Modernising Glasgow's Acute Hospital Services
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South Side Reference Group
M
inutes of the Inaugural meeting

held at 2.30 p.m. on Monday 23 April 2001
in Board rooms A & B Greater Glasgow NHS Board.

 Present:

Mr G Craig 
Mr B Aitken
Mr J Anderson
Ms M Barrie
Mr R Brown 
Mr R Calderwood
Mr T Findlay
Mr K Gibson
Ms J Hughes
Ms P McNally
Mr D Ritchie
Mr C Spry
Ms M Macleod
Trustee, South Glasgow Trust (Chair)
MSP, Scottish Parliament
Medical Staff Association South Glasgow Trust (SGH site)
Staff Partnership Forum Rep South Glasgow Trust(SGH site)
MSP, Scottish Parliament
Chief Executive, South Glasgow Trust
Divisional General Manager, Glasgow Primary care Trust
MSP, Scottish Parliament
MSP, Scottish Parliament
Staff Partnership Forum Rep South Glasgow Trust (VI site)
Medical Staff Association South Glasgow Trust (VI site)
Chief Executive, Greater Glasgow NHS Board
Corporate Affairs Manager, South Glasgow Trust (secretariat)

Apologies:

Mr B Beacom MBE                 Glasgow Local Health Council

1.

WELCOME & INTRODUCTIONS

Mr Craig welcomed Members to the first meeting of the South Side Reference Group.  Introductions were made.  He then invited Mr Spry to speak to Members about the context in which the group had been set up.

Mr Spry reported that discussions about the Review of Glasgow’s Acute Services had commenced  about 1½ years previously, there had followed in-depth discussions within the service and two phases of public consultation, out of which it was now agreed that there was a need for a single inpatient hospital on the south side of Glasgow.  He reminded Members that the Health Board at its meeting on  19 September 2000 had concluded that there was a strong consensus of support that there should be a single inpatient hospital on the south side of Glasgow .  Site options at the Victoria Infirmary (current site and adjoining recreation ground), Cowglen (two potential sites which might be available), and the redevelopment of the Southern General Hospital site, had been systematically reviewed.

The preferred option of the Health Board had been the Southern General site with the location of an Ambulatory Care Centre, and rehabilitation beds for the elderly, at the Victoria Infirmary.

Mr Spry reminded Members of the three strategic aims endorsed at the September 2000 Health Board meeting:

  1. more equality of services across north and south Glasgow

  2. the co-location of  acute mental illness services on the same site as general acute services

  3. the possible re-location of children’s hospital services, and the associated issue of moving from three maternity delivery units to two

Following the outcome of the second phase of public consultation, the Health Board at its meeting on 19 December 2000, agreed that although new analysis of the options had been proffered, it had to be recognised that the public was of the opinion that the possibility of another more centrally site in the south of Glasgow should be explored.  Faced with this opinion the Health Board undertook to ensure that the option appraisal element of the Outline Business Case (OBC), that now needed to be prepared, should be vigorous and transparent, compare the Southern General option with the Cowglen option and, as a comparator, the status quo

2. TERMS OF REFERENCE

 

Mr Craig invited Mr Spry to indicate the Terms of Reference for the South Side Reference Group.  Mr Spry suggested that the Terms of Reference for the Group should be:

  1. To oversee the preparation of the Outline Business Case for submission to the Health Board by October 2001

  2. In particular to oversee the Option Appraisal process based on the three options: the status quo; the redevelopment of the Southern General Hospital; a new hospital at Cowglen.

In essence, the crucial role of the Reference group was to monitor the bona fides of the next stages of the planning/option appraisal process, so that the interested public could be assured that it was truly vigorous, unbiased and transparent.

 

The Group agreed with the Terms of Reference.

 

With regard to the process for the Option  Appraisal exercise, Mr Spry reported that this would culminate in an open and inclusive workshop with public involvement.  He suggested that the Local Health Council might  be contacted to nominate members of the public who could usefully participate in this process.  The Group agreed that this way forward would help to demonstrate the qualities of openness and lack of bias the process demanded.

 

Mr Craig advised that there were four elements within the Option Appraisal for the OBC:

 

A)  The Benefits Appraisal

The identification of the non-financial benefits, an indication of when they were expected to occur, and quantification.  These should, in an option appraisal, be compared with a set of desired service benefits which had previously weighted in terms of their degree of desirability compared with another.  On a subsequent occasion each option would then be scored against these weighted benefits to see which option scored the best.

 

B)  The Financial Appraisal

Identification and assessment of capital and revenue costs associated with shortlisted options over the life span of the scheme.  This would include how much the Health Board was prepared to spend on the services in the proposed scheme and the financial impact on the Trust’s balance sheet.

 

C)  Economic Appraisal

The presentation of capital and revenue costs, excluding VAT and capital charges.  This would include the identification and high level assessment of risks and uncertainties associated with the shortlisted options. It would result in the options being weighed in terms of their Net Present Values relative to the lifetime of the scheme.

 

D)  Risks and Uncertainty Appraisal

A full description of the risks associated with the leading options and how those risks could (or could not) be managed.

3. CURRENT POSITION

Mr Craig invited Mr Spry to give an update on any recent developments on the Strategy.  Mr Spry reported that the Scottish Executive approval to proceed to Outline Business Case had not been received until March.  In the meantime, work was underway on the whole-Glasgow issues concerning:

 

§         Bed numbers

§         Clinical service models for the range of services provided under the umbrella heading of “A&E”

 

It was also anticipated that the work to explore Child Health and Maternity issues (very relevant to the Southside) was due to get underway with a “Reference Group-type”  workshop on 31 May 2001.

 

In addition to the development of definitions and weightings for non-financial benefits, there were two other requirements on a pan-Glasgow Basis

 

§         The appointment of independent Financial Advisers

§         The appointment of transport and traffic advisers

 

Mr Calderwood reported that the South Glasgow Trust had commissioned James Barr & Son, Chartered Surveyors, to do some work on issues relating to land, and in particular:

 

§         To conclude matters with Glasgow City Council on the purchase of the land adjacent to Grange Road (to develop the ACAD at the VI)

§         To approach the owners of the land surrounding Cowglen Hospital including the savings bank and the Retail Property Holdings regarding disposal/purchase/timescale/costs

 

He also advised that the Trust had requested its lawyers to look into the legalities of developing the  greenbelt site at Cowglen.

 

Mr Calderwood informed Members that the Trust had instructed Boswell Mitchell & Johnston, Architects to obtain definitive responses to planning permission in respect of :

  1. the development of an ACAD at the Victoria Infirmary

  2. the redevelopment of the Southern General site

  3. the redevelopment of Cowglen

Mr Aitken asked if the Council had been approached.  Mr Calderwood responded that the Trust had written on 15 December 2000 to the planning department but there had been no formal response.

 

Mr Brown sought clarification on the likely restrictions on developing a site at Cowglen.  Mr Calderwood advised that it was understood that there were four owners of land surrounding Cowglen: the Savings bank;  Greater Pollock Trust; Retail Property Holdings; and a farmer.  Clearly the willingness of any, or all, of the parties to sell would be a factor to consider.  He reported that verbal advice from the Glasgow City Council planners indicated that a greenbelt site (which applied to one of the two sites at Cowglen)could be used to build a hospital if there were no other site options within the area.  He pointed out that it would be difficult for the NHS to assert that that was the case.

 

Mr Aitken asked about the appeals procedure if the Council refused an application to develop a greenbelt site or to redevelop an existing site.  Mr Calderwood reported that the right of appeal used to be  the Secretary of State and he presumed this power had now transferred to the First Minister of the Scottish Parliament. Mr Brown asked if a Compulsory Purchase Order was a possibility.  Mr Calderwood indicated that he would need to obtain legal advice on that issue.

4. PARTNERSHIP UK

 

Mr Craig invited Mr Spry to advise on the role that Partnership UK might play.  Mr Spry advised that Partnership UK was the successor to the HM Treasury PFI Task Force, and had been set up by the government to assist public sector bodies in the best possible procurement practice in using PFI/PPP.  He reported that Partnership UK concentrated on large, complex and risky projects, and aimed to ease the regulatory processes by maintaining close relationships with government departments, the Scottish Executive Finance Department, HM Treasury and Ministers. 

 

Mr Spry reported that Partnership UK would be a partner on the Project Committee and would have the right of veto.  This right was intended to ensure adherence to sound procurement strategy.  They would receive a percentage payment if the PFI was successfully procured.

 

Mr Calderwood indicated that the role of Partnership UK, at this stage, was to advise on the level of risk with the proposed scheme.  He reported in addition to the role  Partnership UK would play, there was still a need for a financial adviser to advise on the pan-Glasgow proposals.

 

Mr Calderwood further indicated that there was a  requirement for a level of design to be available for each of the three options in order that a full option appraisal was possible.  He also indicated that ground conditions would need to be assessed for the proposed sites. Mr Calderwood reported that the Trust would be approaching the Health Board and the Scottish Executive on funding for this work. 

 

Mr Brown asked whether it was likely to be one PFI for the whole of Glasgow, or three individual PFIs.  Mr Calderwood responded that it was likely that there would be three or more PFIs, although no formal decision had been made.

 

Mr Brown sought further clarification on how Partnership UK would be paid.  Mr Spry reported that they would receive an agreed percentage on delivery of a successful PFI.  He advised that he was unsure of the exact details but agreed to obtain this information for the next meeting. ( Post -meeting note: the percentage is agreed by negotiation prior to finalising Partnership UK involvement.  Those negotiations have not yet taken place).

                                                                                                                                                            CS

Mr Calderwood reported that a transport consultant would also need to appointed on a pan-Glasgow basis to measure transport and traffic implications for  all the proposed sites. 

 

Mr Calderwood reiterated the professional input required to move forward:

 

            Pan-Glasgow                 í     Financial Advisers

                                                í     Transport Consultants 

South Side                 í     Technical advice – including engineering
                                 í     Architectural advice – to provide provisional designs for each of the options

                                        (ie SGH redevelopment, Cowglen, status quo)

                                 í          Construction accountants

Mr Calderwood stated that the architects would be excluded from involvement at a later stage.

 

Mr Craig asked how long it would take to appoint the necessary professionals.  Mr Calderwood indicated that representatives from the two acute Trusts and the Health Board had been meeting regularly to look at funding in order that the appointments could be made as quickly as possible following agreement. Mr Calderwood advised that the tenders for the two pan-Glasgow appointments were being prepared and he did not envisage unnecessary delays in any of the appointments.  He commented however, that sourcing funding for this advice had still to be agreed.

 

Mr Craig commented that any delay might impact on the proposed October 2001 date for submission of the OBC to the Health Board.  Mr Spry advised that the aim was still to complete the process for autumn 2001 but this could be reviewed at a later stage.

5. THE ORGANISATION OF  A SINGLE PROCESS TO DEFINE CRITERIA AND             WEIGHTINGS FOR GLASGOW AS A WHOLE

Mr Craig advised that the definition of criteria and process to determine weightings was concerned with the non-financial benefits.  Mr Calderwood reported that the Scottish Executive defined non-financial benefits as:

 

Benefit criterion

 

Benefit definition

 

Promote modern clinical practice

§         Enables benefits from changes in practice & technology

§         Improves quality of care & services

§         Positively promotes health

§         Facilitates seamless working between services

§         Facilitates innovation

Acceptability

§         Good strategic fit

§         Acceptable to users & improves patients’ experience

§         Facilitates patient choice

§         Facilitates smooth “patient journey”

§         Promotes positive image of healthcare

Flexibility

§         Capable of further development

§         Offers opportunities to respond to changes in service levels

§         Facilitates changes in clinical practice

Accessibility

§         Addresses inequalities and delivers improved access to services

Practicality

§         Practical and deliverable to required timetable

§         Improves management of risk

§         Ease implementation

Attracts, retains and mobilises staff

§         Provides opportunities for improved recruitment, retention and job satisfaction

Sustainability

 

Promotes good communications and inter-agency working

 

Meets current and projected forecasts of demands

 

Improves performance of Trust property

 

Positive environmental impact

 

Facilitates efficient use of resources

 

 

 

Mr Craig asked if the weightings exercise would be carried out for the whole  of Glasgow.  Mr Spry responded that it had been suggested non-financial benefits and their weightings should be standardised for all three sections of the Glasgow Review.  This would ensure that all the option appraisals for the OBCs were conducted on the same basis, and therefore less prone to the subjectivity associated with specific localities.

 

Mr Calderwood agreed to provide a paper for the next meeting of the group on the process for weighting non-financial benefits.

                                                                                                                                                            RC

Mr Craig asked who would conduct process of defining the criteria and weightings.  Mr Spry advised that this might  include:

 

§         Public perspective – it had been suggested that the local health council would be approached for appropriate citizens

§         Staff Partnership forum representation

§         Clinicians

§         Local Health Council

 

Mr Spry advised that the group formed in this way would define their own criteria for weighting through a process of mutual interrogation. He suggested that an external company should be used to facilitate the event and advised that this would require a tendering exercise.  Ms Hughes asked if this would delay the process.  Mr Calderwood indicated that this should only take 2/3 weeks and  suggested a June 2001 date for the workshop. He commented however, that some of the work being done by the A&E Group might assist in the weightings exercise.  Ms Hughes asked when this work would be completed.  Mr Spry reported that it was anticipated the bulk of the work would be completed by mid-summer 2001.  He reported that the work involved:

 

§         A prospective study of A&E presentations.  This would include what elements of A&E services were most in demand in which areas of the city.

§         Sizing of facilities at Glasgow Royal infirmary e.g. which hospital do areas like Rutherglen access: Hairmyres? GRI? Cowglen?  SGH?

§           A&E modelling project being conducted at GRI.  How are people accessing A&E – self?  GPs?  Out of Hours services?  NHS24?

 

Mr Spry indicated that whilst a June 2001 workshop would be preferred as neither the West nor the North/East Reference Groups had been convened this might be an ambitious timescale.

 

Mr Craig posed the following questions and the group responded:

                 

1.  Should there be a Pan-Glasgow workshop to define criteria and weight the non-financial benefits?

     THE GROUP

     Agreed this should be done on a pan-Glasgow basis

 

2.  Should there be wider public involvement in that workshop?

     THE GROUP

     Agreed there should be wider public involvement and the Local Health Council should be approached to assist with
     nominations

 

3.  Should the Reference Group be directly involved in the workshop?

     THE GROUP

     Agreed that the Reference Group Members should not be directly involved in the weightings workshop

 

4.  Should Members of the Reference Group be able to oversee the workshop?

     THE GROUP

     Agreed Members could attend to observe if they so wished

6. DATE OF NEXT MEETING

 

10.30 a.m.  MONDAY 11 JUNE 2001 at Dalian House

 

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Last modified: August 15, 2002

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