1. Although a small minority of those who responded regarded the issues as simple ("just replace the existing hospitals in situ"), the great majority recognised that the issues are complicated and that decisions affecting one part of the Glasgow hospital system have disconcerting repercussions elsewhere in the system (uncannily like a Rubik’s Cube). In particular trying to reconcile:

• clinician advice about concentrating teams/facilities versus public preferences about access.

• the need to invest more money in acute hospital services versus the imperative of building up primary care, community health services, children’s services, addiction services, mental health services and other services aimed to tackle fundamental inequalities in health.

2. As might be expected the debate has been vigorous. Some of it has explicitly taken the form of sectional campaigning rather debating the inter-relationship of issues and the difficult trade-offs involved in making choices. On the other hand some of the responses we have received demonstrate a considerable investment of time and effort to understand the issues and to develop a coherent analysis. We are especially grateful to those individuals and organisations because they have contributed greatly to the testing of ideas and propositions.
   
3. It is striking just how uneven the pattern of response has been; confirming that those living in circumstances of deprivation are often those least likely to take part in a debate of this type. Yet their needs must always be in the forefront of our minds. In particular, issues of access and cost of public transport fares are highly significant for them. Later in this paper we reflect on how the consultation process has helped us to focus our minds on these needs. Sections 5 and 6 explore the issues.
   
4. One intrinsic difficulty in a debate at this stage of strategic planning is that many commentators feel frustrated at the lack of convincing operational detail underpinning some of the proposals. But such detail can only come with the costly and time-consuming work that is part of the next stage of the planning process – the development of Outline Business Cases. There is a Catch-22 here. Some people will only be convinced if they see the detail but the detail cannot be provided until the fundamental strategic direction has been agreed. Ironically, many of the comments we received ignored factual detail that we had provided in the consultation leaflets (for example on the numbers and different types of patients currently flowing into Accident and Emergency Departments and how they could be managed in future). It was also clear that many people were expressing concerns about things we were not proposing anyway (for example, many people attending out-patient clinics at the Victoria were concerned about having to go to the Southern General – but that was not what we were proposing at all). Similarly some campaigners described the Southern General option as a proposal for "refurbishing it" whereas the option essentially results in demolition of all the old buildings and their replacement by brand new buildings.
   
5. Much of the debate has focused on issues common across Glasgow as a whole (such as public transport; traffic impact; the role of stand-alone Ambulatory Care Centres; bed numbers etc). The debate about the Southside proposals has been intense. There has been less about the pattern in North Glasgow, probably because the documents published in April posed questions rather than made definitive suggestions (in North-East Glasgow at least).
   
6. Annexe 3 describes the range, subject matter, source and weight of responses that we received.
   
7. Public decision-making can never be based on popularity\unpopularity alone.  The Scottish Parliament, taxpayers, professional regulatory bodies and the like expect other criteria to be taken into account, such as:

1. value for money.
2. management of risk.
3. opportunity cost and wider implications for other areas of public policy.
4. affordability.
5. meeting basic quality standards for service organisation and delivery.
6. how these factors inter-relate with each other.

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Revised 04/01/02