NHS GREATER
GLASGOW
ORTHOPAEDICS IN
NORTH-EAST GLASGOW
PROBLEMS NEEDING
URGENT RESOLUTION
1.
INTRODUCTION
1.1 This
paper describes a significant problem in sustaining safe cover in orthopaedic
services in North-East Glasgow. The
Health Board and Trust have sought to resolve it through the consultation
processes of the last year but without reaching a resolution.
1.2 The
Stobhill Hospital Orthopaedic Consultants and their nursing colleagues have
said emphatically that they cannot sustain their present unsatisfactory
arrangements any longer.
1.3 In
addition to explaining the problem this paper reviews the choices for resolving
it and seeks comments on those choices and the preferred proposal.
2.
THE PROBLEM
IN A NUTSHELL
2.1 There
are 17 orthopaedic in-patient beds in a single (mixed sex) ward at
Stobhill. In 2000\1 572 elective
patients were treated in those beds.
2.2 The
three Consultant Orthopaedic Surgeons working at Stobhill also form part of the
orthopaedic team at the GRI where they play their part in the trauma rota
(there is no trauma service at Stobhill).
2.3 There
is no out-of-hours junior doctor cover in orthopaedics at Stobhill. There are 5 'junior' SHOs at the GRI whose
current rota does not comply with the national agreement for junior doctors
hours. The second level cover is
provided by 3 experienced SHO IIIs and 4 specialist Registrars. Their 1 in 7 rota is also currently
non-compliant. In order to make the
junior orthopaedic cover at GRI compliant it will be necessary to create an
additional SHO post and move to a new shift pattern.
But achieving compliance at the
GRI does nothing to provide out-of-hours cover at Stobhill.
2.4 Out-of-hours
specialist orthopaedic cover at Stobhill therefore has to be provided by the
three Consultants. In addition they
also have to take their part in the GRI Consultants out-of-hours cover
rota. The Consultants concerned are
therefore carrying a burden which is unacceptably onerous. The only way they manage a balance between
maintaining good productivity during the normal working day\week\month and
avoiding excessive out-of-hours on-call commitment is to organise the Stobhill
end of the commitment on an informal basis.
This relies on nurses exercising a high level of discretion about when
specialist orthopaedic expertise is needed, combined with a "wheel of
fortune" approach as to whether any of the three Consultants are actually
available when needed.
This set of arrangements has
worked after a fashion in the past.
But in the event of a mishap neither the Consultants nor the Trust would
have a credible defence against the charge that they continued with an
unreliable cover system long after they became aware that new requirements for
junior doctors rosters and consultants' working hours and more demanding
expectations about patient safety made it unacceptable.
-2-
2.5 The
Consultants have made it clear that they cannot allow this to continue. We agree that something must be done. This paper explores the possible solutions.
2.6 There
is a second factor which also threatens to bring this service close to collapse
and that is the difficulty of maintaining nurse staffing on the ward. The proposal to change the organisation of
orthopaedic services has been so long under debate, with still no resolution,
that the nurse staffing is beginning to erode.
The ward establishment - to
provide 24 hours, 7 days a week cover - is:
........ of which Current vacancies
F
grade 1.5
E
grade 3.5 1.5
D
grade 4.1 1.0
A
grade 7.1
16.2
It has so far not been possible
to fill the vacancies since nurses with the skills and ambitions who would
normally fill such posts are put off by the uncertainty about future
arrangements for this service.
Covering these vacancies through
the Nurse Bank or agencies fails to provide the continuity of skilled nursing
cover which this ward and its work requires, especially given the discretion
nurses have to exercise about summoning out of hours specialist orthopaedic
cover.
To Sum Up
Present specialist cover - medical and
nursing -
is stretched beyond acceptable limits.
3.
BACKGROUND -
HOW DID WE
ARRIVE AT THIS
POINT?
3.1 The
clinical reasons for addressing problems in orthopaedic in-patient services
have been in the public domain since April of last year.
WHAT WE SAID IN
APRIL, 2000
Orthopaedics The need to provide more consultant
cover for emergencies and
better supervision and
training of
juniors means that it is no longer
possible, within European
Union working hour limits, to provide round
the clock cover on three
separate in-patient sites in North Glasgow.
Only one in-patient centre
can be satisfactorily sustained in this way.
Keeping more than one site
will spread the presence of specialists
within orthopaedics (hands,
knees, hips, upper limbs etc) too thinly
and will make waiting lists
longer.
3.2 The
document published by GGNHSB in September, 2000 confirmed the clinical reasons
for wishing to proceed with change. We
said:
" The consolidation of the orthopaedics in-patient service for the North and East at Glasgow
Royal Infirmary
has been the subject of discussion for nearly ten
years. Agreement was reached by
clinical staff many years
ago on the need to achieve it. Actual implementation has always been
hindered by operational and management problems.
The orthopaedic clinicians of the North and East
have co-operated across the two sites by arranging to carry out
in-patient planned surgery at both the GRI and Stobhill
with all trauma (accident and emergencies) treated at the
GRI. These
clinicians are also unanimously in favour of the single in-patient unit for
orthopaedics in North Glasgow.
They see it as necessary to improve the
service. Specifically consolidation
will enable them:
a) to develop departments with
expertise in the various sub-specialties (hands, knees,
shoulders, hip replacement, trauma and so on).
b) to work more closely with
related disciplines such as rheumatology and plastic surgery.
c) to provide the best training
opportunities for junior doctors, nurses and para-medical staff.
There is an opportunity to bring about the long
delayed move of in-patient orthopaedics from Stobhill to the GRI very
early in 2001.
Adequate ward and theatre capacity has been identified within Glasgow
Royal Infirmary which would
enable this move to take place but also increase day
care capacity, thereby reducing waiting times.
It would entail
the transfer of 17 orthopaedic beds at
Stobhill. The number of in-patient
cases at Stobhill in 1998\99 was 806 (compared with 90 day cases and 8,395
out-patient attendances which would remain at Stobhill). The average length of stay for
Stobhill orthopaedic in-patients was 5.4 days.
Staff have been fully involved in the planning of
this move."
3.3 We have therefore consistently flagged up
this issue and had hoped that it might
have been resolved by the period
of consultation ending in December.
However, it was not so resolved since the Local Health Council wanted
more information on financial and staffing implications and bed numbers.
3.4 We had
hoped that the clear commitment given in December to an open and transparent
process for resolving the fundamental long term service strategies for acute
general medicine and general surgery for North-East Glasgow (and their
implications for the role of Stobhill Hospital) would allow the more immediate
needs of some of the small surgical specialties to be resolved on their own
separate merits.
Indeed we were heartened by letters
which the Stobhill Medical Staff Association wrote in January and February of
this year.
"We appreciate the need for
major changes in the delivery of health care in Glasgow and are supportive of
moves to centralise the smaller specialties such as ENT and ophthalmology. We also recognise the need to centralise
specialties such as Orthopaedics"
(Letter to Chairman of GRI Medical Staff Association
dated 25th January, 2001)
"The Stobhill Medical Staff
Association supports re-location of smaller specialties centrally ..... (we)
believe very firmly that this smaller functional unit with continued medical
and surgical receiving is one which has much to attract."
(Letter to Chief Executive of North Glasgow Trust
dated 16th February, 2001)
3.5 However,
controversy in the public domain about Stobhill continued in the early months
despite the explicit assurances given by GGNHSB about the option appraisal
process in both the Board papers of December and February and in an interview
with the GGNHSB Chief Executive published in the Kirkintilloch Herald on 14th
February, 2001. This caused GGNHSB to
hesitate about pursuing the issue of the small specialties during the period
leading up to the long range strategic option appraisal.
3.6 That
hesitation was confronted by the Orthopaedic Surgeons at the beginning of May
who pointed out that the time required for the option appraisal and subsequent
consultation on its conclusions would prolong their unacceptable situation for
a minimum of 6 to 9 months.
4.
WHAT ARE
THE POSSIBLE SOLUTIONS?
4.1 There are basically only
two possible solutions:
a)
appoint more
staff.
or
b)
concentrate the service on one site.
4.2
Appointing more staff might
seem to be the obvious solution but what would it entail?
a) For
a start it is not straight forward because the Stobhill service cannot be seen
in
isolation from the GRI Trauma
Service. Stobhill Consultants need to
be part of the GRI Trauma Service in order to maintain their trauma
skills. So, to institute a formal consultant
out-of-hours rota for Stobhill would need to be synchronised with Stobhill
Consultants taking part in the GRI trauma rota.
GRI
rota
Stobhill
rota GRI
Consultants
Stobhill
Consultants
b) A
viable Stobhill rota interconnected with the GRI trauma rota would require at
least 5 Stobhill Consultants in its own right (which would also result in a GRI
trauma rota of 1 in 10 instead of the present 1 in 8).
c) But
a properly organised Stobhill rota would also require junior cover at SHO and
perhaps
Specialist Registrar level. For such a
rota to be compliant would require a
minimum of 5
or 6 SHOs. In order for their clinical
experience to include the range of
work needed to
satisfy their educational requirements there would need to be
complex
rostering arrangements with the GRI-based junior staff so that clinical
experience
could be shared. Although this is
feasible it would make the educational
supervision of
the junior staff undesirably fractured.
d) Yet
a team of 5 or 6 Consultants is too large to operate out of just one ward of 17
beds. The bed pool would be too small
to allow flexible and efficient use of consultant time and skills. (A similar problem also currently confronts
the larger team at the GRI, although their bed pool is currently larger because
of the availability of trauma beds).
It would be necessary to open another ward at Stobhill and
more theatre capacity.
This would require nursing staff and anaesthetists. There would also be increased
costs in secretarial support, laboratory, radiology and
physiotherapy services,
surgical implants and prostheses, drugs and hotel services.
There are currently 6 unstaffed and
unfunded main theatre sessions at Stobhill.
Although there is also 1 unused Day Surgery theatre session there is no
available
space within the Recovery Area for additional patients. There are two unused wards
(4B
and 13A), either of which could be brought back into use with minor
upgrading.
(This presumes however that they are not needed to compensate for old
wards which
might need to be demolished to create space for the new Ambulatory Care
Hospital).
e) What
would this cost? We should assume that
opening up another ward and up to 6
theatre sessions would involve a
doubling of the present in-patient and day case activity (orthopaedic day
surgery is currently undertaken using ward and in-patient facilities since
there is no space available for orthopaedics in the Stobhill day case theatres
timetable).
Based on the Blue Book for
1999\2000 the costs would be:
Direct Costs per Case |
||||||||
|
Medical |
Nursing |
Pharmacy |
Physio
etc. |
Other
direct care |
Theatre |
Labs |
Total |
|
£ |
£ |
£ |
£ |
£ |
£ |
£ |
£ |
In-patient |
168 |
522 |
264 |
112 |
71 |
528 |
61 |
1726 |
Day
Cases |
205 |
21 |
11 |
- |
116 |
128 |
12 |
493 |
In 1999\2000 there were 706 in-patient
cases and 181 day cases, resulting in direct
costs therefore of £1.22 million and £89k respectively. Since both activities were
using the same ward and theatre capacity we can see that the
total direct cost in
1999\2000 was £1.31 million.
Opening up an additional ward and theatre capacity would more
than double the
present cost because the hospital would have its own
complement of orthopaedic
junior medical staff.
This suggests an increased cost of something between £1.4
million to £1.5 million.
4.3 So why
not do this?
There is no doubt that a doubling of Stobhill's elective
orthopaedic activity would make a
big impact on orthopaedic waiting times (the whole of the North
Glasgow waiting list
currently stands at around 1600 cases for GRI, Stobhill and West
Glasgow combined).
The total current orthopaedic in-patient and day case activity for
the North Glasgow
Trust (including trauma) is around 8500 cases per annum (based on
1999\2000 Blue
Book) - so an extra 600 to 700 cases per year at Stobhill would
increase total activity by
around 7 - 8%.
The key questions are whether this is affordable and whether it is
the best way of using
around £1.5 million each year.
• It certainly isn't affordable in 2001\2
since the Health Board has already
committed all
its available cash and the Trust is still committed to a significant
savings
programme to retrieve the remainder of its deficit.
• And it isn't a priority for 2002\3. We can say without any hesitation at all
that
resolving bottlenecks in cancer and imaging
services, expanding intensive care
unit capacity, improving stroke services
and increasing the use of stents in
cardiology are all examples of far higher
priorities for treating disease but as yet
unfunded and collectively far exceeding
£1.5 million in cost. They would be a
long way ahead of orthopaedics in the queue for funding from
what is available
for acute services development in North Glasgow in 2002\3.
• The benefit in reducing waiting lists would lie between 600 to
700 cases per
year. A benefit of 50%
of this can be achieved by the alternative option of
concentrating the specialty at the GRI site - at a cost of
around £45k per year
compared with the £1.5 million of the Stobhill option.
Many
pressing priorities for cash in North Glasgow
• The March, 2001 GGNHSB agenda paper on its
financial framework set out the full range
of
needs for cash.
• Around £5.5 million available for North
Glasgow
service improvement in 2002\3.
• £4.4 million of this already needed for
commitments
started in 2001\2. Leaves only £1.1 million for
everything else
•
There are serious bottlenecks in cancer, heart and
stroke services which have an indisputable priority.
And this is not a problem that can wait until 2003\4 to be
solved. It has to be resolved
now.
4.4 There may
be some who say why not just appoint, say, 2 more Consultant Orthopaedic
Surgeons without increasing ward and theatre capacity? The answer is that those 5
Consultants would be supported by just 17 beds on their one
ward - which is not enough
to allow them to work productively and to maintain their
skills at a high level. There
would also be a reduction of theatre capacity for each
surgeon unless one or more other
specialties surrendered existing staffed theatre
sessions. Nor would this solution solve
the lack of
orthopaedic junior doctor cover.
4.5 The alternative is to concentrate the
service.
And that means it has to be at the GRI because that is where the
trauma service and the
full range of A & E services are located.
How could this be done?
4.6 At present the facilities for in-patient orthopaedics at the GRI consist of:
2 trauma wards
1 elective ward - which works on
a mixed sex basis
Trauma surgery is undertaken in a dedicated Theatre H.
There are 2 other theatres equipped for orthopaedic surgery,
including laminar flow
facilities (Theatres M and N).
Currently only Theatre M is in use.
Theatre N is
immediately available for use.
There is a vacant ward of 17 beds (Ward 28) located next to the
existing elective
orthopaedic ward. It is
currently used for decanting but is available for use almost
immediately.
4.7 Thus
concentrating the service at the GRI would have the following effect in terms
of capacity:
|
Now |
Following change |
Wards GRI Stobhill |
3 1 1 1 |
4 1 - |
Beds GRI Stobhill |
67 17 |
84 - |
Theatres GRI Stobhill |
2 1 2 |
3 2 - |
Notes: 1. At present
the ward at Stobhill and the one elective ward at GRI are mixed
sex.
With concentration all wards at GRI would be used on a single sex
basis.
2.
At present the Stobhill theatre is used by orthopaedics for only 7 sessions
per
week.
The additional GRI theatre would be available for 10 sessions, allowing
more waiting list activity to be done. The aim is for the team of 8 Consultants
to do an additional session once a
fortnight, achieving full utilisation of the
theatre capacity. Allowing for study leave and annual leave, theatre utilisation
would increase by 126 sessions per year
(compared with the present). At an
average of 2.5 cases per session this would
allow an additional 315 cases to be
done per year. This is
containable within the bed complement, as the following
tables show:
TABLE 1
Current bed utilisation
(1999\2000 Blue Book data) |
||||||||
|
(a) In-patient
cases |
(b) Average
length of stay |
(c) Bed days |
(d) Available
beds |
(e) Available
bed days |
(f) Day
cases |
(g) IP
+ DC total bed days |
(h) (g)
as % occupancy |
Stobhill |
706 |
5.9
days |
4,166 |
17 |
6,205 |
181 |
4,347 |
70% |
GRI |
3,090 |
5.7
days |
17,613 |
67 |
24,455 |
384 |
17,997 |
74% |
|
3,796 |
|
21,779 |
84 |
30,660 |
565 |
22,344 |
|
TABLE 2
Combined unit, with 315
extra in-patient cases per annum |
|||||||
|
(a) Available
beds |
(b) Average
length of stay |
(c) In-patient
cases |
(d) Bed
days |
(e) Day
cases |
(f) IP
+ DC total bed days |
(g) (f)
as % occupancy |
GRI
combined unit |
84 |
5.9
days |
4,111 |
24,255 |
570 |
24,825 |
81% |
Note: If average length of stay (column (b)) were 5.7 days, percentage
occupancy
(column (g)) would be 78%.
Impact on staff
4.8 The
existing three Orthopaedic Consultants would undertake all their in-patient
work
at the GRI but would continue to
meet their existing out-patient clinic commitments at
Stobhill. Junior medical staff would benefit at
Stobhill where currently House Officers
and SHOs in general surgery
currently provide non-specialist cover out of hours. They
would no longer find themselves
faced with orthopaedic patients of whom they had scant
knowledge and for whom they had
no orthopaedic expertise to offer. The
orthopaedic
junior staff would realign their
pattern of in-patient work within the GRI, with an extra
SHO and a new pattern of shifts
allowing a compliant rota to be worked.
The Consultant Anaesthetists who
support orthopaedic surgery currently in Stobhill Hospital will continue to
provide this in the GRI instead.
4.9 Nursing staff (ward and theatre) would
transfer to the GRI. The number of
posts
involved is:
Ward - as shown in
paragraph 2.6 )
) in each case all posts would transfer
Theatre - 1.0 G grade ) to the GRI.
1.0 E grade
3.0 D grade
1.0 A grade
6.0
Nurses would benefit from the richer skill mix and professional
development
opportunities available from a larger pool of staff and a wider
range of clinical work.
4.10 Ancillary staff would not be affected by the
move. The impact on the wider range of
support
staff in the diagnostic, laboratory, therapy and medical records services
would
be
indirect rather than direct. No staff
reductions or transfers would be involved.
There
will need to be a review of secretarial support arrangements but this would not
involve
any staffing reductions.
4.11 All staff have already been involved in
forward planning for this option since it has long
been
seen by those concerned as the only practicable solution to the problem.
Individuals would have some degree of choice as to whether they
transferred from one
hospital
to another with their service or remained at their present hospital. This would
be a
matter of detailed consideration between managers and staff since it involves
striking
an acceptable balance between service viability and continuity on the one hand
and
staff preference on the other.
Financial implications
4.12 The
only additional cost would be the employment of additional SHO (junior doctor)
at a cost of around £45,000. No
inter-Trust financial transfers are involved, which means the North Glasgow
Trust is not dependent on resource being released from another Trust.
4.13 No
additional capital expenditure is required.
Day Case Surgery
4.14 It
has been a long-standing commitment of GGNHSB to ensure that orthopaedic day
case surgery continued to be provided at Stobhill. The balance between in-patient and day case work has continued to
shift in recent years.
|
In-patient cases at Stobhill |
Day cases at Stobhill |
1998\99 |
806 |
90 |
1999\00 |
706 |
181 |
2000\01 |
572 |
222 |
Source: Blue Book for 1998\99 and 1999\00. North Glasgow Trust Clinical Information System
for 2000\01. |
4.15 The
day case work at Stobhill is currently incorporated into main theatre lists
rather than in the hospital's day case unit.
This is because there are not enough cases to justify a regular theatre
slot in the day case unit. The day case
unit is fully booked for higher volumes of work in other specialties.
4.16 This
means that transfer of the orthopaedic in-patient theatre capacity from
Stobhill to GRI will take the day case surgery capacity with it.
4.17 The
scope for increasing day surgery capacity at Stobhill needs to be reviewed as
part of the wider option appraisal process due to be completed later this
year. GGNHSB, the Trust and the
orthopaedic surgeons themselves are committed to providing an orthopaedic day
case service at Stobhill and undertake to report further on this issue as part
of the option appraisal process.
5. THE
IMPLICATIONS FOR PATIENTS
5.1 The
Orthopaedic Surgeons are in no doubt that bringing the two portions of the
North-
East Glasgow elective orthopaedic service
together will offer a more robust set of
specialist orthopaedic services.
5.2 It is already the case that several aspects
of specialist orthopaedic work cannot be
offered at Stobhill.
They include:
-
hand surgery (other than the most simple)
-
anterior cruciate ligament surgery
-
hip revisions
-
shoulders
-
trauma
These are all provided at the
GRI. On the other hand there are some
areas of specialist work which Stobhill's Orthopaedic Surgeons offer to a wider
population than just the local Stobhill catchment. They include:
-
spinal work.
-
complex non-union surgery
-
total knee revision
-
elbows
5.3 This
highlights that it is already the case that this specialty involves patients
travelling from one traditional "catchment area" to another. Postcode analysis of the 572 in-patients
treated at Stobhill results in the following pattern:
|
|
% |
a)
Strathkelvin postcodes (e.g. Kirkintilloch, Torrance,
Bishopbriggs, Lennoxtown, Twechar, Condorat) |
235 |
41 |
b)
The Robroyston to Maryhill Road box, north from (but
including) Balornock |
131 |
23 |
c) Moodiesburn
and Garthamlock |
37 |
6 |
d) The typical
GRI catchment area (from City
Centre, Townhead, to Shettleston, Parkhead,
Bridgeton and Easterhouse) |
34 |
6 |
e) The
South-East sector (e.g.
Burnside, East Kilbride, Uddingston, Cambuslang,
Toryglen) |
24 |
4 |
f) Southside (e.g. Pollok,
Shawlands, Newton Mearns, Castlemilk, Govan,
Gorbals, etc) |
21 |
4 |
g) West Glasgow
and Bearsden |
21 |
4 |
h) Motherwell and
Falkirk postcodes |
37 |
6 |
i) Kilmarnock
and Paisley postcodes |
21 |
4 |
j)
Rest of Scotland (Fife, Perth,
Edinburgh, Aberdeen, Dumfries and Galloway,
Gairloch) |
10 |
2 |
k) Postcode
unknown |
1 |
- |
|
572 |
100 |
5.4 Although
the impact of change is largest in the traditional Stobhill catchment area, the
GRI would be a more convenient location for probably around one third of the
patient population. The access issue is
therefore one which adversely affects around 370 of
the 573 patients and those of their visitors who live in the
same area.
5.5 What
are the main features of access for the two hospitals?
a) For
people who use the train for access, GRI is served by High Street
Station which is a shorter walk
than Bishopbriggs station to Stobhill (½ mile compared with just over ¾
mile). A larger number of trains and
routes stop at High Street (which is in turn readily accessible from the major
rail hub of Queen Street).
b) For
people who use buses it is more complex to generalise since it depends on the
proximity of people's homes to particular bus routes. Annex A shows relevant bus routes. The Buchanan Street bus station is ¾ mile
walk to GRI (or there are many buses which travel up and down Cathedral Street
between the City Centre (for Queen Street and Buchanan Street).
For people travelling from
Kirkintilloch to Stobhill by bus the journey time is currently 35 minutes. The alternative of travelling by bus from
Kirkintilloch to GRI involves a journey of 45 minutes plus a 10 minute walk or
a further bus from either Royston Road or Buchanan Street. The fare is the same (£1.25 single, £1.60
return) for either hospital, unless a second bus is used instead of the 10
minute walk for the GRI.
c) As
far as car travel is concerned, access to Stobhill is off Springburn Road (with
Balgrayhill Road running parallel) from the South; via Broomfield Road\
Balornock Road from the
South-East; Auchinairn Road from the East and Kirkintilloch Road from the
North.
Anyone who currently approaches
Stobhill from the North or East would have to continue south down to the GRI
via Springburn Road, a distance of just less than 3 miles, typically taking
around 9 or 10 minutes (at an average journey speed of 18 mph).
d) Stobhill
has ample car parking. GRI has no
on-site public parking but there are usually spaces in the Castle Street car
parks opposite the GRI. In future there
will be a multi-storey car park at the GRI.
5.6 It
is of course recognised that issues of access loom large for elderly patients
and their relatives. The age profiles
for Stobhill's orthopaedic work are shown below. They suggest that the issue of age is less of an issue in terms
of access for this specialty than is the case in general medicine for example.
5.7 Our
conclusion is that patient access is not made so much worse or difficult to
deal with that it would override the patient safety issues which lie at the
heart of this problem.
0 – 15 |
16 – 30 |
31 – 50 |
51 – 65 |
66 –75 |
75+ |
|||
|
65 |
141 |
172 |
108 |
73 |
0 – 15 |
16 – 30 |
31 – 50 |
51 – 65 |
66 –75 |
75+ |
4 |
33 |
101 |
59 |
15 |
7 |
6
OUR PREFERRED
SOLUTION
6.1 We
have no hesitation in re-emphasising that the problem of cover and its
potential implication for patient safety is paramount and must be resolved.
6.2 The
two choices of increasing staffing at Stobhill or of concentrating the service
at GRI compare as follows:
|
More staffing at Stobhill |
Concentrate at GRI |
a)
Ward space available? |
Yes - unless needed to create site space for new ACAD. |
Yes - Ward 28 |
b)
Theatre space available? |
Yes. |
Yes - Theatre N |
c)
Staffing readily
available? |
Need to recruit 3 or 4 Consultants (orthopaedics and anaesthetics),
junior doctors, ward and theatre nursing teams (in a tight nursing labour
market). Difficult and slow. |
Yes. Just needs
one extra junior doctor. |
d) Cost (revenue) |
Approximately £1.5 million recurring per year. |
Approximately £45k |
e) Affordability? |
No |
Yes |
f) Capital cost |
Nil, except for minimal ward upgrading. |
Nil |
g) Impact on
staff? |
Uncertainty while new staffing complement builds up. No early relief. |
Immediate relief of problem. No loss of employment\posts. Increased opportunities for clinical experience. Better staff cross-cover from larger pool
of staff. |
h)
Impact on patient and visitor
access |
Greater capacity would draw in more patients from outside as
well as inside the Stobhill catchment area. |
Better for around ¯
of patients. Marginally worse for the
others (but travelling to the city centre area is not an unusual feature of
people's normal lives) |
i)
Impact on waiting
list |
Improvement in orthopaedics of around 600 - 700 cases per
year. Equates to 38 - 44% of current
North Glasgow waiting list and 7 - 8% of total orthopaedic case load. |
Improvement due to greater use of theatre time. Around 315 cases per annum, which equates
to around 20% of current North Glasgow waiting list and just under 4% of
total orthopaedic case load. |
j) Speed of
implementation |
Slow |
Fast |
6.3 This
comparison shows that the GRI option rates better against criteria (a), (b),
(c), (d),
(e) and (j).
The two options are the same on criterion (f). On criterion (i) (impact on
waiting list) the Stobhill option yields
twice as many additional cases but at an extra cost
per case of approximately £2,300, compared
with £143 per case for the GRI option.
(The disparity is because the GRI option is
able to use existing staff complements
whereas the Stobhill option duplicates
them). The Stobhill option is better on
option (h)
for two thirds of patients while GRI is
better for the other third. The adverse
impact on
bus travellers is limited to around 20
minutes of extra travel each way and possibly a
small increase in fares.
6.4 Our conclusion is that concentration at the
GRI is the preferred solution basically because the alternative (expansion
at Stobhill) is unaffordable, slow and uncertain in its prospects of successful
implementation (the staff recruitment challenge is daunting). Moreover the Stobhill option delivers little
advantage in the way of waiting list benefit despite the expenditure of around
£1.5 million.
7.
WHAT'S THE
SIGNIFICANCE OF THIS FOR
THE WIDER ISSUE
OF
THE FUTURE OF
STOBHILL?
7.1 The
answer is 'None'.
7.2 The
key point to emphasise for the future of Stobhill is the promise that GGNHSB
has repeated on several occasions.
The GGNHSB Promise
The
option appraisal for the future of acute
services in North-East Glasgow will be
properly
conducted, overseen by a Reference Group of
representatives of the public.
7.3 There
are four options to be considered:
(1) GRI
as the single in-patient centre.
Stobhill has Ambulatory Care Hospital.
(2) Shut
the GRI. All North-East hospital
services in a re-built Stobhill.
(3) GRI
as specialist hospital. Stobhill
provides district general hospital services for the North and East.
(4) Status
Quo - which basically means Stobhill retains general medical and general
surgical receiving, beds for the elderly and has the new Ambulatory Care
Hospital. Small specialist services
(such as ophthalmology, ENT, gynaecology, orthopaedics, urology) would have
their in-patient base either at GRI or Gartnavel.
7.4 Orthopaedics
as a specialty is not itself decisively influential in the choice to be made
later this summer between the four options.
The services that will be decisive, because of their size, their patient
volumes, their needs for accommodation, staff and support services are general
medicine, general surgery and care of the elderly. All the ambulatory care services, including a basic core of minor
injuries\casualty services, are common - and therefore guaranteed - in each of
the four options.
In 1999\2000 there were 23,847
in-patient cases at Stobhill. 18,445
of these (77%) were in the
specialties of general surgery, general
medicine (including respiratory
medicine and haematology) and elderly
assessment. By contrast orthopaedic in-patient work was
706 cases
that year - just 3% of the total
in-patient work of the hospital.
Source:
1999\2000 Blue Book
7.5 Arising
out of the consultation on acute services reconfiguration conducted since
April, 2000, GGNHSB has confirmed that it envisages just two orthopaedic
in-patient services in Glasgow - one on the Southside and one in North Glasgow. This means, as a consequence, that Gartnavel
would not have an orthopaedic in-patient service but that does not
significantly diminish Gartnavel's standing as a hospital.
7.6 The
long term location of orthopaedics will be determined by the strategic
option appraisal, not vice versa.
a) Under
option 1, orthopaedics would be at GRI (but not at Gartnavel nor at Stobhill).
b) Under
option 2, orthopaedics would return to Stobhill, along with
the transfer of all the
other services currently at GRI.
c) Under
option 3, orthopaedics would return to Stobhill, along with
the transfer of many of
the other services currently at GRI.
d) Under
option 4, orthopaedics would be at GRI (but not at Gartnavel nor at Stobhill).
8.
COMMENTS
Individuals or organisations
wishing to comment on the proposals should send their responses to:
Mr.
John C. Hamilton,
Head
of Board Administration,
Greater
Glasgow NHS Board,
P.O. Box
15329,
Dalian
House,
350 St.
Vincent Street,
Glasgow, G3
8YZ.
Telephone
: 0141 201 4608
Fax:
0141 201 4601
no later than
Friday, 3rd August, 2001.