Modernising Glasgow's Acute Hospital Services
Return to Acute Services Main Index
UPDATE ON IMPLEMENTATION OF NEXT STEPS
RECOMMENDATION: The Board is asked to note progress on implementation of the conclusions reached at the Board meeting on 19th December.
1. A letter setting out the outcome so far of the statutory consultation exercise has been sent to the Scottish Executive. It includes a request for authorisation to proceed to Outline Business Case stage for three major investment projects on the basis set out in the December Board paper (with the exception of the proposal for an ACAD at the Victoria Infirmary (see paragraph 5 below).
a) South Glasgow.
b) West Glasgow.
c) North and East Glasgow.
2. Discussions have been held with Trust Chief Executives, the Chairman of the Area Medical Committee and other interested parties as a prelude to establishing:
a) the A & E Services Planning Steering Group.
b) the Steering Group to address the issue of bed numbers.
c) a process for examining options for child and maternal health (more detail on this will be reported to the next meeting of the Board).
3. The Local Health Council have produced a matrix of where they perceive information shortfalls in the interim specialty manoeuvres proposed in both acute Trusts (copy at Annex A).
In the case of South Glasgow, the additional information required is relatively minor and the Trust has been asked to provide it as soon as possible. It is suggested that a consultation paper be issued as soon as the information is to hand since there is now considerable urgency if the extra general medicine capacity at the Victoria Infirmary which the manoeuvres will yield is to be available without further delay.
In the case of North Glasgow, similar urgency applies in the case of the transfer of in-patient orthopaedics from Stobhill to GRI (issues of junior medical staff and deficit recovery) and hence ophthalmology (since its 2 beds are located in the same ward used by orthopaedics). Again the Trust has been asked to provide the necessary information and it is suggested that a consultation paper be issued as soon as possible. Papers relating to the proposals to transfer in-patient ENT, urology and gynaecology from Stobhill will be brought forward for the Board’s consideration in due course.
4. Further work has been done on the setting up of the Reference Group for the option appraisal element of the Outline Business Case for South Glasgow. This is described in Annex B. Further work needs to be done to confirm the precise composition of the public interest element and the Reference Group itself will need to consider how the wider range of interest groups can best be kept in touch with the option appraisal process while it is being undertaken.
5. Attention is also drawn to the final section of Annex B which clarifies the Board’s continuing view of the role of a stand-alone ACAD at the Victoria Infirmary (see paragraphs 15 to 23 of Annex B).
6. As far as the option appraisal element of the North and East Glasgow Outline Business Case is concerned a more complex process needs to be established. There has been some discussion with the North Glasgow Trust Chief Executive about the mechanics of internal service planning in the Trust for this next stage of work. During the next fortnight there will be further thinking about how the Reference Group element of the work might be established.
7. Finally, regarding the Dental Hospital and School, the next step is for the Trust to confirm Dental School space requirements with Glasgow University. The Trust Chief Executive is pursuing this issue.
RECONFIGURATION OF ACUTE HOSPITAL SERVICES
IN SOUTH GLASGOW
1. At the December, 2000 Board meeting it was agreed to endorse the proposition that there should be a single in-patient hospital for South Glasgow, that approval should be sought to proceed to Outline Business Case stage and that a Reference Group should be established to oversee the option appraisal element of the Outline Business Case.
2. This paper suggests broad terms of reference for the Group.
3. At its September, 2000 meeting the Board identified 21 factors against which the choice of site for a single in-patient hospital for the Southside should be considered. On the basis of that analysis the Board concluded that the order of preference for site was:
1. Southern General Hospital site.
2. Cowglen green-belt site.
3. Victoria\Queens Park Recreation Ground site.
The advantage of 1 over 2 was considered to be significant. By contrast option 3 scored extremely poorly against the 21 factors. The Board therefore stated that it regarded the Southern General as the preferred site but it would ensure that the option appraisal element of the Outline Business Case would re-visit the comparison between Southern General and Cowglen in a systematic way so that the soundness of the Board’s judgement could be evaluated in a rigorous way. Since September none of the responses to the second phase of consultation has included any considered critique of the Board’s dismissal of option 3.
4. At its December, 2000 meeting the Board decided to make the option appraisal element even more transparent, and hence rigorous, by exposing it to the scrutiny of a Reference Group.
5. The role of the Reference Group will be to:
- oversee (i.e. observe with unimpeded vision).
- interrogate (i.e. to ask questions).
- report (i.e. to describe for the public the option appraisal element of
the Outline Business Case, not simply at the end of the process but during it).
6. This will include overseeing, interrogating and reporting on:
- the selection of the necessary professional advisers\consultants.
- definition of terms of reference for the option appraisal work.
- the criteria used in the option appraisal.
- the programme of investigation and analysis needed to inform the option appraisal.
- evaluation of work in progress during the option appraisal.
- the scoring of options.
7. The intention is that the Reference Group should be able to observe, interrogate and report in a completely open fashion.
8. The Reference Group cannot supplant the responsibility of the South Glasgow Trust in drawing up the Outline Business Case nor of GGNHSB in considering whether to support it. These responsibilities cannot be abdicated, since to do so would undermine the chain of accountability that must run all the way through to completion of the capital project later in the decade.
9. The Reference Group will timetable its work to both anticipate and track the elements. Its meetings will be comprehensively minuted. The Group will be asked to agree how it will communicate with wider interest groups during the process of the option appraisal. It will be encouraged to find some acceptable consensus on how areas of agreement and areas where there may not be a single view on an issue or element are faithfully and accessibly reported into the public domain.
10. Perhaps unhelpfully the December, 2000 Board paper referred to two quite different mechanisms as ‘Reference Groups’. In South Glasgow the in-patient service model is fundamentally agreed – the controversy relates to the question of location, which is amenable to a technical but systematic process of option appraisal. By contrast the task in north and east Glasgow is more discursive. Although GGNHSB and the North Glasgow Trust have expressed their proposed service model with some clarity, there remains fundamental controversy about the necessity, viability and intrinsic balance of the proposed service model. Quite different service model alternatives need to be explored between GGNHSB, the Trust and a whole range of interested parties.This difference in focus determines the difference in proposed mechanisms:
a) in South Glasgow the mechanism aims to achieve a rigorous scrutiny and interrogation of a site option appraisal. A relatively small group is necessary to enable the necessary rigour to be systematically applied (while at the same time its openness and modus operandi will ensure transparency).
b) in North and East Glasgow the iteration between a Project Group and a much wider Reference Group will encourage the widest possible participation in a considered exploration of clinical service models.
11. Accordingly the membership proposed for the Reference Group was as follows:
Representing the public interest - 4 people
Representing staff interests
South Glasgow Hospitals Medical Staff Association - 2 representatives
South Glasgow Trust Partnership Forum - 2 representatives
Providing perspectives from the 3 NHS management bodies involved
Trust Chief Executive - 1 person
GGNHSB Chief Executive - 1 person
Primary Care Trust Chief Executive
(or senior colleague) - 1 person
13. The composition combines an even balance of key stakeholder interests while
ensuring that the group’s size does not detract from its exercise of systematic rigour.
14. The Reference Group would be supported by minute taking and secretariat
functions and would be able to access Trust Finance and Estates expertise as
required. It is suggested that the Group be convened by a South Glasgow Trust
non-executive member (Trustee) who will not only act as its Chair but will provide a
communication link to the South Glasgow Trust Board.
15. Attention has been drawn to the importance of clarity about the provision – or not –
of an Ambulatory Care Centre (ACAD) at the Victoria Infirmary campus.
16. The original proposal of Spring, 2000 envisaged an ACAD (and 120 rehabilitation
beds) being provided at the Victoria Infirmary campus regardless of whether
Cowglen or the Southern General was the preferred location for the in-patient site.
17. The Health Service Forum – South-East has throughout the consultation period
opposed the stand-alone ACAD concept.
18. Throughout the consultation process GGNHSB has consistently maintained the view
that an ACAD should be provided at the Victoria Infirmary campus so as to assure local access for as many services as possible.
19. In its final response to consultation the Local Health Council said it “would hope that the Board and the Health Minister would agree to the development of an acute hospital in South Glasgow which is more centrally located than the Southern General and the opportunity would then be taken to provide ambulatory care on that site rather than at the Victoria Infirmary”.
20. In the December Board agenda paper the need for the Board to explicitly debate the LHC’s important proposition regarding ACAD location was overlooked. Moreover the paper rather too readily took as its presumption that an option that included an Ambulatory Care Centre at Cowglen would entail there being no such facility at the Victoria. Although this is a possible implication of the LHC’s suggestion, a re-reading of the LHC paper does not make it clear whether this would be their view if Cowglen were the more centrally located site.
21. For the purposes of clarity we should therefore specify that the option appraisal should look at both of the competing variations within the Cowglen option:
a) All Southside in-patient, A & E and Ambulatory Care services at Cowglen with no services at all at either the Victoria or Southern General sites (other than continued use of the PFI scheme for the elderly currently under construction at the Southern General).
b) All Southside in-patient and A & E services at Cowglen with limited Ambulatory Care services at Cowglen for South-west Glasgow residents, plus a comprehensive ACAD (out-patient clinics, out-patient rehabilitation services, diagnostics, day surgery and minor injuries service) at the Victoria Infirmary campus (the original GGNHSB variant).
22. These two Cowglen variant options would be compared with the Southern General option (all in-patient and A & E services plus local South-west ambulatory care services at SGH, plus a comprehensive ACAD at the Victoria as in (b) above).
23. As required by NHS capital planning procedures all these options would be compared with the benchmark “do nothing” option.
Last modified: November 13, 2002
© Greater Glasgow NHS Board.