Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

3.  THE THEME OF CONSOLIDATING IN-PATIENT SERVICES
    1. In our proposals we argued that creating larger specialist teams would greatly increase our ability to ensure that patients most needing treatment and care by specialist teams would get it regardless of the impact of annual leave, study leave, sick leave, and rostered time off. Although published evidence that specialist teams secure the best outcomes for patients is not extensive, where it does exist it is compelling, and intuitively most of us would prefer to be seen by someone specialising in our particular condition, especially if we are seriously ill. Leaflets 3 and 4 explained the issues.
    2. In addition larger clinical teams make it easier to fulfil the new limitations on senior and junior doctors’ working hour commitments. Indeed without such consolidation it will be virtually impossible in most specialties to meet the now very stringent limitations, bearing in mind the national shortage in the supply of doctors, the need not to dilute the skills of doctors and the punitive costs incurred if junior doctors’ hours are not significantly reduced. Leaflet 10 explained the issues in detail but has now been overtaken by a national agreement on junior doctors’ hours and pay which makes much of the present pattern of rotas in Glasgow unacceptable, unsustainable and unaffordable.

Currently North Glasgow Trust has 626 junior doctors with a cost of £23.6 million.

If rotas remain unchanged, by 2002 the new pay agreement means the cost will be £31.8 million.

    1. Achievement of the shorter working hours for junior doctors requires a significant reduction in the number of emergency cover rosters in the city. A relatively small specialty such as gynaecology, for example, cannot sustain five emergency rotas for a mere 126 beds in the city (its present bed complement). ENT cannot sustain three rotas for its 59 beds. Other specialties face similar challenges.
    1. These realities led us to suggest that:
    1. the single site New Western Infirmary at Gartnavel, formally approved by the then Secretary of State in 1996, should be confirmed. (Leaflet 18)
    2. a single in-patient centre for the Southside should be created. (Leaflet 16)
    3. the long term continuation of in-patient beds at Stobhill was unlikely to be sustainable. (Leaflet 19)
    1. In a later section in this paper we discuss the practical implications of achieving the single-site hospital at Gartnavel previously approved in 1996. Support for this move remains almost universal among the responses we have received.
    2. The proposition that there should be a single Southside in-patient centre was strongly endorsed by the Area Medical Committee (representing GPs and hospital doctors), the Local Health Council, most local MSPs, and most members of the public who responded (2,876 out of 3,416 = 84%). The issues of controversy are where such a hospital should be located and whether it should be complemented by a stand alone Ambulatory Care Centre at the Victoria Infirmary site.
    3. As far as North-East Glasgow is concerned, in our original consultation we suggested (in leaflet 19) that the future of orthopaedics, gynaecology, ophthalmology, urology, and ENT as in-patient specialties at Stobhill was unsustainable given their already small bed numbers and the pressure on doctors’ emergency rotas. We suggested that the question of whether there should be a single general surgical service for the 340,000 people of North and East Glasgow should be debated – we implied that there should be such a service. Finally we asked whether general medicine could be sustained alone on the Stobhill site if general surgery had no in-patient presence there. We report in more detail later in this paper what response we got to these suggestions. Although there has not been a large volume of response to these questions, the North Glasgow Trust itself and the medical advisory machinery are advising us that we should aim to create a single in-patient centre for North and East Glasgow at the GRI – the question of when and how this can be completed in practice is explored later in this paper.

 

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