does not have the population to allow all services to be offered on all sites. Concerns over the future of emergency medicine at Daisy Hill are understandable – particularly as the Northern Ireland Ambulance Service is failing to meet response times for even the most critically-ill patients. But successive expert reviews agree that patient outcomes will improve if Northern Ireland concentrates its expertise on fewer sites. And the permanent removal of emergency general surgery at Daisy Hill, if indeed that is what happens, does not mean the A&E must also go. The Bengoa Review was published to much fanfare in October 2016, receiving widespread political support for its calls for reform. It should come as no surprise that, given the lack of reform which has happened since 2016, that services are deteriorating to the point of collapse. The only surprise is that people appear surprised at what is happening. What this week has demonstrated very clearly is that much more work is required to inform and reassure the public when it comes to the urgent need for reform.