Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

10.  DECISION-MAKING AND RISK

  1. Earlier in this review we described the complexity of the overall decision process in reconfiguring hospital services for Glasgow. Decisions or judgements affecting one factor or one part of the Glasgow hospital system have repercussions elsewhere. We likened it to a Rubik’s Cube.
  2. We emphasised too that a coherent and realistic set of decisions of this type cannot be based merely on the weight of sentiment or popularity alone. There are other tests to be passed, applied variously by the Scottish Parliament, the Scottish Executive, the statutory Auditors and professional regulatory bodies. They include:
    1. ensuring that what is proposed meets good quality standards for service organisation and delivery.
    2. ensuring that the decision offers the best possible synergy with other aspects of public policy and avoids conflict with those other policies.  The most relevant policies are:
  • protecting the environment.
  1. achieving best value for the taxpayers’ money.
  2. managing risk so that major overspends, delays or fruitless payments are avoided.

  1. demonstrating that the decision does not create unacceptable opportunity costs adversely damaging the achievement of other needs and priorities.
  1. ensuring that the decision is affordable within the resources allocated by the Scottish Executive.
  2. seeking the best possible fit with all of these factors.
  1. Our proposals have been designed to give the best possible fit across all of these factors. For example, if we had proposed just a three hospital site option with no Ambulatory Care facilities at Stobhill and the Victoria we might have satisfied criterion (a) but the sheer scale of the new investment required would have enhanced risk under criteria (d), (e) and (f) and compromised the traffic impact and accessibility elements under criterion (b) to a significant degree.

    Similarly a proposal to quit the GRI and build a brand new hospital at Stobhill would have raised extremely searching questions about criteria (c) and (d) [in terms of waste of the new capital investment currently under construction at the GRI].
  2. In particular our proposals aim to achieve a transformation of service quality and environment for patients. They maximise the amount of modern (25 years old or less) facilities in use for hospital services in Glasgow, at the same time preserving local accessibility for most services while adopting a model of service organisation and delivery which meets modern quality standards. We seek to achieve this in a way which represents value for money, is affordable and leaves scope to greatly increase the numbers of doctors, nurses and other health care staff providing treatment and care for patients. While we have a responsibility to minimise the risk of cost overruns and fruitless payments, our priority is to minimise the risk of lengthy further delay.
  3. Elsewhere in this paper we apply this framework to the various contentious elements of the decision-set we need to make. It is important that our partners in this important debate for the future of Glasgow’s hospital services recognise the obligation we have to scan across all of these criteria. It would be wonderful simply to be able to make the popular decisions and be greeted with public acclaim but sadly they do not automatically meet the testing expectations of the Parliament and other judges of the quality of our decision-making and stewardship.

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