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
(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.
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. |
what improvements are made in public transport (now an explicit UK government priority).
increases in car ownership.
economic, retail, leisure and housing developments (such as Braehead, Pacific Quay, Drumchapel New Neighbourhood, Clyde Port Authority granaries).
investment in new roads (e.g. M74 extension; Glasgow Southern Orbital).
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. |
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).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
only one visitation per day using public transport, with an average of one and a half visitors per visitation, the figure would be: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
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.
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).
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.
|
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.
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.
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):
£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).
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:
- firstly by subsidising or stimulating some hospital shuttle buses from key points.
- 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.
- 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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Greater Glasgow NHS Board
Revised 04/01/02