May 9, 2000
Greater Glasgow NHS Board
MODERNISING GLASGOW’S ACUTE HOSPITAL SERVICES
Access and Public Transport
We expected access to be an issue that people wanted to discuss arising from the changes in hospital services that we are proposing. Interestingly, we are hearing a lot of concern about access to the existing pattern of service. In other words public transport is a source of concern regardless of whether hospital services change or not.
GGNHSB had an encouraging first meeting with the Strathclyde Passenger Transport Executive (SPTE) on April 13th. The SPTE explained that they have varying influence over the different modes of transport available in and around the city. The SPTE control and run the underground services, specify services and fares for the railway services but with de-regulated buses they only have limited powers or funding to subsidise some services. Some £3million is spent in Strathclyde subsidising routes, mainly evening or weekends or filling gaps in the network.
The discussions picked up on the concerns we have been receiving from people trying to travel by public transport to Glasgow hospitals either as a patient or to visit friends and relatives.
To run a shuttle bus between the Southern General and the Victoria Infirmary between say 9.30am and the early evening on weekdays would cost in the region of £70,000 per year. If the shuttle system required more buses to run a continuous loop, the cost would multiply. We also discussed a possible shuttle bus service between Partick and the Southern General.
There is clearly a lack of available information about the best way of using public transport to get to various hospitals. What’s more bus routes and bus times are prone to change - making leaflets very difficult to keep up to date. Nevertheless, we need to help people make informed choices about the best way of getting from various parts of Glasgow to the individual hospitals. We have agreed with SPTE that we should do some work to find ways of routinely providing patients and relatives with good advice about the quickest and easiest public transport routes.
The dial-a-bus service was discussed, but under the tight criteria to access the service there is not a lot of scope for further development. However we did agree to give further thought to finding better opportunities for transport for people who are relatively immobile.
Hyndland and Partick stations are earmarked for upgrade in the near future to make them more user friendly, particularly for people with restricted mobility. The upgrade at Hyndland may also require some improvements in the Gartnavel Hospital grounds themselves to make sure that there is good disabled access on the hospital sites.
Detailed Planning for the Future
Once we are clear what our future service plans for hospitals are, we will need to commission a series of detailed access surveys which will help us to work up proposals to present to bus companies for changes in bus routes. The surveys will allow estimates to be made of future expectations of different modes of traffic to the various hospital sites for staff, patients and visitors. Alongside proposals for changes in bus routes, we will also need to make each hospital campus more bus-friendly, making it more attractive to take the bus rather than using private cars.
Some people might think this sort of detailed work should have been done already. However such surveys are laborious and expensive and there is no point in spending money on them until we have a clear picture of what the preferred pattern of service is based on patient care considerations. It is also important to emphasise that the pattern we propose involves no change in access patterns for the vast majority of the existing hundreds of thousands of journeys.
More Time for Consultation
Several individuals and organisations have requested a longer period of consultation than the 3 months originally identified. UNISON in particular are seeking a 6-months extension to December, 2000.
The general principles underlying the proposals had been widely discussed in Glasgow over the last two years (issues for specialisation; securing the best outcomes in patient care; doctors’ hours; the significance of ambulatory care). In addition the basic choice in the Southside had been clearly signalled in last year’s Health Improvement Programme – what was new in the current consultation was a straightforward question of making a judgement about opportunity costs and access.
In the case of North Glasgow we recognise that the consultation asks questions and therefore there would need to be further consultation beyond the summer once the Health Board had gauged responses to those questions. Thus by the end of June (or shortly thereafter – we won’t be rigid about that deadline) we hope people will have expressed a view about:
a) overall principles – flagged in the two preceding Health Improvement Programmes.
b) the site choice on the Southside.
c) how to sort out split site working in West Glasgow.
d) the various questions posed for North-East Glasgow.
We would then hope that at its August meeting the Health Board could express tentative conclusions on these four points and then test them through further consultation – hopefully quickly on the first three but probably taking several months on the latter.
We are striking a balance between not excessively prolonging uncertainty, (a factor felt to be important for South and West Glasgow), while providing good scope for debate where choices for the way forward are much less clearly delineated (North-East Glasgow).
Telephone Inquiry Line 0800 85 85 85
Since becoming operational on April 3rd, the telephone inquiry line has taken 154 calls for further information on the consultation. Over 4000 leaflets have been distributed on request, and many people have accessed the consultation package via the Health Board’s website.
Public Meetings Update
Attendance at the public meetings has been variable. The quality of questions and the level of interest from those attending, whether it is 4 or 40, has been very encouraging. As we stated at the beginning, this is a genuine consultation process. There have been some helpful suggestions about how the meetings could be best organised in order to promote effective debate about issues in a systematic way.
Throughout the meetings, a common theme has been the transportation issues which have been touched on earlier in the Newsletter. Some of the other concerns raised include:-
Q How do you identify which patients need A&E treatment from those requiring to be treated at a casualty department?
A If patients are in ambulances, organised by a GP or by 999, they will automatically be taken to the right hospital. The vast majority of patients who make their own way to hospital will be suitable for minor injuries/casualty treatment. The small minority who aren’t will be stabilised and transferred by ambulance. Experience elsewhere shows that the arrangement works well.
Q Ambulance response times have been criticised lately – could patients die as a result of additional transferral times to the major trauma centres?
A Two factors are important in dealing with major injuries, firstly, the length of time to be first stabilised by a paramedic at the scene and secondly, who the patient sees when they reach the A&E department. Currently not all seriously injured patients are seen by senior medical staff. By consolidating the major trauma services to two sites, more patients will have vital access to senior consultant staff on arrival at A&E. A few minutes extra in an ambulance is highly unlikely to make a critical difference to outcome.
In recent years there has been a decrease in the numbers of major accidents through a reduction in the injuries sustained in road traffic accidents, largely due to people wearing seatbelts and traffic calming measures. There has also been a reduction in the numbers of heavy industry accidents. This has resulted in A&E treating fewer patients with multiple injuries.
The proposals for trauma in the consultation document will take effect over a 5-year period so there is time for the ambulance services to be expanded. The Scottish Executive have recognised that there is a need for more ambulances and paramedical staff and are allocating additional funding for this.
We need to be careful not to confuse A&E with medical and surgical emergency referrals arranged by GPs. Such referrals will go to Gartnavel as well as to the GRI and the Southside in-patient centre. The question of medical and surgical receiving services at Stobhill is an issue that is being debated as part of this consultation.
Q Is this consultation just about cutting beds?
A No! It’s about combining the best quality pattern of in-patient care with continuing local access for ambulatory care, all provided in up-to-date facilities. At present there are about 3,500 beds in Glasgow. After all the changes there will be about 3,200. That is a 300 bed reduction over 10 years which is small compared with past trends in the NHS. What’s more the reduction is wholly in the surgical specialties, reflecting the continuing trend towards day surgery, minimal intervention techniques and shorter lengths of stay in surgery. No reductions in acute medical beds are proposed.
Q What about in-patient beds at Stobhill?
A With the proposed Ambulatory Care Centre at Stobhill, 85% of patients will continue to receive their care and treatment locally, on an out-patient and day case basis. So, for the vast majority of patients the only change is a much better organised service in modern facilities.
The North Glasgow Trust is organising debate and consultation on the whole question of in-patient beds at Stobhill. The Royal Infirmary and Stobhill have been working in partnership in many different ways in recent years. However, the impact of specialisation, reduced in-patient lengths of stay in hospital, the switch from in-patient diagnosis and treatment to ambulatory care and the effect of working hours regulations have brought us to the point of needing to explore, during this consultation, the in-patient services at Stobhill. This is what the North Trust are now doing. (Further information is contained within Leaflet 19 - The GRI / Stobhill Partnership).
Q Does the HCI have a place in the future plans?
A It’s interesting that the issue has been raised at a public meeting. HCI has, from time to time, been used by NHS patients for radiotherapy treatment. This is primarily due to a gap between the rising demand for the service and the time it takes to increase the existing capacity. The number of linear accelerators is being increased, but this takes time. The question of whether West Glasgow general hospital in-patient services should be based at Gartnavel or at HCI has been raised by various people over the past few years. Our proposals reflect the presumption that Gartnavel is in the best interest of patients and taxpayers but we have always been open to debate on this issue if people feel it should be re-examined.
The Evening Times have run some features over the last few weeks on:
Similar features on the Southside proposals and Accident and Emergency services are to be published soon.
Greater Glasgow NHS Board
MODERNISING GLASGOW’S ACUTE HOSPITAL SERVICES
PROGRAMME OF PUBLIC MEETINGS
Your chance to hear the Board’s proposals and debate and influence the issues which concern you.
|1st Issue detailed a meeting on
May 11th at the Brunswick Centre; please note that the meeting is not now
taking place. However a meeting is scheduled for May 16th.
Public meetings are for everyone, come along talk to doctors and NHS staff and hear and ask question about Greater Glasgow NHS Board’s proposals for new and better services. This is your chance to be heard.
Send your comments on the consultation:-
If you have any issues you’d like us to cover in the Newsletter, or for extra copies, please contact Elaine McKean, Press Officer, GGNHSB, Dalian House, 350 St Vincent Street, Glasgow, G3, 8YZ. Or alternatively you can fax on 0141 201 4426 or e-mailelaine.mckean@Glasgow-hb.scot.nhs.uk
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