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A shortage of doctors forced the night-time closure of the A&E unit at the Downe Hospital in Downpatrick, the High Court has heard.

A judge was told services would have remained unchanged if enough middle-grade practitioners were available to staff the department round the clock.

Campaigners are challenging the health minister's decision to have GPs provide out-of-hours cover at the hospital.

Judicial review proceedings have been brought by pensioner John Duggan.

His case is being backed by Down District Council.

Campaigners want the decision to have GPs provide the out-of-hours cover reversed.

They argue it is irrational to undertake such a change just over a year after the hospital opened in 2009.

It has also been claimed that the Department of Health recognised 24-hour emergency services were needed for the local rural population, and that the night-time closure decision involved an element of predetermination.

Since April, GPs have been staffing shifts between 22:00 GMT and 08:00 GMT.

The decision taken by the South Eastern Trust and approved by Health Minister Edwin Poots earlier this year was said to be necessary because of a shortage of middle-grade doctors.

Counsel for the department set out on Wednesday the staffing levels assessed as necessary to properly run the unit.

Unsustainable

Eleven middle-grade doctors, not including consultants and associate specialists, would cover the rota without using locums, the court heard.

Barrister Paul McLaughlin said the trust began to realise a 24-hour service was unsustainable when only five such doctors were available.

Asked by Mr Justice Treacy if the A&E department would have continued as envisaged if the staffing problem had not arisen, the barrister replied: "Absolutely.

"Quite simply the staff just don't exist. That is the case right across the UK and it isn't actually challenged by the applicant."

He confirmed that the steps would not have been taken but for the regional shortage.

"These changes wouldn't have been made. That's the trust's position."

The judge questioned him about a radio interview where a doctor claimed he and others would have been interested in positions if they had been aware of a job advertisement.

Mr Justice Treacy put to him a suggestion made in the case that the authorities were more interested in financially-driven reductions by stealth than filling vacancies.

He was told that no evidence exists to support any such theory.

Mr McLaughlin claimed the doctor in question had been "coy" when asked in the interview if he would go for one of the jobs.

A similar problem was identified at the Ulster Hospital, according to the barrister.

"There's a critical shortage of middle-grade staff there," he said.

"That is the ultimate problem here and that affects the sustainability of the service."

The hearing continues.

The decision to use local GPs to staff the A&E unit at the Downe Hospital was agreed by the South Eastern Health Trust (SEHT) at a meeting in November.

Campaigners opposed to the move said lives would be put at risk.