Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

14.  OTHER SPECIALTIES
  1. The position on some other specialties needs further discussion.
  2. During consultation, the dermatologists have produced a document which proposes a unified Dermatology service for Glasgow. The proposal combines a well developed vision of local ambulatory care at all hospital sites with a single in-patient unit (they propose 24 beds). The proposal is attached at Annex 8.

    Dermatology is currently located at both the Southern General and the Western
    Infirmary. Clearly with the closure of the Western Infirmary some relocation is unavoidable. The questions is "to where?".

    GGNHSB would want to encourage the dermatologists towards the achievement of their
    vision of excellence and accessibility.

We therefore endorse the principle of a single in-patient centre for Greater Glasgow and will now explore what the preferred location should be. As part of that process we seek views on the thinking set out in Annex 8.

  1. Some months ago we requested advice on the organisation of Nephrology services (for kidney patients). In leaflet 4 we had indicated that we proposed one in-patient centre at the Southern General and one in North Glasgow. This reflected earlier advice from nephrologists that there should be two units in Glasgow and GGNHSB’s own desire to see a nephrology service established in South Glasgow.

    We are not sure whether professional opinion on this issue has shifted in the intervening months. Our view is that the major A & E centres proposed for the GRI and the Southern General should have on-site nephrology services in support. We are open to persuasion that Gartnavel and its mix of services may also need on-site nephrology services in support.

We wish to receive definitive advice on the pattern of provision for nephrology based on the disposition of other specialties now becoming clear through the present consultation exercise.
  1. The position of urology in North Glasgow was discussed in paragraph 12.13 in relation to the transfer of in-patient urology services from Stobhill to the GRI and Gartnavel. The North Glasgow Trust has indicated that it is not yet clear whether such a transfer would be a transitional step towards a single in-patient service in North Glasgow or not. If there is a proposal to establish a single North Glasgow in-patient service it will be subject to separate consultation in due course.

In the meantime GGNHSB confirms its proposal to transfer in-patient urology from Stobhill to the GRI and Gartnavel as soon as appropriate capacity and support services can be provided (see paragraph 12.13).

  1. The significance of mental health services has been raised in connection with several aspects of the consultation. There is of course a well developed Mental Health Framework and Implementation Plan which is currently being put in place throughout Glasgow as new facilities (e.g. the new wards at Stobhill) and revenue money become available. It was itself subject to extensive consultation during 1998 and 1999.

    The three areas of significance in relation to acute services configuration are:

    1. the need for "liaison psychiatry".
    2. the replacement of Leverndale Hospital in South Glasgow.
    3. the future of Stobhill Hospital.
  2. "Liaison psychiatry" recognises the connection between physical and psychiatric ill health. The Primary Care Trust’s Psychiatric Medical Advisory Committee wrote
    1. "Improving the psychological health of medical\surgical in-patients and out-patients improves the quality of life, ...... reducing bed occupancy, investigation and procedural costs ...... Each provider unit should provide facilities, both in medical wards and Accident and Emergency Departments which is sufficiently private, safe and properly furnished for interviewing patients concerning psychological, sexual problems and assessment of suicide risk".

In Glasgow there is a high level of need in relation to patients with drug and alcohol addictions and others who have committed deliberate self-harm.

We shall need, in the detailed next stages of planning, to ensure that liaison psychiatry is available whenever it is needed on all acute hospital sites.

  1. The Primary Care Trust is planning the re-location of mental health services from their isolation at Leverndale and reprovision of existing mental illness beds at the Southern General currently provided in very old and unsuitable buildings. Their preferred option is to co-locate acute mental health services on the Southside’s acute hospital site.  This would:
  1. help to make the provision of liaison psychiatry more efficient.
  2. help to reduce the stigma of mental illness which is perpetuated by the existence of stand-alone "mental hospitals".

This service improvement goal is relevant to the choice of location for the Southside acute services in-patient hospital. Environment and design are important in good mental health care. High rise development is not appropriate and adequate dedicated recreation space is important. The requirements are therefore quite "land hungry".  The need could not be met at the Victoria Infirmary\Queens Park Recreation site. The Trust’s preference is for the Southern General site and space has been earmarked on the Coila Park site within the campus which neither interferes with the space needed to rebuild the Southern General nor add to the risk of site disruption during construction.

  1. Some commentators have raised questions about the position of mental health services at Stobhill if there are no general acute in-patient services there. Such a change in Stobhill’s role would not undermine the clinical effectiveness of the mental health services in any way. The fact that the Stobhill campus would still be an extremely busy general acute services site (with over 300,000 patient attendances per year) would mean that its atmosphere would be dominated by that activity rather than by the presence of a relatively small number of mental health wards. Most importantly the risk of mental illness being stigmatised would be reduced by Stobhill’s multi-purpose healthcare role.

    The presence of mental health services on the campus would help to provide liaison psychiatry support needed for Stobhill’s Ambulatory Care Centre.
  2. The issue of clinical support specialties such as laboratory services and imaging (x-ray, ultrasound, MRI) was not addressed in our original consultation material. Work is underway to develop an investment plan for imaging services in Glasgow and will be reported in our next Health Improvement Programme. In the case of laboratory services we recognise that capital investment is needed to modernise facilities, harness new technologies, create flexibility between disciplines and provide a platform for further new scientific development. We wish to work with the Trusts and laboratory medicine staff to consider what the most effective investment strategy would comprise.

 

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