Modernising Glasgow's Acute Hospital Services
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MODERNISING GLASGOW’S ACUTE HOSPITAL SERVICES

 

1. INTRODUCTION

1.1   This Consultation Paper is published under the terms of Scottish Office guidance published in 1975 which set out arrangements for statutory consultation. But much has changed since then and we want to use this opportunity to promote a wider and well-informed debate about Glasgow’s hospitals. The aim is that by the autumn firm proposals will be put to the Minister for Health. Decisions then will give a green light to sorely needed modernisation of Glasgow’s acute hospital services.

1.2   The formal consultation questions and a note about the consultation procedure are set out at the end of this paper.

1.3   But we want to emphasise the interactive nature of debate and consultation that we are promoting over the coming months. The proposals are extensively based on advice from NHS professional staff (doctors, nurses and others) and public debate that has already been running for two years. There are still aspects that need to be resolved through further debate. Above all, we hope that Glaswegians will feel that our approach to modernising Glasgow’s hospital services is able to command their confidence and enthusiasm. We believe the approach is genuinely visionary but at the same time practical and capable of being translated into action.

By the end of the summer we hope that there will be some agreement about how to move forward.

2.  WHAT ARE WE TRYING TO ACHIEVE?

2.1   Our aim is a hospital service which provides the most up-to-date treatment quickly, using advanced technologies and specialist skills in settings which are modern, friendly and convenient. Achieved within the next decade. Glaswegians have seen the modern facilities now available elsewhere and expect us to deliver a well designed service for them.

Too often for patients there are delays, postponements and trekking around hospital corridors, going to scattered departments in old or shabby buildings.

2.2   Almost all patient experience of acute hospital services does not involve the use of in-patient facilities. Our aim is to keep local access for at least 85% of these services – (the term used to describe them is "Ambulatory Care") – but to do so in facilities that are modern and provide the best possible experience for the patient.

2.3  In-patient care currently accounts for only 9% of all patient episodes with the acute hospital service.

Meeting demand for in-patient services needs to balance:

a)   the continuing trend in surgical specialties towards day case treatment
rather than in-patient treatment. (Made possible by what are known as "minimally invasive technologies" – for example the use of fibre-optic probes which not only see inside the body but can remove growths, clear blockages etc. Laser technologies and robotics are increasing the scope for this approach).

b)   the need to group both consultants and junior doctors into larger clinical teams so that they can better programme their work (including the need to cover emergencies without interfering with waiting list work and ambulatory care sessions). Many of the existing clinical teams are too small to avoid breaches of the EU Working Times Directive and the national agreement on junior doctors’ working hours.

c)   the growing evidence that specialists within the surgical disciplines often achieve better outcomes, especially if treatment needs the back-up of multi-disciplinary teams focused on particular conditions or disease-groups.

d)   meeting the demands of the continuing increase in general medical admissions.

2.4   There is a strong degree of support among doctors in Glasgow for a pattern of hospital services which:

a)  provides Ambulatory Care just as locally accessible as it is now but in
facilities that are patient-friendly, well equipped with the necessary technologies and organised efficiently around what the patient needs.

b)  concentrates in-patient services which are still reasonably accessible but which are in modern facilities, allow working hours regulations and educational standards to be met and, most importantly, provide greater assurance to patients that they will be in the hands of the specialist with the most appropriate knowledge and skills for their disease or injury.

2.5  Above all, the Glasgow NHS wants to see a thoroughly modern service pattern substantially in place within the first half of this decade.

One key to early progress is to make the best use of the modern facilities we already have. Where there are no suitable modern facilities, the priority is to secure capital investment to put them in place.

2.6   Glasgow’s Health Board and NHS Trusts have been examining choices and the
practicalities of how to move quickly. At the same time the public debate has continued in a wide range of settings – meetings with MSPs, Councils, Councillors, some community councils, local interest groups, large public meetings, and debate through the media. People value local access highly and are insistent that it is now right to invest in new facilities. But many also recognise that the resources available are not limitless and that for many patients safe and effective care means specialist care. Our approach differs from most other UK cities. In recent years they have cut the number of hospital sites and concentrated all services into fewer very large hospitals – significantly reducing bed numbers at the same time. Our approach is cautious about bed numbers and retains local access for most things. But we also believe we can sustain it within the money we have and with the number of doctors and specialists who are available.

2.7   While keeping local access for most services, we also need to ensure that the service pattern makes sense on a Greater Glasgow basis too. In an ideal world it would be nice to be able to start with a totally blank sheet of paper but that’s a luxury we do not have. We have looked hard at the shape of the road and transport system and how they relate to existing sites. We have been influenced by the major modern investment that exists at GRI and Gartnavel. In the South the NHS Trust has looked at what new sites might be acquired as an alternative to using the Victoria Infirmary and Southern General – would they be big enough for a brand new hospital and how well placed would they be for the population served?

2.8   The ideas we are now presenting combine local access for the vast majority of
Services, with a north\east and south\west axis for the significant major accident and emergency services well located in relation to the strategic road routes that are important for ambulance services.

3. THE PATIENT’S EXPERIENCE

We’ve already said that what we propose is firmly rooted in seeking to transform the patient’s experience. The touchstones are:

a)   an altogether more user-friendly experience. Fast, responsive, "one-stop shop" wherever possible and in facilities that are attractive and good to use.

b)   making as much as possible as local as possible. In broad terms around 85% of people’s use of hospitals will continue to be just as local as it is now (out-patients, x-rays, day case treatment, rehabilitation services and minor injuries services).

c)   making sure that where specialisation matters (and avoiding doctors being over-worked and over-stretched) we achieve strong clinical teams to create just that assurance of the best possible expertise.

d)   making sure that the linkages between primary care (GPs) and hospitals are made as fast and informative as possible so that the GP’s responsibilities for overseeing the patient as an individual are made easier. Changes in health care practice and technology will affect these linkages as time unfolds.

We have produced some leaflets which say more about these issues. We have tried to write them in plain English and as jargon-free as possible. These leaflets are:

  • The Patient’s Experience.
  • Getting it right for patients : what it means for organising services.
  • Cancer Services : Specialisation in action.
  • Why Specialisation matters – and what we propose to do to make its benefits more available.
  • Creating more responsive Accident and Emergency Services.
  • Ambulatory Care : What is it?
  • Minimally Invasive Technologies : Keyhole Surgery and the like.
 

4. SOME OF THE PLANNING BACKGROUND

4.1  In developing practical ideas about how to improve the patient’s experience we have also had to take into account a range of planning factors .

Our leaflets "The overall planning challenge for Greater Glasgow" and "Some Recent Background History" set the general scene.

 

4.2   One major influence is the need to ensure that we get the organisation of doctors’ working hours right. People will be familiar with the long history of junior doctors (those training to become specialists or GPs - often described as House Officers or Registrars) working ridiculously long hours. Things have improved in recent years but there is still more to be done. And it’s not just a matter of working hours. Junior doctors are in training and the quality of their educational experience has increasing priority compared with their role as service workers. The quality of their training is crucial to the quality of service they will provide in the future. As a result Consultants are expected to do more of the hands on medical work and to exercise more continuing supervision. This is very much in the interests of patients!

But this is happening at a time when European Union working hours regulations are making a major impact.

Our leaflet "Impact of regulations on doctors’ working hours" tells you more.

4.3   Although in-patient care is increasingly a less significant part of the hospital services, the question of whether there are enough beds continues to attract wide interest. And because wards require a lot of staff, the number of beds provided in any new hospital development has a major influence over our ability to afford it.

Our leaflet "The number of beds we propose to provide " sets out our approach to assessing this.

 

4.4   Glasgow is the home of a number of important regional services serving a population wider than just Greater Glasgow alone. There are three significant changes to regional services:

 

We have four leaflets which will help those with an interest in these issues to see what is proposed and why. They are:

- "Regional Services provided by Glasgow Hospitals"

- "Radiotherapy: Linear Accelerators – a Patient’s Guide"

- "Maternal and Child Health"

- "Why centralise cardiothoracic surgery?"

 

4.5   An aspect of planning which rarely gets the attention it deserves is the need to
support teaching and research . The presence in Glasgow of high quality teaching and research has many benefits:

 

    1. a stimulus for continuous improvement of clinical practice.
    2. recruitment and retention for the city of practitioners of high standing.
    3. the best possible development of the next generation of health professionals.

Our leaflet "Why teaching and research matters" tells you more.

 

4.6   The pace of change in health care is accelerating. Whether we invest in modern facilities or not we need a positive approach to maintaining an NHS workforce that is well trained, motivated and adaptable. We have been working with trade unions on the Greater Glasgow Partnership Forum to get some clarity on how this rhetoric can be turned into reality.

Our leaflet "Staffing matters" sets out in more detail what some of issues are.

4.7   Our proposals mean the investment of a lot more money in Glasgow’s acute services. Around £400 million in capital (new buildings and equipment) across the 10 year period. And more revenue (the running costs of new hospital buildings). The way in which the NHS capital and revenue system works is complicated. Unlike a private business the NHS cannot generate its own income - it has to operate within a cash limit determined by the Scottish Executive and Parliament. The acid test is whether our ambitions to improve our acute hospital service can be afforded within the cash limit we are given.

We believe the proposals can be afforded while at the same time leaving enough money available to improve other services outside the acute hospitals which make such an important investment in tackling the chronically poor state of health of many of Greater Glasgow’s residents. Services for children, mentally ill people, those addicted to drugs and alcohol, people with chronic disabilities and the whole range of primary care (GPs and their teams).

Our leaflet "How the finance works" provides the detail.

The next sections describe our proposals for the Southside, North and East Glasgow and West Glasgow. There is also an important suggestion about Children’s Hospital Services.

5.  PROPOSALS FOR THE SOUTHSIDE

5.1   The 347,000 people of the Southside equate to an expected need for acute in-patient services by 2005 of just over 1,000 beds. The Southern General currently has 600 modern beds (although some of these are for regional services for a wider population – such as Neurosurgery). The Victoria infirmary’s facilities are provided in old and unsatisfactory accommodation.  There has been significant public support for the creation of a new hospital for the Southside to replace both the Victoria Infirmary and the Southern General. The Trust have examined this suggestion in great detail.

5.2   Comparing large capital projects is a complicated task since the costs and economics have to be looked at over a hospital ‘life-time’ period ranging from 30 years to 60 years depending on whether the scheme is paid for by the Government’s capital programme for the NHS or through Public Private Partnership (using private sector capital). A totally new hospital, built on a new site in a single phase (with an Ambulatory Care Centre being built at the Victoria Infirmary site) would cost around £360 million and would take about 4 years building time. The total capital allocation for the whole of the NHS in Scotland amounts to around £165 million, although this is planned to rise to £200 million in about 2 to 3 years time. So this one project alone would consume between a half and two thirds of the whole of the country’s capital programme for that 4 year period. This is unrealistic – so a Public Private Partnership (PPP) approach would be needed. The capital and running cost structure of PPP is different (for example it assumes a 30 year life and VAT is not payable on construction costs). The Trust have compared a PPP approach for two options:

a)   a new hospital on a new site with a new Ambulatory Care Centre at the Victoria Infirmary.

b)   a new Ambulatory Care Centre at the Victoria and a phased re-development of the Southern General to provide in-patient beds for the Southside.

5.3   Because PPP uses private capital, the cost for the NHS is felt in the form of annual running costs covering capital, interest and maintenance charges. Option (a) would have running costs of £20 million per year higher than the present annual cost (£165 million) of running Southside hospitals. Option (b)’s running costs would be £13 million per year higher than the present costs. The difference of £7 million matters. Both options produce an exciting new-style Victoria. Both options produce the same amount of modern in-patient facilities. although (b) takes 10 years from now to achieve it fully, it delivers a major set of improvements in the first half of the period. On the other hand (a) achieves it in around 6 years from now. That £7 million per year extra would be paying for a small difference in geographical location and 4 years faster completion for the final parts of the project (with the extra annual cost being paid at the higher level for the 30 years life of the PPP agreement). There are many much needed hands on services for patients and local communities that £7 million a year could pay for. (See our leaflet on ‘The Overall Planning Challenge for Glasgow’).

5.4   Our conclusion is that the best way to get a modern hospital service in position for the Southside’s population of 347,000 people is to:

a)   build a state-of-the-art Ambulatory Care Centre at the Victoria Infirmary to open by 2004.

This will keep existing local access for some 85% of present patient visits with the Victoria Infirmary but in a vastly improved service setting. It would also include walk-in facilities for people with minor injuries\illnesses, a new locally accessible renal dialysis service, and 120 rehabilitation beds which would reduce the burden of visiting for relatives from the south-east of Glasgow. It would also provide day case surgery for the whole of the Southside.

b)   build 355 new beds at the Southern General Hospital to open by 2005.  The hospital already has 600 modern beds. This new build would give the hospital 955 modern beds. The 310 older beds which would remain in use have either already been refurbished or will be brought up to a very good standard by 2003. A second phase of development to replace them would be worked up with construction starting as soon as site space had been cleared (well before the end of the decade).

This would provide all the acute in-patient services for the Southside and regional\national services for neurosciences and spinal injuries. It would also have the major accident and emergency\trauma centre service on the Southside, readily accessible off the M8, M77 link and Clyde Tunnel.

It would have in-patient beds for:

[Note: * indicates one of two units in the city – one South, one North]

 

c)   provide shuttle bus links between the Victoria Infirmary and the Southern General Hospital as part of a wider process of improving public transport links between east and west on the Southside.

6.  MATERNITY AND CHILDREN’S HOSPITAL SERVICES

6.1   During the public debate in 1998 we were asked why no consideration had been given to including the re-provision of services provided by the Yorkhill NHS Trust at the new Southside Hospital campus. Yorkhill NHS Trust is the home of the Royal Hospital for Sick Children, the Queen Mother’s Maternity Hospital, the West of Scotland Medical Genetics Service, the Headquarters of the Community Child Health Services for Greater Glasgow, 8 academic departments of the University of Glasgow and a major teaching and training hospital for health professionals caring for mothers and children. The development of a new children’s hospital would allow GGNHSB to retain and improve upon all existing children’s services provided by Yorkhill NHS Trust, develop new services in line with future patients’ needs and ensure that both are provided by a modern, purpose-built hospital for mothers and children.

6.2   The Yorkhill site has relatively modern facilities (a new theatre suite opened in 1998) but the Queen Mother’s Maternity Hospital has significant design limitations and has not worn particularly well as a building. The main building for the Royal Hospital for Sick Children is adequate for the foreseeable future although perhaps not particularly flexible to adapt to future changes in children’s health care. In any event Yorkhill’s replacement would become a pressing forward planning issue by the end of the decade.

6.3   There is a considerable weight of professional opinion that children’s services should ideally be on the same site as adult and maternity services so as to make the mutual sharing and accessing of clinical expertise easier. There are also advantages in sharing, rather than duplicating, those hospital support services which are common to both adult and children’s services. Examples elsewhere in the UK show how the crucial child –centred separate identity of a Children’s Hospital can flourish within the same site as a larger general hospital.

6.4   The overall shape of services in Glasgow suggests that the Southside would be a potentially favourable location for a new Royal Hospital for Sick Children.

Relocating children’s services to a site which provides adult and maternal health services for South Glasgow would result in a strong foundation for integrated child, adult and maternity services. Obviously if the new hospital goes ahead detailed consideration needs to be given to how all existing maternity services currently provided from the Queen Mother’s Maternity Hospital and the maternity unit at the Southern General can be integrated with the new children’s hospital and community services. There would be a period of 7 to 10 years before building was completed. The question of how to manage maternity services currently provided by the Queen Mother’s and Southern General during that interim period will be the subject of a separate public consultation.

There are other benefits of siting a Children’s Hospital alongside a Southside Adult Hospital:

a)  Children’s Neurosurgery, ENT and maxillo-facial surgery would be better integrated with other children’s services than at present.

b)   The Paediatric A & E services of Glasgow would be sited alongside one of Glasgow’s two Trauma Units (compared with the lack of paediatric support at any of the Glasgow’s adult A & E Departments at the present time).

c)   It would greatly strengthen the research and academic environment in South Glasgow.

d)   An exciting opportunity for the development of specialised adolescent services for Glasgow.

6.5   By contrast, although re-locating the Royal Hospital for Sick Children alongside adult oncology and adult cardiothoracic surgery in West Glasgow would have some benefits, it would do nothing to help with maternity and A & E service linkages. The oncology and cardiothoracic links are easier to sustain on a separate site (and involve fewer children) than is the case if maternity and A & E services are on separate sites from children’s services.

A third alternative – re-location to the GRI – would further unbalance the maternity services as between north\east and south\west Glasgow and would achieve far fewer important service linkages with other adult services than would be the case with Southside location (or with West Glasgow adult services).

It would also be more difficult to achieve in site space\capital investment terms.

7. NORTH AND EAST GLASGOW

7.1  The current capital scheme under construction at the Glasgow Royal Infirmary will result in the GRI having 600 modern beds. The hospital will also have 500 old beds, 219 of which will be empty when the new scheme is complete. Stobhill Hospital has 297 acute beds – all of them in old buildings. The 340,000 people in north and east Glasgow equate to an expected need for acute in-patient beds by 2005 of around 1,020. The question of how to meet those needs between the GRI and Stobhill has been a highly contentious matter. Taking as our guide the aim of:

we see the pattern for the north and east being very similar to that proposed for the Southside.

a)   a state-of-the-art Ambulatory Care Centre at Stobhill to maintain existing local accessibility to such services (including the minor injury\illnesses patients who attend the Stobhill casualty) but in a vastly improved service environment. This will assure Stobhill’s long term role as a major provider of health services.

b) a strong core of in-patient services at the GRI including:

There would also be out-patient services in modern facilities at GRI but we would expect a significant amount of day surgery for the east Glasgow population to be undertaken at Stobhill.

c) a major accident and emergency\trauma centre service in modern facilities at the GRI, readily accessible off the M8, M80, Springburn Road and the Clyde bridges in the east of the city.

7.2  The Health Board at its March 2000 meeting supported an Outline Business Case for a new Ambulatory Care Centre at Stobhill, recognising the strong local support for this service. We have asked the North Glasgow Trust to consult locally on issues of size, content, scope for future expansion and other issues identified in recent local public debate. By the time this wider consultation on Glasgow’s acute hospital services reaches conclusions in the summer we shall know the outcome of that more local consultation about the detail of the Stobhill Ambulatory Care Centre.

7.3  We know the strength of feeling its local community has for Stobhill Hospital. The plan to modernise Glasgow’s hospitals offers much of the certainty about the future role of Stobhill which its community and staff have long wanted. In shaping this role we have to take into account the reality of the clinical and workforce influences that cannot be simply ignored or rejected. Over the next few months the North Glasgow Trust will lead a local debate about the issues so that by the autumn there can be full clarity about the long term role of Stobhill Hospital.

7.4  There is a fuller exploration of the issues in some of the back-up leaflets that we have produced to aid debate.

7.5  The proposal here would require a further capital investment of £30 m. for the Ambulatory Care Centre at Stobhill and £6 m. for fitting out the new orthopaedic floor at the GRI. (This would complement the £53 m. currently being spent on new facilities at the GRI).

8.  WEST GLASGOW

8.1   The West Glasgow population of some 226,000 will need an acute general medical and general surgical in-patient service of 198 beds and 87 beds respectively.

8.2   There have been plans made before for health services in the west of Glasgow. These plans have focused on the relocation of the hospital services from the Western Infirmary to Gartnavel in order to end the arrangements whereby care for many patients was split across both the Western Infirmary and Gartnavel sites. Another objective has been to modernise the facilities at the Beatson Oncology Centre. Other elements of our Greater Glasgow Plan include:

The Plan recognises that money for capital investment is not available in unlimited supply. This means that we have to make best use of existing modern facilities. These proposals have now been re-examined by the North Glasgow Trust in the context of the plan to Modernise Glasgow’s Hospitals.

Gartnavel General has 543 modern beds and the Western Infirmary has 260 beds in relatively modern accommodation.

8.3   We believe the way forward is:

a)   to use Gartnavel General as the in-patient centre for general medicine and general surgery for west Glasgow. It currently offers no walk-in service for minor injuries\illnesses – we propose to create a service of this type at Gartnavel giving much greater local accessibility for Clydebank, Drumchapel, Knightswood, Scotstoun, Yoker, Maryhill and their neighbouring areas. (People living in Hillhead and Partick would have the choice of going to Gartnavel or the Southern General (through the tunnel).

We would also need to improve emergency receiving and ambulatory care facilities at Gartnavel.

Our aim is to have these facilities in place by 2004\05 at the latest.

b)   to use the Western Infirmary as the in-patient and out-patient centre
for the Beatson Oncology Centre and a single cardiothoracic centre for the West of Scotland. These would use the Phase I block of modern facilities, requiring some capital investment to provide up-to-date imaging services.

We would vacate G Block.

Capital investment to make these various changes at both hospitals would be around £31.2 million.

8.4   This approach would make general acute services for West Glasgow more locally accessible for more people (core in-patient services, ambulatory care and minor injuries services) and provided in modern facilities at Gartnavel. It would allow regional services for cancer and cardiothoracic services to occupy modern facilities in a location readily accessible by public transport (exploiting the Partick bus\rail\underground interchanges). This improvement would be achievable by 2005.  In the meantime there will need to be further planning for a subsequent integration of cardiothoracic services and the Beatson Oncology Centre onto a larger hospital campus. The programme of expanding and modernising linear accelerator capacity will force the pace of this decision-making since in-patient beds should not be separated from the linear accelerators their patients need.

Separate leaflets are available for different aspects of these proposals:

  • Detailed analysis of the options for South Glasgow.
  • Maternal and Child Health.
  • Better access for West Glasgow residents.
  • The GRI\Stobhill partnership.
  • Why centralise cardiothoracic surgery?
  • Radiotherapy: Linear Accelerators: A Patient’s Guide

 

9.  NOTE ON THE CONSULTATION PROCEDURE

9.1   We have summarised here an ambitious set of ideas for Glasgow’s acute hospitals. Between April and the end of June 2000 we are organising a series of meetings with local interests throughout Greater Glasgow. Our Website (www.show.scot.nhs.uk/GGNHSB) also provides access to information and the opportunity to comment. We hope to generate an active period of debate that will help people to understand and influence what needs to be done to improve Glasgow’s hospitals.

9.2   In July the Health Board will start to reflect on what has emerged from the debate, with a discussion at its public meeting on 15th August on what proposals should be put to the Minister for Health. Following that the Greater Glasgow Local Health Council (which represents the consumer voice in the NHS) and others will be able to comment on those proposals before the Health Board has a final discussion in public on 18th September. We hope that by then we will be able to send some firm proposals to the Minister in late September.

9.3   Once a Ministerial decision has been made the NHS Trusts in Glasgow can get
on with organising the major building schemes needed to get the process of hospital modernisation going.

9.4   The key questions on which we are seeking views are:

a)   should we seek to strengthen Accident and Emergency services by designating the GRI and the Southern General (or new Southside Hospital) as Trauma Centres with Consultant staffing to match while keeping local access for minor injuries at Stobhill and the Victoria Infirmary and providing such a service for the first time at Gartnavel General?

b)   does our aim to maintain local access to out-patient clinics, x-ray, day case surgery and out-patient rehabilitation services at Victoria Infirmary, Southern General* (or new Southside Hospital), GRI, Stobhill and Gartnavel have widespread public support? (*We are proposing that most day case surgery for the whole of the Southside would be undertaken at the Victoria Infirmary and some day case surgery for east Glasgow would be done at Stobhill).

c)   do the public agree that the Victoria Infirmary and Stobhill are the top priorities for the creation of new Ambulatory Care Centres?

d)  in seeking to modernise the out-dated hospital facilities and deal with issues of specialisation and doctors hours in South Glasgow is our conclusion that a new Ambulatory Care Centre with rehabilitation beds at the Victoria Infirmary and a two phase redevelopment to concentrate Southside acute in-patients at the Southern General the most practicable option?

e)   should we take the opportunity of creating a new Child and Maternal Health service based at the Southern General as an integral part of the first construction contract for the redevelopment of the Southern General campus?

f)   in seeking to tackle the specialisation and doctors’ hours issue in the North Glasgow Trust we are making firm proposals to concentrate in-patient gynaecology and orthopaedics at GRI in association respectively with the new facilities for maternity services and Accident and Emergency\Trauma. In each case there is strong medical advice in support of the change. Ambulatory care for these two services would also be provided at Stobhill and Gartnavel. Are there any persuasive and practicable alternatives to this solution?

g)   in tackling the same issues of specialisation and doctors’ hours in the North Glasgow Trust there is a need to decide what the in-patient base for several specialties should be (with ambulatory care provided at GRI, Stobhill and Gartnavel). The specialties are urology, ophthalmology (eyes), ENT (ear, nose and throat), nephrology (kidneys) and vascular surgery (veins and arteries). The North Glasgow Trust will be leading an interactive debate about the possibilities and practicalities for these specialties so that by the late summer\early autumn a clear basis for future modern accommodation requirements can be established.

h)   similarly the North Glasgow Trust will lead a debate about how medicine and surgery can work in partnership between GRI and Stobhill so that medium to long term clarity can be achieved.

i)   the achievement of single site working for medicine and surgery for West Glasgow at Gartnavel was previously agreed in the 1996 consultation. This updated plan includes a proposal to create a single cardiothoracic unit in Glasgow, concentrated initially at the Western Infirmary in modern accommodation. This has benefits for the specialty but helps to create space at GRI for other use of modern accommodation there as part of the wider picture of modernisation. Are there any good grounds for not making this change?

 

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Last modified: August 15, 2002

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