Campaigners for rural hospitals in Northern Ireland believe direct rule could lead to the collapse of services.

Doctor Caroline Marriot of the British Medical Association said tough decisions over the future of rural hospitals are long overdue and will be further delayed with the suspension of devolution.

"We need to have a Westminster Government which is willing to take decisions instead of putting them on hold for a number of years, which is what Westminster has done for the last while."

Last year saw the formation of the pressure group the Campaign for Rural Hospitals, which represents six hospitals' action committees fighting to save acute facilities.

Campaigner for the South Tyrone Hospital in Dungannon, Ethna McCord said the return to direct rule will lead to services slipping away from rural hospitals throughout Northern Ireland.

"We're extremely concerned that those who have always wanted to see the end of South Tyrone Hospital and close our hospital will now seize their opportunity. Our hopes for democracy and accountability have been dashed."

Training credit lost

It is feared Royal Training Colleges could now withdraw training accreditation from certain posts, which would mean junior doctors would no longer work in those places.

Politics lecturer at Queen's University in Belfast, Doctor Rick Wilford said this would have a significant impact on rural services and may go unchallenged under direct rule.

"If for instance a Royal College did decide to withdraw training recognition in a particular hospital, if we had devolution, theoretically at least, what politicians could decide to do is to pump resources into that hospital in order to rescue it or to maintain the level of service it formerly provided."

Painful decisions

The future of rural health care facilities was always known to be one of the most controversial matters for the Assembly and the health minister to deal with.

Northern Ireland currently has 17 acute hospitals. There is a plan to reduce that in the long term to just nine.

Under threat are hospitals in Dungannon, Magherafelt, Downpatrick, Whiteabbey and in the long term the Lagan Valley in Lisburn and the Mater in Belfast as well.

In the south west, either the Erne in Enniskillen or the Tyrone County in Omagh will close or both will go to be replaced by a brand new hospital on a green field site.

When the new Causeway hospital opens to patients in November 2000, it is planned Coleraine hospital will close.