Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

 6.  ACCESS, PUBLIC TRANSPORT AND TRAFFIC IMPACT
  1. These issues were the foundation of more comment in the consultation than anything else.
  2. GGNHSB’s proposal to have stand-alone Ambulatory Care Centres and associated Minor Injuries Units at the Victoria Infirmary and at Stobhill was intended precisely to address the issue of local accessibility. In all the debate, virtually nobody has acknowledged this feature and its significance. It is, therefore worth repeating:

 

(a)

(b)

(c)

  
 

Present total patient encounters\

episodes per year

Future

Number affected by change of service location

%

Victoria Infirmary

393,000

316,500

76,500

19.5

Stobhill

324,747

287,537

37,210

11.5

These figures were derived from the 1998\99 Blue Book. Column (a) shows all in-patients, day surgery cases, out-patients (consultant clinics, physio and other therapies, hearing aids, out-patient, diagnostic services), A & E attendances and day patients.  Column (b) assumes day surgery cases, out-patients, day patients and estimated adult attendances at the local Minor Injuries Unit at the rate of 60% - see Scenarios 5 and 6 in Annex 6. Of the other 40% of A & E attendances who go to main A & E Departments at GRI or Southern General / Cowglen, many of those will ‘walk-in, walk-out’ on the same day.

Of the numbers in column (c), approximately 40% at the Victoria (around 30,500) are in-patients. At Stobhill the figure is around 75% (28,000 in-patients). Many of these will be emergency admissions, taken to hospital by ambulance. For them, ease of access for themselves is not an issue.

Our proposals therefore offer state-of-the art modern facilities at the Victoria Infirmary and Stobhill with no change in accessibility for a massive number of over 700,000 attendances. The number of patients from these two hospitals affected by change adds up to around 114,000 by contrast. This is not to dismiss the issue of access but it does need to be put in context.

  1. The impact of our proposals in West Glasgow has attracted relatively little comment other than in relation to Accident and Emergency services (see Section 5) and orthopaedics . In fact, with the exception of the population clustered immediately around the Western Infirmary the transfer of services to Gartnavel (or to the Southern General if that becomes the chosen option for South Glasgow) makes access to hospital services easier for most of the West Glasgow catchment population.
  2. What has come out loud and clear from the consultation is that public transport access, road congestion and car parking are seen as problems here and now. Even if we were not proposing change in hospital configuration these are issues that would need to be addressed. The concerns that have been identified are as follows:

 

Action needed

a) Car parking at GRI

Implement multi-story car park as required by planning consent for the Maternity\Plastic Surgery\Emergency Receiving Scheme currently under construction.

b) Traffic congestion at Townhead

(affecting GRI)

Mostly outside the influence of the NHS, but re-orientation of more of GRI’s services along Alexandra Parade will mean that the problems of Castle Street are not added to. Completion of the M74 in the strategic planning period would take pressure off the M8.

c) On-site access for A & E at GRI

Detailed planning issue that the Trust must resolve. There is scope to do so.

d) Bus routes to GRI from East

Glasgow

These are seen as poor at some times of the day. The Trust need to explore this issue with the bus companies. GGNHSB also needs to explore whether the creation of a more locally accessible healthcare facility in the East End offering a range of diagnostic and therapy services and a Minor Injuries Unit is feasible. This would improve access to services for this population and reduce some of the traffic pressure local to the GRI.

e) Car parking at Gartnavel

The Trust acknowledges this needs to be addressed in the next stages of site development planning. This issue emphasises the importance of not overloading the Gartnavel site with services transferred from elsewhere.

f) Access from Hyndland Station to Gartnavel

Strathclyde Passenger Transport Executive intend to make the station easier to use for people with restricted mobility. The Trust need to review access from the station to the hospital for such people and improve where necessary.

g) Making Gartnavel site more attractive for bus routes to come on site

Trust to consider at the next stage of planning. Strathclyde PTE can offer advice as to what is needed.

h) Traffic densities at Gartnavel.

Identified as an issue to be addressed in finalising the whole site development plan (including mental health services). The Trust need to work with the City Council and local residents in addressing this. Access onto the Great Western Road will be a central focus of this work.

 

i) Car parking at Southern General

An issue often quoted by opponents of the Southern General Hospital option. Yet the hospital, like Stobhill, currently has the best parking provision of any hospital in Glasgow and there are as many anecdotes about absolute ease of parking as there are difficulties. It is possible that the issue is one of needing improved sign-posting on site and advance information for patients and visitors – people may currently be experiencing localised difficulty on site and not realising that there is plenty of space elsewhere. For the future, if the hospital is the site of the new Southside Hospital, it would have plenty of space for car parking.

j) Congestion through the Clyde Tunnel affecting road access to the Southern General

Liaison between tunnel management and the ambulance services ensures that this is not a problem for emergency ambulance access. At most times traffic flows smoothly, with the tunnel being no more prone to blockage or congestion than surface roads in the conurbation. When traffic is congested driver\passenger perceptions of delay often feel much greater than the actuality measured in minutes of delay.
k) Bus access onto the Southern General site

Some buses already go onto the Southern General site. The Trust need to explore with Strathclyde PTE and the bus companies the scope for an increase in routing through the site, especially where it can result in people not having to use the unpopular pedestrian underpass at Drumoyne.
l) Bus routes to the Southern General

This issue is considered more fully below.
m) Car parking at the Victoria Infirmary

There is virtually none available at present. Redevelopment of the site owned by the Trust to build an Ambulatory Care Centre will include car parking – a significant improvement on the present position.
  1. Some responses to the consultation have complained that our proposals have not been underpinned by detailed Traffic Impact Analysis. This will certainly need to be done at the next stage of detailed planning and discussed with City Council planners. However, such analyses are costly to undertake and we did not feel that expense could be justified until there was clarity about strategic service direction.
  2. However, there are some observations that can be made on this issue at this stage:
    1. predictions of future traffic levels and their relationship to road capacity are fraught with uncertainties depending on:

    1. what improvements are made in public transport (now an explicit UK government priority).

    2. increases in car ownership.

    3. economic, retail, leisure and housing developments (such as Braehead, Pacific Quay, Drumchapel New Neighbourhood, Clyde Port Authority granaries).

    4. investment in new roads (e.g. M74 extension; Glasgow Southern Orbital).

      5.
    5. by proposing Ambulatory Care Centres at Stobhill and the Victoria Infirmary we are creating less change in current traffic patterns than would be the case if we adopted the three hospitals option preferred by the Area Medical Committee for example (GRI, Gartnavel and Southside).
    6. moving the Southern General’s in-patient and A & E services to the Victoria Infirmary would have a significantly adverse traffic impact in an area where there is little spare capacity on the existing road network and little opportunity to substantially improve it.
    7. the prospect of increased traffic impact at Gartnavel is unavoidable unless we continue its present split-site working with the Western (clinically unacceptable) or closed it altogether, redistributing its services onto other sites altogether. We say more about this in Section 7.
    8. much has been made of traffic impact in concentrating more in-patient services at the Southern General but it has more local manoeuvrability in choice of road access than most other hospitals:

Gartnavel

Great Western Road only. (Access off Crow Road is not supported by City Planners or local residents).

GRI

Castle Street from the east and south Wishart Street from the south Alexandra Parade from the east and north.

Victoria

The Langside Road, Battlefield Road, Grange Road tight triangle at the junction of busy east / west, north\south through routes.

Stobhill

Stobhill Road (narrow residential street), Belmont Road from Balgrayhill Road, back entrance of Balornock Road

Southern General

Served by a "box of roads" giving flexible local choices (Govan Road, Renfrew Road, Shieldhall Road, Hardgate Road, Moss Road).

Beyond that there are other choices of approach involving Edmiston Road into Shieldhall Road, M8 into Moss Road, Berryknowes Road from Paisley Road to Moss Road. These choices offer opportunities for spreading traffic impact.

  1. One of the most valuable contributions to debate in the consultation period was a "Southside Hospital Travel Time Study" commissioned from Mr. A.W. Drewette, a Consulting Traffic and Transportation Engineer by the Health Forum (South East). This is attached at Annex 7. Mr. Drewette’s study contains much useful information.  Unfortunately the brief he was given limits the full value of his study because several relevant factors were omitted:
    1. the significance of patient access southwards for some residents in the west of Glasgow north of the river (e.g. for A & E, maternity, gynaecology, orthopaedic services).
    2. the options of access to GRI or Hairmyres for people in Rutherglen and Cambuslang.
    1. non-GGNHSB residents in Renfrewshire who use the Southern General.
  1. Nevertheless Mr. Drewette’s report is helpful because it demonstrates the application of accepted strategic transport models. Mr. Drewette is also scrupulous to point out that his modelling would be affected by future changes in public transport, car usage and road capacity.
  2. In the debate about access to Cowglen versus Southern General, Mr. Drewette’s report (his Table 1) is very helpful in providing insights at the individual patient\visitor level.

    It demonstrates how accessible the Victoria Infirmary site is to such a large proportion of the Southside population by both car and public transport. However, as we explain later in Section 11, we do not regard the creation of a new Southside Hospital on the Victoria Infirmary campus as a viable option.
  3. We therefore need to examine Mr. Drewette’s Table 1 to see what light it casts on the significance of access to the choice between Southern General and Cowglen.
  4. Taking public transport we need to consider first the needs of in-patients. Many of them will have been taken to hospital by ambulance.

For example, over 10,000 of the Victoria Infirmary’s 29,000 in-patient admissions were in general medicine and the majority of them will have been taken by ambulance. This is corroborated by the one week survey of A & E attendances in 1998 which suggest that on an annual basis around 8,320 GP referrals are conveyed to the Victoria Infirmary by A & E\urgent ambulance. The total number of A & E\urgent ambulance journeys to the hospital in 1999\2000 was just over 16,000 (Ambulance Service data).  Not all of these would have been admitted as in-patients but a large proportion would have. If, say, of the hospital’s 29,000 in-patients just under half were conveyed by ambulance, the other 15,000 to 17,000 would have come in by other means. With family, friends and neighbours rallying round in a time of need, and with a not insignificant proportion of the population able to afford taxis, it is difficult to see how in-patients using public transport to go to the Victoria Infirmary would be more than about 20 to 25 people a day (7,300 to 9,000 people a year).

  1. The larger need arises from patients’ visitors. Mr. Drewette’s report suggests that each patient might have 5 sets of visitors per day (3 sets travelling by car or taxi, 2 sets travelling by public transport). We have no separate survey data to confirm or vary this assumption. Arguably as an average it might be on the high side but is certainly helpful for modelling purposes. Mr. Drewette’s analysis of the travel implications of this pattern is flawed slightly since he assumes 100% bed occupancy whereas 80% to 85% is probably a more realistic average figure.

Mr. Drewette converts his calculations into assessments of additional traffic vehicle kilometres travelled and total person hours spent on public transport per day. Without seeing the detail underneath the calculations it is not possible to gain a picture of what his global figures mean in terms of individual people’s experience. However, taking his own assumptions about visiting rates, public transport users, bed numbers (but corrected to an 85% occupancy) and add a further assumption of 2 visitors per set of visitors, we can estimate that if the beds at the Victoria were re-located (to the Southern General or to Cowglen) the number of visitors using public transport would be:

  2 sets of visitors using public transport
X 2 visitors per set
X 2 2 journeys per visit (i.e. there and back)
X 485 (85% occupancy of 570 beds)
  3,880 visitor journeys per day by public transport, principally  from people living in the current Victoria Infirmary catchment area.

(If one felt that Mr. Drewette’s estimate were too high and that each patient might get only one visitation per day using public transport, with an average of one and a half visitors per visitation, the figure would be:

  1 visitation per day
X 1.5 visitors per day
X 2 2 journeys each (there and back)
X 485 beds occupied
  1,455 visitor journeys by public transport per day.

This demonstrates that the global totals are very susceptible to only very slight changes in assumptions about number of visitations, numbers of visitors and mode of transport.

It is also the case that Mr. Drewette’s analysis does not take into account the easing of patients’ visitors’ travel times resulting from our proposal to provide 120 rehabilitation beds at the Victoria Infirmary site. This would benefit precisely those people who have been expressing the most personal concern about this issue.

  1. So, what are the implications of the choice between Cowglen and Southern General in terms of public transport access? Mr. Drewette’s Table A shows the following profile of respective advantage in public transport times at off-peak (when most patient visitors will be travelling):

    Cowglen advantageous compared with Southern General by: (minutes)

Mansewood

34.9

Thornliebank

29.0

Shawlands

28.8

Rouken Glen

21.9

Priesthill

21.8

Crookfur

21.8

Croftfoot

20.0

Govanhill

19.2

Pollokshields

13.3

Pollok

13.2

Cambuslang

12.3

Eaglesham

9.8

Burnside

9.4

Giffnock

8.6

Crookston

8.2

Mosspark

6.8

Castlemilk

6.7

Carmunnock

6.7 *

Oatlands

5.8

Rutherglen

5.6 *

Busby

4.5

Craigton

Equal *

Cathcart

2.1 SGH advantage over Cowglen

Hillington

2.9

Clarkston

3.6

Gorbals

5.5

Netherlee

7.1

Toryglen

8.3

Kirkhill (Newton Mearns)

8.3

Cardonald

8.4

Ibrox

14.7

Kingston

15.8

Drumoyne

23.6

Govan

26.9

* For these places SGH is advantageous during peak hour travel by public transport.

This analysis shows us that for 19 of the 34 places the difference in public transport time is 10 minutes per journey or less. Moreover in commissioning Mr. Drewette’s report the Health Forum (South-East) omitted to ask him to include Renfrew and Dean Park in his analysis nor any flows from north of the river or further afield (where access via the Underground and shuttle bus link from Govan station to the Southern General would be relevant).

  1. It is worth taking a sideways look at the travel times by car columns in Mr. Drewette’s Table 1. They suggest, for example, that the slow public transport access from places like Mansewood, parts of Pollok, Pollokshields, Shawlands and Thornliebank is not caused intrinsically by distance or road travel time but by bus frequencies and\or routing. Most if not all of these problems should be amenable to negotiation with the bus companies or by the development of dedicated shuttle bus routes to which we have already committed ourselves.

At an individual public transport user level therefore we do not consider that the public transport issue is a differentiator between the Southern General and Cowglen.

  • For 19 of the 34 places the difference is 10 minutes per journey or less.
  • In both cases public transport would need to be improved.
  • In both cases most of the more onerous differences can be resolved by the development of express shuttle buses.
  • In both cases, the 120 rehabilitation beds and the Ambulatory Care Centre at the Victoria Infirmary means that public transport access for the vast majority of people, especially the elderly, is no different from what it is now.

 
  1. We must turn now to the question of road access and travel times by car (or taxi).  Again Mr. Drewette’s Table 1 is a helpful source of information. It shows, for example, that the Victoria Infirmary has the shortest travel times by car for 17 of the 34 places, while Cowglen has the shortest travel time for 10 places and Southern General 6. Crookston is equidistant in travel time to both Cowglen and the Southern General.

In understanding travel time as a differentiator between options for the future we need to look at the pattern of advantage between the Southern General and Cowglen. At off-peak times (which is when most patient visitors will be travelling) the profile is as follows:

Cowglen advantageous compared with Southern General by: (minutes)

Thornliebank

10.3

Mansewood

9.8

Giffnock

9.8

Netherlee

9.7

Cathcart

9.6

Croftfoot

9.5

Burnside

9.5

Rutherglen

8.5

Rouken Glen

8.4

Eaglesham

8.4

Clarkston

8.4

Carmunnock

8.4

Busby

8.4

Castlemilk

8.3

Kirkhill (Newton Mearns)

8.3

Crookfur

8.1

Priesthill

7.5

Toryglen

6.5

Shawlands

6.3

Cambuslang

5.7

Pollok

5.3

Govanhill

4.5

Oatlands

3.7

Mosspark

3.1

Pollokshields

2.4

Gorbals

1.8

Kingston

1.5

Crookston

Equal
Craigton

0.8  SGH advantage over Cowglen

Cardonald

1.9

Ibrox

2.3

Hillington

3.1

Govan

3.7

Drumoyne

4.0

Cowglen clearly has the balance of advantage. At what point might such differences become truly decisive at an individual driver\passenger level? At less than five minutes? At eight minutes? The maximum travel time given by Mr. Drewette in his Table A is 30 minutes from Burnside and from Cambuslang to the Southern General. (From each of these two places the alternative travel time to Cowglen is 20.6 minutes and 23.9 minutes respectively).

Thus the debate about the impact of access time for car\taxi users is contained within an envelope of 30 minutes of maximum actual travel time where the difference between the two options is six minutes or less for 15 of the 34 places. for another 12 of the 34 places, the difference is less than 9 minutes.
  1. The question of what significance to place on individuals’ feelings about differences in travel times, whether by public transport or by car\taxi is fraught with subjectivity. For some people an extra ten minutes is onerous; others regard it as inconsequential. Mr. Drewette’s Report quite correctly seeks to address this issue by converting it into an economic analysis (see Section 7 of his report).

As we have pointed out Mr. Drewette’s analysis has some important drawbacks. It is based on 100% occupancy rather than 80-85%; it is highly susceptible to variations in the number of visitations to patients and the number of visitors per visitation; it will be influenced by the pattern of origin of journeys, which will not be of equal density or mode of transport from all 34 places, it ignores patient (and visitor flows) from Renfrew and from north of the river and it ignores the significance of maintaining 120 rehabilitation beds at the Victoria Infirmary site.

  1. However, the analysis is still helpful in giving some sense of how wider economic considerations might look alongside the differences in cost to the NHS. Mr. Drewette suggests that the comparison of the two options would be (as discounted costs over 30 years):

    2.
 

£M

£M
 

SGH option

Cowglen Option

Additional travel time costs

72.0

32.1

Additional vehicle operating costs

5.9

1.2

Additional accident costs

7.6

1.6
 

85.5

34.9

This needs to be seen against the difference in costs to the NHS. Compared with the present cost of hospital services in the Southside we estimated (see leaflet 16) that the Southern General option would cost us £11 million a year more whereas the Cowglen option would cost around £18 million a year more.

If that difference is discounted over 30 years at 6% in exactly the same way as Mr. Drewette’s calculation the additional service cost of the Southern General over 30 years would be £151.4 million whilst that of Cowglen would be £247.7 million. Putting Mr. Drewette’s transport-related 30 year cost alongside the equivalent 30 year calculation for NHS cost results in the following:

 

Net Present Value at 6% over 30 years
 

Southern General

Cowglen
 

£m

£m

Transport

85.5

34.9

Change in hospital running costs

151.4

247.7

TOTAL

236.9

282.6

The Southern General Hospital has a net economic advantage (when measured on transport and hospital running costs) of £45.7 million. This advantage would be even greater when the flaws in Mr. Drewette’s analysis are taken into account (see earlier in this paragraph).

  1. There is one final issue concerning access which has emerged from the consultation period. It concerns access to services for six areas each of which has not only significant problems of deprivation, social exclusion and poor health status but also difficulties with access to hospital services already – the East End, Rutherglen, Cambuslang, Castlemilk, Drumchapel and Clydebank and Kirkintilloch.

In each case there are already problems of access to services, including limitations in public transport (frequencies, routing and the cost of journeys involving more than one bus or bus\train combinations). Although GGNHSB cannot resolve all the problems of public transport in the Glasgow conurbation we can alleviate the access problem in three ways:

  1. firstly by subsidising or stimulating some hospital shuttle buses from key points.
  2. secondly by exploring scope to increase Community Transport Schemes.  We understand that in London the Camden Community Transport Scheme has one hundred vehicles and one hundred and fifty staff, providing non-emergency patient transport to Barts, the Royal Free, Chase Farm Hospital and Enfield Community Trust. There are already community transport schemes in Greater Glasgow but they are usually localised, sometimes specialising on particular specialist purposes. There may be scope in Greater Glasgow to strengthen the capacity of community transport.
  3. secondly by strengthening local health services. This is most likely through working with Local Health Care Co-operatives and the Primary Care Trust to extend the range and quality of local primary care. Although these would not result in services on the scale proposed for the Ambulatory Care Centres at Stobhill and the Victoria Infirmary they would make a significant contribution to achieving easier local access to a wider range of healthcare and reduce pressure on waiting times elsewhere in the Glasgow NHS. GGNHSB commits itself to exploring these potentials with LHCCs, NHS Trusts, Social Inclusion Partnerships and local authorities.

We think it is highly likely that this work will also be relevant to other Social Inclusion Partnership areas such as Gorbals, Glasgow North and Pollok and we intend to explore the issues with them in the light of what we learn from discussion with the other SIPs.

 

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