Greater Glasgow NHS Board
THE FUTURE OF GLASGOW’S HOSPITAL SERVICES
REPORT ON FIRST PHASE OF CONSULTATION
ACUTE HOSPITAL SERVICES - HOW IT LOOKS TO US NOW
1. We’ve learned a lot during the consultation
Literally hundreds of documents, letters and meetings – with public groups, staff, MSPs, Councils, the Local Health Council – have given us a strong sense of what people want and what issues cause them problems (like public transport difficulties). A lot of detailed contributions have been received. They’ve helped us to think hard about how we should go about modernising Glasgow’s hospital service and how it should connect with other parts of the health care system.
As in all debates the headlines concentrate on areas of disagreement but underneath all that everyone’s agreed on one thing – we’ve got to make change happen. We can’t stay locked in a pattern of run down hospitals, and services that are fragmented or overstretched.
It’s not possible to meet everyone’s expectations. There are too many contradictions to reconcile but the way that debate has tested ideas and raised new suggestions has been great.
"Nothing’s changed as a result of consultation"
Wrong! There are some hugely important changes. And we go forward with so much better understanding than we had before. Read on!
2. What’s new as a result of consultation?
promise of a faster plan to get the Beatson Regional Cancer Service onto a single site at Gartnavel.
confirmation that people really do want a new Southside Hospital – and as soon as possible. We weren’t sure of that before consultation began.
That sounds OK – but what about other issues?
Actually nothing has been untouched by what we learnt during the consultation exercise. There are some difficult choices to make. We’ve likened the challenge of bringing Glasgow’s hospital service into the 21st Century to a Rubik’s Cube. Change one part of the puzzle and you find it’s put something else out of shape in another part of the system. There are some parts of our original proposals which look very much the same as they did before but they’ve been tested under the fire of vigorous debate and we still feel confident about them. They include judgements that:
a pattern of two Accident and Emergency Departments (GRI and SGUH) supported by locally accessible Minor Injuries Centres at the Victoria, Stobhill and Gartnavel is in the best interests of the different types of patients and is workable.
3. For the vast majority of people, they will still go to the same hospital as they do now
And in future, those hospitals will be modern and efficient for the patient.
• "I have to go to the chest clinic every month, where will I go in future?"
To exactly the same hospital as you do now.
• "I’m attending physio sessions following an accident, where will I go?"
To exactly the same hospital as you do now.
• "I’ve sprained my ankle, where can I get it dealt with?"
At your local hospital – the GRI, Stobhill, Gartnavel, Victoria or new South Glasgow University Hospital. Go wherever is most convenient.
• "My GP’s referred me for an x-ray, where will I go?"
To the same hospital as you do now, unless it’s a very specialised examination (but it’s already the case that not every hospital meets all local needs for specialist x-rays).
• "I’ve had an earache for several days, where will I get that dealt with?"
You should go to your GP who is very locally accessible. Accident and Emergency Departments aren’t intended for that sort of problem.
For 85% to 90% of what patients go to hospital for, they will still go to the same place.
4. We’re aiming to spend a lot of extra money to bring Glasgow’s hospitals up to date
By 2010 virtually all the old buildings will have gone, replaced by new state-of-the-art facilities. As well as spending a lot of money to build them, we’ll also be spending a lot of extra money to run them.
"The plans as just about saving money"
Wrong! We will spend millions of pounds more.
5. The new pattern will mean shorter waiting times
There are 4 reasons why:
6. Public Opinion favours a new South Glasgow Hospital on a new site
So they do. People also told us they were fed up with decades of hospital planning blight. So are we. The consultation process has flushed out more information about sites. A new hospital needs more than 50 acres. Scottish Enterprise-Glasgow is also looking for sites this size. They couldn’t find any that we hadn’t already identified. Many people favoured Cowglen but the National Savings Bank site is not for sale and the other site at Cowglen is Green Belt. Horrendous town planning problems. Years of delay if we pursued it. Little prospect of success at the end of it. No site, no new hospital.
7. The Southern General site is big enough and ready now
And that’s why we should go for it. The tunnel makes it an excellent second site for Accident and Emergency to match the GRI – very accessible for ambulances from West Glasgow as well as from most of the Southside.
In 10 years the South Glasgow University Hospital will be an all modern campus.
Wrong! It’ll be all new build.
Wrong. It’s central for its A & E role for the west side of Glasgow north and
south of the river. Ambulatory care services – 90% of all patient experiences – will still be provided at the Victoria , as central for those patients as ever. For those in-patients who do have further to travel the trade-off is safer, more consistent specialist care for the most serious illnesses.
Wrong! There will be a large new-style hospital built there, its focus on Ambulatory Care. If you currently go to a clinic at the Vicky, you’ll still go to a clinic at the Vicky.
No. We pledge ourselves to improving public transport, including some express shuttle bus routes. For most people travel will be improved. Whatever site is used for a new hospital, public transport would have to be improved.
8. The Queens Park Recreation\Victoria suggestion as a site for a single Southside Hospital won’t wash
Some people have suggested that this site could be readily made available as a site for a new South Glasgow hospital. We strongly disagree:
the site isn’t big enough. as designated Open Space, it would take years of town planning process before we even knew if it was actually available.
But we do think the location is an excellent place for an Ambulatory Care Hospital which will meet most people’s needs for hospital services in a very locally accessible way.
9. What about Ambulatory Care Centres?
This has been an interesting debate. All sorts of different agendas. The bottom line is that Ambulatory Care is what we do already. – out-patients, routine diagnostics, physio, other therapies and day surgery. New multi-million Ambulatory Care Hospitals are simply about doing it better from the patients’ point of view – fewer visits, fewer reception desks to negotiate, fewer corridors to trek, fewer delays. All in a thoroughly modern environment.
Everyone likes the idea. Some people have raised a question about a tiny part of their role the day surgery bit amounts to around 5% of what an Ambulatory Care Hospital would do. Some of those who oppose Ambulatory Care Hospitals for the Victoria and Stobhill just don’t want to have to spend time working away from what they see as their ‘base’ (GRI, Gartnavel or the South Glasgow Hospital). We want these Ambulatory Care Hospitals at Stobhill and Victoria because they’ll provide most of what people currently use these hospitals for. We can’t let a 5% tail wag the whole dog – which is about local access to services, which is what everyone says they want.
Complication rates in day surgery?
Are very low and are usually slowness to recover from anaesthetic.
They’re just glorified Health Centres
Hardly! These places are big and complex. They do almost everything that conventional hospitals do – but an easier experience for patients.
10. The proposals secure the long term future of Stobhill
The new Ambulatory Care Hospital for Stobhill will be big, busy and built to serve the population who currently use Stobhill. It will be the guarantee that most of what people use Stobhill for, they will continue to use.
For the in-patient experiences, people will be referred to GRI or Gartnavel (or to Southside, as already happens for some conditions). Longer travel, yes, but the benefits will come from the ability of clinical teams to provide their expertise in a much more sustained and responsive way in an era where the notion of "working all hours doctors" is no longer acceptable.
11. The new pattern of Accident and Emergency Departments will save lives
Yes – a bold statement but clinical audit shows too many seriously injured patients not being seen by a consultant. We intend to invest in two "gold standard" A & E Departments. There aren’t enough of the seriously injured to justify three gold standard departments – instead we want well organised Minor Injuries Units at each hospital – GRI, Stobhill, Gartnavel, Victoria and South Glasgow – to provide fast service for the "walking wounded". Fewer delays for them because they won’t be competing for attention with the more seriously injured cases.
12. The Ambulance Service will be up to the job
It’s already investing in extra crews and getting a paramedic on every 999 vehicle. We shall invest more on top to match the new pattern of Accident and Emergency Departments.
It’s speed of response to the scene of incident that saves lives. Subsequent journeys of no more than 25 to 30 minutes to the nearest Accident and Emergency Department are not unusual in the UK. In many areas of Glasgow the journey times will be much less. The current average journey time from scene to hospital is about 10 minutes – it will not change much. For people in West Glasgow, the ambulance time to the South Glasgow Hospital site will be around 3 minutes shorter than the current journey time to the Western.
13. We’ve got a better handle on public transport access problems than we’ve ever had
The consultation has confronted us with the problems that many patients have in getting to the present pattern of hospitals. Whatever change is made for the future pattern, something has to be done to improve public transport. This is not a problem that the NHS alone can solve but we will do our bit, including commissioning some express shuttle buses, working with Strathclyde Passenger Transport Executive to get better information about bus routes.
14. We’ve flagged up some more work that needs to be done on:
• bed numbers
• Dental Hospital
• expanding the new Accident and Emergency Department at the GRI
A lot of people were worried abut there being fewer surgical beds in future (we had proposed there should be more medical beds). We’ve agreed to review what we expect future average lengths of stay and trends in day surgery to be. And how the new concentrations of beds will deal with peaks of demand. We’ll publish the results of that work as soon as we can. Our aim is to ensure that there will be enough beds. We will be opening extra medical beds at the GRI (27) this year and 38 at the Victoria if gynaecology transfers to the Southern General next year. There will also be extra medical beds for the winter at Gartnavel, Stobhill and, this winter, the Mansionhouse Unit.
The Trust have produced some useful work on choices for the future which we will be exploring with them and others. If a proposal to build a new Children’s Hospital does emerge we will consult on it. Already it is clear that some people favour a move, others don’t.
The Dental Hospital
One of the new issues that has emerged during the consultation period. People want to know its future, bearing in mind the building is not in good condition. We’ve published a note on progress so far.
GRI Accident and Emergency Department
The new Department will need more space. There is space available. The Trust will plan the details.
Greater Glasgow NHS Board