Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

1. In our original consultation material we went to some lengths to explain why "bed numbers" has been such a source of hot debate for so many years and why trying to predict requirements for the future is difficult. We referred to trends that might continue to reduce beds (decline in population, new clinical techniques etc) and trends that might increase them (more elderly people in the population, for example).
   
2. We wished to be cautious in our approach – using the phased approach to the implementing the strategy during the decade to take stock of bed requirements half way through the programme of change.
   
3. We published two different projections for bed requirements. One showed the position if demand in general medicine continued to grow (at a rate of 5% by 2005) while requirement for beds in other specialties remained unchanged in that period due to continuing reduction in length of stay and increases in day surgery. The other assumed 2% growth in all specialties by 2005.
   
4. Regrettably the calculations we had done for us made an error in the way they calculated the average length of stay of remaining in-patients after applying the assumption that all current zero, one and two day stay in-patients would in future be treated on a day case basis.
   
5. Some of the assumptions in the model were also queried:

1. our model assumed 85% occupancy; clinicians feel 80% makes it easier to manage peaks in demand.
   
2. the assumption that all zero, one and two day stay in-patients would in future be day cases was felt by clinicians to be over-ambitious.
   
3. the variant that assumed no increase in demand impacting on bed requirements in surgery was queried, although no statistically argued alternative hypothesis was put forward.

6. Clearly we would wish to correct the statistical error but a meaningful agreed bed model cannot be finalised until there has been further discussion with clinicians about:

1. legitimate scope for increased rates of day surgery (we are below national case-mix adjusted benchmarks in a number of specialties).
   
2. an analytical approach to verifying different bed occupancy rates against their capacity to absorb peaks in demand in large or small pools of beds.
   
3. bed requirements to deal with medical emergency admissions (for the immediate future we shall be increasing medical bed numbers this winter – 2000\1).

1. As an example of the range within which this work now needs to be done, the Table below shows:

1. the current number of beds in the North Glasgow Trust.
2. the (arithmetically flawed) number suggested by ISD.
3. figures suggested in recent discussions with North Glasgow clinicians.