8. THE OVERALL PLANNING CHALLENGE FOR GREATER GLASGOW – ACUTE HOSPITALS IN A WIDER CONTEXT

Planning acute hospitals does not take place in a vacuum. Acute hospitals work in partnership with primary care to address the ill-health needs of the population they serve.

The poor health status of much of the population of Greater Glasgow has been well reported elsewhere. Severe socio-economic deprivation, poor housing, low educational attainment, a sense of hopelessness and social exclusion combine to threaten health. Poor health in turn can often intensify these problems in a vicious circle.

Greater Glasgow NHS Board needs to ensure that it is playing its part in addressing these problems. In particular we need to:

    1. invest in strengthening primary care.
    2. concentrate on children in order to tackle the inter-generational consequences of deprivation and social exclusion.
    3. strengthen services to meet the needs of people with mental illness or addiction problems (tobacco, alcohol and drugs).
    4. increase our efforts in community development and health promotion to help people overcome low self-esteem and to strengthen their capacity to contribute to their community.

Although these efforts will be all the stronger if they are pursued in conjunction with our partners (local authorities, voluntary sector, Scottish Homes, the police and others), they will also require significant additional financial investment.

For the acute services, the major national priorities of cancer, coronary heart disease and stroke, loom particularly large in Greater Glasgow. Poor health status, poor nutrition, smoking, drug and alcohol abuse, damp housing and the legacies of old heavy industries, all play their part in producing high incidence of heart and vascular diseases, respiratory problems (such as emphysema and bronchitis), lung cancer and asbestos-related illness and various other cancers. We need to invest in the necessary specialist team skills, sophisticated diagnostic support and treatment facilities now needed to achieve the best possible results. It is unlikely that we can keep pace with technological change without significant investment. Scarcity of capital resources suggests we will need to concentrate technology and equipment investment around associated clusters of specialist teams.

Glasgow also experiences high demand in its trauma and accident services. The NHS needs to be sure that its response to trauma and accidents is expert and has strength in depth to deal with the most serious life-threatening cases. Yet at the same time the risk of less serious cases experiencing delays as other more serious arrivals take priority is a regular feature of our current service.

The importance of modernising acute hospital services in fit for purpose facilities is overwhelmingly evident. There are too many old facilities with scattered and obsolete accommodation which prevent different parts of the service working together effectively and efficiently. The impact on the patients’ experiences of the service will often be dispiriting and frustrating. The public’s patience and forbearance in the face of shoddy facilities and disjointed organisation has been remarkable but if we do not address the problems – if we simply continue to "patch up" and "cobble together" – public patience will run out and the very concept of the NHS will become debased.

The challenge is how to modernise the acute hospitals without that taking all the extra investment that is so badly needed in primary care, children’s health, community development, health promotion and services for mental illness and addictions. The NHS does not have infinite resources. Greater Glasgow NHS Board has a statutory duty to live within its cash limit.

A brand new Southside Hospital and a New Western Infirmary would probably result in a net increase in capital and interest charges (the equivalent of mortgage charges) of a conservative estimate of at least £25 million per annum. That alone equates to nearly double the amount which GGNHSB is currently expecting to get in additional development money to bring it up to the new proposed NHS funding formula target which recognises the impact of deprivation on Glasgow’s needs for health care. That leaves no space for new drugs or new treatments in acute services and would squeeze out any improvement in all the other services aimed at tackling the worst aspects of deprivation and health inequalities.

Our proposals do involve spending more money on acute hospitals but not so much more that they swallow up what we also need to be spending on our other health improvement challenges. What’s more we think we have found a way of maintaining local access for most services, providing good modern facilities and solving the problems associated with specialisation and working hours regulations.

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