2nd May 2001
Tel: 0141 201 4641
Fax: 0141 201 4426
Mr. Steve Farrell
Public Petitions Committee
The Scottish Parliament
PHQ Room 5.16
Dear Mr. Farrell,
Thank you for your letter of 24th April. I would be grateful if you could convey the following response to members of the Public Petitions Committee regarding the petition raised in respect of Stobhill General Hospital.
The review of acute hospital services in Greater Glasgow was launched in March 2000 and precipitated one of the largest consultation exercises undertaken by the NHS in Scotland. The context of the review was to take forward an appropriate and sustainable pattern of services over the coming decade following many years of under-investment which had led to all facilities, many of which were established in the Victorian era, being essentially unfit for purpose. Added to this were the continual pressures of technological and treatment development hand in hand with an increasing pace of specialisation. These clinical issues, plus changes to the working arrangements of junior doctors, collectively made the continued organisation of services in small ‘penny packet’ departments across different hospitals less sustainable and more impractical.
The anxiety which prompted this petition is well understood by the Board and is acknowledged. However, there are some wider factors about the proposals for Stobhill that have to be identified. The acute service proposals affect the entire city: the specific proposals for one hospital are not independent of proposals for others. The original proposals and their subsequent development followed extensive debate with a considerable number of groups - institutional, clinical, public and voluntary – as well as individuals.
The Board has made considerable efforts to ensure that local demands, needs and access to the vast majority of services would be met but balanced with the clinical need for consolidation – hence, the proposal for Ambulatory Care Centres and new forms of community primary care provision in the first place.
As indicated above, the Board acknowledges the petition submitted to the Public Petitions Committee and recognises the anxiety and strength of feeling behind it. However, the central proposition of the petition does not actually tally with the Board’s current position on the future of Stobhill General Hospital and the Glasgow Royal Infirmary, nor does it reflect the process we have been putting in place since December 2000 to take the review forward.
To appreciate the change in the Board’s position as a consequence of wider consultation and debate, I have set out the key stages in the diagram below. I will follow this with a further explanation of the issues at each stage and then with responses to the key issues raised by the Committee in its letter.
In prompting public debate through the March to December 2000 consultation exercise on the future of acute hospital services, Greater Glasgow NHS Board based its proposals on a number of factors. The Area Medical Committee advised that there should be a “reduction in adult in-patient hospital sites from five to three…the Glasgow Royal Infirmary, Gartnavel Hospital and one site south of the River Clyde”.
It was proposed in the consultation to concentrate in-patient services at the Glasgow Royal Infirmary. Balancing this with the views and needs of the local people however, the Board supported the building of an Ambulatory Care and Diagnostic Centre (ACAD) at Stobhill as a mark of long-term commitment to the maintenance of general hospital services on the site (of the 325,000 total patient encounters per year at Stobhill, the proposed ACAD and associated out-patient, day case and day surgery capacity elsewhere on the site would maintain 288,000 – nearly 90%).
The first phase of public consultation generated relatively little public response to these particular proposals, although individual clinicians and clinical groups were thoughtful about the ability of the Glasgow Royal Infirmary to house all the in-patient services.
In its September 2000 paper, the Board stated that it shared the caution of some clinicians and modified the proposal to the effect that in-patient services would not be concentrated in two sites without further consultation and tangible practical plans to allow it to happen satisfactorily. The North Glasgow University Hospitals NHS Trust anticipated that the transfer of services would take seven years to achieve and therefore the Ambulatory Care Centre and in-patient services would run concurrently on the Stobhill site for at least that period.
The final phase of consultation elicited a far greater degree of public response. Despite this, and the obvious level of strong local support for Stobhill, no real consensus on its future role was revealed. Some members of the public wished it to continue its present role, being modernised in due course. Others recognised the logic of a reduction of in-patient hospitals but argued that the Glasgow Royal Infirmary be abandoned with a brand new hospital built at Stobhill to combine the roles of both hospitals. This was mirrored too by a divergence in clinical opinion.
2 Is There a Reference Group for North East Glasgow?
The answer is yes.
The Board therefore proposed the setting up of a ‘Planning Group’ with extensive clinical and staff involvement. In view of the importance of local community opinion, it was confirmed also that a ‘Reference Group’ – similar but not the same as one proposed for South Glasgow - drawn from community representatives served by the Glasgow Royal Infirmary and Stobhill would be set up to ‘interrogate and influence’ the next stage of the review process.
At the same time the Board indicated that it would work with the North Glasgow University Hospital NHS Trust to strengthen management capacity for North East Glasgow in continuing the next stage of the process. There was also a requirement to put in place pan-Glasgow financial modelling and project control capacity and to secure Scottish Executive agreement to proceed on the basis outlined to carry out an ‘option appraisal’ exercise for North East Glasgow hospital sites and service combinations leading to the development of an ‘Outline Business Case’ for capital investment.
The Scottish Executive granted permission to proceed with development of outline business cases on 14th March 2001.
Subsequently, progress has been made in assembling a North East Glasgow Reference Group with confirmation that those representing the public interest will be the MSPs Paul Martin, Pauline McNeill, Patricia Ferguson, Frank McAveety and Sandra White. Word is expected shortly on the possible participation of a Conservative list MSP. Robert Brown of the Liberal Democrats will keep a ‘watching brief’ due to his existing commitment to the South Glasgow Reference Group and we have offered a similar courtesy to Tommy Sheridan MSP. Peter Hamilton, Convenor of Greater Glasgow Health Council has also agreed to serve on the Group.
The Reference Group will also encompass clinical and NHS management representation. It will oversee the option appraisal process and will ensure that guidelines and regulations are adhered to and verify that criteria have been applied correctly and that proper and meaningful comparisons and assessments of the possible options are made. The Reference Group will advise on how the wider public are kept informed on progress, process and outcomes, with the probability of further public consultation.
The first meeting of the Reference Group will take place shortly (but no date has yet been fixed).
3 What is the Status of the Proposals?
Given that, unlike South and West Glasgow, there is no consensus on the future service model for the north and east, this makes the role of the planning and reference groups more complex than elsewhere in the city. The Board committed itself to ensuring that an Outline Business Case for further capital investment to provide sustainable in-patient services is conducted in a way that addresses the messages that did emerge from consultation to date.
Four options will be subject to appraisal:
· Glasgow Royal Infirmary as the site for all in-patient services for the north and east. Stobhill has an Ambulatory Care Centre but no acute in-patient beds
· Glasgow Royal Infirmary closes. Stobhill is re-built as the sole hospital for the north and east
· Glasgow Royal Infirmary retains a specialist services role. Stobhill is redeveloped as a district general hospital for the north and east
· The ‘do minimum’ option. The Glasgow Royal Infirmary and Stobhill stay as they are but are brought up to an estate condition that meets basic health and safety and plant replacement requirements
In all options it is foreseen that a new Ambulatory Care Centre is built at Stobhill.
Before option appraisal can be undertaken there are two preceding pieces of work. Firstly, there is information gathering where mainly technical detail will be sought on projected patient volumes, service and department schedules, initial descriptions of how each site combination might work operationally, site appraisals, traffic analysis, capital and revenue cost profiles and risk assessment. Secondly, the benefits criteria against which each option are to be compared must be defined through e.g. service objectives, benefits to patients, clinical operations, environment and value for money, and thereafter the weighting applied to each criterion must be agreed.
At this stage discussions are underway concerning a wider community event or process that on a pan-Glasgow basis that would help define the latter criteria and weightings The Greater Glasgow Health Council has agreed to assist in planning and organising such an event, which is acceptable to the South Glasgow Reference Group, but we must seek the view of the nascent North East Glasgow Reference Group before proceeding.
Once the option appraisal process is complete, the option which emerges will then be developed to Outline Business Case status. After further public consultation, this would be submitted to the Scottish Executive for approval, granting of which would allow progress to Final Business Case, whereby appropriate capital and revenue investment could be secured and detailed specifications issued and contractors sought. The aiming point to present the Outline Business Case to the Executive remains the late autumn of this year.
At this stage the options identified above remain proposals with no formal decisions being taken until the completion of optional appraisal, preparation of the Outline Business Case as overseen by the Reference Group and further public consultation.
The Committee requested details of the consultation carried out to date north of the River Clyde. As with the rest of the City, extensive efforts were made to inform the public and to stimulate debate. For the sake of clarity I have summarised the detail of the consultation process at Appendix 1.
I hope that the information I have provided meets the requirements of the Public Petitions Committee and I have been able to show that the anxieties inherent in the petition submitted by Councillor Kennedy have been addressed in some respects and are perhaps unwarranted in others.
I hope too that we have shown that there has been a clear process of genuine consultation followed by the Board and that we have modified our proposals considerably from the beginning of this process to the current date. We have made efforts to alert the public, partner organisations and local media to the emerging approach and to demonstrate that we have no preferred option within a debate that is far wider and advanced than was the case March 2000. For various reasons this message has not been recognised or accepted in some quarters.