Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

  1. SOUTH GLASGOW SERVICES
    1. This element of the proposals has attracted significantly more comment than any other. There have been hundreds of letters from members of the public, responses from Community Councils, comments from local authorities, professional advisory committees and the Local Health Council. Local MSPs have maintained a close interest throughout the period of consultation.
    1. If decision-making were a matter of weighing the sheer volume of comment it would point unequivocally to overwhelming support for the concept of a single in-patient hospital on the Southside. But beyond that there is mixed opinion as to whether it should be at the Victoria/Queen’s Park Recreation site or Cowglen.
    2. Up until 31st August there was a desire for it to be built at Cowglen (103 responses): however, in the last few days of the consultation period the volume shifted for it to be located at the Victoria or Queen’s Park Recreation site (171 responses).

      In addition the lack of response from people from the south-west of Glasgow does not mean that the option of the Southern General would have no support.

    3. The concept of a single in-patient hospital for the Southside appears to have attracted support for a number of reasons:
    1. frustration at the appalling quality of most of the buildings in the Southside hospitals, particularly at the Victoria Infirmary where there has been a lack of investment in upgrading or replacing existing facilities over the last 10 to 15 years. The Southern General has been better served by its management in that period. However, it too is burdened by a legacy of Victorian buildings which cannot add up to a hospital designed efficiently around the needs of patients, no matter how well individual ward upgradings and link corridor schemes have been undertaken.
    1. recognition of the importance of creating larger specialist teams.
    1. a concern that the current fragmented pattern will continue to cast the Southside in a less favourable position compared with the bigger groupings and more recent investment that can be seen – albeit incompletely and unbalanced – in North Glasgow. This can undermine staff recruitment attractiveness and has also retarded specialist service development in South Glasgow.
    1. GGNHSB believes that failure to deliver on this consensus would be highly damaging to the quality of hospital services in South Glasgow.
    1. The issues of controversy concern the question of location.
    1. As is said in paragraph 11.2 some respondents have argued that a new Southside hospital should be located at or alongside the existing Victoria Infirmary site, (171 respondents). It is timely to remind ourselves why this has not been seen by GGNHSB to be a viable option:
    1. In a "two A & E for Greater Glasgow" configuration, with one of those two being at the GRI, the Victoria Infirmary is not an acceptable site because the whole of West Glasgow, north and south of the river, would have to look to the East for access. A North\East and South\West axis for A & E services provides the most balanced position, particularly if the two units are close to the strategic road corridors (M8, M77, Clyde Expressway, Clyde Tunnel).
    1. the site is too small. The acreage already owned by the Trust is only some 11 acres (including the Grange Road School site).
    1. the suggestion made by some respondents that a larger site could be made available by the Trust acquiring the whole of the Queens Park Recreation site does not seem to us to be viable:

i) it would still only offer 34.2 acres (compared with 67 acres at the Southern General and 73.6 acres at Cowglen)

ii) it would not be large enough to accommodate acute mental illness beds for South Glasgow nor a relocated Royal Hospital for Sick Children if that were transferred.

iii) advice from town planners confirms that the acquisition of Queens Park Recreation site would require a change of use of land currently designated as Open Space. We are advised that areas designated as Open Space are "key elements in the green-space network of the city and .... there will be a strong presumption against loss of designated open space, whether in public or private ownership" and that the Open Space Land Use Policy requires that such areas "should remain primarily as open space and that development will only be permitted which relates to open space\recreation purposes" (letter from City Council Development Control dated 22nd August, 2000). It would require specific public consultation, the formal overturning of its own Land Use Policy by the City Council as town planning authority, and the agreement of Sport Scotland.

It is likely that a formal public enquiry would be held. The complex town planning process would take between one to two years. It would also be necessary for the Trust to meet the cost of providing replacement playing fields in the vicinity. Given the size of site involved it is far from clear whether such alternative space is available (it would already have been identified by Scottish Enterprise – Glasgow if it were since they are very anxious to find large sites for industrial development in South Glasgow and are finding it difficult to identify any).

The existing Queens Park Recreation site is used as overflow car parking for matches at Hampden Park – its loss for that purpose would also pose problems in finding acceptable alternatives.

This option would almost certainly add two years to the process of securing a new hospital for the Southside, thus prolonging the present problem of improvement blight experienced by the Southside’s hospital service.

Acquisition and re-provision would clearly add to the cost and delay of any hospital development. It is more likely however, that the option would fail to overcome the planning barriers.

    1. The Victoria is located in a "highly developed area where there is little spare capacity on the existing road network and little opportunity to substantially improve it". (Source : Travel Time Study commissioned by the Glasgow Health Forum (South-East)). It hardly seems likely that the traffic impact of bringing the Southern General’s in-patient work into the area would be viewed favourably, nor would they be physically easy to resolve. This issue adds to the town planning complexity already described earlier.
        1. A new Southside Hospital at the Victoria Infirmary campus would have to be phased since a quarter of the total 34.2 acres (if Queens Park Recreation were available) is already occupied by the existing hospital which would have to remain in use while new facilities were built on the adjacent site. A two phase development would therefore be unavoidable. Added to the town planning delays, this means that the Victoria Infirmary option would be much slower to deliver than the Southern General option.
  1. These reasons continue to be compelling.
  1. In leaflet 16 we set out the differences between the other two alternatives (Cowglen and the Southern General). We said that the differences centred on:

During the consultation period three other factors have been raised:

    1. It is important to revisit each of these in turn in the light of consultation. However, before doing so it is necessary to revisit the position on Ambulatory Care.
  1. An Ambulatory Care Centre at the Victoria Infirmary campus would provide local  access for at least 85% to 90% of all patient contacts that currently use the Victoria Infirmary. (Details given in leaflet 16). Many of the letters of concern we have received have been from people who currently go to ambulatory care services at the Victoria and who have gained the impression that in future they would have to go to the Southern General. There is no basis for such anxiety.

Such patients would continue to go to the Victoria Infirmary as they do now:

- around 275,000 out-patients No change 1

- around 5,000 day patients No change

- around 9,000 day surgery cases No change 2

(1 - "out-patients" also includes visits to x-rays, physio, speech therapy, hearing aids etc.)

(2 - assumes the issues around complication rates are satisfactorily resolved)

Of around 75,000 A & E attendances, between a minimum of around 14,900 would go to the Minor Injuries Unit at the Victoria, more likely a figure of 27,000 would go there. (Annex 6 explains this range) Around 14,000 children attend the Victoria A & E Department each year; an expert Paediatric A & E Review Group has recommended that all such children should go to the Yorkhill A & E or else attend local primary care services.

In addition the proposal to provide 120 rehabilitation beds in a new building next to the Ambulatory Care Centre would help local people needing to visit a patient who needs more extensive time in hospital to recover.

Thus for over 310,000 patients concerns about access to a new Southside Hospital at Cowglen or to the Southern General do not arise.

As Section 4 of this paper sets out GGNHSB sees no reason to depart from its original view that stand-alone Ambulatory Care Centres have a major part to play in the future pattern of service.

  1. Section 6 of this paper explores the issues of accessibility which attracted a large amount of comment in the consultation.

We suspect that much of the concern was from people who did not appreciate the significance of providing an Ambulatory Care Centre and 120 rehabilitation beds at the Victoria Infirmary (see above). Certainly many of the letters specifically referred to difficulties in attending out-patient clinics – which we are not proposing to move from the Victoria Infirmary campus. Others quoted the concerns of elderly people visiting their partners or friends during lengthy spells in hospital – the 120 rehabilitation beds are aimed to meet precisely the needs of such people.

For in-patients we suggest, in section 6, that the number relying on public transport to get from the present Victoria Infirmary catchment area to either Cowglen or Southern General (i.e. those not taken to hospital by ambulance, by taxi or by car driven by family, friends or neighbours) is unlikely to exceed 20 to 25 people a day. This would involve a public transport journey averaging 57.1 minutes (if Cowglen) or 62.4 minutes (if Southern General) if off-peak or 60.3 minutes and 64.7 minutes respectively if at peak hour – an average difference of between 4 and 6 minutes.

In the case of patients’ visitors we have drawn on a useful analysis commissioned by the Health Forum (South-East) – see Annex 7. We analyse the position in some detail in section 6. We concluded that: 

    1. at an individual public transport user level, public transport is not a differentiator between the Southern General and Cowglen because:
    1. for car users the difference is contained within a 10 minute margin either way and on a personal level the significance of this will be subjective.
    1. the economic advantage of Cowglen over the Southern General option in terms of travel times and costs was more than outweighed by the economic advantage to the NHS and taxpayers of the Southern General option over Cowglen.
    1. the significance of the 120 rehabilitation beds at the Victoria Infirmary site had been overlooked by many respondents but would significantly remove differences in public transport access for many patients’ visitors, especially the elderly.

A further issue that was raised during the consultation concerned the speed with which a new hospital for the Southside could be achieved. Many of those who commented on this issue preferred the Cowglen option because it assumed a single phase construction completed in approximately 7 years time (i.e. 2007). By contrast the Southern General option would involve a first phase of new building (not upgrading) complete by the same time scale and with a second phase of new building following demolition of old buildings elsewhere on the site freed up by the availability of the new hospital blocks.

The two phase approach was principally determined by the need to create potential site space for the relocation of the Royal Hospital for Sick Children (if that was decided). The Trust has reviewed the way in which site space could be released for new building and there might be scope for a single phase provision of a Southside hospital at the Southern General site. This needs further consideration both in terms of practicality and the profile of revenue funding requirements which the Trust would be able to examine reliably at Outline Business Case stage.

    1. A major differentiator in the choice between the two principle options has been cost.  In our original consultation material we highlighted that the Cowglen option would cost an extra £18.4 million per year more than the present cost of hospital services in South Glasgow compared with an extra £11.1 million per year for the Southern General option. We felt that the difference of £7.3 million was too high both in terms of absolute affordability and as an opportunity cost (i.e. taking into account that the £7.3 million could otherwise be spent on doctors, nurses and other healthcare staff providing extra healthcare for patients).

The responses to consultation were not impressed by this argument. However, the significance of this issue is now greater because the revision of bed numbers (see Section 8) means that the running costs of a new Southside Hospital (whether at Southern General or Cowglen) will be higher than we estimated in our original consultation period.

In Section 8 of this paper we revisit the issues of financial affordability in the light of the consultation responses the revision in bed numbers and new developments in NHS funding. Section 8 includes a new financial model for the period up to 2004\5 but also looks at the prospects for 2005\6 and beyond.

Its conclusion is that there is a very real risk that in 2006\7 the Cowglen option revenue requirement would be unaffordable within the GGNHSB formula allocation from the Scottish Executive. Indeed even the Southern General option with its higher number of beds will require careful financial stewardship over the next few years if its additional revenue costs are to be met.

  1. Cowglen - site issues.

At the start of the consultation we said two potential sites had been identified in the Cowglen area.

    1. a 44.7 acre site incorporating the present Cowglen Hospital and the National Savings Bank. Adjacent land owned by Retail Property Holdings Ltd would have created just enough additional space to build a hospital.
    2. a 73.6 acre site incorporating the Pollok Playing Fields and owned by the Pollok Estate.

Early in the consultation period the South Glasgow NHS Trust met representatives of the National Savings Bank (NSB) and, at the latter’s request, recognised that the NSB site was not for sale. Siemens, who run the operation on behalf of NSB, have recently won another contract which will further increase employment on this site.  Building a hospital on the site would not create new jobs in South Glasgow (since NHS jobs would simply be transferring from the Southern General and Victoria to Cowglen) but would involve displacement of the NSB and all the hundreds of jobs it provides.

This leaves the Pollok Playing Fields site as the only potential location large enough in the Cowglen area. 

  1. Cowglen : New Hospital on the Green Belt for Pollok?

The Greater Pollok Social Inclusion Partnership has written to point out that this site has been identified as an alternative site for the reprovision of playing fields at South Pollok which were lost when the M77 was built. The Greater Pollok Partnership wrote that they "would not support construction of a new hospital which encroached onto Broompark Farm without the full support of the local community. The provision of these playing fields is a requirement under the National Planning Guidance following the loss of the former facilities at South Pollok".

It is also the case that this site, which is designated as Green Belt Open Ground and as a Conservation Area is subject to a Conservation Agreement between Nether Pollok Ltd (now Pollok and Corrour Ltd) and the National Trust for Scotland. Use of the site would therefore require the agreement of the National Trust, the Trustees of Pollok Park and the City Council as local planning authority. The City Council’s Pollok Park Local Plan aims to "promote and maintain it as a high quality countryside area within which leisure and cultural pursuits can be undertaken without detriment to the countryside environment. In these circumstances ..... serious doubts as to the viability of any proposal to develop a new hospital on this site" (City Council Development Control letter dated 22nd August, 2000).

Any planning application to build on designated Green Belt needs to demonstrate very special circumstances which include demonstrating that:

Even if, contrary to its own Local Plan and policies, the City Council approved a planning submission that approval would still need to be referred to the Scottish Executive who might decide to ‘call it in’ and then to hold a public enquiry. It seems inconceivable that there would be no "green\conservation" interest groups that would not be opposing loss of Green Belt in the sensitive Pollok Estate. The odds on a public enquiry must be very high and the certainty of a successful outcome very low. The process would take a minimum of one to two years.  It would also be unfortunate, to say the least, for a Health Board committed to promoting physical exercise as a major contributor to good health maintenance to be dismissive of recreational space close to an area of significant health and social deprivation. Likewise for a Health Board to seek to convert a Green Belt Conservation Area into a high density concentration of buildings, car parking and yet more traffic is also out of tune with what is expected in responsible corporate decision-making.

  1. Are there any other sites in a central location in the Southside? In their response the Local Health Council urge GGNHSB "to pursue a longer term strategy which is more radical and will lead to the development of a much needed new hospital on a more centrally located site in South Glasgow". We understand this ambition, and who could not be tempted by its challenge? However, in starting its work on the proposals last year the South Glasgow Trust and its property advisers were unable to locate any such sites of adequate size other than those at Cowglen, Darnley and the Southern General.

At a meeting of the Glasgow Alliance Management Board on 25th August Scottish Enterprise – Glasgow gave a presentation on its programme to secure an adequate supply of good quality, well located, serviced sites in order to attract employment opportunities into Glasgow.

Among their criteria for success are:

They reported that the city is running out of the first class sites now needed to attract major inward location of new industrial\business opportunities. Such sites usually take two or three years to assemble and make ready for business occupation.  They were aware of our initial interest in the Cowglen NSB site and were intending to work in partnership with the owners to help bring the Savings Bank building into full business use thereby increasing employment opportunity in the area. The only other site identifiable in the city south of the river was Darnley Mains. Scottish Enterprise – Glasgow were concerned that use of prime vacant sites for a new Southside Hospital would possibly deny the city a major new net extra employment opportunity in one of the very parts of the city where such opportunities are both needed (adjacent to Pollok) and most difficult to create. It was also pointed out that although an NHS development in such a site large enough for a new hospital would in due course release the Southern General site for industrial development that opportunity would not be ready for use until the end of the decade whereas the need to attract net additional employment existed here and now.

The sense of the Glasgow Alliance Management Board meeting was that the creation of net extra employment opportunity for the Southside should not be overlooked when decisions are to be made about Southside Hospital configuration (which offers no net increase in employment).  Three issues therefore arise in addressing the Health Council’s challenge: 

    1. what alternative sites are there?
    2. if there were alternative sites how should we weigh employment opportunity against those considerations of public feeling about the Southern General site explored elsewhere in this paper? 
    3. how long are we prepared to wait in order to identify a site and resolve tortuous planning issues (or find that we cannot resolve them) when we already own a site (Southern General) which is certainly large enough and has fewer town planning problems associated with it?
    1. Some responses to consultation rightly draw attention to the traffic impact of options for the Southside. In section 6 we analyse this issue in overall terms. There will certainly need to be a traffic impact analysis as part of the next stages of planning, involving liaison with the City Council in its planning, roads and traffic management roles. The salient points emerging from our considerations of comments made so far are as follows:
    1. any reconfiguration of hospital services in Glasgow will change traffic patterns one way or another.
    2. our creation of a stand-alone Ambulatory Care Centre at the Victoria Infirmary keeps overall traffic change to a minimum. It will however reduce traffic around the congested area of Battlefield Road\Langside Avenue\Prospecthill.
    3. conversely our judgement not to locate a single hospital for the whole of the Southside at the Victoria Infirmary site avoids what would almost certainly be a quite unacceptable increase in local traffic and reduction in local environmental amenity.
    4. the Cowglen option would clearly be better than the Southern General in involving a more manageable traffic impact but, as we identified in 11.13 and 11.14 above there are serious other problems involved with the acquisition and use of sites at Cowglen.
    5. the whole issue of traffic impact at the Southern General would need to be examined alongside issues of existing road capacity, scope for improved public transport to reduce extra traffic, neighbouring developments at Braehead, Pacific Quay, Meadowside Granary and Yorkhill and any road or bridge developments associated with them.
    1. A large number of consultation responses cited the smell from Shieldhall Sewage Works, adjacent to the Southern General as a significant reason why a single-site Southside hospital should not be located there.  GGNHSB has raised the issue with West of Scotland Water who replied that they were very conscious of the potential impact that the Shieldhall facility can have on neighbouring properties. They went on:

"Consequently, three years ago this Authority developed an outline plan to reduce odours from this site. This plan is based on reliable measurement of odour nuisance to locate the principal sources of complaint and , therefore, to find innovative and cost effective solutions.

 Measurement of odour levels has been undertaken at Shieldhall continuously since 1997. The information collected is utilised by site personnel on a daily basis to monitor and improve operational performance. A site specific odour dispersion model has been developed by a specialist consultant and is used to help identify the problem locations and determine priority investment.

The Authority has invested in excess of £1 million at Shieldhall during the past 18 months addressing odour issues.

In addition, the underlisted investment is planned:

Financial year 2000\1

Financial year 2001\2

When this programme of work is completed, all of the presently identified significant sources of odour will be largely abated. Thereafter, there will be a further programme of measurement to ensure that there will be no outstanding odour generators. 

The operation of this site does generate odours. However, West of Scotland Water is endeavouring to ensure that at the boundary with our neighbours, there is no cause for complaint as a result of site operations. In this regard, we have established day-to-day liaison with representatives of the local community, Barr and Stroud and your hospital to assist in identifying sources of complaint and speedy advice of difficulties."

Clearly it is not possible for us to predict the precise success of these measures but we are confident that West of Scotland Water recognise the importance of the issue and are demonstrating a significant commitment to tackling it. Because they are monitoring complaints and linking them to specific site operations and weather conditions it will be possible to assess with some precision the effect of their current investment when it is completed by Spring, 2002.

Some consultation responses raised concern about the risk of airborne infection from the Sewage Works. Public health monitoring shows no pattern of disease in the area which could be attributed to the Sewage Works nor is there any experience elsewhere of disease being transmitted from a sewage works to neighbouring communities by an airborne route.

The issue of the Shieldhall Sewage Works is not, in our view, a factor that should influence the decision about future strategic configuration of hospitals, particularly since by the time change occurs West of Scotland Water’s investment programme will have been undertaken and its effectiveness monitored. If an odour nuisance remains it will be necessary to press for further measures by West of Scotland Water. 

    1. In leaflet 16 we identified a number of risks associated with the two main options on the Southside. They concerned:
    1. site availability.
    2. site acquisition cost.
    3. degree of flexibility in relating ultimate bed numbers to clinical experience and need over time.
    4. relationship of building contract size to degree of risk of cost-overruns.
    5. traffic impact issues.
    6. the risk, with two or three phase developments, of hiatus between phases.
    7. on-site disruption during building works.
    1. In terms of differentiating between the Southside option, the risk profile is as follows:
 

Southern General

Cowglen

Victoria (incl. Queen’s ParkRecreation)

a) Site availability

Nil risk. Already fully owned by Trust

High risk. Competing public policy considerations and long town planning process delays. Successful outcome cannot be guaranteed.

High risk. Competing public policy considerations. Long town planning process delays. Successful

outcome cannot be guaranteed.

b) Site acquisition cost

Nil risk. Already fully owned by Trust.

Medium risk. Costs of reprovision\relocation of playing field space (but where?) likely to arise.

Medium to high risk. Cost of providing alternative playing field space arises, so amount of land to be paid for is almost twice the area needed for the hospital itself.

c) Flexibility on future bed

numbers

Good flexibility unless we seek to achieve a single phase exercise.

Low flexibility because single phase project.

Good flexibility because it would have to be a two phase project.

d) Risk of cost overrun

magnified by sheer

scale of building

contract

High, especially if a single phase approach is sought and if PPP not used.

Medium if PPP used.

High because of site complications and phasing.

e) Traffic impact

Medium, depending on other nearby retail and leisure developments.

Low, although any expansion of other retail\ commercial activity around junction 2 of the M77 may raise this risk.

High, due to existing lack of local road capacity.

 

 

 

 

f) Phasing hiatus

High, unless single phase approach is feasible.

Nil risk.

High.

g) Building work

disruption on site

Medium. Site layout makes demolition and new building on a zoned basis possible without excessive disruption of other zones.

Nil risk.

Low risk. Disruption would be to the local neighbourhood rather than to the Victoria Infirmary itself.

Of these (a) is critical – no site, no hospital. Risk (b) is also a first order risk, since it will magnify cost differences between options to a significant degree. Risk (c) is not a significant differentiator. In our view the risks at (a) and (b) outweigh the risks at (e), (f), and (g). If risk (d) becomes high for the Southern General option because a single phase approach is adopted, then risk (f) becomes a nil risk for the Southern General.

  1. Taking Stock

Taking into account all the perspectives raised and explored during the consultation process how does GGNHSB view the position now?

    1. Firstly we wish to re-affirm our ambition that the Southside should have a pattern of hospital services that stand comparison with those available north of the river. This means:
    1. Secondly, we do believe a stand-alone Ambulatory Care Centre, including a Minor Injuries Service and 120 rehabilitation beds, located at the Victoria Infirmary will provide the best possible local access to as many services for as many people as possible.
    1. Thirdly, we continue to subscribe to a pattern of two Accident and Emergency Services for Greater Glasgow (supported by a network of more local Minor Injuries Units) which is best positioned on a north\east and south\west axis.
    1. Fourthly, we are anxious that the strategic planning blight which has afflicted South Glasgow for at least two decades should be brought to an end. We wish to see an early start to replacing the Southside’s obsolete hospital buildings.

Ending the blight requires a decision on siting to be made within the next few months.  If decisions become dependent on the most lengthy town planning processes, including public enquiry and the decision-making timescales that flow from a public enquiry, then the planning blight afflicting the Southside hospital service will remain rigidly unresolved for up to three years or more.

During that period of blight no resources could be committed to planning the new Southside Hospital in any meaningful detail, which in turn means that building would be unlikely to start until 2005 or 2006. The Southern General option is the only one which avoids this prospect of blight.

  1. The Board has reviewed its decision matrix for the Southside which is as follows:
 

Victoria + Queens

Park Recreation

SGH (+ACAD

at Victoria

Cowglen (+ACAD

at Victoria)

Site Issues

     

1. Site size

34.2 acres.

67 acres (SGH) +

5.5 acres (Victoria).

73.6 acres (Cowglen) +

5.5 acres (Victoria).

2. Site availability

Highly uncertain.

Already owned.

Highly uncertain.

3. Site acquisition

problems and cost

Highly uncertain. Need

to include cost of reproviding playing fields and re-routing main sewer on Grange Road. Would enable sale of SGH site

(?£7.5 million).

Nil (apart from 4 acres next

to Annan Street). Would enable sale of part of Victoria site (? £6m) + Mansionhouse

(? £2 million).

Highly uncertain. Would enable sale of SGH, part of Victoria site and Mansionhouse (? £15.5 m

in total).

4. Building work

disruption

Low risk to hospital. Significant impact on local neighbourhood.

Medium risk but minimised by zoned nature of site and order of demolitions. Less intrusive

impact on local neighbourhood.

Nil risk.

5. Environmental

impact\issues

High. Removes local playing fields and open space. Heavier traffic in residential\

recreational\shopping area with congested roads already.

Minimal. No loss of public amenity space. No change in use of site. Modern buildings replace muddle of older buildings on site. Options available for resolving traffic impact. Sewage works nuisance being addressed by West of Scotland Water.

High. Loss of open space. Traffic impact unlikely to be a major problem.

Accessibility

     

6. Number of patients

affected by change

of location.

All SGH patients = 450,000

VI in-patients +

A & E less MIU = 75,000

VI in-patients +

A & E less MIU +

All SGH = 525,000

7. Number of patient

unaffected by

change in

accessibility

All VI patients = 375,000

VI ACAD\MIU = 300,000

SGH = 450,000

750,000

VI ACAD\MIU = 300,000

8. Public transport

Best. Current off-peak average journey of 34 minutes (based on Mr. Drewette’s

work).

53 minutes average journey.

48 minutes average journey time.

9. Car\taxi access

Best. Average off-peak journey of 11 minutes.

Average of 17 minutes.

Average of 12 minutes.

Town Planning Risk

     
  1. Ease\difficulty of
  2. of town planning

    (also see factor 5)

Very difficult. Likely to take several years. Prospect of successful outcome is highly uncertain.

Easiest of the three options. Unlikely to take years. Prospect of successful outcome is very good.

Very difficult. Likely to take several years. Prospect of successful outcome is highly uncertain.

Conflict with Policy

Considerations (see

also factor 5)

     
  • Impact on employment
  • opportunities in

    South Glasgow

    Exports jobs from Govan to Langside\Queens Park area.

    Exports jobs from Langside\

    Queens Park to Govan.

    Exports jobs from Govan, Langside\Queens Park to Pollok.

  • A & E Services for
  • Glasgow

    Will require 3 major A & E Departments in Glasgow.

    Consistent with 2 A & E Department configuration.

    Will require 3 A & E Department configuration.

     

    • Possible relocation
    • of Children’s

      Hospital

    Not possible. Site too small.

    Achievable.

    Achievable.

  • Co-location with
  • Mental illness

    services

    Not possible. Site too small.

    Achievable.

    Achievable.

    Cost

         
  • Capital cost (leaflet
  • 16). Excl. Yorkhill

    relocation and site

    acquisition\disposal

    Not costed but would be no less than Cowglen option, certainly much more than SGH option.

    £190 million.

    £295 million

  • Annual running
  • costs (leaflet 16)

    Not costed but would be similar to Cowglen option.

    £11.1 million.

    £18.4 million.

  • Risk of capital cost
  • overrun

    High.

    High.

    Medium (if PPP)

    • Is there a big ‘sunk
    • cost’ penalty of

      walking away from

      recent significant

      capital investment?

    Yes. £41 million spent on new build at SGH in last 10 years (excluding refurbishment of old buildings).

    No. Capital spending at Victoria has been refurbishment only.

    Yes. £33 million at SGH.

    Other risks

         
  • Flexibility in
  • provision of most appropriate bed numbers

    Good flexibility.

    Good unless done in single phase.

    Low flexibility.

  • Risk of delayed
  • start and planning

    blight.

    Very high.

    Low.

    Very high.

  • Risk of phasing
  • hiatus (e.g. non-

    completion of a second phase)

    High. Two phases unavoidable.

    High unless single phase approach is feasible.

    Nil risk.

     

    1. This analysis indicates that the Southern General option is significantly the best in terms of:

    Factor

    2 Site availability.

    3 Site acquisition.

    5 Environmental impact.

    6\7 Access disruption to the smallest number of people.

    10 Lowest town planning risk.

    12 Fit with GGNHSB policies on A & E.

                        15 Value for money in capital investment terms.

                        16 Affordability and least adverse opportunity cost for other health care services.

    18 Least ‘sunk cost’ penalty.

    20 Minimum risk of further delay and planning blight.

    On some other factors there is little difference between it and the Cowglen option.

                        1 Site size (both are large enough).

    11 Employment.

    13 Scope to re-locate Children’s Hospital services (no difference).

    14 Fit with GGNHSB policy on mental health services (no difference).

    19 Flexibility on bed numbers (possibly some advantage to SGH).

    For factor 17 (risk of capital cost overrun) is difficult to judge since it depends on whether the SGH scheme is phased or not (higher risk), or subject to Public Private Partnership (lower risk) or not.

    In four factors Cowglen has an advantage:

    4 Site disruption during building work.

    21 Lower risk of phasing hiatus (although this would not be the case if the feasibility of a single phase approach at SGH proves to be possible.)

    8 Public transport (but both involve the need to improve it. Current time differences between them are within a narrow band. We do not see this as a significant differentiator).

    9 Car\taxi access (depending on how differences of 10 minutes or less are viewed).

    But factors 8 and 9 need to be seen in the context of the Cowglen option causing access disruption to the largest number of patients (factors 6\7).

    1. The Victoria Infirmary\Queens Park Recreation Site option falls, in our view, due to the significance of its position in relation to:

    We do not see these as being outweighed by its advantages in relation to factors 4 (building work disruption), 8 and 9 (public transport and road access – many residents in the present Southern General catchment area would feel as much dismayed by their perception of increased travel difficulty to the Victoria as do many of those from the Victoria Infirmary catchment area who complained about this issue during the consultation period), 19 (flexibility on bed numbers).

    1. Our conclusion therefore is to re-state our preference for the option of locating the Southside in-patient hospital at the Southern General, with an Ambulatory Care Centre (including Minor Injuries Unit) and 120 rehabilitation beds at the Victoria Infirmary campus.
    1. Is this unambitious? We think not.
      1. it meets a vision of clinical services significantly stronger than the present pattern and on a footing that will no longer compare adversely with other parts of the city.
      2. it retains as much local access as possible.
      3. it provides the Southside totally with all-modern buildings within which a high quality patient experience can be provided by well organised and supported teams of staff.
      4. it is the solution capable of the fastest delivery.
    1. Does this mean we have not taken notice of what has emerged from the consultation process? No, it does not. We have:
      1. We have also thought hard about how to deal with a number of pressing clinical service issues that need to be addressed in the period between now and the completion of the major capital investment later in the decade: 
      1. an urgent need to ensure that the Victoria Infirmary has stronger capacity to deal with the rising tide of medical emergency admissions during the next few years.
      2. concentrating haemato-oncology (cancer of the blood and lymphatic systems) services.
      3. concentrating gynaecology in-patient services.
      4. concentrating breast cancer surgery.
      5. concentrating in-patient vascular surgery services.
    1. The biggest single clinical pressure at the Victoria Infirmary for years has been its lack of capacity to deal satisfactorily with medical emergency admissions. In part that was due to inadequate staffing (mainly medical and nursing) and a need for improved organisation. The Trust has been addressing these issues in the last 12 months, with significant additional financial support from GGNHSB. However, the problem will remain intractable for as long as there are too few medical beds. At present medical patients continue to "board out" in the wards of other specialties, principally general surgery. This makes it more difficult to manage the patients efficiently and it also causes significant disruption to general surgery, making it more difficult to improve waiting list performance.

    Unfortunately the Victoria Infirmary does not have any vacant wards which can simply be staffed and re-opened.

    In order to tackle the problem, and put the hospital onto a sound footing for the remaining years of its acute in-patient role, we suggest the following sequence of changes should take place:

      1. It is already the case that when in-patient ENT moves to newly created accommodation at the Southern General in 2001 (a move already agreed following earlier consultation), an adult ENT ward of 24 beds will become vacant at the Victoria Infirmary.
      2. It is proposed also that in-patient gynaecology should be concentrated at the Southern General Hospital by the autumn of 2001. The benefits and implications of this are explained more fully below. This transfer from the Victoria Infirmary will free up ward 12A (25 beds).
      3. It is already the case that within the Victoria Infirmary general medicine bed complement 12 beds are allocated (in a 12 bed ward) for haemato- oncology. However, it is often the case that 3 or 4 haemato-oncology patients are also placed in another 11 bed general medical ward across the corridor.

    Our proposal aims to produce a significant improvement in the Victoria general medicine capacity, simultaneously provide some small easement for general medicine capacity at the Southern General and improve quality of service for Southside haemato-oncology patients.

    The current haemato-oncology ward at the Victoria Infirmary has single rooms with positive and negative ventilation systems to reduce risks of infection in patients whose treatment may make them vulnerable to infection. The ward across the corridor does not have this and haemato-oncology patients are placed alongside other patients with a range of general medical conditions. Haemato-oncology in-patients at the Southern General Hospital currently use 5 beds within a general medical ward. The proposal is to convert the ward adjacent to the existing haemato-oncology ward at the Victoria Infirmary so that an integrated unit for the whole of the Southside with suitable facilities and environment can be dedicated to this patient group. The cost of conversion would be around £200,000. This would affect 124 in-patient haemato-oncology admissions per year that currently go to the Southern General who would in future go to the Victoria for in-patient and day case care (375 attendances per year). Their routine out-patient consultation would continue at the Southern General. 

    This conversion would allow the concentration of haemato-oncology staff expertise in the Southside and would allow better cover for staff absences.

    This manoeuvre would free up 5 extra beds for general medicine at the Southern General but would reduce the Victoria’s designated general medical bed complement by 11 beds (slightly less in terms of current availability for general medicine), but 

    d) .......... general medicine’s bed complement would be increased by allocating to it the wards vacated by gynaecology (25 beds) and adult ENT (24 beds). There would thus be an extra 38 beds for the designated general medicine bed complement. GGNHSB would provide the revenue necessary for this expansion. This should provide significant easement of the Victoria Infirmary’s difficulties in absorbing general medical workload and should significantly reduce the level of patients boarding out in general surgical wards. Waiting list performance will also benefit therefore.

    We believe these changes would provide enormous benefit to the Victoria Infirmary and its busiest acute services.

    1. As already indicated, this manoeuvre depends on a ward being vacated by gynaecology. What is the rationale for this and what are its implications?

    Firstly the clinical logic flows from the advice of the Area Sub-Committee in Obstetrics and Gynaecology which favours co-location of gynaecology with obstetrics (maternity services) and urology. As is the case with other surgical specialties there are also trends towards the development of sub-specialisation within gynaecology which are particularly difficult to accommodate at a time when legal and regulatory constraints on doctors’ working hours (senior and junior doctors) are tightening. As specialisation continues so does the importance of ensuring as much continuity and strength in depth among the dedicated nursing team (and other staff) for gynaecology, many of whom also develop specialist knowledge and skills.

    The Glasgow-wide proposal for gynaecology envisages in-patient gynaecologybeing located at the Glasgow Royal Infirmary and the single in-patient hospital for the Southside. Ambulatory Care would continue to be provided at the Victoria Infirmary, Stobhill and Gartnavel (as well as at GRI and the Southside hospital), although the Gynaecologists share the caution of some other surgeons about day-surgery in stand-alone centres (an issue discussed earlier in this paper).

    There are strong reasons for proceeding with the concentration of in-patient gynaecology on the Southside at the earliest opportunity:

      1. It allows the benefits of a larger clinical team (specialisation and better staffing cover) to be secured without waiting several years.
      2. It allows use to be made of currently idle ward space at the Southern General.
      3. It creates sorely needed space to expand general medicine at the Victoria Infirmary.
      4. It allows in-patient gynaecology services to be relocated from West Glasgow at an early opportunity, thereby freeing up room for manoeuvre to facilitate the highly desirable service changes that would release West Glasgow acute services from their present wholly unsatisfactory pattern of split-site services for in-patients during their episode of care.
      5. It will save about £300,000 a year, mostly as a result of a reduction in junior doctors’ rota commitments and from more efficient use of beds. GGNHSB is currently underwriting that excess cost and no longer having to do so will allow that £300,000 to be spend on expanding general medicine capacity at the Victoria Infirmary.
    1. The impact of these changes for patients would be as follows:

     

    Out-patient

    Attendances

    Day Cases

    In-patient

    episodes

    TOTAL

    Southern General

    9,361

    985

    1,909

     

    Victoria Infirmary

    9,746

    1,296

    2,390

     

    Western\Gartnavel

    10,587

    1,367

    1,668

     

    No change

    29,694

    3,648

    1,909

    35,251


    Change

    Nil

    Nil

    4,058

    4,058

    The total bed days in hospital for the 4,058 patients affected by change (based on data in the 1998\99 Blue Book) is 9,450, an average of 2.3 days per patient.

    These figures assume that the patient population currently attending the West Glasgow hospitals would in future have their in-patient stays at the Southern General. GPs would be able to refer their patients to the GRI\Stobhill service if they wished for clinical or other reasons.

    1. How could the concentration of gynaecology in-patient services be achieved?

    There is currently one 25 bed gynaecology ward at the Victoria Infirmary and one 25 bed gynaecology ward at the Southern General (located in the Maternity Block). There is also a vacant 25 bed ward in the Southern General Maternity Block.

    The Trust would propose to upgrade the existing and vacant wards (Wards 40 and 49) in the Maternity Block at a cost of £1.2 million (£600,000 per ward). The service would also need to be supported by a triple theatre suite by the time gynaecology from West Glasgow joined the concentrated service. A site exists adjacent to the gynaecology wards in which to locate this.

    If capital funding is available, this work could be started in the Spring of 2001, allowing gynaecology to vacate its ward at the Victoria Infirmary by the Autumn of 2001, it time for general medicine to occupy it before the winter of 2001\2.

    The detail of the scheme to create a triple theatre capacity to accommodate the current West Glasgow in-patient workload would depend on whether the Southern General or Yorkhill was the location of the second of only two maternity delivery services in Glasgow (an issue subject to separate consultation – see Section 15).

    Whatever the outcome of that, there is site space in which the necessary theatre capacity could be created.

    If the need to expedite changes to split-site working for medicine and surgery between the Western and Gartnavel pointed to the desirability of transferring in-patient gynaecology from there to the Southern General in late 2001\2, theatre time would need to be accommodated. According to the 1998\99 Blue Book the number of operating theatre hours is as follows:

    Day cases

    (Hours per year)

    (Hours per year)

    In-patient cases

    (Hours per year)

    (Hours per year)

    Total needed

    at SGH

    Victoria

    Stays at Victoria

    1,912

    1,912

    SGH

    394

    1,336

    1,730

    West Glasgow

    Stays in West Glasgow

    1,334

    1,334

         

    4,976

    4,976 hours equate to 103 theatre hours per week over a 48 week work year, which for 3 theatres equates to 34 hours per week each (7 hours per day).

    The two upgraded wards would provide space for 50 beds. The transfer of in-patient Gynaecology from the Victoria Infirmary would see one of the two wards working on a day a week basis and one on a 5 day a week basis. When the West Glasgow service moved both wards would work on a 7 day a week basis.

     

    VI

    SGH

    Western\

    Gartnavel

    a) In-patient episodes

    2,390

    1,909

    1,668

    b) Average length of stay (days)

    2.0

    2.8

    2.8

    c) Beds days per year (a x b)

    4,780

    5,345

    4,670

    d) Victoria and Southern General combined

    (bed days)

    10,125

     

    e) All combined (bed days)

    14,795

    First phase (Victoria and Southern General combined)

    25 beds @ 7 days per week x 85% occupancy = 7,756 bed days

    25 beds @ 5 days per week x 85% occupancy = 5,525 bed days

    13,281

    Second phase (West Glasgow service included

    50 beds @ 7 days per week x 85% occupancy = 15,512 bed days

    This analysis demonstrates that the configuration provides sufficient capacity.

    1. As far as staffing implications are concerned there would be a reduction in the number of Senior House Officer posts in gynaecology, but with the reduced number working in a pattern consistent with the new national agreement on working hours and pay.

    The interim arrangement of one ward working 7 days a week and the other 5 days would require fewer nurses than at present but this will be more than compensated by the increase in general medical beds at the Victoria Infirmary. In overall terms the net change in capacity is created by re-opening the closed Ward 49 and increasing theatre capacity at the Southern General. There will be no fewer overall jobs in nursing, professions allied to medicine, ancillary or administrative\clerical at the Victoria and slightly more overall at the Southern General.

      1. The impending transfer of ENT in-patient services to the Southern General creates an opportunity to achieve a significant early improvement in the breast surgery service by concentrating its in-patient element at the Victoria Infirmary.

    Currently there is a breast unit staffed by two consultant surgeons and their teams with high quality accommodation at the Victoria Infirmary – single rooms in a dedicated ward with its own team focused on a specific group of patients needing great sensitivity at a difficult and worrying time. At the Southern General one consultant surgeon specialises in breast surgery and the in-patients are managed within the general surgical bed complement.

    The existing children’s ENT ward at the Victoria is located next to the Breast Unit. It is proposed that in the summer of 2001 it be converted (approximate cost £200,000) to the standard of the Breast Unit. Together the two wards would form an integrated Breast Unit to provide the in-patient care for the Southside breast service.

    It would:

      1. create a 3 consultant team, giving better absence cover.
      2. strengthen the multi-disciplinary specialist breast care team.
      3. create a ward environment purpose-designed for all Southside breast surgery patients needing in-patient treatment.
      4. create a bed complement protected from emergency admission pressures, thereby reducing the risk of late cancellation of booked admissions.
      5. use a dedicated elective theatre, also protected from emergency admission pressures.
      6. create the capacity at the Southern General to allow a similar strengthening of the in-patient vascular surgery service (see below).

    Out-patient clinics and day case surgery would continue to be undertaken a both the Victoria Infirmary and the Southern General.

    The number of patients affected would be around 100 per year which in future would go to the specialist unit at the Victoria Infirmary rather than to the Southern General.

    There would be no net change in staffing, although some change in the base hospital of a small number of staff would occur.

      1. The creation of a single in-patient Breast Unit at the Victoria Infirmary would create the capacity at the Southern General simultaneously (i.e. in the second half of 2001) to form a single integrated vascular surgery service whose in-patient work would be based at the Southern General (out-patients and day cases still provided at the Victoria Infirmary).

    The key features of this service would be:

      1. the creation of a 3 consultant team (compared with the current pattern of 2 at the Southern General and 1 at the Victoria Infirmary).
      2. a dedicated in-patient area for vascular surgery created at the Southern General, with a trained dedicated nursing team.
      3. more in-patients would be in closer proximity to the specialist Vascular Laboratory (mainly using ultrasound imaging) located at the Southern General (there is currently no dedicated equivalent at the Victoria).
      4. the Southside vascular service would be better placed to play a leading role in the South Clyde Vascular Network currently being developed with vascular service clinicians in hospitals in Argyll and Clyde.

    Emergency vascular surgery could still be undertaken when necessary at the Victoria Infirmary by the surgeons going to the patient rather than vice versa. This is already the arrangement in Glasgow, where vascular surgeons work as a specialist network to cover out-of-hours emergencies.

    The number of in-patients affected would be around 240 per year who would be treated at the Southern General rather than at the Victoria Infirmary.

    There would be no significant impact on staff other than possibly a change of hospital base for a small number.

     

     

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