Greater Glasgow NHS Board
Acute Services

THE FUTURE OF GLASGOW’S HOSPITAL SERVICES

REPORT ON FIRST PHASE OF CONSULTATION

 

15.  MATERNAL AND CHILD HEALTH
  1. In leaflet 17 ‘Maternal and Child Health’ we described the suggestion that had been made about the possibility of re-locating Yorkhill Trust’s hospital services into brand new facilities. This would at the same time facilitate an on-site link with adult services which does not currently exist and strengthen the child-centred focus on some children’s hospital services not currently provided by Yorkhill.
  2. We acknowledged that the suggestion had not been developed in any planning detail but felt, in the spirit of early consultation on issues, that we should stimulate discussion about it.
  3. The responses to consultation have not been studied in any depth since they only emerged at the last moment in the consultation period. We can summarise their gist but not get very far in any evaluation of them.
  4. The Yorkhill Trust conducted extensive consultation themselves with a wide range of staff, family \ parent support groups and others with an interest in the health, development and healthcare of children. They report that over 100 written responses were received but have not shared those with GGNHSB. Instead the Trust Board has referred to the inevitability that a wide range of comments were received but has distilled a number of recurring themes emerging from their consultation exercise:
  1. GGNHSB itself received very few letters from the general public on this issue. Some thought the idea of re-location was worth exploring, some opposed it.
  2. The trust developed 10 Key Principles which they feel should guide the continued development of Child and Maternal Services. These are shown at Annex 9.

The Trust’s commentary (also shown in Annex 9) on how the principles would be met by the choice between re-locating children’s services or leaving them at the present Yorkhill campus needs fuller analysis. For example:

  1. In Principle 1 (access), no reference is made to what the differences in travel might be in measurable terms nor is the significance of over 21,000 children attending adult A & E services at the Victoria and Southern General considered. The analysis given on access also excludes consideration of access for longer stay children and their parents\visitors.
  2. Principle 7 (advocacy for children) seems to be about Yorkhill’s status as a separate Trust rather than about the difference that location might make to this Principle.
  3. There appears to be no recognition of the possibility that Principle 10 (a child and family focus) might be diminished depending on how location influenced the degree of achievement on Principles 4 (links with maternity services) and 5 (links with adult medicine).
  4. The analysis of Principle 5 (links with adult medicine) appears to be limited to the benefit it might have for children whose later care as adults would be served by the host adult acute hospital site. It is highly likely that the benefits of links with adult medicine will be greater than that, especially for older children and adolescents and for maternity patients.
  1. The Trust also commissioned W.S. Atkins to provide an estate development plan for the Yorkhill site. The report has only just been received by GGNHSB and needs examination. However, it appears to have several main messages:
    1. the existing Queen Mother’s Maternity Hospital building is in "very poor physical and functional condition. Even with an investment of over £15 million, an upgrade would not address some of the fundamental functional problems that were inherent due to the building’s structure.  ...... the constraints inherent in the existing structure and difficulty of site access do not lend themselves to the provision of 21st century maternity services. In addition construction work would be logistically extremely difficult, due to site access and especially if a clinical service had to be retained throughout".
    1. there is site space to provide a new Ambulatory Care Centre at Yorkhill if the present Queen Mother’s building is demolished.
    2. the existing Royal Hospital for Sick Children‘s main block is in reasonably good condition. Physical and functional upgrading costing around £25 million would take it into the next 30 years.
    3. the report does not appear to address whether and how the existing Main Block could eventually be replaced on site while continuing to provide its services. The suggested site development plan does appear to offer only what would in future be the hospital’s main car park as a site but that would be immediately adjacent to the existing block (and therefore very disruptive during construction) and when completed would result in a less good functional relationship with the proposed Ambulatory Care Centre.
    4. the cost of building a new maternity unit at the Yorkhill site would be £13.3 million (excluding VAT and equipment) on one of two suggested site development options or £14 million on the other.
    5. the cost of redeveloping the Royal Hospital for Sick Children and give it its "30 year lease of life" would be some £23.5 million on one option or £28 million on the other. The second option is the most ambitious. The difference between the two is essentially that the second provides a brand new Ambulatory Care Centre while the first does not.

      This is a useful piece of work which now needs closer examination.

  1. By comparison the South Glasgow Trust had estimated that it would need to spend around £51.7 million (excluding equipment) in order to include Yorkhill’s services at either Cowglen or at the Southern General campus.

    This option too needs closer examination over the next few weeks. In particular its adequacy in terms of site space, internal functionality and service linkages needs to be tested.
  2. The Yorkhill Trust’s conclusion, following its consultation process, and its consideration of the 10 Key Principles and the W.S. Atkins Report was that it should remain on its present site, with progressive redevelopment of child and maternal hospital facilities on the site.

    A number of other commentators took this view.

  3. A different view was taken by the Area Medical Committee. It supported the provision of Maternity services at the GRI and on the South Glasgow site. With regard to children’s services it said:

"there is strong and unanimous support for the longer term continuation of Glasgow’s children’s hospital, the Royal Hospital for Sick Children, providing services to children and maintaining its own unique ethos. The Committee supports the principle that there are advantages to the Glasgow children’s hospital and regional referral centre for children being co-located with an adult general hospital on a shared campus. The Committee is ...... sensitive to the concerns of those who are unconvinced that the possible benefits outweigh the perceived dangers of the loss of facilities specially designed for the needs of children. Our children’s hospital must not become ‘just another department’ in an acute Trust".

Within the medical advisory machinery those supporting this view included the Area Anaesthetics, GP and Obstetrics and Gynaecology Sub-Committees. The Paediatric Sub-Committee rehearsed the pros and cons in an even-handed way and concluded that it did "not see the need to move RHSC from its present site at Yorkhill. Until it is clear what alterations are being offered it supports the view that Paediatric and neo-natal services should continue to expand and develop on this site".

  1. The Local Health Council felt more information about choices and benefits should be developed. It felt there was merit in exploring the matter further but that GGNHSB should not commit itself at this stage to a policy to transfer Yorkhill’s services.
  2. The issue needs to be seen alongside the future disposition of maternity services. In 1999 GGNHSB consulted on a recommendation from the Maternity Services Liaison Committee that in the light of falling numbers of births and the imminent surplus capacity in Glasgow once the new GRI Maternity Unit had opened, we should reduce the number of delivery units from 3 to 2. In other words GRI plus the Southern General or GRI plus Yorkhill.

The Maternity Services Liaison Committee has done further work on the factors that should affect this choice and GGNHSB expects to receive some suggestions in the next month or so. We shall then conduct public consultation as to what choice we should take.

  1. Where does this leave the issue of Yorkhill’s services for children? We need to examine the analysis of issues produced by the Yorkhill Trust, the W.S. Atkins Report and the issues of space, functionality and linkages of other options. We shall encourage those analyses to be conducted openly and on a shared basis, during the next two months.

If, by December 2000, GGNHSB felt that there was a justifiable case for considering the transfer of children’s services from Yorkhill to brand new facilities elsewhere we would develop a fully worked up consultation paper for widespread consideration early in 2001.

 

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