ACUTE HOSPITAL SERVICES IN GLASGOW
A PROCESS FOR DEFINITIVE PUBLIC DEBATE AND CONSULTATION
Tuesday, 15th February 2000
Board Paper No. 00/10
The Board is asked to consider proposals for a process of public debate and consultation to be pursued from the spring onwards, hopefully to lead to proposals being put to the Minister in the autumn.1. INTRODUCTION
1.1 Glaswegians want a hospital service that provides the most up-to-date treatment quickly, using the best of modern technologies and specialist skills, in settings which are modern, friendly and convenient. Achieved within the next decade. They are aware of the modern facilities elsewhere and expect us to deliver a well designed service for them.1.2 This paper suggests a process by which we can complete the debate which has been reverberating around Greater Glasgow in the last couple of years. We need to move from argument to action.
1.3 We want to do this in a way which satisfies the statutory requirement for formal consultation (which is laid down in an old Scottish Office circular and must be complied with) but is significantly more participative and interactive with the public we serve.
2. CURRENT REALITIES
2.1 The public are increasingly aware that the NHS is in danger of falling far behind their expectations.
2.2 Too often for patients there are delays, postponements and trekking around hospital corridors going to scattered departments in old and shabby buildings.2.3 Equipment budgets have failed to keep pace. We are slow to adopt new technologies and too much of our equipment is out-of-date, slow and over-loaded. This means quality of service is not what it should be. And it means yet more delays.
2.4 Almost all patient experience of acute hospital services does not involve the use of in-patient facilities. In-patient care currently accounts for less than 10% of all patient experiences with the acute hospital service.
2.5 There is a continuing trend in surgical specialties towards day case treatment rather than in-patient treatment. (Made possible by what are known as "minimally invasive technologies" – for example the use of fibre-optic probes which not only see inside the body but can remove growths, clear blockages etc. Laser technologies and robotics are increasing the scope for this approach).
2.6 The EU Working Times Directive and the national agreement on junior doctors’ working hours pose a major challenge to the present organisation of clinical teams – many are too small to avoid breaching legal requirements. We cannot go on organising our services in ways that would now presume that staff will forego their legal rights. Yet the national supply of doctors will take almost a decade to increase significantly.
2.7 The continuing increase in general medical admissions needs a planned response. Current systems for medical emergency receiving, treatment and discharge planning vary. Too often they suffer from poor facilities and over-stretched staff.
2.8 There is growing evidence (in the surgical disciplines especially) that specialists often achieve better outcomes, especially if treatment needs the back-up of multi-disciplinary teams focused on particular conditions or disease-groups.
2.9 These trends and the problems are being played out in a pattern of hospitals which has, in many aspects, gone well past its "sell-by" date. Only a determined and thorough-going modernisation will give Glaswegians the standards of service and quality of experience they expect in other aspects of their lives.
3. WHAT DO WE NEED TO ACHIEVE?
3.1 There has already been substantial debate. There is strong support among doctors in Glasgow for a pattern of hospital services which:
a) provides Ambulatory Care just as locally accessible as it is now but in facilities that are efficient, patient-friendly and well equipped with the necessary technologies.3.2 There has been significant public support for the creation of a new hospital for the Southside to replace both the obsolete facilities of the Victoria Infirmary and the Southern General. Work on practicalities and costs has now been done and needs to be shared for public debate, leading to a decision by the summer so that capital investment processes can get under way. Basically the choice is between:
b) concentrates in-patient services which are still reasonably accessible but which are in modern facilities, allow working hours regulations and educational standards to be met and, most importantly, provide greater assurance to patients that they will be in the hands of the specialist with the most appropriate knowledge and skills for their disease or injury.
3.3 North of the river there is already strong public support for an Ambulatory Care Centre at Stobhill. The extensive modern facilities at the GRI need to be brought into use in a way that makes the best possible use of them in strengthening trauma and associated services in Glasgow. In West Glasgow the key issues continue to be how to overcome the present split site working for acute medical and surgical receiving, how to improve cancer services and how to move "walk in, walk out" services for minor injuries and illnesses closer to where most of the population live – and how can all of this be achieved quickly in modern facilities?
a) a new hospital on a new site with a new Ambulatory Care Centre at the Victoria campus.b) a new Ambulatory Care Centre at the Victoria and redevelopment of the Southern General campus to provide in-patient beds for the Southside.
(There is not enough space at the Victoria campus to create a single new hospital for the Southside nor would such an option make geographical sense on a Glasgow-wide basis when thinking about the way in which trauma services need to be provided for the Glasgow conurbation).
3.4 During the public debate on the Southside in 1999 we were asked why no consideration had been given to including the re-provision of the Yorkhill facilities in the new Southside Hospital. Yorkhill has relatively modern facilities (the theatre suite opened in 1998) but the Queen Mother’s Maternity Hospital has significant design limitations and has not worn particularly well as a building. The main building for the Royal Hospital for Sick Children is adequate for the foreseeable future although perhaps not particularly flexible to adapt to future changes in children’s health care. In any event Yorkhill’s replacement would become a pressing forward planning issue by the end of the decade.
There is a considerable weight of professional opinion that children’s services should ideally be on the same site as adult services so as to make the mutual sharing and accessing of clinical expertise easier. There are also advantages in sharing, rather than duplicating, those hospital support services which are common to both adult and children’s services. Examples elsewhere in the UK show how the crucial child-centred separate identity of a Children’s Hospital can flourish within the envelope of a larger general hospital.
In the spirit of the public debate and consultation which we wish to encourage we think it would be right to include this question in the forthcoming period of debate and consultation. We will set out the issues involved in the information which we are now assembling (see Section 4).3.5 In debating the future of hospital services most people tend to focus almost exclusively on their local part of Greater Glasgow and to be less concerned about the position elsewhere. Our job is to find a way of meeting all of these various aspirations without the process being spun out over 15 to 20 years. We want to achieve very substantial improvement within 10 years, with the Ambulatory Care elements up and running within 3 to 4 years from now.
3.6 So we have to be ambitious but we also have to pay regard to what is realistic. The total capital allocation for the whole of the NHS in Scotland amounts to around £145 million a year and that has to cover everything from hospitals to health centres, equipment to major plant replacement. Our local debate and consultation needs to recognise that reality, just as it has to recognise the implications of revenue affordability for a Public Private Partnership (PPP) approach – just how far can or should we go in trading beds and staffing numbers to pay for facilities? Glaswegians would not thank us for spanking new facilities with too few beds and with staff still over-stretched.
4. A BETTER WAY OF DEBATING AND CONSULTING THE ISSUES
4.1 There is a formal NHS Consultation Procedure which applies if a hospital is being closed or if a very substantial change of use to an existing hospital is being proposed. As a procedure it is rather long in the tooth (dating back to the 1970s) and is rather mechanistic. It requires a formal consultation paper with proposals and all the necessary supporting information. Such documents are usually so dense and detailed that they are not an easy read. They appeal to the cognoscenti of NHS consultation papers but rarely attract wider readership or understanding. Yet this process has the force of statutory requirement – if its form is not followed, a Health Board would be open to judicial challenge.4.2 There is no formal NHS Consultation Procedure for new service developments. Usually such proposals are generated in a participative way with those most closely concerned in commissioning, providing and using the new service.
4.3 What we are contemplating here is something far more ambitious and exciting. A modern, effective and patient-friendly set of hospital services across the whole canvas of Greater Glasgow. Glaswegians will want to feel that there will be a set of services that are genuinely tailored to their needs and of which they can be proud for Glasgow as their home city.
4.4 So we need to design a process for debate and consultation that genuinely encourages involvement and discussion, is easily accessible and yet which meets the statutory requirements of the formal Consultation Procedure.
4.5 A key requirement is to have a portfolio of available information which can be made available in a whole range of combinations, depending on what people are interested in. Taken all together they would constitute the substantive formal proposition needed for statutory requirements but each element\leaflet would be written in plain English, jargon-free and well presented so that issues are clear.
Figure 1 indicates what this portfolio of information might consist of. We might aim for every household to get a "Summary of Proposals" through their letter box with information on how to get any other leaflet they might be interested in. MSPs, the Local Health Council, Local Authorities, Councillors, Libraries, the media, Community Councils, Social Inclusion Partnerships, Professional Advisory Committees, and the other usual recipients of NHS Consultation Papers would get the whole portfolio.
4.6 We would need also to organise displays for shopping centres, hospital entrances and other public places. Notices publicising the issue and saying how people can get hold of information would also need to be provided for libraries, GP surgeries, hospital waiting areas etc.4.7 A Web Page would also be constructed, containing key information and providing a comments facility. This might also be complemented by a telephone help-line / enquiry point.
4.8 But all of this is simply about assembling source information and making it accessible. Beyond that we need to organise a programme of discussion that allows the issues to be explored, identifies queries and views and encourages genuine exchanges of information and opinion. The programme of discussion needs to include:
- Each local authority.
- Community councils.
- Social Inclusion Partnerships.
- The Local Health Council.
- Open public meetings.
- The Glasgow Alliance.
- Participation in TV and radio programmes.
- One or more citizens’ panels or similar processes.
- Professional advisory committees.
- Other groups which express an interest.
- Staffed displays in public places giving opportunities for people to expand on their knowledge of issues and express a view.
- Internal discussions with NHS staff and trade unions.
4.9 The timescale for this process would be as follows:
|21st March 2000||GGNHSB approves materials to be used for the process.|
|1st April to 30th June 2000||
Distribution of information in first week of April.
|July 2000||Health Board staff analysis of the outcomes of discussion and consultation, undertaken in conjunction with Trusts and Local Health Council staff. Scope here for informal dialogue with LHC.|
|15th August 2000||
Health Board considers report on outcomes and reaches conclusions about the proposals to be put to the Minister.
|16th August 2000||
Health Board conclusions sent to LHC for comments.
|18th September 2000||
Health Board reviews conclusions in the light of LHC comments.
|Late September 2000||
Proposals sent to Minister for approval.
4.10 During the period March to September, Trusts will be encouraged to make as much progress as possible with the sort of detail that would be needed to support the necessary Outline Business Cases for capital investment. Much of the material will be needed whatever the outcome of the process of discussion and consultation. There is clearly some risk of work being abortive but this is a risk worth taking in trying to avoid subsequent delays in getting much needed new capital investment underway.
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Copyright © Greater Glasgow NHS Board
Author: Brian A. McMullan
28th February 2000