Modernising Glasgow's Acute Hospital Services
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CONCLUSIONS AT THE OUTCOME OF
SECOND PHASE OF CONSULTATION

  1. After seven months of extensive consultation GGNHSB is confident that its five key aims have widespread recognition and support. The five aims are:
  1. Modern facilities for a better patient experience.
  2. Creating larger specialist teams of doctors in order to assure more continuous availability of specialties and to tackle new requirements governing the working hours of senior and junior doctors.
  3. Maintaining local access for as much as possible.
  4. Creating a pattern of hospital services that makes sense across Glasgow as a whole.
  5. Levering in major capital investment in a way that is affordable.
  1. Equally GGNHSB recognises that it is the interaction of these aims that makes a single universal consensus about the precise future pattern of services so difficult to achieve.
  2. GGNHSB’s decisions at this stage in a continuing process of capital – and service – planning seek to build on those areas where there is widespread agreement while at the same time putting in processes for the next stage of planning which provide transparency and further interrogation for those aspects where agreement is not widespread.
  3. The component service\specialty structure around which the proposed pattern of acute hospital reconstruction should be built is as follows:
  1. Local access to a wide range of consultant out-patient clinics, diagnostic services, out-patient rehabilitation services, day surgery and minor injuries services (Ambulatory Care). This local access to be provided at the GRI, Stobhill, Gartnavel, Victoria Infirmary and Southern General (unless a new greenfield site hospital were built on the Southside, in which case these services would not be provided at the Victoria Infirmary or Southern General).
  2. In-patient general medicine (including respiratory medicine and cardiology), general surgery and acute geriatric assessment services should be located alongside each other on the same hospital campus. GGNHSB accepts the advice of the Area Medical Committee that there should be three in-patient sites for these services in Glasgow – one in South Glasgow, one in West Glasgow and one serving north and east Glasgow. 
  3. Regional services should be organised so as to give them the best possible in-patient platform on which to build their future service development. In some instances this means retaining their present base, in others amalgamation or transfer is in hand or proposed:
  1. The term "Accident and Emergency" covers a wide range of different needs:
    1. a receiving point for medical and surgical emergency referrals from GPs.
    2. resuscitation and emergency stabilisation of patients who arrive with cardiovascular or other acute systems failure.
    3. patients with multiple injuries requiring a prompt trauma response.
    4. a minor injuries service which can be provided by nurse practitioners working to clinical protocols determined by A & E Consultants.
    5. patients with initially indeterminant symptoms (breathlessness, abdominal pain etc) who need assessment, treatment and\or onward referral where appropriate. (Such patients also present to GPs in primary care and similar diagnostic skills are required).

Each acute receiving hospital should have policies and capacity for managing (i) and (ii). For the number of patients in category (iii) Glasgow needs no more than two units with this clinical capability, as long as their strategic accessibility on the main road networks are complementary (as would be the case with one unit at GRI and the second at the Southern General). Services for category (iv) should be provided as part of locally accessible Ambulatory Care services. Each acute receiving hospital and each minor injuries unit should have clinical protocols, staff training and onward referral arrangements that allow category (v) ("primary care at hospital") to be managed in a way that is clinically competent and helps to reinforce the necessary links with primary care.

  1. Orthopaedic in-patient services should be co-located alongside category (iii) trauma services. If there were two such services (at the GRI and Southern General) this would indicate two orthopaedic in-patient units (which has benefits for orthopaedics as a specialty in terms of capacity to sustain sub-specialisation, optimum working hours cover arrangements and research interests). If there were three category (iii) services (e.g. in the event of there being a greenfield site Southside Hospital at Cowglen), then there would need to be three orthopaedic in-patient units.
  2. There are several specialties where their future bed numbers will be such as to make their presence on three (or even two) sites in Glasgow non-viable. The future pattern for these in-patient services is proposed to be as follows:

Specialty

South Glasgow

North Glasgow

 

ENT

a

Gartnavel

LHC seek further consultation

Ophthalmology

a

Gartnavel

on North

Urology

a

1 or 2

Further consultation needed in North

Gynaecology

a

GRI

LHC seek further consultation.

Dermatology

a (?)

-

Further consultation needed on proposed single unit for Glasgow, probably in South Glasgow.

Nephrology

?

?

Policy still to be finalised. Will require consultation.

Rheumatology

a

?

Policy in North still to be finalised. Will require consultation.

Maternity

?

GRI

Consultation on location of Glasgow’s second maternity unit still subject to consultation.

Maxillo-facial surgery

a

-

Already being implemented following 1996 strategy.

Haemato-oncology

a

Gartnavel

 

 

  1. In integrating this shape of clinical services into a pattern of capital investment, GGNHSB proposes that:

South Glasgow

  1. there should be a single in-patient hospital on the Southside of Glasgow (a South Glasgow University Hospital).
  2. this will entail transferring in-patient services from the Victoria Infirmary to the new South Glasgow University Hospital.
  3. its preferred site for the South Glasgow University Hospital is the Southern General Hospital. The new hospital will be completely new construction, with the exception of:
  1. in recognition of widespread public preference for a greenfield site option (Cowglen is the only available suitable site), the option appraisal element of the Outline Business Case should compare the Southern General, Cowglen and do nothing options – with the option appraisal process being overseen by a reference group composed of representatives from the Trust management, Medical Staff Association, GGNHSB, Primary Care Trust, the South Glasgow Trust Partnership Forum, Local Health Council and three MSPs (one from a South-east Glasgow constituency, one from a South-west Glasgow constituency and one chosen by Glasgow List MSPs).
  2. in the event that the Southern General is confirmed as the preferred site at Outline Business Case stage, an Ambulatory Care Centre should be provided at the Victoria Infirmary site, together with approximately 120 rehabilitation beds, replacing the Mansionhouse Unit, which would close.
  3. in the event that the Southern General was not confirmed as the preferred site at Outline Business Case stage, then in due course it would close when replaced by the new build hospital. In this event the Victoria Infirmary would also close, with no facilities remaining on site.
  4. West Glasgow

  5. an Outline Business Case be developed for capital investment at Gartnavel to include:
(i)  the concentration of medical and surgical receiving services for West Glasgow.

(ii)  creation of Ambulatory Care facilities.

(iii)  creation of Emergency Receiving Unit facilities enabling Gartnavel to deal with medical and surgical emergency referrals from GPs, minor injuries services and patients with initially indeterminant symptoms. Further detailed planning will examine what arrangements should be made to deal with the resuscitation and emergency stabilisation of patients who arrive with cardiovascular or other acute system failure. Provision for patients with multiple injuries requiring a prompt trauma response is not proposed unless the South Glasgow option appraisal produces a conclusion which does not support the Southern General as the preferred option.

(iv)  creation of ITU and High Dependency Nursing Unit.

(v)  the single North Glasgow in-patient centre for ophthalmology and ENT.

(vi)  the Beatson Oncology Centre (including haemato-oncology).

(vii)  the single Regional Cardiothoracic Centre.

(viii)  laboratory facilities.

(ix) car parking provision.

  1. On completion of the necessary alternative facilities, the Western Infirmary should close (in accordance with the 1996 approval by the then Secretary of State). GGNHSB wishes the Trust to give early priority to any interim steps that can be taken to secure the early integration of acute medical and surgical receiving at Gartnavel prior to completion of the full capital investment programme at Gartnavel.

North and East Glasgow

  1. the work to complete a Full Business Case for an Ambulatory Care Centre at Stobhill should continue.
  2. a Planning Group be established to develop an Outline Business Case for further capital investment to provide a sustainable in-patient service configuration for north and east Glasgow. This Planning Group will undertake an option appraisal around the respective roles of GRI and Stobhill within the context of service policy decisions made for other parts of Glasgow (e.g. the role and service complement of Gartnavel, the closure of the Western Infirmary, the probability of some A & E flows from parts of South-East Glasgow). There will be a wider reference group drawn from community representatives served by the GRI and Stobhill which can interrogate and influence the option appraisal and the clinical and other issues associated with it.
  3. GGNHSB’s commitment to there being formal public consultation on how medical and surgical receiving services in north and east Glasgow can be satisfactorily and viably provided will be met by using the product of the Option Appraisal element of the Outline Business Case as the vehicle for formal consultation.
  1. In the case of child and maternal health GGNHSB proposes to establish an inclusive and transparent process to examine options, reaching some initial conclusions by March, 2001. This will allow a period of consultation between April and August, 2001. In total the issue would have been explored transparently in the public domain for nearly 8 months.
  2. The development of Outline Business Cases for South Glasgow, Gartnavel and north and east Glasgow will be informed by parallel work in some areas of detailed planning:
  1. bed numbers: a Steering Group comprising representatives from the two acute Trusts, the medical advisory machinery, GGNHSB, the Local Health Council and ISD will aim to produce a report to GGNHSB for 17th April, 2001.
  2. A & E Services: the physical capacity, support services, in-patient service back-up, clinical policies and public information details for the five different service elements need to be reflected in the Outline Business Cases. This work will be overseen by a Glasgow A & E Services Planning Steering Group comprising Health Board and Trust senior managers, representatives of the A & E Consultants, GPs and other clinical groups affected by the services.
  1. The three major Outline Business Cases will provide the springboard for significant capital investment which will come on stream from the middle of the decade onwards. In the interim period there are several specific transfers of in-patient services which GGNHSB would wish to see take place. Details were given in the September, 2000 paper:
  1. Southside – a number of changes aimed to improve patient care in specific services and to improve the capacity of both the Victoria Infirmary and Southern General to manage the pressures of medical and surgical receiving in the years prior to the building of the new Southside Hospital:

GGNHSB now regards these changes as urgent in order to relieve pressures without unnecessary delay. It is however awaiting a Local Health Council response on these specific proposals – which were set out in detail in the September, 2000 Board paper.

  1. In North Glasgow there are a number of intermediate changes which were specified in the September, 2000 paper and on which the Local Health Council is requesting further information:

GGNHSB will ask the North Glasgow Trust to ascertain precisely what information is deemed sufficient by the Local Health Council and to produce consultation proposals accordingly.

  1. There may be other interim changes that become either feasible or necessary as part of the process of preparing for the proposed major investment. These will be more clearly understood when the three major Outline Business Cases have been prepared. Examples include:

There will be detailed consultation on these if and when they are substantively identified.

  1. A consultation proposal for centralisation of dermatology in-patient services will be published shortly.
  2. Work on future policy for nephrology and gynaecological oncology is still underway and there will be consultation on proposals in due course.
  1. In the case of the need to replace the Dental Hospital and School, GGNHSB has asked the North Glasgow Trust to suggest an appropriate planning mechanism with an aim to reaching initial conclusions by March, 2001 so that a consultation process can then ensue.
  2. GGNHSB confirms that other strands of work signalled in the September, 2000 Board paper are in hand and will continue to complement the capital planning processes. These include:
  1. continuing a dialogue with Strathclyde Passenger Transport Executive, bus companies and other interests to secure improvements in public transport.
  2. discussion with SIPs, LHCCs and others about strengthening extended primary care services in those parts of the Greater Glasgow area most distant from hospital facilities (Clydebank, East End\Easterhouse, Rutherglen, Cambuslang, Castlemilk, Drumchapel and Kirkintilloch).

 

  1. Finally GGNHSB and the Trusts agree that there is a need to strengthen overall project management capacity and will be taking steps to:
  1. strengthen project management capacity for the Southside, Gartnavel and north-east Glasgow components.
  2. put in place a pan-Glasgow financial modelling capacity for this whole programme of acute services development.
  3. appoint a pan-Glasgow Project Controller to oversee the whole range of interlocking projects and advise Trusts and GGNHSB accordingly.
  4. put in place an overall Steering mechanism that keeps all necessary elements of work under review and ensures good communications with NHS stakeholders, MSPs and the public.
  5. secure Scottish Executive approval to move into Outline Business Case stage for South Glasgow, Gartnavel and north-east Glasgow so that the necessary consultancy expertise can be brought to bear in developing the complex Option Appraisals that are needed and the design and financial analyses to underpin them and convert them into robust Outline Business Cases.

18.12.00

Last modified: August 15, 2002

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