Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

7.    POPULATION CHANGE, CROSS-BOUNDARY FLOWS AND WIDER PLANNING CHOICES

  1. Some commentators have said that they regard future population changes as an important issue which we had not adequately addressed.
    1. There are several features to consider:
    1. overall change in population numbers and age structures.
    2. changes in flows of patients across Health Board boundaries.
    1. The GGNHSB population profile for the future is expected to decline although the rate of decline is susceptible to two relatively new factors:
    1. a concerted effort by the Glasgow Alliance to reduce decline through the creation of New Neighbourhoods (at Drumchapel and Ruchill) and a continuing improvement in housing and infrastructure.
    2. the expectation that Glasgow will be home for several thousand asylum seekers.

The Government population prediction used by the Arbuthnott Report in its calculations of funding used a 1994-based population projection which showed Greater Glasgow having a population of 893,000 in the year 2000, declining to 852,000 by 2010, a decline of 41,000 (or 4.6%). One might expect that due to the new factors referred to earlier the rate of decline might be rather slower.

    1. Age structure has a particular impact on planning services for children, adolescents and the elderly, although in Greater Glasgow as much attention has to be given to its locally distinctive health status and patterns of illness. The impact of deprivation and social inclusion worsens many adults’ health much earlier in their lives than elsewhere.
    1. The impact of the scale of expected population change is marginal at the level of our
      strategic planning. It does not affect:

      It will affect the number of beds provided, and that will need to be picked up by Trusts at the next stage of Outline Business Case planning. Even so, population change is only one factor in determining bed numbers – as we see in the next section of this paper.

    1. As far as changes in flows of patients are concerned, we are already aware that Lanarkshire Health Board wish to see some changes affecting their residents. Discussions with Lanarkshire Health Board and the acute hospital Trusts concerned are still underway but it is anticipated that over a three year period from 2001\2 there will be fewer patients coming to Glasgow hospitals from the Cumbernauld, Wishaw, East Kilbride, Hamilton and Monklands areas. These changes have been translated into estimated numbers of cases.
    1. In advance of definitive agreement being reached we cannot be precise about impact, but it might help to illustrate the impact by reference to a range of specialties affected. The numbers that follow are illustrative only:

In year one 2,200 fewer cases to North Glasgow, 1,100 fewer to South.
In year two 3,400 fewer cases to North Glasgow.
In year three 2,400 fewer cases to North Glasgow.

    1. The impact on bed requirements depends on the mix between in-patient cases and day cases (which is not yet clear). If this followed the normal current ratio of cases to in-patient (1 : 3), then 1,100 fewer patients in South Glasgow might equate to 275 day cases, 825 in-patients. If those in-patients had average lengths of stay of as much as 5 days (which is relatively high), that equates to 4,125 bed days or around 13 beds at 85% occupancy. Clearly the potential impact is higher in North Glasgow, where a similar illustrative calculation results in an impact of some 96 beds (at a 5 day average length of stay). Clearly if the ratio of day cases to in-patient care is different or length of stay were less than 5 days – which is likely – then the impact on bed numbers is likely to be less than this.  
    1. What is more problematic is the loss of income from Lanarkshire. Because the bed numbers impact will be scattered in small numbers between different specialties and different hospitals it will be difficult for the Trusts to reduce their costs. This means prices to GGNHSB (mostly) and other Health Boards are likely to rise. The withdrawal of income is estimated at:

2001\2 £2.2 million

2002\3 £2.9 million

2003\4 £3.9 million

and the impact has to be factored into GGNHSB’s financial planning.

  1. Argyll and Clyde Health Board rightly draw attention to a more complex set of inter-relationships between their hospital services and those in Glasgow. For example, they point to the fact that a "modern healthcare facility (Royal Alexandra Hospital, Paisley) already exists a short distance from the Southern General and ..... this could present significant opportunity for improved working and modernisation across boundaries".

The Chief Executive of GGNHSB has used several opportunities provided by Argyll and Clyde in the last two years to share thinking from within Greater Glasgow with a range of stakeholders in Argyll and Clyde. The Health Board response reflects the questions that have been raised on those occasions and provides a useful agenda for some further discussion both within the next two months and in the more detailed planning processes that lie beyond.

  1. The dilemma of how to regard the potential roles of nearby hospitals such as the Royal Alexandra, Paisley; the Vale of Leven and Hairmyres has hovered uneasily through the process of reflection during the last two years. At one extreme one could say that South Glasgow does not need any new hospitals at all and that patients could argue either travel north of the river or outwards to the Royal Alexandra or Hairmyres.  Both hospitals are modern and could be expanded if necessary. Yet this is not a strategy which Greater Glasgow NHS Board felt it could promote with any prospect of success even if it were minded to (which it was not).
    1. We think the more fruitful line of approach is through encouraging collaboration between clinical teams, using the Managed Clinical Network approach as a model. It is highly likely that problems such as single-handed specialists, or gaps in specialist services, or conforming to to-day’s requirements on doctors’ working hours, would look very different when viewed from the perspective of having larger clinical teams, telemedicine links, electronic records and joint clinical policies. We think this is the way forward; not hospital closures nor the loss of particular clinical specialties from their local access.

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